Chile is one of the few countries in the world that succeeded in eradicating undernutrition between the 1960s and the 1980s. It did so by managing to apply well-designed policies on maternal and child health even while it weathered two severe economic crises (1974–1976 and 1982–1986) in an adverse sociopolitical and cultural environment.
The vertical implementation of these ongoing policies was supervised by the Ministry of Health. The effort was backed up by clear-cut guidelines and budgeted for under supplementary food programmes and by the Child Nutrition Corporation (CONIN). These policies were also supported by a consensus of opinion among technical experts, politicians and society as a whole that the existence of undernutrition was simply unacceptable for the country and was a problem that required the solidarity of all stakeholders in order to be resolved. This has not been the case with regard to obesity, however.
First of all, there is no such consensus about obesity. In some circles, the belief is that lifestyle choices are an individual responsibility and that any action on the part of the State in that regard constitutes an infringement of personal freedoms. Others espouse social determinants of health strategies and hold the view that structural changes in society are the pivotal factor and that people’s personal habits are a result of those changes.
Still others take a short-term view and emphasize the need to invest in the people who are already stricken and provide them with good medical care before spending on health promotion and prevention programmes for the population at large whose results would be uncertain and apparent only over the long run.
Nor is there the type of policy continuity that marked the effort to address undernutrition, since each new Administration alters these programmes. As of now, there is no office responsible for directing, coordinating and evaluating efforts to tackle the problem of obesity. The worst aspect of the situation, however, is that the population does not see overweight as a problem that warrants a society-wide effort to solve but instead simply views it as an individual condition requiring personal medical attention.
Meanwhile, obesity – and especially child obesity – continues to be on the rise in Chile and in the world and is regarded as the main public health problem today, given its implications in terms of the most prevalent medical conditions: cardiovascular disease, cancer, diabetes, osteoarticular disorders and mental health problems.
There are as yet no success stories in the effort to control obesity. There is, however, a consensus that policies are needed at three different levels.1 The first type of effort should focus on the nation’s schools, which should provide students with fruits and vegetables, along with clear-cut dietary guidelines and sound nutrition education programmes. Second, taxes on sugary carbonated beverages and processed foods containing high levels of fat, sugar and salt should be paired with subsidies for healthy foods, especially fruits and vegetables. The third area of action, which is the one in which Chile has made the most progress to date, is nutrition labelling.
In order to deal with this problem, a long-term policy of State is required that will prevail over political changes and maintain continuity. Such a policy will also need to be properly funded and to be overseen by a centralized coordinating body with the authority to implement programmes aimed at promoting healthy lifestyles and preventing obesity in all regions of the country.
In order for this to happen, the support and cooperation of society as a whole will be needed. When a problem is not seen as such by the population, it is very unlikely that an effort to solve it will take the form of a long-term public policy. This is why educating people about healthy diets and lifestyles from an early age is of such crucial importance for the future of public health in Chile and in the world in general.
[1] C. Hawkes y otros (2015), “Smart food policies for obesity prevention”, The Lancet, 385(9985)