After such a good dinner, I believe you are all dreading that I will ruin your desserts with some stern comments on nutrition. I will try not to do that. Because the landscape I see when I look at the whole area of nutrition from my chair at the World Health Organization is a complex one, where the future actually holds as many exciting opportunities as it contains alarming problems.

Just consider some of the paradoxes: More than a billion people do not have enough to eat every day and suffer malnutrition as a result. That figure is enormous, but it is almost matched by another, rapidly growing cause of malnutrition, namely obesity.

Every year, some 5 to 7 million hectares of prime agricultural land are lost. Desertification threatens 27 million hectares of irrigated land. In short, we are losing valuable land for food production at an unprecedented rate. Yet, we have no global shortage of food, despite having reached a global population of six billion. Hunger is a question of distribution and inequity – not a lack of food.

Contamination and bad quality food are causing food-borne disease to increase at an alarming rate, making hundreds of millions of people sick every year. Yet, at the same time, bio-technological research bears promise of bringing us more nutritious, healthier and more cost-effective food products which may reduce malnutrition and improve food quality.

In this complex picture, what is it that needs special attention, what are the main priorities? Where can industry make a difference in improving nutrition globally?

For WHO, our mission is clear: we work to enhance human development through improving health.

Nutrition is a key element in any strategy to reduce the global burden of disease. Hunger, malnutrition, obesity and unsafe food all cause disease, and better nutrition will translate into large improvements in health among all of us, irrespective of our wealth and home country.

Hunger and malnutrition, however, remain amongst the most devastating problems facing the majority of the world’s poor and needy, and continue to dominate the health of the world’s poorest nations. Nearly 30% of humanity - infants, children, adolescents, adults and elderly in the developing world - are currently suffering from one or more of the multiple forms of malnutrition.

And as we speak, several million people on Africa’s Horn are yet again in the grips of a major famine. Hunger remains a continuing affront to the recognized fundamental human right to adequate food and nutrition, and freedom from hunger and malnutrition - particularly in a world that has both the resources and knowledge to end this catastrophe.

The tragic consequences of malnutrition include death, disability, stunted mental and physical growth and as a result, retarded development. 50% of the 10 million deaths each year among under-five children in the developing world are associated with malnutrition. Iodine deficiency is the greatest single preventable cause of brain-damage and mental retardation worldwide. Vitamin A deficiency remains the single greatest preventable cause of needless childhood blindness.

Overall progress in reducing protein-energy malnutrition among infants and young children is exceedingly slow. Currently, an estimated 150 million children under 5 years of age, that is every fourth child in this age group, are still malnourished when measured in terms of weight for age. Still we see some progress when compared with 1980 when that tragic fate was a reality for every third child.

The slow progress also conceals the remarkable success being achieved by a substantial number of individual countries. For example 25 out of a sample of 60 developing countries now show a measurable improvement in nutritional status in their under-five populations.

Over the last decade, extraordinary progress has been made in reducing iodine deficiency through increasing the number of people consuming iodized salt. Whereas in 1990, only 46 countries had salt iodization programmes, by 1998 the number had increased to 93, more than 80% of which have introduced legislation. Overall, more than two-thirds of households living in IDD-affected countries now consume iodized salt.

Where salt iodization has been in place for more than 5 years, improvement in iodine status has been dramatic. The elimination of iodine deficiency worldwide will be one of the greatest global public health triumphs of this new millennium.

Vitamin A deficiency affects 100-140 million children in 118 countries, mainly in Africa and South-East Asia, causing blindness and increased risk of infection an death. Successful prevention and control strategies include supplementation, food fortification and dietary improvement. In 1998 vitamin A supplements provided through national immunization programmes produced rapid, if temporary, improvement in the vitamin A status of 24 million children. Thus world-wide, this condition is also slowly, but progressively, waning.

If we are to accelerate this progress, new technologies, new scientific breakthroughs are urgently needed. We may be on the brink of a new, exciting period for food research.

In one such potentially exciting development, scientists from the Institute of Plant Sciences at the Swiss Federal Institute of Technology in Zurich announced only days ago that they have developed a strain of genetically-modified rice capable of eliminating vitamin A deficiency.

The new strain, called "golden rice" for its colour, has the potential for being an important new source of vitamin A for large populations. Moreover, the technology used in developing the strain opens up the possibility to infuse several other essential vitamins and micro-nutritients, such as iron, into staple crops.

With these observations, we have already stepped deeply into perhaps the most controversial issue the food industry is facing today.

Research carried out with the new genetic technologies during the last 15 years has shown that they can help to improve crops in more precise and faster ways, compared to the traditional Mendelian methods. The potentials for improving quality of food, and increasing productivity and reducing crop-losses are great.

But these technologies have also aroused widespread public concern in several respects. There is a widespread sense in Europe, which now is rapidly spreading to North America and other continents, that the force driving these developments – namely the wish to reduce costs and increase profits for seed suppliers, farmers and food producers – is a force that actually works against consumer interests. This may be a misconceived anxiety, but it needs to be taken seriously.

The wide-ranging public demands on the industry and regulatory authorities are increasing. They include:

• ethical codes for experimentation and field testing;
• increased research on any long term health effects by these new products on populations;
• clear policies for which technologies we should allow to be introduced, and assessment of their environmental and social impact;
• increased knowledge and information about toxic or allergenic effects of the new foods;
• and the right to choose – in other words, compulsory labelling of food products.

These are not demands that can be brushed aside as a simple fear of progress. The biotechnology and food industries have to be sensitive to consumer doubts. Biotechnology has an important role to play to improve nutrition values and food security worldwide. But unless we accommodate consumer concerns and accept the need for increased testing and research on the possible effects on humans and the environment of the new crops, we will not achieve the progress we hope for.

As a leading agency on food safety standards, WHO has a role to play here. I have proposed food safety as an area of selected priorities for WHO in the years to come. Last week, our Executive Board approved our plan to expand and intensify WHO’s role in the area of food safety. Among our areas of interest is the determination of research needs on genetically modified foods to assess whether they have any potential implications for human health.

The biotechnology debate reminds us that we are living in a world of rapid change. Even in the calmest and most prosperous corners of the world, people are facing a breath-taking pace of newness. From new technology to new jobs to new fashions in entertainment and culture, we are all being swirled along in what may well be the most rapid global transformation anyone has ever seen.

This has also led to a rapid change in diet and lifestyles. And, sadly, it has not all been for the better. Anyone who has stood in line at the cashier of a small supermarket in a poor part of Sao Paulo, New York, Cairo or Jakarta can bear witness to the transformation that is taking place. Poor mothers count up their coins to pay for a loaf of white bread, some cheap jam or mayonnaise and noodles or other pre-made food.

This is the cheapest food they can find, and it fills the tummies of their children. Gone are the vegetables and the fish they lived on before they moved from the countryside to the city. And with it is gone the health that followed basic, good nutrition. In its place comes obesity and diseases caused by lack of vitamins and other micro-nutritients. In the long run, even more serious health problems are bound to follow.

In July 1997 the World Cancer Research Fund and the American Institute for Cancer Research undertook an in-depth review of current scientific and expert literature linking food, nutrition and their effect on risk of human cancers. The panel of experts found that:

• Between 30% and 40% of all cases of cancer are preventable by feasible and appropriate diets, physical activity and maintenance of appropriate body weight.
• On a global basis and at current rates, this means that appropriate diets may prevent 3-4 million cases of cancer every year.
• Diets containing substantial and varied amounts of vegetables and fruits will prevent 20% or more of all cases of cancer.

The scientific evidence has challenged WHO to redouble its efforts to support countries in developing appropriate food-based dietary guidelines.

I cannot address this audience and talk about damaging changes in lifestyle in developing countries, without mentioning the biggest health threat of them all. There is one product that kills four million people world-wide each year. If it spreads unchecked, that figure will increase to 10 million deaths each year by 2020. Seventy percent of the dead will be in developing countries.

I am talking, of course, about tobacco. Tobacco is emerging as the single largest cause of death and disability in the near future – eclipsing HIV/AIDS, malaria and tuberculosis put together. Some say WHO should not concern itself with a health threat they say is voluntary and whose effects appear mainly in old age. WHO should instead focus on eradicating polio or fighting malaria.

I say we will do both. WHO – the World Health Organization - would not be doing its job if it does not do whatever it can to reduce the impact of the tobacco epidemic.

Industry talks about people "enjoying our products". But most people are unaware of the manipulative use of nicotine to addict smokers, and when as many as 80% of smokers start in their teens, I would dispute that tobacco is a voluntary risk. Civilized societies protect their children and adolescents against risks. Tobacco looms high among them. And when half of those who die do so in middle age, I would dispute that this is not a central problem in terms of economic burden and tragedy.

Had tobacco use been voluntary and the risk been just to lose a few years of old age, one should be able to visit the cancer wards and meet calm elderly people who say: "I made my choice and I don’t regret it." What you are more likely to encounter is a forty-year old man who clutches your hand, looks at you through his tears and asks: "why me?"

Currently, food products are regulated by foods and drugs authorities in most countries, while tobacco is not. This will have to change. And it will. Through regulation, taxation and advertising bans, societies will stem the rising wave of tobacco consumption. We must, if our claims of wanting improved health for all shall have any meaning.

The World Economic Forum is now, above all else, about globalization. And no issue is as global as health.

The separation between domestic and international health problems is losing its usefulness as people and goods travel across continents. This is an accelerating trend, and is not likely to be reversed.

Health is tradable – as is ill-health. Health may indeed be the single most important bridge to tie together – whether we like it or not – the destinies of the fortunate and the unfortunate.

The private sector has an important role to play. No UN agency, no non-governmental organization – indeed, no health ministry, has the reach and the distribution power of the giant, multinational food and beverage companies, many of whom are represented here tonight. The quality of their products, the slant of their marketing, the values that make up their approach to developing country markets, can all make a difference in the health of whole populations. Even in a world where shareholder values are king, food and beverage companies have a responsibility to contribute to global health gains through better nutrition.

I believe that, to really make a difference, WHO must work together with the private sector. We may have different goals, but we may have many shared interests along the way. A healthier world is a better world for all, and that we should all strive towards.