Tipping the Scales in favour of obesity prevention – how should we use the crisis of Covid-19?

Early in the Covid pandemic the head of the World Health Organization, Tedros Adhanom Ghebreyesus noted the importance of staying healthy firstly by eating a healthy and nutritious diet to support the immune system functioning properly.[i]  This was followed by advice to limit alcohol consumption, and avoid sugary drinks, not smoke and to exercise regularly.

For Australians, these behaviours are the leading risk factors for disease in our society, with diet and obesity starting to close in on tobacco smoking as top of the ladder for the burden of disease. [ii] Diet already leads the way globally.[iii] 

Evidence is also emerging about the role of obesity and how, along with age, it contributes to the severity of Covid-19.  Other significant contributors to risk are hypertension and Type 2 diabetes. The health of Australia’s population is important for many reasons, including that it can affect the impact of communicable diseases, such as viruses like Covid-19.

The pandemic has resulted in a shift to intervention of government in not just the economy, but also over the lives of our population…

Right now we are seeing exactly how prevention saves lives in the response to the corona virus. The Australian government’s response is a success story in reducing transmission and deaths of the virus, starkly contrasted with the logarithmic spread and deaths overtaking countries with relatively advanced health systems such as Italy and the USA. The absence of disease and death, the fact that we ‘flattened the curve’, is not a new concept for Australia. Consider the success of tobacco control whereby we reduced smoking prevalence and saved lives, providing a model for the rest of the world. [iv] The key differences are that this has taken place over a much longer period of time and with the influence of vested commercial interests fighting every step of the way.[v]

The pandemic has resulted in a shift to intervention of government in not just the economy, but also over the lives of our population to a degree that most of us have never experienced.

One of the difficulties posed by prevention, including of obesity, is that there are many parts of government that can influence the policies and programs that either contribute or detract from healthy eating and physical activity – these include transport infrastructure, urban planning, education, agriculture and the food system – including the processing, distribution and marketing of food and drinks.[vi] The development of a National Obesity Strategy, through the Council of Australian Governments, is an important step to a co-ordinated long-term approach across all levels of government to slow the growth in obesity and improve the health of the population.[vii]

The pandemic has resulted in a shift to intervention of government in not just the economy, but also over the lives of our population to a degree that most of us have never experienced. This is to be contrasted with the  light touch approach and calls for less government intervention in the lives of Australians that we have experienced in the past. In regard to where the responsibility lies for the health of the population, polls show the vast majority of Australians endorsed the view of personal responsibility for health (91%), however despite this 46% believed that the government had a large role to play in prevention (46%).[viii] It will be interesting to see if this sort of support increases as a result of this health crisis and acceptance of government intervention will be enhanced.

The impact of the pandemic has resulted in seismic shifts in our society that will improve, and be detrimental, to our diets and health. It has had a very swift impact on our eating habits, with a number of polls showing that people are eating more unhealthy foods such as icecream and chocolate, as well as 27% eating less healthily than before.[ix] It has also disclosed vulnerabilities in our food supply chain and impacted the ability of some to access healthy food, particularly for the most vulnerable. Access to fresh produce in particular, has been a serious issue in remote communities where some populations are locked down and unable to travel to larger regional centres to purchase essentials, including food. This has shone a light on the entrenched problem of significantly higher prices for food in these communities, which is exacerbated by shortages. Research has found that over the ten years to 2017 prices in remote communities have increased by 38% compared to 5% in regional centres.[x]

For example with potential changes to the GST, it is critical that it does not result in healthy food attracting the tax.

The Minister for Indigenous Affairs, Ken Wyatt has set up a food security working group to monitor specific issues, such as this, in rural and remote Australia.[xi]  Further, a large coalition made up of more than 200 signatories has raised concerns around the vulnerability of Aboriginal remote communities and calling for a guarantee for affordable food and other essential items during the pandemic and into the future.[xii]

In the longer term as we move through this pandemic and policy reforms are considered, we need to be wary that some of the gains that we have made to shore up nutrition and healthy diets could be removed or relaxed. Tax reform, which is being discussed as a result of the current crisis, should not undermine health. For example with potential changes to the GST, it is critical that it does not result in healthy food attracting the tax. On the other hand, there is an opportunity to support healthier diets by taxing sugary drinks or taxing sugars added to processed foods. These policies have potential to significant health benefits to the community, as well as raising significant funds for government at a time when resources are scarce.

The value of prevention is now clearer than ever and increase in investment have been called for by the public health community for many years. We need to build the relevant structures and funding within government to enable investment in effective and long-term prevention programs and policies, we have a potential opportunity to shift the focus for the better health of all Australians. Currently the Public Health Association is leading a coalition calling for 5% of the health budget to be allocated to prevention activities, up from the current 1.5%.  It also proposes the development of a mechanism within government to be established, similar to the Pharmaceutical Benefits Scheme, to assess the allocation of investment based on potential effectiveness and impact on the health of the Australian population.[xiii]

One of the barriers to progress is the delay between taking powerful coordinated action to address obesity and support healthy eating and reaping the future health and economic gains. Added to this is the power and influence of the ultra-processed food lobby, who push back hard on policies that will impact on their sales and profits. Political will is necessary to drive and challenge the corporations whose activities and profits would be curtailed; we need to foster this and build a strong civil society calling for change.  Now is the time to commit to building a healthy and resilient population and we should not let this crisis go to waste.

[i] Teo J. Coronovirus WHO gives advice on how to boost your health. 20/3/2020 (Accessed 4th May, 2020) https://www.straitstimes.com/singapore/health/coronavirus-who-gives-advice-on-how-to-boost-your-health-to-fight-covid-19

[ii] Australian Institute of Health and Welfare. 2019. Australian Burden of Disease Study: impact and causes of illness and death in Australia 2015. Canberra, Australia.

[iii] Health effects of dietary risks in 195 countries, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Afshin A., Sur P.J., Fay K.A., Cornaby L., Ferrara G., Salama J.S., Mullany E.C.et al, GBD 2017 Diet Collaborators (2019)  The Lancet,  393  (10184) , pp. 1958-1972.

[iv] Public Health Association of Australia (PHAA). Top ten public health successes over the last twenty years. PHAA Monograph Series No. 2, Canberra: Public Health Association of Australia, 2018

[v] A Rob Moodie, Penny Tolhurst and Jane E Martin. Australia’s health: being accountable for prevention. Med J Aust 2016; 204 (6): 223-225. doi: 10.5694/mja15.00968

[vi] Nishtar, Sania et al. Ending childhood obesity: a time for action. The Lancet, Volume 387, Issue 10021, 825 – 827

[vii] National Obesity Strategy, Consultation Hub. (Accessed 3 May, 202. https://consultations.health.gov.au/population-health-and-sport-division/national-obesity-strategy/

[viii] Anne C. Grunseit, Samantha Rowbotham, Melanie Crane, Devon Indig, Adrian E. Bauman & Andrew Wilson (2019) Nanny or canny? Community perceptions of government intervention for preventive health, Critical Public Health, 29:3, 274-289, DOI: 10.1080/09581596.2018.1468020

[ix]Mills D.YouGov report reveals the mental and physical costs of the coronavirus lockdown. https://www.heraldsun.com.au/coronavirus/yougov-report-reveals-the-mental-and-physical-health-costs-of-the-coronavirus-lockdown/news-story/f2c671b4121d35f20cf7d6d98b14df11 15th April, 2020.

[x] Donna Ah Chee, quoted in report: Remote communities going without essentials amid lockdown NT groups say. The Guardian, 21 April, 2020 https://www.theguardian.com/australia-news/2020/apr/21/remote-communities-going-without-essentials-amid-lockdown-nt-groups-say

[xi] Wyatt K. Securing essentials for remote communities. Accessed 3rd May, 2020 https://ministers.pmc.gov.au/wyatt/2020/securing-essentials-remote-communities

[xii]First Nations Covid 19 letter. Accessed 5th May, 2020 https://www.firstnations-covid19-letter.org/

[xiii] Public Health Association. Commonwealth Budget 2020-2021 – Pre budget Submission. 31st January, 2020. phaa.net.au/documents/item/4243