The Commonwealth Health Minister has been a strong advocate for the creation of a new Commonwealth government agency to be known as the Australian National Preventative Health Agency. This article questions why the government needs to establish this separate Agency in relation to initiating and implementing policies that will help counter obesity and its related adverse health consequences. The article suggests a need for the government to review its approach and to consider a better way to achieve more effective results.

Background to this initiative

On 1st September 2009, the Federal Government’s Preventative Health Taskforce, which had been established in April 2008 and headed by Professor Rob Moodie of the University of Melbourne, released to the government its report entitled “Australia: The Healthiest Country by 2020“.

The Report described itself as a National Preventative Health Strategy. The establishment of this Taskforce itself was part of Australia’s own response to international moves that began more than 5 years ago at the World Health Organization with the stated aim of countering the epidemic of obesity and the chronic health consequences showing up in many countries – such as the growing prevalence of chronic heart disease, diabetes, and high blood pressure inducing strokes.

In May 2004, Australia as a member of the international community endorsed the World Health Organization (WHO) Global Strategy on Diet, Physical Activity and Health. This obligated the WHO’s member States to develop national strategies to improve diet and physical activity and to draw up national dietary guidelines, and to take more proactive steps in their respective countries to impose greater regulation on food marketing, advertising, sponsorship, and promotion, as well as to improve systems of food labelling.

Changes in food laws by governments around the world are framed in the context of international standards that are negotiated through the international forum of Codex Alimentarius. Many of the interventionist arguments for promoting a new regime for food laws are fuelled by research sponsored under the auspices of the World Health Organization and numerous supportive NGOs.

The international regulatory policy direction

The role of the World Health Organization itself has shifted in recent years. Whereas, once upon a time, the WHO concentrated on preventative health measures to prevent communicable diseases such as smallpox, malaria or HIV AIDS, a considerable part of its resources are now spent developing programs for government policies around the world aimed at reducing the incidence of non-communicable diseases such as coronary heart disease and the other obesity-related health consequences.

While the World Health Organization’s impact on food regulatory policies in every country is continuing to grow, this also represents a potential for a major shift away from the dominance of the free market and free trade criteria in the development of food standards. It may also signal either the further demise, or alternatively a revamping in a new form, of Australia’s own food standards agency FSANZ (Food Standards Australia New Zealand).

Proposal for an Australian National Preventative Health Agency

A key response by Australia’s Federal Health Minister to the report issued in September 2009 by Professor Moodie’s National Preventative Health Taskforce was the idea of creating an ‘Australian National Preventative Health Agency’. This article now examines and questions the basis for such a move.

The most obvious question to be asked is why there is a need to establish such an agency in the context of preventative health and obesity when there are already substantial government commitments and programs in place and research being undertaken by numerous government agencies in all of the areas where the government believes there is supposedly a lack of government initiative.

The following is an examination of just some of the programs and policy activities that already are being implemented in the preventative health and dietary/nutrition-related area well before the formation of an Australian National Preventative Health Agency, particularly through such existing government bodies as the Commonwealth Health department itself, and agencies such as Food Standards Australia and New Zealand (FSANZ), the CSIRO, the National Health and Medical Research Council (NHMRC), the Australian Bureau of Statistics, the Australian Institute of Health and Welfare, and the Federal Department of Education Employment and Training.

Federal Department of Health

The Commonwealth Department of Health has handled numerous matters concerning preventative health planning for some time. For example, there have been anti-obesity/preventative health programs operating already for some time under the umbrella of a Commonwealth Health Department initiative that goes by the title “A Healthy and Active Australia”. Details of the multitude of programs can be found at the Health Department website.

Furthermore, considerable information can be easily and regularly collected and collated on the extent of overweight and obesity conditions in Australia through the Annual National Health Survey (NHS), for example see details at:
http://www.healthyactive.gov.au/internet/healthyactive/publishing.nsf/Content/overweight-obesity

Foods Standards Australia New Zealand (FSANZ)

FSANZ is an independent statutory agency which sets food standards for both Australia and New Zealand. This is the primary government agency to create food compositional and food marketing and labelling standards for the food industry. These appear as food standards that form part of the Australia New Zealand Food Standards Code. This Code is intended to address all relevant food compositional, food labelling and food safety issues and FSANZ or the Australia New Zealand Food Regulation Ministerial Council each can initiate any proposals of their own volition or initiate new standards in response to government dictated policies.

In order to do its normal work, FSANZ must undertake scientific studies and assessments of the impact of dietary patterns. FSANZ has in fact made numerous findings upon which it has based its assessments for such preventative health measures as mandatory fortification of foods. For example in making its assessment in FSANZ Proposal P230 relating to Iodine fortification of bread-making salt, FSANZ needed to be in a position to understand how much salt was being consumed in bread.

Similarly in formulating several drafts (there have been 4 drafts to date) of a proposed ‘Health claims foods standard’ in connection with the making of any health claims or nutritional property claims (see in particular FSANZ Proposal P293), FSANZ has used a detailed scientific database in order to consider the health effects of different nutrients and food substances to determine the ‘health claims eligibility criteria’ for food to carry either a ‘high level health claim’ or a ‘general level health claim’ or a ‘nutrient content claim’.

Incidentally, FSANZ may have had difficulty in resolving its approach to ‘nutrient dense foods’ that may in fact be healthier than many anti-obesity preventative health advocates will admit. For example, considerable medical evidence indicates that some dairy fats may be heart health neutral (e.g. buteric acid and stearic acid) despite being saturated fats and not monounsaturated or polyunsaturated. Nevertheless, FSANZ has had access to considerable scientific information to be in a position to determine the eligibility of different foods in the context of the respective health claims that might be made for them. If FSANZ does not have sufficient expertise, it is highly doubtful that the expertise can come from a more generalist body such as the Australian National Preventative Health Agency.

Commonwealth Scientific and Industrial Research Organisation (CSIRO)
Preventative Health Flagship of CSIRO

The CSIRO has a Preventative Health Flagship division, headed by Professor Richard Head. This Flagship develops diet and lifestyle programs, investigates how food design can influence obesity and related diseases, and studies metabolic factors which affect obesity. Initiatives by the CSIRO include the Wellbeing Plan released in 2007 which devoted $2 million over two years to target obesity and promote healthy eating and physical activity in young Australians. Other research includes the study of metabolic pathways in obesity, and the impacts of diet and lifestyle in reducing obesity. These prior research projects prove that the CSIRO already has the capability of providing evidence-based advice and conducting considerable relevant research on obesity insofar as it has particular characteristics in Australia.

Food and Nutritional Sciences Division of CSIRO

The CSIRO Food and Nutritional Sciences division was initially established as a research collaboration with other governments. Currently headed by internationally-renowned Professor Martin Cole, this CSIRO division now partners with various Universities, Federal and State Governments and the Food and Health Industries to conduct food and nutrition research at every stage of the food processing business system. The research of the Food and Nutritional Sciences Division of the CSIRO has included consumer and market access research, research in nutrition and healthy foods, and best practice methods for healthy product delivery and assembly. Again, the work of this division of the CSIRO demonstrates that effective partnerships between agencies and government bodies can occur without the need for a separate Preventative Health Agency.

Australian Bureau of Statistics (ABS)

Australian Bureau of Statistics also regularly publishes statistics relevant to food consumption and obesity. For example, the Australian Social Trends report published in September 2009 including data about changes in body mass index over time, level of physical activity and the levels of sedentary time of Australians.

Australian Institute of Health and Welfare (AIHW)

The Australian Institute of Health and Welfare is Australia’s national agency for health and welfare statistics and information. It is constituted under a separate Act of Parliament. Its work includes partnering with various organisations under the Australian Government Initiative ‘Health Insite’, to provide publications and news in various subject areas of health and welfare such as cardiovascular disease and diabetes. Since obesity was made a health priority area in April 2008 at the Australian Health Ministers’ Conference, it has been an area of great interest for the AIHW. One of the most important publications by the AIHW is the “Australia’s Health” reports published biennially which provides statistics and commentary on various preventative health and illness issues. The reports already cover many areas of obesity research and its impact on society. It would seem logical that should the government wish to provide further statistics and information on obesity, the AIHW would be able to expand its reporting functions without the need to create an entirely new National Preventative Health Agency. Inevitably, there seems little point to creating an Agency generating overlapping statistics and information if the information is already available.
If the government truly believed that the current research lacks coherence or comparability, it would be more efficient and cost effective to encourage these agencies and government bodies to communicate with each other about their research with an aim to improve comparability. It is difficult to see how setting up an entirely new Agency to compile data and provide reports would improve the usefulness or comparability of the data/research.

Australian Better Health Initiative (ABHI)

In 2008, Australian state and territory government set up a four year joint program called the “Australian Better Health Initiative” (ABHI) which “aims to reduce the prevalence of risk factors for chronic disease”. The ABHI launched the “Measure Up” campaign in 17th October 2008. This $30 million campaign included advertising on TV, print and radio, as well as an informative website and brochures and other information provided throughout the community. Given that there is already this program in place solely to target chronic diseases, government funding will clearly be better spent in coordinating existing efforts rather than creating yet another Agency to tackle the same issue.

National Health and Medical Research Council (NHMRC)

The NHMRC is a body which supports health and medical research and develops health advice for the Australian community. It also regularly partners with other government bodies and agencies to conduct research relevant to obesity. For example, collaboration between the NHMRC and the Department of Health and Ageing, lead to the development of a clinical practice guideline for doctors on the management of overweight and obesity in children, adolescents and adults. Although these guidelines were developed for doctors dealing with overweight and obesity people, these guidelines show that other guidelines can be created for the general public with a similar partnership between agencies such as NHMRC with a government body.
See: http://www.health.gov.au/internet/main/publishing.nsf/Content/obesityguidelines-index.htm

Additionally, the NHMRC also has a procedure for people to apply for funding in research programs/projects; hence it is questionable whether the grant facility of the proposed Agency is required. Between 2000 and 2007, $68.9 million was allocated by the NHMRC to obesity research. The amount allocated to each year has steadily increased, with $13.8 million allocated in 2006 and $17.9 million allocated in 2007. Given that in April 2008 the Australian Health Ministers’ Conference made obesity the eighth National Health Priority Area, it is clear that the NHMRC will continue to grant research funds where required. According to the Australian National Preventative Health Agency Bill, only around $2-4 million per year will be spent on the proposed Preventative Health Research Fund between 2010-2013 – See Page 3 of the Explanatory Memorandum

– Yet this is a much smaller amount in comparison with the funds currently allocated by the NHMRC for obesity research ($17.9 million in 2007), and it seems unnecessary to set up another grant funding facility where there is one already in existence. If governments are keen to provide funding for research, it is more efficient from an administrative perspective to channel all of the funds through an existing funding facility.

A Massive Social Marketing Campaign by the new Federal Agency

According to the Explanatory Memorandum that accompanied the introduction of the Australian National Preventative Health Agency Bill 2009, the current plan of the government is that of the total budget of $133.2 million allocated towards the creation and operation of the new Agency, a sum of $102 million of the $133.2 million in funding for the Australian National Preventative Health Agency will be spent on “Social marketing campaigns (obesity and smoking)” – See Explanatory Memorandum Page 5.

Although additional funding on education and community awareness programs is always welcome, such funding must be used appropriately and effectively. The effectiveness of anti-smoking campaigns such as the ‘Quit’ program are already proven to work, so why is there a need for replication through the creation of a new Agency?

There is also an assumption in the Bill that the work of the new Agency is to be finally determined by the CEO (who is to be appointed by the Health Minister) to plan and implement a National Preventative Health Strategy, and that further supportive research is necessary. Yet if this is the case, then it is highly surprising that the government already has allocated the vast bulk of the budget of the new Agency towards ‘social marketing’.

First of all, there is no demonstrative proof that expenditure on such ‘social marketing’ will lead to demonstrable beneficial health effects.

Secondly, unlike the workings of other government agencies and frameworks in relation to the various bodies mentioned earlier in this article, the Commonwealth Health Minister is empowered by the new legislation, to act with substantial rights of veto in relation to the new Agency and there is no real accountability for the substantial ‘social marketing’ expenditures beyond the accountability of the Agency’s CEO directly to the Minister. Unlike other government agencies and processes, there is no Federal-State interactive process in policy formation. In other words, the Commonwealth Health Minister has a massive budgetary opportunity to direct the flow of marketing dollars as she sees fit.

Conclusions

From one perspective, it might be argued that the government needs to be seen as proactive in tackling the issue of obesity and chronic diseases by setting up an Agency purely to target this issue. However, the closer one scrutinises the legislation and the more one compares its workings to the pre-existing policy frameworks of government in the same area, the more one must express concern of the unnecessary duplication and waste of precious government resources.

As this article has sought to highlight, there are already a large number of government initiatives, agencies and government bodies with responsibilities to be fulfilled in reducing obesity and dedicating substantial government investment and financial support for programs that enhance obesity research, education and awareness. There is no obvious imperative to create an entirely new Agency of this nature.

Rather, the Health Department and its Minister have the choice to accept responsibility to play an important national policy coordination role of government in gathering the information from the various existing bodies and institute cohesive policies. The funding which is proposed to be spent by the Agency on a massive ‘social marketing’ campaign that enriches the private television stations with revenues from advertising that many might consider to be ‘feel good’ government propaganda is disconcerting in the least, especially if there is no demonstrated proof at this stage that there will be a directly positive health impact on the ultimate consumers.

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How necessary is an Australian National Preventative Health Agency for anti-obesity policy?
Written by Joe Lederman,
Managing Principal of leading food industry lawyers FoodLegal
© Lawmedia Pty Ltd, March 2010