Public health advocates have consistently failed to get substantial Government support for their initiatives to tackle the obesity epidemic. And they only have themselves to blame.
Last week on ABC radio’s AM current affairs program the former chair of the National Preventative Health Taskforce lamented that the Government had failed to address obesity. In 2009, the Taskforce released a report titled Obesity in Australia: a need for urgent action which was supposed to be the springboard for Government action on the issue. Instead, the report was tossed onto a large pile of obesity reports and recommendations that have been ignored by our politicians.
What went wrong? Why did the then Government, which was favourably disposed to public health and disease prevention, fail to act? My guess is that it was the appalling quality of the report.
Convincing the Minister
Have a read of this report and try to imagine how the conversation went when the good professor presented it to the Minister for Health. Maybe it went something like this:
Professor: Minister, here is our carefully crafted blueprint for addressing the obesity epidemic that has been raging in Australia for the last 30 years.
Minister: Hmmm. How come there is no chapter outlining the causes of the epidemic? How can you address a problem if you don’t understand its cause?
Professor: Oh, we skipped that bit. But everyone knows the cause – its sugar and fat.
Minister: So the fat content of the Australian diet has gone up in the last 30 years?
Professor: No … not exactly. It’s gone down a little.
Minister: But there is scientific evidence of a link between fat intake and obesity, isn’t there?
Professor: Actual evidence? No. But it’s common knowledge that fat makes you fat.
Minister: I see. And sugar intake? Has that gone up in the last 30 years?
Professor: Well, total sugar intake may have come down a bit too. But it’s the sugary drinks we are really worried about.
Minister: So, intake of sugary drinks is going up?
Professor: Um, no. It’s coming down too.
Minister: How come? What’s going on there?
Professor: Dunno … Minister, I can see where you are going with this …
Minister: Oh, is that the time? Next!
The battle between good and evil
Both the radio interview and the report reflect a belief system among some of our public health colleagues that goes something like this:
• People are getting fat because they are eating unhealthy food.
• Unhealthy food is easily defined, in terms of sugar and fat.
• Rapacious food companies pump food full of sugar and fat because these ingredients are cheap. The capitalists reap the rewards; society pays the price in the form of obesity.
• The food companies are just like Big Tobacco – they know they are wreaking havoc but they deny their guilt and just focus on profit. Bastards!
• The only solution is to regulate everything – food advertising, food labelling, the composition of food and the cost of food, through taxation.
• Alas, the food companies are all-powerful and governments buckle to their will.
• Our cause may seem hopeless but we must fight the good fight.
These folks really need to stop talking to themselves and get out more.
Equating food companies with the tobacco industry is just a dumb strategy that only serves to make its proponents look extreme and its opponents appear moderate. Ideological conflict in relation to food may provide some with a warm inner glow but the recent evidence suggests that it doesn’t achieve very much. The success of public health activities depends on outcomes, not on the purity of the cause. In particular, ideological battles enable and encourage politicians to sit back and do nothing while opposing sides slug it out.
How much failure is enough?
When the same approach fails time after time, what should happen next? Obviously, try it again. In this morning’s Sydney Morning Herald there is an article titled “Big Junk is just as evil as Big Tobacco” penned by a leading public health academic. The belief system is on display again and the author comes to the same hand-wringing conclusion:
“There is little evidence that governments of any colour will take serious action on obesity. They will continue to involve the junk food industry in policy discussions, run soft education programs, and back off from any tough measures. We should not kid ourselves that there is any real intent to tackle the problem.”
You see, everyone else is to blame. At no stage do our public health experts consider that their adversarial strategy may be flawed. Given the recent election of a Government even less inclined to respond to the ‘regulate everything’ approach, I respectfully suggest that the public health strategy needs to change. Some thoughts:
• Drop the ideological crusade. It will fall on deaf ears.
• Step across the aisle and partner with an industry, company or association around specific projects. Show the politicians that you can work collaboratively with other sectors in the food and nutrition system.
• Conduct research. Develop some programs that actually work.
• Avoid using terms such as ‘unhealthy foods’, based on meaningless criteria like sugar and fat. Work up some sophisticated models for classifying foods. Be scientific.
This consensus approach won’t appeal to those who define themselves by what they hate. However, I am sure the new Health Minister in Canberra would respond well to an obesity prevention proposal that is soundly based in science, broadly supported by various constituencies and practical to implement.
If only his predecessors had received one.