Issue 25 / 4 July 2016

MALNUTRITION in all its forms is one of Australia’s most critical health concerns.

Almost two in three Australian adults are overweight or obese (along with 25% of children), and poor diets and high body mass are leading contributors to Australia’s burden of disease. Unhealthy diets are a key risk factor for non-communicable diseases (NCDs) including heart disease, cancer and diabetes, which account for 90% of all deaths in Australia.

The health risks of poor nutrition are not distributed equally. There is evidence of a socio-economic gradient in nutrition and diet-related health, and Aboriginal and Torres Strait Islander people have much higher rates of chronic disease and obesity than the non-Indigenous population.

It is estimated that up to 19% of the burden of disease in Indigenous populations is due to poor diet.

While food in Australia is generally plentiful, food insecurity persists. One in 20 Australians cannot feed themselves and their families safe, healthy food without relying on charity. This rate is up to five times higher among Australia’s First Peoples, with marginalised groups such as asylum seekers and the homeless also being vulnerable to food insecurity.

Under- and over-nutrition are flip sides of the same coin, with some groups at heightened risk for both forms of malnutrition.

Dietary patterns also have profound implications for environmental health. The agricultural sector (and livestock production in particular) accounts for 10-12% of global anthropogenic greenhouse gas emissions, suggesting that increasing meat consumption is a key contributor to climate change.

Climate change depletes the environmental resource base for food production, in turn decreasing crop yields and contributing to global food insecurity.

The federal government has been slow off the mark addressing the challenge of creating a healthy, equitable and sustainable food system. The 2008 report of the National Preventative Health Taskforce set out a blueprint for addressing obesity and diet-related chronic disease, but the then Labor government rejected the Taskforce’s most hard-hitting recommendations for encouraging healthy eating and improving dietary health.

Industry self-regulation of food marketing to children was endorsed over stronger statutory measures, the idea of food taxes was swiftly dismissed, and the voluntary Health Star Rating labelling system was selected over the “traffic-light” model recommended by the government’s own commissioned independent review

On the plus side, progress was made through the establishment of the Australian National Preventative Health Agency and dedicated funding to new, community-based prevention initiatives. Work also began on a National Food Plan, which included a focus on nutrition and food system sustainability.

Unfortunately, food and nutrition policy in Australia appears to be a case of “two steps forward, one step back,” with the incoming Coalition government disbanding the Australian National Preventative Health Agency and removing almost $400 million in funding for state-based prevention efforts. The nutrition component of the National Food Plan was hived off into a separate National Nutrition Policy, which has yet to see the light of day.

In the areas of product reformulation, food marketing to children and interpretive food labelling, government continues to prefer voluntary, industry-led initiatives, some of which have laudable objectives but have been poorly implemented and enforced.

This may be unsurprising given the economic power of Australia’s food industry. Making up almost one third of Australia’s total manufacturing sector, the industry is able to wield significant power in food and nutrition’s “regulatory space”, often at the expense of more effective regulatory measures to improve the accessibility of healthy foods and beverages, and encourage healthy eating.

Worse still, nutrition policy for Australia’s First Peoples has fallen off the radar completely.

The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 provided a framework for nutrition interventions, but it was 3 years before one project officer was appointed and the strategy lapsed in 2010.

An evaluation report on the strategy was only made public this year following a freedom of information request. There is no mention of food or nutrition in COAG’s most recent Closing the Gap health strategy, nor does nutrition feature strongly in the National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Yet diet remains the single most important factor in the chronic disease epidemic facing Aboriginal and Torres Strait Islander communities.

Australia’s poor performance on nutrition stands in stark contrast to the many countries around the world experimenting with innovative and progressive policies to promote healthy diets and prevent chronic NCDs.

Among these are 14 countries implementing taxes on sugar-sweetened beverages, including high-profile examples Mexico and the UK, statutory restrictions on unhealthy food marketing to children in Ireland and South Korea, and mandatory restrictions on the salt content of certain processed foods in South Africa and Argentina.

Increasingly, national efforts are being driven by action at an international level, with the World Health Organization and the United Nations creating a global framework for chronic disease prevention, including measurable, time-bound targets, and monitoring and implementation mechanisms.

The incoming federal government has the opportunity to find surer footing on food and nutrition policy. 

Given the health, social, and economic costs at stake, it remains incumbent upon the public health community to rally support for a more proactive and effective policy response.

Inaction is costing our community already, with overweight and obesity estimated to cause $8.6 billion a year in direct and indirect costs, such as absenteeism and foregone tax revenue. We can also challenge voters, communities and public health advocates to unite around a more comprehensive policy platform for improving nutrition and preventing diet-related NCDs.
 
It is time for Australia to take strong leadership in nutrition policy. We suggest seven ways to do so, following this federal election:

•    Establish a dedicated, comprehensive policy framework for improving nutrition and diet-related health, with specific, measurable targets on key nutrition indicators, accompanied by monitoring and accountability mechanisms.
•    Ensure universal nutrition education for all primary school aged children – regardless of their socio-economic situation or geographic location.
•    Renew focus on nutrition and dietary health in Aboriginal and Torres Strait Islander communities, including dedicated, national-level Indigenous nutrition policy, and structural and regulatory changes to improve the accessibility and affordability of healthy food.
•    Tighten urban planning laws to encourage access to fresh food vendors while easing the density of junk food outlets.
•    Strengthen regulation of food reformulation, interpretive labelling, and food marketing to children.
•    Introduce a tax on sugar-sweetened beverages, with funds going towards an appropriate public health cause such as improving childhood nutrition or public dental care.
•    Invest in cost-effective nutrition and NCD-prevention policies and programs, accompanied by tracking and monitoring of the impact of spending on population health.

Australia is a global leader in tobacco control, and we can do it again in relation to food governance. But to move from laggard to leader we need a federal government with the fortitude to tackle vested industry interests, to untangle the complex relationships between sustainability, equity and nutrition, and to commit to policies and laws that enable all Australians to access fresh, nutritious and sustainable food.

Dr Belinda Reeve is a lecturer in law at the University of Sydney. Alexandra Jones is a lawyer leading the George Institute’s Food Policy Division’s program on regulatory strategies to prevent diet-related disease. They are lead organisers of the Food Governance Conference, a collaborative endeavor between the University of Sydney’s Charles Perkins Centre, Sydney Law School, the George Institute for Global Health, and the Cancer Research Network. The conference will be held at Sydney Law School on 1-3 November this year, and will cover a range of topics related to nutrition and sustainability, equity and innovation in the food system. The call for abstracts is open until Friday 15 July. The authors would like to thank Dr Josephine Gwynn and Dr Sandro Demaio for their comments on various parts of this piece.

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4 thoughts on “Time to commit to good food policy

  1. Dr Louis Fenelon says:

    The 7 points listed above will fail for the following reasons. It is governance heavy not food heavy. It is too costly. Even the sugar tax is as manipulable by the industry as were previous population nutrition initatives. Worst of all is there is no indication the quality of advice will be any better than that given over the last 30 years. Low salt, low fat, no fat, no saturated fat, “whole grains” (like the one’s in the margarine add directed at kids) combined with sun avoidance and reduced tolerance for physical activity = the mess we face now. People don’t know what to eat. Government and the medical profession have failed to advise them. Supermarket giants have instead! Add broadacre cropping and international markets manipulated by subsidies and fluctuating currency values and you have the perfect storm for ongoing nutritional disaster.

    Indiginous people face most risk from “our diet”. Their nutritional needs are ignored? Then make funds available for indiginous farming to local markets. An indiginous diet may be the diet best for all. A balanced food industry based on local seasonal produce, local marketing and small plots to leverage the land and give back their space. Pockets of suitable land are scattered throughout our national parks, state forests and reserves in places the land managers fails to care for appropriately due to limited funds.

    Nutritionists, doctors, dietitians and government have failed Australia and failed it’s first generations. Would they be prepared to teach us where we went worng?

  2. Frances Ann Warnock says:

    I think this debate needs to be broadened to hear the views of the wider community. Note that Australia does provide leadership through its WHO Collaborating Centres, including nutrition, physical activity, health promotion/education and obesity. Finally, it is worthwhile acknowledging positive actions taken and progress made to improve the nutritional quality and safety of our food supply. There is a long way to go in reaching consensus on the role of ‘food governance’ in improving nutrition and the overall health of our nation.       

  3. cordell vardy says:

    I remember hearing about Karen O’Day taking a group of kimberly aborigines bush in the eighties and helping diabeties with bush tucker and exercise…it upsets me to hear fresh food is still difficult to acess outback

  4. Amanda Lee says:

    Congratulations on a great article.

    However it is surprising that the scoping study to inform the development of a new nutrition policy in Australia, which was conducted in 2013 by a team based at QUT and released under FOI in March 2016, has not been mentioned. The scoping study is available at http://www.health.gov.au/internet/main/publishing.nsf/Content/D309AF86C0…$File/1%20-%20Final%20Report%20-%20National%20Nutrition%20Policy%20Scoping%20Study%20(Report%20and%20Appendices).PDF

    The scoping study consists of a serious of systematic reviews on what nutrition policy actions have been implemented globally and nationally, to answer what works and why- and what doesn’t work and why not? It applies a framework for action based on stakeholder submissions to several food and nutritional consultations in Australia. Importantly it includes recommendations based on the findings, including an exemplar nutrition policy for Australia.

    For obvious reasons is important that the evidence-based findings of the scoping study are not overlooked in efforts to improve nutrition in Australia. 

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