The Preventive Health Agency Bill, passed by the lower house last night, is an important element in a comprehensive approach to addressing overweight and obesity.
The Agency will engage with a range of experts and take an evidence-based approach, a strategy also used by the expert group appointed by government — the National Preventative Health Taskforce — in developing their obesity prevention blueprint.
This is in stark contrast to Childhood Obesity: An Economic Perspective, a working paper produced by the Productivity Commission.
While the report is creating big headlines, it takes only a narrow economic assessment of the rationale for action on childhood obesity and an incomplete review of the evidence, concluding that major action is not warranted at this stage.
The Productivity Commission’s findings are at odds with those of the Taskforce. The findings are also inconsistent with two major Assessing Cost-Effectiveness (ACE) Studies, ACE Obesity and ACE Prevention, which identified a number of cost-effective interventions for obesity prevention.
For example, the ACE studies found that bans on junk food marketing to children and a 10% tax on junk food would have a high health impact while being cost saving, but the Productivity Commission’s report assessed their likelihood of success as low.
Three long-term, community interventions — Be Active Eat Well (primary schools), Romp and Chomp (pre-schools) and It’s Your Move (secondary schools) — have all been successful in reducing unhealthy weight gain in children in these settings and are ready to be translated to much larger scales.
Many other programs cited in the Productivity Commission’s report have also had positive results on behaviours and environments and, while none can be expected to provide the magic bullet, a combination of the most promising of these programs could be expected to make a significant difference to rates of overweight and obesity in children and young people.
This is the comprehensive approach recommended by the Taskforce, which hopefully will be implemented utilising the funding of around $400m for the Healthy Children and Healthy Communities initiatives through the Council of Australian Governments.
There are some telling gaps in the Productivity Commission’s assessment of the evidence. For example, almost all of the major evidence is missing from the report’s summary of research on unhealthy food marketing to children.
Specifically, there is no mention of the three leading international reviews of the evidence on the influence of junk food marketing on children, prepared on behalf of the World Health Organization and the US Institute of Medicine. These reviews have all reached clear conclusions: junk food advertising affects what children eat, what they want to eat and what they pester their parents to buy.
Professor Rob Moodie, Chair of the National Preventative Health Taskforce, led a previous analysis concluding that childhood obesity was a clear sign of ‘market failure’ because two key assumptions of the orthodox economic theory of markets are clearly violated: individuals do not consistently act in ways to maximise benefits to themselves because short term pleasures often trump long-term benefits; and children are very vulnerable to the commercial pressures which seek to manipulate them.
In contrast, the Productivity Commission, while conceding that children have very limited rationality and willpower in relation food choices, concluded that there were few ‘market failures’ in relation to childhood obesity, thus only weak, low risk strategies such as more education were justified. It appears that the general public understands the seriousness of childhood obesity and the vulnerability of children to commercial influences, as over 90% of consumers support bans on junk food marketing to children.
The Productivity Commission report states that childhood obesity’s causes and solutions are too complex to be certain, thus regulatory or fiscal strategies, despite evidence of their cost effectiveness, are not warranted and only the softer options of education and information should be used.
This approach is contrary to the widely held views of Australian and international experts in obesity, who agree that information and education alone will do nothing to address the childhood obesity problem. This approach will merely ensure that obesity in children, adolescents and adults continues to rise and that the obesity-driven tsunami of diabetes, cancer and other debilitating health consequences will continue unabated.
Despite the Productivity Commission’s assessment of the increasing health cost of this burden as a “probably minor” externality, it is clear that its impact in the future will be serious. In addition to the financial burdens of spiraling health care costs and lost productivity, increasing numbers of obese children will continue to face serious health and psychosocial consequences in childhood, and disease and early death as adults.
Federal and State governments acknowledge that prevention is better than cure, and they must not let the Productivity Commission’s report deter them from putting this into action.
*Boyd Swinburn is from Deakin University and Jane Martin is Senior Policy Advisor for the Obesity Policy Coalition