Nanny Endovelicus. Preventing prevention Part 2

This is part 2 of a series on health prevention. It was initially posted in October last year.  John Menadue.

Yesterday, in part 1, I began the task of analysing the cuts to the Commonwealth’s health budget and to the promised payments to the States and Territories in the area of prevention. Are the cuts well justified by the statistics?

Obesity – Nutrition and Physical Inactivity

Other than tobacco and excess alcohol consumption, the rising rates of obesity are the most concerning statistics in the area of preventable diseases. People’s diets and their levels of physical activity both contribute to obesity and overweight. By mid 2012, almost two thirds of Australians over 18 years were either overweight or obese according to the Australian Bureau of Statistics, a significant increase from a decade ago. The current combined level for obesity and overweight is 63% for adults (70% of men and 56% of women). Of children between the ages of 5 – 17, about 18% are overweight and 8% are obese; this is very bad news, but at least it isn’t worse news – these numbers for children are largely unchanged since 2007-08. Unsurprisingly, a clear pattern of socio-economic disadvantage is visible: the prevalence of obese children, for example, is four times higher in disadvantaged areas.

Australia is now in the top league tables in the obesity stakes, still lower than the United States but we’ve been catching up fast.

On specific metrics for exercise and nutrition, the AIHW (Australian Institute of Health and Welfare is also being abolished as a standalone statutory body by decision of the 2014 Budget with the functions to be amalgamated in a mega ‘productivity and performance’ entity) reported this year that: 92% of Australians did not eat 5 serves of vegetables per day and 52% did not eat 2 serves of fruit; and only 43% of adults were active enough to meet recommended guidelines of 150 minutes per week of walking or other moderate or vigorous activity.[1]  

The nation has a long way to go on the obesity problem. Dutton often cites the alarming obesity statistics – but mainly as a precursor to argue for his plans to charge people more for primary care from their GP – which is of course where a lot of prevention advice is given and where lower-income people are most likely to go. Given the current minister is well aware of the problem, presumably there are major initiatives to tackle obesity. However, there is no evidence in the federal budget of anything much being done. Perhaps the government is making good on its comment that this is a matter for people’s personal responsibility.

Other Risk Factors

There are of course other risk factors both behavioural and biomedical – eg. high blood pressure, high cholesterol, high salt intakes – but it is in particular the key risk factors described above which drive the major increases in chronic disease.   So while not unimportant, the Commonwealth, States and Territories chose to focus their efforts and funds on the SNAP behavioural risks that could potentially be influenced in a better direction.

Where to now?

So, with the data under our belts, does the picture suggest less attention or a reduction in funding for prevention activity?  The answer is self-evident.  More emphasis on prevention is clearly in order.  And that is what most countries are doing – increasing considerably their attention to the difficult area of lifestyle risk factors in order to counter the significantly increasing burden of preventable chronic diseases. The head of the World Health Organization, Margaret Chan, has noted that chronic noncommunicable diseases have overtaken infectious diseases as the leading global cause of morbidity, disability, and mortality and stated that “prevention must be the cornerstone of the global response.” So what’s going on in Australia? Why this attack on lifestyle-related prevention activity.

There are perhaps two interrelated answers.

That the Abbott Government is proving to be highly ideological – not a feature of their campaigning before the election – is hardly a matter for debate any longer.  The extent of the ideological thrust is however a surprise to many as is the extent of the influence of the far right think tanks like the Institute of Public Affairs. The IPA had waged a highly visible campaign against nanny state prevention activities in the election lead up. During the Budget, the ideological tenor of the government was especially on display when increasing spending. More money for medical research! Terrific idea? In principle, you’d think so. But the funds are for Medical – big M – research; Dutton made clear that it’s a Medical Research Future Fund – not a Health Research Fund – which is far more likely to rule out research into, for example, factors influencing behavioural elements like fast food or alcohol consumption. Particularly ironic (depressing) – but sending the clear ideological message – the savings from killing off the COAG Preventative Health Partnership and abolishing the national Prevention Health Agency are being directed into the Medical Research Future Fund according to Budget Paper #2.

Just as worrying, and well documented by others, is the influence of the alcohol and food industries on the government (see for example Big Food with a regional flavour – how Australias food lobby works). The embarrassing Fiona Nash’s behaviour in hiring a junk food lobbyist as her chief of staff was probably just the visible tip of a very large iceberg. Her hamfisted attempt to delay the website and possibly wipe out the food star labelling system – and this is a voluntary system for the industry! – created the first scandal for the then new government. Given the level of control over ministerial staff appointments out of the PM’s office, one could suppose the PM thought there was no problem with having a junk food voice so intimately involved in the food minister’s work — a supposition largely confirmed in his refusal to have his non-performing junior minister resign over the matter. (As an aside, however, his reluctance could well be compounded by that fact that there are rather few women in the ministerial club and losing one – and a Nat at that – might have been rather problematical). At least they don’t let Nash out in public very often – although her launching of the most recent phase of the national tobacco campaign from a party base that still accepts Big Tobacco funding had a number of us seriously exceeding the NHMRC alcohol guidelines for single occasion risk!!

Where the industry influence and the ideology will take us eventually is probably not to better health outcomes. Cuts to areas like prevention, just like undermining investment in newer green technologies, do not have outcomes that are immediately visible – the negative results take some time to manifest.   Eventually, our performance or rather lack of it, in prevention will become evident in the burden of disease measures and in comparison with other countries who are diligently tackling the tough lifestyle issues. The actions of an ideological government, out-of-touch with international evidence and action on these matters, is not likely to serve Australia’s longer term interests.

[1] Australia’s health 2014, AIHW

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