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Freedom of choice a weighty problem

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Governments will have little choice but to tighten food and marketing regulations and possibly increase taxes on unhealthy products if the nation’s waistline continues to bulge, the AMA has warned.

The peak medical representative organisation told a Senate inquiry into so-called “nanny state” laws that unless Australians improved their diets and increased physical activity, rates of overweight and obesity would continue to climb and the consequent social and economic costs could force governments to act.

While not calling for a sugar tax, the AMA warned that simply giving people information for them to make informed choices may not, by itself, be enough.

“If people continue to make poor choices, and the number of adults who are overweight or obese continues to increase, Government will have little choice but to regulate,” it said, suggesting this might extend to include “restricting…advertising, increasing price, and reducing access, to products known to have a negative impact on health”.

Its views were echoed by ACT Chief Health Officer Dr Paul Kelly, who told The Canberra Times that although he did not advocate a sugar tax, government needed to be “part of the solution” to obesity.

“Just telling people [about healthy food choices], and asking them to make their own decision, is insufficient,” Dr Kelly said. “We know that the majority of the work we do in the hospital system is related to chronic diseases, many of which, if not caused by, are at least made worse by people being overweight or obese. And that’s a real cost to the whole community.”

The AMA made its warning in a submission to the Senate inquiry being led by Liberal Democratic Party Senator David Leyonhjelm, who objects to what he sees as unwarranted Government constraints on freedom of choice, and has taken particular aim at public health measures such as tobacco controls, alcohol restrictions and bicycle helmet laws.

“It’s not the government’s business, unless you are likely to harm another person. Harming yourself is your business, but it’s not the government’s business,” Senator Leyonhjelm said. “So bicycle helmets, for example, it’s not a threat to other people if you don’t wear a helmet; you’re not going to bang your bare head into someone else.”

Poor choices can hurt many

But the AMA argued this was a narrow view that ignored the society-wide consequences of individual choices.

The Association said that often people failed to appreciate the effect of their choices on those around them.

“All too often it is family members and governments who are left to provide support and care for poor individual decision-making,” the AMA said. “More tragically, sometimes innocent victims have to bear the consequences. As doctors, we see too many innocent victims, victims of road traffic accidents caused by drunk or speeding drivers, victims of alcohol and drug-induced violence.”

The Association said that millions were alive today because of public health initiatives such as vaccination programs, road safety laws, smoking restrictions and air and water standards that initially encountered resistance, but which are now widely accepted and supported as reducing the risk to individuals and enhancing the common good.

For example, smoking is a leading cause of preventable deaths, and dealing with its health and economic consequences costs the country billions of dollars each year. For this reason, the community accepts and expects measures to control tobacco marketing and use.

Similarly, compulsory bicycle helmets laws introduced in the early 1990s have been found to have greatly reduced the risk of head injury for cyclists, to the benefit of individuals, their families and the community.

Sydney University philosopher Professor Paul Griffiths and Sydney Law School Professor Roger Magnusson said Senator Leyonhjelm’s critique of public health measures missed the mark.

“Australia’s health legislation is a poor candidate for Libertarian criticism,” they wrote in The Age. “Accurate information about the risks and harms posed by consumer products increases freedom by helping people understand their options.”

In its submission, the AMA rejected the view that these and similar regulations were an unwarranted intrusion on individual liberty.

It said that even with such public health measures in place, “people in Australia are largely able to do as they wish, even when it is likely to cause harm to themselves or others – some people continue to smoke or consumer excessive amounts of alcohol”.

But the AMA asserted governments had a responsibility to protect people from harm caused by others, and to regulate behaviour to improve individual health and promote the greater good.

“Government does have a role to play in making this country a safer and healthier society,” it argued, “…in regulating and modifying the behaviour of individuals so that the rest of us can be confident that we won’t be affected by the poor decisions of others, such as being run off the road by a drunk driver.”

“We need all those who have a responsibility for prevention, including governments at all levels, to live up to their responsibilities for public health and prevention.”

Adrian Rollins