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Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [phrase omitted] Les responsables politiques doivent repenser les liens entre economie et sante. Le Conseil de Organisation mondiale de la Sante sur l'economie de la sante pour tous a demande que le bien-etre et la sante, aussi bien de l'humain que de la planete, soient desormais au creur du processus de prise de decisions afin de creer des economies au service de la sante. Il est donc imperatif d'identifier et de valoriser ce qui compte, d'accroitre et d'optimiser le financement de la sante, d'innover pour le bien commun et de renforcer les capacites du secteur public. En partant de cette reflexion, nous plaidons pour une reconnaissance de l'allaitement dans les statistiques relatives a l'alimentation et au bienetre, et estimons que tout investissement realise dans ce domaine devrait etre considere comme un credit-carbone dans le cadre des modalites financieres mondiales liees aux systemes economiques et sanitaires ainsi qu'a une alimentation durable. Les femmes allaitantes nourrissent la moitie des enfants en bas age dans le monde avec d'immenses quantites de lait extremement precieux. Ces activites de soins ne sont pas comptabilisees dans le produit interieur brut ou les bilans alimentaires nationaux, contrairement aux ventes de lait maternise en constante progression. Atteindre les cibles mondiales de nutrition pour l'allaitement contribuerait davantage a reduire les emissions de gaz a effet de serre que decarboner la production de lait maternise. De nouveaux parametres et mecanismes de financement sont necessaires pour beneficier des avantages en matiere de sante, de durabilite et d'equite qui decoulent d'une meilleure alimentation des nourrissons et jeunes enfants. Valoriser correctement les principales ressources consacrees a l'environnement et aux soins dans les systemes de mesure nationaux et mondiaux permettrait de detourner les moyens financiers internationaux du developpement d'activites a fort taux d'emissions pour les rediriger vers ce qui compte vraiment, c'est-a-dire la sante pour tous. Et pour y parvenir, la premiere etape consisterait a reconnaitre l'allaitement comme l'aliment de base, local, durable et de qualite pour les generations futures. [phrase omitted] Los responsables de formular las politicas deben volver a plantearse las conexiones entre la economia y la salud. El Consejo sobre la Economia de la Salud para Todos de la Organizacion Mundial de la Salud ha pedido que la salud y el bienestar humanos y del planeta se situen en el centro de la toma de decisiones a fin de desarrollar economias para la salud. Esto requiere valorar y medir lo que importa, mas y mejor financiacion sanitaria, innovacion para el bien comun y reconstruccion de la capacidad del sector publico. Nos basamos en este pensamiento para argumentar que la lactancia materna deberia reconocerse en las estadisticas de alimentacion y bienestar, mientras que las inversiones en lactancia materna deberian considerarse como una compensacion de emisiones de carbono en los acuerdos globales de financiacion para sistemas alimentarios, sanitarios y economicos sostenibles. Las mujeres lactantes alimentan a la mitad de los bebes y ninos pequenos del mundo con inmensas cantidades de una leche muy valiosa. Este trabajo de cuidados no se contabiliza en el producto interior bruto ni en los balances alimentarios nacionales y, sin embargo, si se contabilizan las ventas cada vez mayores de leche de formula comercial. Alcanzar los objetivos mundiales de nutricion para la lactancia materna supondria una reduccion mucho mayor de las emisiones de gases de efecto invernadero que descarbonizar la fabricacion de leche de formula comercial. Se necesitan nuevas metricas y mecanismos de financiacion para lograr los beneficios en materia de salud, sostenibilidad y equidad de una alimentacion mas optima de los bebes y los ninos pequenos. Una valoracion adecuada de los cuidados esenciales y de los recursos medioambientales en los sistemas de medicion globales y nacionales redirigiria los recursos financieros internacionales lejos de la expansion de las actividades que emiten carbono, y hacia lo que realmente importa, es decir, la salud para todos. En este contexto, habria que empezar por considerar la lactancia materna como el sistema de primera alimentacion de mayor calidad, local y sostenible para las generaciones futuras., Introduction Amid widespread health system weaknesses and inequities exposed by the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization (WHO) Director-General tasked the WHO Council on the Economics of [...]

BackgroundBreastfeeding is important for the health and development of the child, and for maternal health, in all country contexts. However, global sales of breast-milk substitutes (BMS), including infant, follow-up and toddler formulas, have 'boomed' in recent decades. This raises the importance of international food standards established by the Codex Alimentarius Commission (Codex) on the safety, composition and labelling of BMS. Such standards appear to be strongly contested by governments, industry and civil society groups, yet few studies have investigated the politics of Codex standard-setting processes. The aim of this paper is to understand who participates in decision-making, and how actors frame and contest proposals to revise the Codex Standard on Follow-up Formula (FUF).MethodsWe adopted a case study design involving two steps. First, we enumerated government, industry, civil society, and international organization stakeholders participating in standard-setting processes of the Codex Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU). Second, we conducted a framing analysis of stakeholder inputs during the FUF standard revision in CCNFSDU meetings. Publicly available online meeting reports (2015-2019) were retrieved, analyzed using a theoretical framework, and organized thematically.ResultsHigh-income country (HIC) delegates greatly outnumbered those from other country income categories. Industry representation was higher compared with other observer categories. Member state delegations included more industry representation than civil society representation, and were occasionally the only member state delegates. Industry stakeholders framed arguments in terms of trade implications, science, and flexible standards. Civil society groups used public health, science, and pro-breastfeeding frames.ConclusionCodex BMS standard-setting procedures are dominated by HICs and industry groups. Limited representation of civil society, and of low- and middle-income countries (LMICs), suggest actions are needed to substantially increase support for their involvement at Codex. Such representation may help to counteract power asymmetries and commercial influences on food standards for infants and young children.

BackgroundInternational food standards set by the Codex Alimentarius Commission (CAC), have become more prominent in international trade politics, since being referenced by various World Trade Organization (WTO) agreements. We examine how this impacts implementation of the World Health Organization (WHO) International Code of Marketing of Breast-milk Substitutes.MethodsUsing trade in commercial milk formulas (CMFs) as a case study, we collected detailed data on interventions across various WTO bodies between 1995 and 2019. We used language from these interventions to guide data collection on member state and observer positions during the CAC review of the Codex Standard for Follow-up Formula (CSFUF), and during CAC discussions on the relevance of WHO policies and guidelines.ResultsExporting member states made 245 interventions regarding CMFs at the WTO, many citing deviations from standards set by the CAC. These did not occur in formal disputes, but in WTO Committee and Accession processes, toward many countries. In Thailand, complaints are linked to weakened regulation. Exporters also sought to narrow the CSFUF at the CAC in a way that is at odds with recommendations in the International Code. Tensions are growing more broadly within the CAC regarding relevance of WHO recommendations. Countries coordinated during WTO committee processes to advocate for reapportioning core WHO funding to the CAC and in order to further influence standard-setting.ConclusionThe commercial interests of the baby food industry are magnifying inconsistencies between health guidelines set by the WHO, standard-setting at the CAC, and functions of the WTO. This poses serious concerns for countries' abilities to regulate in the interests of public health, in this case to protect breastfeeding and its benefits for the health of infants, children and mothers.

BackgroundThe global milk formula market has 'boomed' in recent decades, raising serious concerns for breastfeeding, and child and maternal health. Despite these developments, few studies have investigated the global expansion of the baby food industry, nor the market and political practices corporations have used to grow and sustain their markets. In this paper, our aim is to understand the strategies used by the baby food industry to shape 'first-foods systems' across its diverse markets, and in doing so, drive milk formula consumption on a global scale. We used a theoretically guided synthesis review method, which integrated diverse qualitative and quantitative data sources.ResultsGlobal milk formula sales grew from ~US$1.5 billion in 1978 to US$55.6 billion in 2019. This remarkable expansion has occurred along two main historical axes. First, the widening geographical reach of the baby food industry and its marketing practices, both globally and within countries, as corporations have pursued new growth opportunities, especially in the Global South. Second, the broadening of product ranges beyond infant formula, to include an array of follow-up, toddler and specialized formulas for a wider range of age groups and conditions, thereby widening the scope of mother-child populations subject to commodification. Sophisticated marketing techniques have been used to grow and sustain milk formula consumption, including marketing through health systems, mass-media and digital advertising, and novel product innovations backed by corporate science. To enable and sustain this marketing, the industry has engaged in diverse political practices to foster favourable policy, regulatory and knowledge environments. This has included lobbying international and national policy-makers, generating and deploying favourable science, leveraging global trade rules and adopting corporate policies to counter regulatory action by governments.ConclusionThe baby food industry uses integrated market and political strategies to shape first-foods systems in ways that drive and sustain milk formula market expansion, on a global scale. Such practices are a major impediment to global implementation of the International Code of Marketing of Breastmilk Substitutes, and other policy actions to protect, promote and support breastfeeding. New modalities of public health action are needed to negate the political practices of the industry in particular, and ultimately to constrain corporate power over the mother-child breastfeeding dyad.

Normative aging is known to affect how decisions are made in risky situations. Although important individual variability exists, on average, aging is accompanied by greater risk aversion. Here the behavioral and neural mechanisms of greater risk aversion were examined in young and old rats trained on an instrumental probability discounting task. Consistent with the literature, old rats showed greater discounting of reward value when the probability of obtaining rewards dropped below 100%. Behaviorally, reward magnitude discrimination was the same between young and old rats, and yet these same rats exhibited reduced sensitivity to positive, but not negative, choice outcomes. The latter behavioral result was congruent with additional findings that the aged ventral tegmental neurons (including dopamine cells) were less responsive to rewards when compared to the same cell types recorded from young animals. In sum, it appears that reduced responses of dopamine neurons to rewards contribute to aging-related changes in risky decisions.

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health. [ABSTRACT FROM AUTHOR]