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AustrAliA:the heAlthiest countryby 2020

A n pap p pa thNat na P ntat H a th Ta

Preventative Health Taskforce


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National Preventative Health Task orceAustralia: the healthiest country by 2020 A discussion paper

ISBN: 1-74186-727-4Online ISBN: 1-74186-728-2Publications Approval Number: P3-4510Copyright Statements:

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A k w dg m THe discussioN PAPer wAs PrePAred oN beHAl o THe NATioNAl PreveNTATive HeAlTH TAsk orce

Pro essor Rob Moodie, ChairPro essor Mike Daube, Deputy Chair

Ms Kate Carnell AODr Christine ConnorsMr Shaun LarkinDr Lyn Roberts AM

Pro essor Leonie SegalDr Linda SelveyPro essor Paul Zimmet AO

Ms Meriel Schultz - writer

wiTH Advice rom THe ollowiNg exPerTs

Alco ol To accoPro essor Rob Moodie (Chair) Pro essor Mike Daube (Chair)

Pro essor Steve Allsop Ms Viki BriggsMs Kate Carnell AO Pro essor Simon Chapman

Mr David Crosbie Dr Christine ConnorsPro essor Margaret Hamilton AO Mr Shaun LarkinMr Todd Harper Ms Kate PurcellMr Michael Livingston Dr Lyn Roberts AMPro essor Robin Room Ms Denise SullivanPro essor Leonie Segal Pro essor Melanie Wake eldDr Linda SelveyAssociate Pro essor Ted Wilkes Ms Michelle Scollo - writerPro essor Paul Zimmet AO

Mr Brian Vandenberg - writer O ityDr Lyn Roberts AM (Chair)Pro essor Paul Zimmet AO (Deputy Chair)

Ms Ange Barry Dr Marj MoodiePro essor Wendy Brown Pro essor Kerin ODea AOPro essor David Craw ord Mr Terry SlevinDr Sharon Friel Associate Pro essor Susan ThompsonDr Tim Gill Associate Pro essor Melissa WakeMs Michele Herriot Dr Peter WilliamsMs Jane Martin

Ms Tessa Letcher - writer and all Task orce members

suPPorTed by THe AusTrAliAN goverNmeNT dePArTmeNT o HeAlTH ANd AgeiNgThe contributions made by the Population HealthStrategy Unit, Publications Unit and CommunicationsBranch are grate ully acknowledged

i


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F w d

rom THe miNisTer or HeAlTH ANd AgeiNg

As a nation we must recognise that doing more to stay healthy and wellwill be key to coping with the human and nancial costs o chronic andpreventable illness.

The Rudd Government was elected on a plat orm that recognised that thingsneed to be done di erently in health care in the uture. Prevention o illness andchronic disease is central to a sustainable health system and a uller li e or allmembers o the Australian community.

Too o ten in the past, individuals, communities and governments have ocussed on the immediateissues o treating people a ter they become sick. Whilst this will always remain vital, and there ismuch to do in this area, we cannot a ord to limit our ocus to treatment and ignore prevention.

I established the Preventative Health Task orce in April and tasked it with developing acomprehensive and lasting Preventative Health Strategy by mid 2009. In the rst instance theTask orce was asked to ocus on how to reduce harm fowing rom obesity, tobacco and alcohol.

In order to develop this discussion paper, the Task orce has reviewed Australian and international

research to come up with its preliminary views on what interventions could be available toprevent illnesses.

In this discussion paper the Task orce identi es a wide range o options, some o them contentious,that it considers would have a positive impact in preventing illness. Importantly, the Task orce hasthrown down a challenge to the community to respond to its work and provide input. With which

ndings and suggestions do you agree? Which do you disagree with and why? Do you havealternative or better ideas, and i so what are they?

All parts o the community have a role to play, be they individuals and amilies, communities andindustry, and o course ederal, state and territory governments. No one sector alone can deal withthe prevention agenda we must act in concert and take responsibility or actions within eacho our domains. So your views will be vital to the next stage o development o a truly nationalprevention strategy. I encourage you to provide input at this important time.

I thank all Task orce members or their work, and particularly the Chair, Pro essor Rob Moodie, ortheir e ort and oresight in preparing this discussion paper Australia the Healthiest Nation by 2020.

The ball is now in your court.

I encourage everyone to read the discussion paper and submit their views to the Task orce to helpdevelop an exciting and constructive new prevention agenda or the decades to come.

NICOLA ROXON, MPMinister or Health and Ageing

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i v a f m c a

The title o this discussion paper sets a great challenge or us. To achieveit we will have to make major reductions in the diseases caused by obesity,tobacco and alcohol.

We have to ensure that all Australians will bene t, particularly those with the

poorest health Indigenous Australians, those in rural and remote Australia andthose with least education and income.

We base our recommendations on the best evidence we have to date. We inviteyou to respond. As a nation, as local communities, as corporations, and as amilies and individualswhat major changes are we prepared to make to improve our health? What new resources ande orts are we prepared to invest? We need to know what you think.

We hope you will join the challenge to make Australia the healthiest nation by 2020.

ROb MOOdIeChairNational Preventative Health Task orce

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c

A n nt

th m n t

in tat n th cha

e t a

1 int t n 1

1.1 Raising the bar or prevention 1

1.2 Setting targets or obesity, tobacco and alcohol 2

1.3 Understanding the challenges 3

1.4 About prevention 3

1.5 A ramework or prevention 5

1.6 Principles or preventative health 5

1.7 Working together 8

2 Th a p nt n: ht an t 9

2.1 The scale o the epidemic 9

2.2 High-risk groups 10

2.3 The need or urgent action 10

2.4 The costs o overweight and obesity 11

2.5 Challenges 12

2.6 Halting the epidemic 13

2.7 Priorities or action 14

3 Th a p nt n: t a 19

3.1 The current situation 19

3.2 Historical trends in mortality 20


3.4 Bene ts rom reducing smoking levels 21

3.5 Challenges 21


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3.6 Future outlook 22


4 Th a p nt n: a h 29

4.1 The current situation 29

4.2 Patterns o drinking 30


4.4 Bene ts o re orm 32

4.5 Challenges 33

4.6 Future outlook 36


5 s pp t n p nt n 43

5.1 Common aspects across obesity, tobacco and alcohol 43

5.2 Support structures 44

5.3 Major policy imperatives to strengthen support systems 45

6 m a n p an 47

6.1 Choosing per ormance indicators 47

6.2 Monitoring the indicators 50

6.3 Setting targets 50

6.4 Governance and per ormance monitoring 50

6.5 The monitoring system 51

7 c n n 53

7.1 Towards a National Preventative Health Strategy 53

r n 55


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ex v mma

A stra ia: the Hea thiest C ntr b 2020A discussion paper by the NationalPreventative Health Task orce

Th p p th pap :Australia is by international standards a veryhealthy country. But i we are to bequeath ourchildren the legacy o the worlds healthiestcountry, major reductions in disease caused byoverweight and obesity, tobacco smoking andharm ul consumption o alcohol are needed.

Combining these threats with the increasingdisparities in health between Indigenous andnon-Indigenous Australians, between citydwellers and rural and remote Australians andbetween rich and poor Australians, means wehave a real challenge on our hands i we aspireto being the healthiest nation by 2020.

The discussion paper outlines the case orre orm in our approach to the prevention oillness and the promotion o health. Majorchanges in the way we behave as individuals,as amilies, as communities, as industries, asstates and as a nation will be required.

The solutions are not only about individual

choice and personal responsibility but alsoabout the role o governments, business andindustry, and non-government organisations.The ideas proposed in this paper are or allAustralians, not just governments.

The aim o this paper is to test our overall targetsand the initial recommendations we havedeveloped, in order to in orm and provokediscussion and debate between Australiansabout how these targets can be achieved.

Ta t th h a th t ntThe Task orce is convinced that we canachieve the ollowing targets by 2020:

n Halt and reverse the rise in overweight

and obesity

n Reduce the prevalence o daily smokingto 9% or less

n Reduce the prevalence o harm ul drinkingor all Australians by 30%

n Contribute to the Close the Gap target orIndigenous people, reducing the 17-year li eexpectancy gap between Indigenous andnon-Indigenous people[1]

Th Ta

The National Preventative Health Task orcewas created in April 2008 by the Hon NicolaRoxon MP, the Minister or Health and Ageing.Established initially or a three-year period, theTask orce will produce the National PreventativeHealth Strategy in June 2009, ocusing on theprimary prevention o obesity, tobacco andharm ul consumption o alcohol. Because othe need to prioritise these concerns, other

important areas o preventative health suchas mental health, injury, immunisation, sexualand reproductive health, and illicit substanceuse will be considered in the next phase o theTask orces work in 2009.

The Task orce has based its recommendationson the best evidence to date. The evidencesupporting the case or change and proposedactions is set out in the paper and in threecomprehensive technical reports availableonline at www.preventativehealth.org.au.


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Th a nt, p h nan ta n a t nThe answer does not lie in short-term projects.In order to reach the whole community, weneed highly e ective public education andthe cooperation o mass media. We needevery kindergarten, school and university, everyworkplace and business, and every communityand neighbourhood in Australia involved andcommitted to improving and maintaining their

health and productivity.Chronic diseases not only result in death anddisease, they are also a massive economicburden on the community and the healthsystem. We can no longer a ord to wait until weget sick. The answer lies in preventative action.

Consumer demand needs to be redirectedtowards healthier choices. This can beachieved by industry producing, promotingand marketing much healthier products. Wealso need e ective legislation and regulation,using pricing, taxation and subsidies as a meansto encourage healthier choices. It could besuggested that the community is not yet ready

or some o these ideas, but just think howunlikely it would have been 25 years ago tohave introduced the approaches to tobaccocontrol that are now commonplace.

In order to succeed, we need greatly enhancedmonitoring, evaluation and research. Preventionprograms need to reach the whole o thepopulation and they must be given time to takee ect. Changing the attitudes and behaviourso populations does not happen overnight.

wh p n t p ntat h a th?

Our health is not only determined by our physicaland psychological make-up and healthbehaviours, but also by our education, incomeand employment; our access to services; theplace in which we live in and its culture; theadvertising we are exposed to; and the lawsand other regulations in place in our society.

Australia cannot become the worlds healthiestnation unless health becomes everyonesbusiness. Industry as supplier, marketer andemployer; unions; the media as promoter;community and non-government organisations;philanthropists; academe they all haveinfuential roles to play. Similarly, all governments local, state and ederal across many sectors,led by the health sector have distinct roles.Prevention must become the business o stateand ederal Treasuries, and o leaders in theprivate sector.

We must be an inspiration to others: to early-learning centres, schools and universities; urbanplanners; the sports and recreation industries;public transport and in rastructure; agriculture;police and emergency services; and to thehospitality and entertainment industries.

Where the market is ailing, governmentsneed to act to protect our health particularlythe health o children and adolescents.

Standards need to be established, regulationsimposed where necessary and consumereducation provided.

Governments, industry, advertising and themedia need to work to reshape consumerdemand in avour o healthy choices, and tomake those choices available and accessible.Healthier choices could include lower-alcoholbeverages and lower-energy nutrient-rich oodsand drinks.

Given the huge preventable losses o workplace

productivity due to obesity, tobacco andalcohol, the private and public sectors have keyroles as employers and in the promotion o muchhealthier workplaces. The experience o thenew WorkHealth program in Victoria provides animmediate example rom which we can all learn.

While Australias health care system playsa pivotal role in prevention, it requires bettersupport and training in order to deal with thesenew challenges.


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The National Health and Hospitals Re ormCommission and the External Re erence Group

or the Primary Health Care Strategy are workingon ways o ensuring that prevention is moree ectively carried out across the health systemas a whole, and in the primary health caresystem in particular.

Ultimately, it is communities, amilies andindividuals who must change behavioursi we are to become a healthier nation.

in q t n h a thMajor health inequities exist not only betweenIndigenous Australians and non-IndigenousAustralians, but between rich and poor, andbetween rural and city dwellers. Even withina city such as Melbourne, li e expectancycan vary by up to ve years within a mattero kilometres.[2]

The World Health Organizations Commission onthe Social Determinants o Health makes threeoverarching recommendations to tackle thecorrosive e ects o inequality o li e chances:

n Improve daily living conditions, including thecircumstances in which people are born, grow,live, work and age.

n Tackle the inequitable distribution o power,money and resources the structural drivers othose conditions globally, nationally and locally.

n Measure and understand the problem andassess the impact o action.[3]

With respect to obesity, tobacco and alcohol,Australian governments at all levels have arole in unding and supporting programs incommunities, schools and workplaces. Theseinvestments have to take into account theinverse care law that those with more getmore, and those with less get less and reverseit so that underserved communities receive thesupport and resources they need.

Th h ha t a

We do have choices we can do nothing newor do little but this will mean a great deal opremature illness, su ering and death, all owhich are preventable. As is already being seen,it will mean the overloading o hospitals, healthand wel are services, a situation made moreacute by the ageing o the Australian population.Similarly, it will mean rising costs within the healthsystem and losses in workplace productivity.

We need urgent and sustained action.Australias record in prevention has beenoutstanding in many areas such as tobacco,road trauma, cardiovascular disease, skincancer and immunisations. These preventativeactions have been crucial in increasing our li eexpectancy, but they have required substantiallong-term unding.

The certainty o what needs to be donevaries between the three immediate priorities:tobacco, alcohol and obesity. We know whatwe need to do to get our smoking rates down.Much is known about measures to reducethe harm caused by alcohol and overweightand obesity, but there is more to be learned.However, our need or knowledge should notstop action we must act now on the basis owhat we know, ollowing the best practice andadvice available, and learning by doing.

The necessary actions to reduce tobaccosmoking are clear. They include makingcigarettes more expensive, eliminating all ormso promotion and marketing, and revitalisingpublic education campaigns. Lessons romtobacco control are instructive, but approachesto obesity and alcohol will di er as governments,industry and communities work together toreshape consumer demand and supportindividuals in exercising healthy choices. Theemphasis will be on reshaping attitudes andbehaviours, rather than prohibiting them.


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wh th n t , t aan a h ?Put together, smoking, obesity, harm ul useo alcohol, physical inactivity, poor diet andthe associated risk actors o high bloodpressure and high blood cholesterol causeapproximately 32% o Australias illness.[4]

The World Health Organization estimates that, or many people, modi ying these risk

actors could help them gain an extra fve years o healthy li e.[5]

The prevalence o overweight and obesity inAustralia has been steadily increasing over thepast 30 years. In only 15 years, rom 1990 to 2005,the number o overweight and obese Australianadults increased by a staggering 2.8 million.

I the current trends continue unabated overthe next 20 years, it is estimated that nearlythree-quarters o the Australian population willbe overweight or obese in 2025.

The National Childrens Nutrition and PhysicalActivity Survey 2007 indicates that almost aquarter o Australian children are overweightor obese, an increase rom an estimated 5% inthe 1960s. Nearly a third o children dont meetthe national physical activity guidelines. Onlyone- th o 48-year-olds and one-twentieth o1416-year-olds met the dietary guidelines orvegetable intake.

Recent trends in Australian children predict that their li e expectancy will all two years by the time they are 20 years old, setting them back to levels seen or males in 2001 and

or emales in 1997[6]. This is not a legacy we should be leaving our children.

As the ollowing examples illustrate, i thesehealth threats are le t unchecked, our healthsystems will nd it increasingly di cult to cope:

n Type 2 diabetes is projected to become theleading cause o disease burden or malesand the second leading cause or emales by2023, mainly due to the expected growth inthe prevalence o obesity. I this occurs, annualhealth care costs will increase rom $1.4 billion to$7 billion by 2032. [27]

n Almost 2.9 million Australian adults smoke ona daily basis. Around hal o these smokers whocontinue to smoke or a prolonged period willdie early; hal will die in middle age.[7] Smoking-related illness costs up to $5.7 billion per year inlost productivity. [9]

n The most recent national survey o drug useestimates that one in ve Australians drink at alevel that puts them at risk o short-term harm atleast once a month. [64]

Almost three-quarters o Australians drink belowlevels or long-term risk o harm. However,among young adults aged 2029 years, theprevalence o drinking at levels or long-term risko harm is signi cantly higher (16%) than amongother age groups.

The harm ul consumption o alcohol notonly causes problems or those who drink atrisky levels but has repercussions across oursociety. Alcohol is involved in 62% o all policeattendances, 73% o assaults, 77% o street

o ences, 40% o domestic violence incidentsand 90% o late-night calls (10 pm to 2 am).[8]

The annual costs o harm ul consumptiono alcohol are huge. They consist o crime($1.6 billion), health ($1.9 billion), productivityloss in the workplace ($3.5 billion), loss oproductivity in the home ($1.5 billion) and roadtrauma ($2.2 billion).[9]

In total, the overall cost to the health care system associated with these three risk

actors is in the order o almost $6 billion dollars per year, while lost productivity is estimated to be almost $13 billion.[9, 10]


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Our ocus on obesity, tobacco and alcohol isalso due to two other important actors:

n The burden o disease caused by obesity,tobacco and alcohol makes up a signi cantpart o the 17-year di erence in li e expectancybetween Indigenous and non-IndigenousAustralians. Similarly, a large part o thedi erences in health status between rich andpoor Australians and between city dwellers andrural and remote Australians can be attributed to

obesity, tobacco and alcohol.n A relationship exists between growth and

development during oetal and in ant li e andhealth in later years. Poor nutrition, cigarettesmoking and alcohol use during pregnancy canresult in long-term adverse health e ects. Earlyli e events play a power ul role in infuencinglater susceptibility to chronic conditions suchas obesity, cardiovascular disease and type2 diabetes.

what ha p nt n a h ?In the 1950s three-quarters o Australian mensmoked. Now less than one- th o men smoke.As a result, deaths in men rom lung cancer andobstructive lung disease have plummeted rompeak levels seen in the 1970s and 1980s. [4]

Similarly, deaths rom cardiovascular diseasedecreased dramatically rom all-time highs inthe late 1960s and early 1970s to today.

Road trauma deaths on Australian roads have

dropped 80% since 1970, with death rates in2005 being similar to those in the early 1920s. [4]

Australias commitment to improvingimmunisation levels has resulted in much higherimmunisation coverage rates, eliminatingmeasles and resulting in a decrease o nearly90% in sero-group C meningococcal cases inonly our years. These results have come aboutbecause o a 34- old increase in unding overthe last 15 years.

Deaths rom Sudden In ant Death Syndrome(SIDS) have declined by almost three-quarters,dropping rom an average o 195.6 per 100,000live births rom 1980 to 1990 to an average o51.7 per 100,000 live births between 1997 and2002.[11]

P nt n a at n t ntA study commissioned by the Departmento Health and Ageing in 2003 showed quite

spectacular long-term returns on investment andcost savings through the preventative action otobacco control programs, road sa ety programsand programs preventing cardiovasculardiseases, measles and HIV/AIDS.[12]

For example this report estimated that the 30% decline o smoking between 1975 and 1995 had prevented over 400,000 premature deaths[13] and saved costs o over $8.4b,more than 50 times greater than the amount

spent on anti-smoking campaigns over that period.

The recent US study Prevention or a Healthier America shows that or every US$1 invested inproven community-based disease preventionprograms (increasing physical activity,improving nutrition and reducing smokinglevels), the return on investment over and abovethe cost o the program would be US$5.60 within

ve years.[14]

what a th a t p ?There are a number o barriers to increasingthe level o investment in e ective preventionprograms.

Despite the evidence, some infuential peoplewithin the community still do not believe thatprevention works, or that population-levelbehaviour change can occur.

Vested interests such as tobacco companieswill do everything in their power to discredit ordilute prevention programs.


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The e ectiveness o preventative methodshas also been a ected by variable populardemand. Results are not immediate, and ittakes time be ore the bene ts are seen by thecommunity. The Task orce sees preventionas an essential and complementary part oour national health system, and o our overallnational in rastructure. It is now clear romthe Australian 2020 Summit and the worko the National Health and Hospital Re ormCommission that overall community support orpreventative approaches is increasing.

Prevention has sometimes been seen asblaming the victim, thus not endearing itselto the public.[15] It can also be seen as a meanso controlling peoples behaviour i legislationor regulation are required, particularly whereeconomic market orces ail. Unnecessarycommunity antagonism to regulation canbe success ully diminished over time, ashas happened here and in many othercountries with the introduction o legislationon tobacco advertising.

As noted earlier, our health behaviours aredriven by a complex mix o social, economicand environmental orces levels o income,education, employment, habits, customs,images and norms, advertising, prices oproducts, and so on. The Task orce believes itis the role o governments to enable people tomake the healthiest choices they can. However,those who believe that health behaviours resultonly rom individual responsibility are much lessinclined to see a role or regulation or e ective,scaled-up public education.

Balanced, e ective regulation and legislation,usually alongside e ective and sustained publiceducation, have been an essential element omost prevention programs to date.

Divided responsibilities can present realdi culties. For example, where the state andterritory governments control liquor licensingand the Australian Government controls alcohol

taxation, pricing and promotion. Nationalleadership is needed, along with an increasein the capacity o monitoring, evaluation andresearch systems.

what n t ?

ObesITy

T Ta k orc li v t at in or r toalt an r v r t ri in ov rw ig t

an o ity t major action ar :

n Reshape ind str s pp and c ns mer demand

t wards hea thier pr d cts by increasingavailability and access to healthier ood andactivity choices and through the development

o comprehensive national ood policy(eg. modelled on the UKs Food Matters ).

n Pr tect chi dren and thers r m inappr priate

marketin o unhealthy oods and beverages,and improve public education and in ormation.

n Embed ph sica activit and hea th eatin in

ever da i e through school, community andworkplace programs. At the same time these arerein orced by individuals and amilies choosing tobecome more active and to eat healthier oods.

n Reshape rban envir nments t wards

hea th pti ns through consistent townplanning and building design that encouragegreater levels o physical activity and throughappropriate in rastructure investments( or example, or walking, cycling, ood supply,sport and recreation).

n Stren then, ski and s pp rt primar hea th

care and the p b ic hea th w rk rce to supportpeople in making healthy choices, especiallythrough the delivery o community educationand advice about nutrition, physical activity andthe management o overweight and obesity.

n C se the ap r disadvanta ed c mm nities

through the development o targetedapproaches to overweight and obesity ordisadvantaged groups, particularly Indigenousand low-income Australians, pregnant womenand young children.

n B i d the evidence base , monitor and evaluatethe e ectiveness o actions.


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TObACCO

T Ta k orc li v t at in or r tor uc t pr val nc o aily mokingto 9% or l , Au tralia n to:

n Ens re that ci arettes bec me si nifcant

m re expensive , and that e orts to achievethis through increases in excise and customsduty are not undermined by the increasingavailability o products on which these dutieshave been evaded.

n F rther re ate the t bacc ind str withmeasures such as ending all orms o promotionincluding point-o -sale displays and mandatingplain packaging o tobacco products.

n Increase the req enc , reach and intensit

ed cati n campai ns that personalise thehealth risks o tobacco and increase a senseo urgency about quitting among people in allsocial groups.

n Ensure that all smokers in contact with anysingle part o the Australian health care systemare identi ed and given the strongest and moste ective enc ra ement and s pp rt t q it .

n Ensure access to in rmati n, treatment andservices r pe p e in hi h disadvanta ed

r ps who su er a disproportionate level otobacco-related harm.

n Increase nderstandin about how beinga non-smoker and smoking cessation canbecome more contagious so that these

processes can be accelerated among lesswell-educated groups and amongdisadvantaged communities.

ALCOhOL

T Ta k orc li v t at in or r to r uct pr val nc o arm ul rinking or allAu tralian y 30% t major action ar :

R ap con um r man towar a rrinking t roug :

n Mana in b th ph sica avai abi it (access)

and ec n mic avai abi it (price). The highaccessibility o alcohol in terms o outletopening hours, density o alcohol outlets anddiscounting o alcohol products is an issuein many Australian communities. I managedwell this leads to reduction in alcohol-relatedviolence, injury, hospitalisation and death.

n Addressin the c t ra p ace a c h . Socialmarketing and public education are required,and will be more e ective i the marketing oalcoholic beverages is restricted, includingcurbing advertising and sponsorship o culturaland sporting events.

R ap upply towar low r-ri kpro uct t roug :

n Chan es t the c rrent taxati n re ime thatstimulate the production and consumption olow-alcohol products.

n Impr ved en rcement c rrent e is ative

and re at r meas res (such as ResponsibleServing o Alcohol or bans on serving intoxicatedpersons and minors, or continuing to lower bloodalcohol content in drink-driving laws).

n Rem va tax ded ctabi it or advertising anddevelopment o staged approach to restrictalcohol advertising.

str ngt n, kill an upport primary altcar to lp p opl mak alt y c oic :

n S pp rt brie interventi ns as part o routinepractice by health pro essionals and other healthworkers in primary health care settings to assistchanges in drinking behaviour and attitudes toalcohol consumption.


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Clo t gap ori a vantag communiti :

n There is a need or tai red appr aches andservices to reach Indigenous and otherdisadvantaged groups.

Improv t valuation oint rv ntion t roug :

n M nit rin and eva ati n re at r

meas res and ther pr rams to underpin

the urther evolution o prevention strategiesdirected at inappropriate alcohol consumption.

n Deve pin e ective m de s sa er patterns

a c h c ns mpti n in di erent c mm nities through changes to alcohol taxationarrangements, and an understanding o theimpact o di erent types o alcohol outlets andtheir density on hospitalisation, violence andcrime rates.

what a t n n tnat na p nt n ?Inadequately unded or single, short-termand ad hoc projects and programs areunlikely to succeed. In act, they may even becounter-productive, as they can give rise to anargument that prevention doesnt work.

Australias experience in immunisation, HIV/AIDScontrol and road trauma has demonstratedadmirable returns on investment in preventativeaction. The success ul outcomes have

eventuated, however, because o substantialand long-term unding, supporting well-coordinated and well-directed national andstate programs.

Separate in rastructure investments ore orts targeting each o the three risk actorswill be costly. A robust prevention supportsystem is called or, including mechanisms ore ective coordination across all strategies.

An ntial compon nt to na l ctivaction is to ensure leadership and coordinationthrough the establishment o a NationalPrevention Agency.

At the national level, such an agency is neededto support the coordination o partnershipsand interventions, ensure the relevance andquality o work orce training activities, e ectivesocial marketing and public education, and themonitoring and evaluation o interventions.

By bringing together expertise across therelevant areas, a national agency wouldprovide leadership or the implementationo the National Preventative Health Strategyand build national prevention systems withstrong capabilities.

Among its tasks, a national agency would:

n Ensure the delivery o a minimum set oevidence-based, illness prevention/healthpromotion programs that are accessible toall Australians.

n Engage key leaders and build new partnershipsacross ederal, state and territory governments,national agencies, pro essional associations,local government, peak community groups,non government organisations, the privatesector, the philanthropic sector and academia.

n Commiss ion and promote the uptake o newmonitoring, evaluation and surveillance models

or illness prevention.

nServe as an authoritative source o in ormationon evidence, policy and practice.

n Develop the evidence base on preventionthrough the design, implementation andevaluation o large-scale programs to improvethe health and wellbeing o the population, orpopulation sub-groups, by testing innovativestrategies, programs and policies or illnessprevention/health promotion.


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n Ensure the development o the necessarynational work orce or illness prevention/healthpromotion, working with and through relevantnational, state and local agencies to buildcapability in:

n surveillance, prevention research,evaluation, economic impact researchand modelling

n social marketing and public education

n legislation, regulation, economicsand taxation

n leadership and management.

c n nWe are constantly changing our behaviours.Just look at the changes in our nutrition,physical activity and smoking behaviours overthe last 30 years. To be the healthiest country by2020, and to have that good health shared byall Australians, will require substantial new shi ts.There are no magic tablets in the laboratory.It will require all o us as individuals and amilies

to make healthier choices.

It will also require industry, governments andcommunity organisations to make healthierchoices whether it is the products they makeand promote, or the policies, regulations andprograms or which they are responsible.

Health is a undamental human right. It is also,as the Prime Minister has pointed out, a major

determinant o social inclusion, work orceparticipation, productivity growth and apotentially huge drain on the public and privatepurse. Get it right and literally everyone wins.Prevention is an essential element o gettingit right.

o n tat n t This paper proposes a range o actions toimprove our health in the three action areaso concern. The aim o the paper, and theensuing consultation, is to seek communityand stakeholder views on the rameworkand ideas we have developed.

We invite you all individuals, communitygroups, government and non government

organisations and industry groups toparticipate by making a submission onhow we can make Australia the healthiestnation by 2020.

At the end o each chapter in thediscussion paper, we propose a series oquestions which will guide the Task orcesconsultations and which we hope will beuse ul to guide your contributions.

Please contribute to the Task orce byusing the orm provided at the Task orcewebsite: www.preventativehealth.org.au

su mi ion will acc pt until2 January 2009. The Task orce will beholding meetings in each capital cityand some major rural centres betweenOctober 2008 and February 2009.

We hope you will join the challenge to makeAustralia the healthiest nation by 2020.


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1. i d

1.1 ra n th a p nt n

T c all ng or Au tralia i to igni cantly cal up pr v ntion ort. T i will tartwit t r priority ar a : r ucing tgrowing pi mic o ov rw ig t an oAu tralian , ac i ving a virtually mok - rAu tralia, an com ating t alt an

ocial arm r ulting rom ri ky rinking.

Two speci c actors have increased the

momentum or a signi cant change in ourapproach to health: the national re ormagenda o 2006 and the approach taken bythe new government rom late 2007.

Initiated by the Council o AustralianGovernments (COAG), the National Re ormAgenda identi ed the crucial importanceo better health to economic productivityand opened the way or a new whole-o -government approach to health. COAG hasestablished the Australian Better Health Initiative

(ABHI), with the aim o re ocusing the healthsystem towards promoting good health andreducing the burden o chronic disease.

In April 2008 the Minister or Health and Ageing, the Hon Nicola Roxon MP, appointed a newNational Preventative Health Task orce to advise on the action needed in preventative health

or Australia, ocusing on obesity, tobacco and alcohol as immediate priorities or action.

The Task rce, made p hea th experts r m ar nd A stra ia, is t deve p strate ies ttack e hea th cha en es ca sed b besit , t bacc and a c h and deve p a Nati naPreventative Hea th Strate b J ne 2009 the b eprint r preventative hea th re rm.

The strategy is to be directed at primary prevention, and will address all relevant arms opolicy and all available points o leverage, in both the health and non-health sectors, in

ormulating its recommendations.

This disc ssi n paper sets t the case r preventative hea th re rm and s ests a n mber p ic pr p sa s, acti ns and s pp rt meas res r besit , t bacc and a c h .

The paper raises some key questions that will orm the basis o consultation, leading to thedevelopment o a National Preventative Health Strategy by June 2009.

The Australian Government has decided toreorient Australias approach to the healthsystem, with a much more vigorous strategyregarding prevention and greatly increasedinvestment to prevent chronic disease. TheAustralian Government will:

treat preventative health care as a rst order economic challenge because

ailure to do so results in a long- term negative impact on work orce

participation, productivity growth and the impact on the overall health budget.[16]

To achieve this end, the Task orce is workingclosely with other groups involved in healthre orm. These include the National Healthand Hospitals Re orm Commission, whosepriorities include looking at ways o ensuringa greater emphasis on prevention across thehealth system, and groups such as the NationalPrimary Health Care Strategy, the IndigenousHealth Equity Council and the National Advisory

Council on Mental Health.


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1.2 s tt n ta t t ,t a an a h

In the rst instance, the Task orce has beenasked to provide advice in three speci c areas:obesity, tobacco and alcohol. Each o theseimportant public health risks is at a di erentpoint in its development. We know what worksin tobacco control. We know much o whatneeds to be done to address alcohol problems,especially in terms o stemming intoxication

and the social harms that result. The obesityepidemic is di erent. Australia is in the earlystages o managing the rise in overweight andobesity prevalence perhaps on a par withtobacco control 30 years ago.

Addressing these three very di erentareas and putting strong support systemsin place will provide an important plat orm

or uture action in other areas such as mentalhealth, injury, immunisation, sexual andreproductive health, and illicit substance use.

M a ura l targ t or 2020 or o ity,to acco an alco ol:

by 2020 AusTRALIA CAN:

n Halt and reverse the rise in overweight andobesity prevalence

n Reduce the prevalence o daily smoking to9% or less

n Reduce the prevalence o harm ul drinking

or all Australians by 30%

n Contribute to the Close the Gap target orIndigenous people, reducing the 17-year li eexpectancy gap between Indigenous andnon-Indigenous people[1]

Achieving these targets will require substantialcommunity e ort, leadership and new unding.

Figure 1.1

Tobacco

Keys to prevention: Top seven selected risk factors and the burden of disease

Source: AIHW (adapted from Australia's Health 2008 Table 4.1)

Blood Pressure

Overweight/obesity

Physical InactivityBlood cholesterol

Alcohol

Low fruit & vegetables

0.0 2.0 4.0 6.0 8.0

% DALYs*

* Disability adjusted life years.

risk factors cause32% of burden

of disease


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1.3 un tan n th ha n

Figure 1.1 (below le t) shows how obesity,tobacco and alcohol (along with the relatedrisks o physical inactivity, low-level consumptiono ruit and vegetables, high blood pressureand high blood cholesterol) make up the topseven preventable risk actors that infuence theburden o disease. The total o modi able risk

actors make up 32% o the burden o diseasein Australia.[4]

T pr val nc o moking i cliningtoo lowly; ov rw ig t an o ity an t

arm ul u o alco ol ar calating. Tcal an pac o ort in all t ar a

mu t incr a .

A number o other broad trends will havea continuing impact on the health andwellbeing o Australians and on our healthsystem. These include:

n The ageing o the population, which has

important implications or health services usageand labour orce participation.

n Increasing levels o disability, chronic illness

and injury, which wil l continue to grow,challenging health services, workplaces,communities and amilies.

n Growing discrepancies in health status and

outcomes or some population groups,

particularly the needs o Indigenouscommunities, whose li e expectancy at birth isaround 17 years less than that o non-IndigenousAustralians. Other disadvantaged groups includerural and remote Australians, recent immigrants especially re ugees and those escaping confict those on limited incomes and people with lowlevels o education.

n Climate change and sustainability representboth a challenge and an opportunity. There aremany issues where improving health is entirelycompatible with increasing sustainability, suchas promoting walking and cycling as a meanso transport.

1.4 A t p nt n

Well-planned prevention programs havemade enormous contributions to improvingthe quality and duration o our lives. Preventiondoes work. We learned that rom the greatpublic health revolutions o the 19th century.While much remains to be done to preventmodern health problems, we have achievedmajor improvements through tobacco control,road trauma and drink driving, skin cancers,

immunisation, Sudden In ant Death Syndrome(SIDS) and HIV/AIDS control.

In the 1950s three-quarters o Australian mensmoked. Now less than one- th o men smoke.As a result, deaths in men rom lung cancer andobstructive lung disease have plummeted rompeak levels seen in the 1970s and 1980s. [4]

Similarly, deaths rom cardiovascular diseasehave decreased dramatically rom all-timehighs in the late 1960s and early 1970s to today.

Road trauma deaths on Australian roads havedropped 80% since 1970, with death rates in2005 being similar to those in the early 1920s. [4]

Australias commitment to improvingimmunisation levels has resulted in much higherimmunisation coverage rates, eliminatingmeasles and seeing a drop o nearly 90% in sero-group C meningococcal cases in only our years.These have come about as a result o a 34- oldincrease in unding over the last 15 years.

Deaths rom Sudden In ant Death Syndrome

(SIDS) have declined by almost three-quarters dropping rom an average o 195.6 per 100,000live births rom 1980 to 1990 to an average o51.7 per 100,000 live births between 1997 and2002.[4,11]


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P nt n a at n t nt

A study commissioned by the Departmento Health and Ageing in 2003 showed quitespectacular, long-term returns on investment andcost savings rom prevention in tobacco controlprograms, road sa ety programs and programspreventing cardiovascular diseases, measlesand HIV/AIDS.[12]

For example, this report estimated that the

30% decline in smoking between 1975 and 1995 had prevented over 400,000 premature deaths[13], and saved costs o over $8.4 billion, more than 50 times greater than the amount spent on anti-smoking campaigns over that period.[12, 13]

A recent US study Prevention or a Healthier America shows that or every US$1 invested inproven community-based disease preventionprograms (increasing physical activity,improving nutrition and reducing smokinglevels), the return on investment over and abovethe cost o the program would be US$5.60 within

ve years.[14]

T Worl h alt Organization (WhO)n pr v ntion a :

Approaches and activities aimed at reducingthe likelihood that a disease or disorder willa ect an individual, interrupting or slowing theprogress o the disorder or reducing disability.

n Primary prevention reduces the likelihood othe development o a disease or disorder.

n Secondary prevention interrupts, prevents orminimises the progress o a disease or disorderat an early stage.

n Tertiary prevention ocuses on halting theprogression o damage already done.

E ective prevention brings signi cant bene tsto society as a whole, including improved

economic per ormance and productivity.

Prevention has worked in Australia, romearly public health legislation to more recentsuccesses in areas such as road trauma,tobacco, HIV/AIDS, skin cancers, cardiovasculardisease and childhood in ectious diseases.

PReveNTION CAN:

n Reduce the personal, amily and communityburden o disease, injury and disability

n Allow better use o health system resources

n Generate substantial economic bene ts,which, although not immediate, are tangibleand signi cant over time

n Produce a healthier work orce, whichin turn boosts economic per ormanceand productivity

(National Prevention Summit 2008)[17]

This includes a ocus on health promotion,de ned by WHO as the process o enabling people to increase control over the determinants o health and thereby improve their health.[18]

These determinants include the personal, social,economic and environmental actors (such asaccess to education, housing, employment,income) that infuence the health status oindividuals or populations ( urther described in

Figure 1.2 below).


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Figure 1.2

1.5 A a p nt nA strong preventative health strategy needsa ramework that takes into account the keyissues a ecting Australians today, such asequity, health and the environment.

Figure 1.2 above is adapted rom Australias Health 2008[4] and shows the way in whichthe determinants o health relate to obesity,tobacco and alcohol, and to individual and

population health and unctioning.A recent report rom the World HealthOrganization Commission on the SocialDeterminants o Health shows that healthinequities (un air, unjust and avoidable causeso ill health) between countries also occur within countries. The report shows that, in general,the poor are worse o than those who are lessdeprived. The less deprived are in turn worsethan those with average incomes, and so on.This slope linking income and health is the social

gradient, and is seen everywhere not just indeveloping countries including the richestcountries such as Australia.[19]

1.6 P n p p ntat h a th

T ollowing principl , a on t ov lop y t h alt an ho pital

R orm Commi ion, r f ct w at p oplin t community g n rally xp ct roman ctiv pr v ntativ alt y t m,an outlin t principl t at can gui

ctiv action y gov rnm nt .

The use o an agreed set o principles will help

draw together the interests o di erent sectors inensuring e ective action and in developing anagreed National Preventative Health Strategy.

Socioeconomiccharacteristics

Education

Employment

Income and wealth

Family , neighbourhood

Access to services

Housing

Knowledge, attitudesand beliefs

Health behaviours

Tobacco use

Physical activity

Alcohol consumption

Dietary behaviour

Sexual behaviours

In utero nutrition

Breastfeeding

Psychologicalfactors

Early life factors

Biomedical factors

Blood pressure

Blood cholesterol

Body weight

Impaired glucoseregulation

Individual physical and psychological makeup(genetics; ageing, life course and intergenerational influences)

Individual andpopulation healthand functioning

Broad features ofsociety

Culture

Resources

Systems

Policies

Affluence

Social cohesion

Media

Environmentalfactors

Natural

Built

Source: AIHW: adapted from Australia's Health 2008 (Figure 4.1)

A conceptual framework for determinants of health as they relate to obesity, tobacco and alcohol


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Community-driven principles Strengthening prevention People and family centred Equity Shared responsibility Recognising broader environmental infuences

Governance principles

Common frameworks Comprehensive, staged approach taking the long-term view A mix of universal and targeted approaches Combined approaches Selected settings for action A comprehensive support system

COMMuNITy-dRIveN PRINCIPLes

Strengthening prevention Australia needs greater emphasis on helpingpeople to stay healthy through a strongerinvestment in prevention, early detection andappropriate interventions to keep people in thebest possible health.[20]

People and amily centred

The direction o prevention should be shapedaround the health needs o individuals, their

amilies and communities. Responsiveness to

individual di erences, stage o li e, culturaldiversity and pre erences through choice isimportant.[20]

Equity

Prevention activities should be accessible to all,based on health needs, not on an ability to pay.Inequality arising rom geographic location,socio-economic status, language, culture,Indigenous or ethnic status must be identi edand addressed .

Shared responsibility

All Australians share responsibility or our healthand the success o the health system.[20] As individuals we each make choices about ourli estyle and behaviours; as a community we

und the health system; and as patients wemake decisions about how we use the healthsystem. The health system has an importantrole to play in helping people to become moresel -reliant and better able to make the bestchoices to manage their own health needs.Business and industry both have importantroles to play or obesity and alcohol, andgovernments have a responsibility to coordinatepreventative health re orm, to deliver preventionprograms and action, and to make sureadequate supports are put in place to enableindividuals, amilies and communities and thehealth system to make use ul contributions.

Recognise broader environmental infuences

The environment plays an important role in

our health and in helping to make sensibledecisions about health. The environmentis taken to include the global climate, thephysical and built environment ( or example,the workplace, air quality, planning decisionsthat a ect our health), the socio-economicenvironment (including the workingenvironment) and external infuences, such aspromotion o healthy or unhealthy behaviours.


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GOveRNANCe PRINCIPLes

Common rameworks

An international review o chronic diseaseprevention programs prepared or the Task orceindicates that the use o a comprehensive

ramework is a common eature o preventionstrategies. Important components o sucha ramework include:

n a whole-o -society approach, includingidenti cation o high-risk population groups

n a li e-course approach highlighting theneeds o di erent groups as they move throughdi erent stages o their lives

n a special ocus on closing the health gap ordisadvantaged groups

n a concern or both individual and environmentalrisk actors and interventions

n a commitment to improving the links betweenresearch, policy and practice

n establishing a national coordinating body toset standards, drive and monitor preventativehealth re orm

n diverse orms o partnerships to develop andimplement innovative approaches

A comprehensive, staged approach taking the long-term view

Prevention is most success ul whencomprehensive approaches are adopted, with

multiple strategies. The priorities recommendedin this discussion paper represent critical

rst steps in the roll-out o a comprehensiveapproach over time.

A mix o universal and targeted approaches

Shi ting population norms require small changesrom everyone. Additional and di erent

e orts are o ten required or disadvantagedpopulations, such as Indigenous Australians.

Addressing the health risks rom obesity,tobacco and alcohol is one o the mostimportant ways to close the health gap andimprove the health o the wider community. Inthese, as in other areas, the targeting o healthinequalities will require innovative and localisedapproaches within a broadly based universalprevention strategy.

Combined approaches

Multiple and long-term strategies are moree ective than one-o programs. The mix ostrategies needed will vary, depending onthe area o ocus. In particular, regulatoryand educational approaches are o ten moste ective when implemented together.

Selected settings or action

The settings within which people work,learn, live and play schools, workplaces,neighbourhoods provide valuableopportunities to promote health. Programs

delivered in these settings should, wherepossible, adopt an integrated approach to risk

actor reduction.

A strong support system

Prevention policies and programs require strongsupport systems and structures. These includelinked components such as:

n adequately unded and relevant research

n comprehensive and relevant data

collection systemsn shared in ormation across governments

and other sectors

n a strong surveillance system

n a skilled and motivated work orce

n e ective national public education

n locally identi ed mechanisms to establish andmaintain partnerships and collaborations


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1.7 w n t th

COMMON APPROAChes & COLLAbORATION

e ctiv pr v ntion program will p non t participation o all Au traliancommuniti in t citi , in t u anin t r mot ar a o t country.

Australians as individuals will make preventionwork. It is individuals who will take up regularphysical exercise and make the right oodchoices or themselves and their amilies, whocan voice a concern or public sa ety andan intolerance o drunken behaviour, andwho can help make Australia a virtually smoke-

ree nation.

But individuals cannot achieve change on theirown. They will need the support o employersand workplaces, unions, community leaders,industry, business and private sectors, the healthservices and all three levels o government.

Governments play a vital role in driving changeand putting in place the support structuresneeded to achieve change. Genuine andsustained partnerships between the three levelso government are essential i Australia is toachieve the targets described in this paper.

In broad terms:

n The Australian Government has responsibilitiesor policy and program coordination, across-

government policy, scal incentives andregulation, the development o a strongevidence base and practice guidelines,monitoring and surveillance systems andpartnerships with national organisations,including employer and employee organisationsand community agencies.

n State and territory governments haveresponsibilities or legislation and regulation intheir own sphere, coordination and programsthroughout the community, across-governmentpolicy, partnerships with local governments andstate-based non-government organisations,and monitoring and surveillance o the healtho their population.

n Local governments have responsibility or localplanning and support structures. They play avital part in engaging local communities, andin providing some o the services, amenitiesand programs that prevent illness and promotegood health.

For the three tiers o government to workwell together, excellent coordination o therespective roles and responsibilities will berequired, along with clear accountability orall their activities and outcomes.


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2020 target: halt and reverse the rise in overweight and obesity prevalence

2.1 Th a th p

On o t gr at t pu lic altc all ng con ronting Au tralia anmany ot r in u triali countri it o ity pi mic.

Australia is one o the most overweightdeveloped nations, with overweight andobesity now a ecting over 60% o Australianadults[21] and one in our children. The situation

is worse or Aboriginal and Torres Strait Islanderpeople, with nearly one in three IndigenousAustralian adults obese.

The escalation o obesity prevalence is part oa worldwide trend linked to changing li estyles,modernisation and technological change.These changes a ect the type and amounto energy-rich ood we eat and our levels odaily physical activity. The increase in obesityover the past 20 years is a signi cant threat toAustralias current levels o good health. It is

already impacting on the healthcare systemand threatens to reduce li e expectancy or

uture generations. Tackling the obesity crisisand addressing diet, physical activity, maternaland child health and environmental actorsmust be a priority or prevention.

The major conditions or which obesity predictshigher mortality and/or morbidity includecardiovascular disease, type 2 diabetes,some cancers and, increasingly, osteoarthritis.Obesity is also strongly associated with a

wider range o conditions, including sleepapnoea and mental health, reproductive

and back problems. Overweight and obesechildren and adolescents ace some o thesame health conditions as adults, and theymay be particularly sensitive to the e ects on

sel -esteem and peer-group relationships. Forexample, type 2 diabetes, previously rare inchildren and young adults, is now increasinglyseen, particularly in the Indigenous communityand in some newly migrating groups.

Diabetes prevalence is projected to increasetwo- to three old over the next 25 yearsbecause o expected increases in theprevalence o obesity, along with demographicchanges. Diabetes is also expected to causethe largest growth in disability in the elderly.

CuRReNT sNAPshOT

n The prevalence o overweight and obesityin Australia has been steadily increasingover the last 30 years

n The number o overweight and obeseadults increased rom 4.6 million in 198990to 5.4 million in 1995, 6.6 million in 2001 and7.4 million in 200405

n Approximately 25% o children areoverweight or obese, up rom an estimated5% in the 1960s

n The mean body mass index (BMI) at whichAustralians enter adulthood has beengradually increasing over the last 20 years

n The mean waist circum erence increasedbetween 2000 and 2005, and weightincrease was most pronounced in youngadults, par ticularly women[21]

2. t a f p v :v w g a d


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n High body mass alone was responsible or7.5% o the total burden o disease in 2003,including 20% o cardiovascular diseaseburden. High body mass and physicalinactivity were responsible

or 60% o the burden or type 2 diabetes)

n Obesity is particularly prevalent amongmen and women in the most disadvantagedsocio-economic groups, people without

post-school quali cations, IndigenousAustralians and among many peopleborn overseas

n The combined e ect o the cluster oassociated risk actors linked with obesity poor diet, physical inactivity, high body massand central (abdominal) obesity, high bloodpressure and high cholesterol is responsible

or more than 50% o the total burden ocardiovascular disease

n The total nancial cost in Australia o obesityalone, not including overweight, wasestimated at $8.3 billion in 20 08[10]

2.2 H h- p

O ity i particularly pr val nt amongm n an wom n in t mo t i a vantag

ocio- conomic group , p opl wit out po t-c ool uali cation , In ig nou p opl an

among many p opl orn ov r a .

While overweight and obesity are widelydistributed among Australian adults andchildren, there are some signi cant variations inits distribution across the Australian population.

n For Indigenous people, obesity is the secondhighest contributor to burden o disease a tertobacco use.[22]

n Adults born in Southern and Eastern Europeand those rom the Oceania region are morelikely to be overweight or obese (65% and 63%

respectively).

n Among school children, boys o middle Easternand European background and boys and girls

rom Paci c Islander backgrounds are more likelyto be obese.

n People rom certain ethnic backgrounds inAustralia who are disproportionately moreoverweight or obese su er higher rates o type 2diabetes and cardiovascular disease.

2.3 Th n nt a t n

ba on curr nt tr n t r i anurg nt an imm iat n to a rt growing pr val nc o o ity anov rw ig t in Au tralia.

Australias adult obesity rate is the fth highest among OECD countries, behind the UnitedStates, Mexico, the United Kingdom andGreece.[23] While Australias mortality rates orcoronary heart disease, stroke, lung cancer andtransport accidents have improved signi cantlyin terms o our ranking with other OECD membercountries, this is not the case

or our obesity ranking.

Assuming a constant increase in obesityprevalence over the next 20 years in line withcurrent trends, the most recent projections arethat there will be 6.9 million obese Australiansby 2025.[10] Figures 2.1 and 2.2 below showthis trend.

Figure 2.1 (Source: AIHW 2008

Males: obesity

5

10

15

20

25

% o

f P o p u

l a t i o n

RFPS/AusDiab

1.3-1.7 millionmales obese

NHS

BEACH

01975 1980 19901985

Year

1995 2000 2005 2010


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AusDiab = The Australian Diabetic, Obesity and Li estyle StudyRFPS = Risk- actor prevalence studyNHS = National Health SurveyBEACH = Better Evaluation and Care o Health Survey

2.4 Th t ht an t

T total nancial co t o o ity inAu tralia in 2008, not inclu ing ov rw ig t,i timat at $8.3 illion.[10]

Reductions in the prevalence and incidence o

overweight and obesity could realise savingsnot only to the health system but also to overallworkplace productivity and a reduction insocial costs.

O the total nancial costs, the AustralianGovernment bears over one-third (34% or $2.8billion per annum) and state governments 5.1%.This estimate includes productivity costs o $3.6billion (44%), including short- and long-termemployment impacts, as well as direct nancialcosts to the Australian health system o $2 billion

(24%) and carer costs o $1.9 billion (23%).

l h a th n f antPredictions o health loss (loss o healthyli e) to the year 2023 indicate the largestprojected increases will be or neurologicaldisorders and diabetes, with a lesser increase

or musculoskeletal disease. In comparison,rates o health loss are expected to decline

or conditions such as heart disease, cancer,injuries and chronic respiratory conditions.[24]

The projected increase in rates o loss o healthyli e associated with diabetes is due mainly toexpected increases in body mass.

Diabetes prevalence is projected to increasealmost three old over the next twenty years,and with higher rates o neurological conditionsit is expected to cause the largest growth indisability in the elderly.[25]

H a th p n t

A modelled case study prepared or theUnited Nations estimated that Australias totalhealth expenditure will increase by 127% in the

period 2002 to 2032, rom $71 billion to $162billion an increase o $91 billion.[22] A studyin the US ound that i rising trends in obesitylevels continue, as in Australia, disability rateswill increase across all age groups, o settingpast reductions in disability and that i thiscontinued in the US, one- th o US healthcareexpenditure would be needed or treating theconsequences o obesity by 2020.[26]

ba on curr nt tr n :

n Australians will continue to become moreoverweight and obese

n There will be six million obese Australians by2020 and 6.9 million by 2025[10]

n The percentage o the Australian populationwho will be overweight or obese will havegrown to a record 73% in 2025. This includesone-third o our children and three-quarterso our adult population[27]

n Recent trends in Australian children predictthat their li e expectancy will all two yearsby the time they are 20 years old, settingthem back to levels seen or males in 2001and or emales in 1997[6]

n A projected rise in the rates o type 2diabetes, mainly due to expected growthin prevalence o obesity, will increasehealthcare costs by $5.6 billion each year( rom $1.4 to $7 billion) by 2032[27]

n The burden o disease attributable to high

body mass is likely to overtake tobacco asthe leading preventable cause o burden assmoking rates decline[28]

Figure 2.2 (Source: AIHW 2008 {4})

5

10

15

20

25

% o

f P o p u

l a t i o n

RFPS/AusDiab

1.2-1.8 millionfemales obese

NHS

BEACH

01975 1980 19901985

Year

1995 2000 2005 2010

Females: obesity


30/8012

2.5 cha n

T c all ng acing utur pr v ntionort or ov rw ig t an o ity inclu :

esTAbLIshING effeCTIve LeAdeRshIPANd COORdINATION

The scale o the epidemic requires actionto begin now. It is crucial that this involvesall aspects o national, state and localgovernments, the non-government sector,industry, business, private interests andlocal communities, and across all levels ogovernment and within and across sectors.Together, these key players must develop astaged approach that will sustain action in thelong term, and will start by halting the currentrise in the prevalence o obesity.

shIfTING TO A POPuLATION-WIde fOCus

I there is to be real change, Australia needsto avoid the natural tendency to ocus onlyon individual and personal responsibilityand ensure that policy directions to tackleoverweight and obesity as a major publichealth issue have a population-wide ocus.A wide range o orces, some outside thecontrol o individuals and amilies, interact toshape patterns o overweight and obesity. Themagnitude o this problem warrants a strongerpopulation-level response.

equITy

Targeted approaches are needed or groupswith disproportionately high rates o overweightand obesity, including Indigenous people,people o di erent cultural backgrounds(particularly rom Paci c Islands and the MiddleEast), people o lower socio-economic status,children and young or pregnant women.Interventions aimed at children and pregnantwomen may have a signi cantly higher impact.

WORkING WITh INdusTRy

The contribution o Australian industry is crucialin tackling the obesity problem. Industrysectors have already demonstrated theirwillingness and ability to work in partnershipwith others to develop strategies and productsto enhance the health o Australians. Industry(especially the ood and beverage industryand restaurant and catering industries) canmake an important contribution by providing

in ormation ( or example, product and menulabelling and responsible marketing); placinghealthy products in more prominent positionsin supermarkets; improving the ood supply ( orexample, making healthier and a ordable oodproducts available); and developing a moreenvironmentally sustainable ood chain.

buILdING The evIdeNCe bAse

It will be important to continue developingthe evidence base or action on overweight

and obesity, but this should not be a cause ordelayed action. Australia can build a strongevidence base through research, evaluation,monitoring and surveillance. This should includea much higher investment in research andevaluation o interventions, as well as improvingour understanding o the causes o obesity. Aspeci c research agenda should be developedwith appropriate levels o unding public andprivate. This will need to be supported by theimproved monitoring and harmonisation osurveillance systems across Australia.

eNsuRING PubLIC sAfeTy

The weight loss industry in Australia is worthmillions each year ( or example, it is estimatedthat young women aged 1832 years spentalmost $414 million on managing their weightin 2002). There are a wide range o weight lossprograms available, including commercialweight loss programs (such as pharmacy-basedprograms), internet-based programs, weight

loss products (such as meal replacements) andcommunity-based weight management orexercise groups.


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These programs are popular but there islimited data on their e ectiveness. To ensurethat practices are sa e and e ective, programsneed to be reviewed and a common code opractice or the industry needs to be developed.

2.6 Ha t n th p

R uction in t pr val nc an inci nco ov rw ig t an o ity woul l a to

igni cant ocial an conomic n t or

all Au tralian , inclu ing igni cantimprov m nt in t alt an w ll ing oin ivi ual an amili , u tantial avingto t alt car y t m an improv m ntin workplac pro uctivity.

In addition to improvements in weightmanagement and the prevention o weightgain in those already overweight or obese, theprevention o overweight and obesity providesan outstanding opportunity to realise a widerange o bene ts. By encouraging healthy

eating and a more physically active li estyleacross all age groups in the population, we canimprove the health and wellbeing o individuals,reduce costs to society, maintain and improvethe high levels o li e expectancy Australianscurrently enjoy, and help to narrow gaps inli e expectancy.

Investment in prevention not only bene ts thosewho are already overweight or obese, but thosewho are currently at a healthy weight. Weightloss in people who are overweight and obese

improves physical, metabolic, endocrine andpsychological complications. Obesity-relatedmortality can be reduced through weight loss:even a modest loss o 510% o body weightcan lead to signi cant health bene ts.[29]

The beNefIT Of ACTING NOW

n The Australian healthcare system could save$1.5 billion annually i more people werephysically active or 30 minutes a day(based on the gross cost o the prevention,diagnosis and treatment o medicalconditions attributable to physical inactivityrelated to direct public and private healthexpenditure][30]

n Weight loss in people who areoverweight and obese improves physical,metabolic, endocrine and psychologicalcomplications. Obesity-related deaths canbe reduced through weight loss even amodest loss o 510% o body weight canlead to signi cant health bene ts(24)

n As well as helping in weight loss and theprevention o weight gain, being physicallyactive can also help prevent type 2diabetes, lower blood pressure, reduce

the risk o some cancers and contribute tomental health wellbeing[28]

n A healthier diet can help in the reductiono high blood at ( or example, cholesterollevels), one o the conditions placingsigni cant pressure on the PharmaceuticalBene ts Scheme, as well as providing manyother health bene ts[28]

n As BMI increases, so do length o hospitalstay, medical consultations and use omedication.[31] Halting current increasesin BMI will there ore assist in preventingassociated cost rises

n Strategies that are e ective in halting and/or reducing the rise in population BMI willbene t national productivity. Obesity wasassociated with over our million days lost

rom Australian workplaces in 2001. Obeseemployees tend to be absent rom workdue to illness signi cantly more o ten thannon-obese workers, and or a longer periodo time, and they are less likely to be in thelabour orce[32]


32/8014

or n wly m rging ar a o alt ri k uc a o ity t r ar n t rom

a opting a learning by doing approac .

Obesity is a relatively new area or preventionglobally. Australia is one o an early group ocountries committed to making a concertede ort. We are at the beginning o a long journeyto reverse the current situation, and 2020 willdeliver only on the rst steps in that journey.

Already, there is evidence about the

interventions that are necessary to improvenutrition and physical activity. Lessons romother areas o success ul action, such astobacco control, HIV/AIDS and road trauma,are trans erable to obesity.

While many pieces o this jigsaw are known,community readiness or a set o hard-hitting,multi aceted interventions on obesity may atthis stage be similar to that in the early days otobacco control.

There is also much evidence about the

e ectiveness o interventions that is yet to becaptured. These actors speak to a learning by doing approach that is, the staged trialling oa package o interventions accompanied byan appropriate allocation o resources as wellas comprehensive monitoring and evaluation.

The World Health Organization recommendsthe ollowing actions:

n legislate to support the healthier compositiono ood products

n limit the marketing o ood and beverages

to children

n enact scal policies to encourage theconsumption o healthier ood products

n promote access to recreational physical activity

n change physical environments to supportactive commuting and create space orrecreational activity

n create healthy school and workplaceenvironments

n undertake mass media, education andin ormation campaigns to promote healthydiets and physical activity

n o er health advice and preventative servicesin primary healthcare settings[5]

2.7 P t a t n

In the rst instance, policy re orms should aimto halt and reverse the rise in the prevalenceo overweight and obesity.

MAJOR IMPeRATIves ARe TO:

n Reshape industry supply and consumerdemand towards healthier products byincreasing availability and access tohealthier ood and activity choices

n Protect children and others rominappropriate marketing o unhealthy

oods and beverages, and improve publiceducation and in ormation

n Embed physical activity and healthy eatingin everyday li e through school, communityand workplace programs

n Reshape urban environments towardshealthy options through consistent

town planning and building design thatencourage greater levels o physical activityand through appropriate in rastructureinvestments ( or example, or walking,cycling, ood supply and recreation)

n Strengthen, skill and support primary healthcare to support people in making healthychoices, especially through the deliveryo community education and adviceabout nutrition, physical activity and themanagement o overweight and obesity

nClose the gap or disadvantagedcommunities through the developmento targeted approaches to overweightand obesity or disadvantaged groups,particularly Indigenous and low-incomeAustralians, pregnant women andyoung children

n Build the evidence base, monitor andevaluate the e ectiveness o actions taken


33/8015

T a b l e 1 s e

t s o u

t s o m e o

t h e w a y s

i n w

h i c h

i n d i v i d u a

l s a n

d a m

i l i e s , c o m m u n

i t i e s ,

h e a

l t h s e r v

i c e s ,

i n d u s t r y

a n

d g o v e r n m e n

t s c a n w o r k

t o g e

t h e r o n

t h e s e p r i o r i

t i e s

t o a c

h i e v e c h a

n g e

i n o v e r w e

i g h t a n

d o

b e s i

t y .

P

r i o r i T i e s

A c T i o N s

b e N e f i T s

i n d v d u a a n d f a m e

c o m m u n t e h o o &

w o r k p a e

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i n d u t r y

c w t h , s t a t e & l o a g o v e r n m e n t

R e s h a p e i n d u

s t r y s u p p l y a n d

c o n s u m e r d e m a n d t o w

a r d s

h e a l t h i e r p r o d u

c t s

R e v i

e w

t h e t a x a

t i o n s y s t e m t o e n a b l e a c c e s s t o

h e a l t h i e r o o d s a n d r e c r e a t i o n ( e g i n c r e a s e t a x

b r e a k s o r f t n e s s r e l a t e d p r o d u

c t s a n d r e c r e a t i o n a l

a c t i v i t i e s a n d o r s c h o o l a n d w

o r k p l a c e s t o

p r o v i

d e h e a l t h y

o o d

s ) a n d p r o v i

d e d i s i n c e n t i v e s

o r u n h e a l t h y

o o d s ( e g c o n s i d e r i n c r e a s i n g t a x e

s

o r e n e r g y

d e n s e o o d s )

F a m i l i e s h a v

e a c c e s s t o a o r d a b l e r u

i t a n d

v e g e t a b l e s ; s c h o o l s p r o v i

d e v a

r i e t y o h e a l t h y

o o d s i n s c h o

o l c a n t e e n s ; w

o r k p l a c e s c a n p r o v i

d e

h e a l t h i e r o o d s a n d e n c o u

r a g e p h y s i c a l a c t i v i t y ;

a n d a m i l i e s c a n s p e n d m o r e t i m e w

i t h t h e i r

c h i l d r e n i n a c t i v e p l a y

a n d r e c r e a t i o n

n

n

n

n

R e g u

l a t e t h e a m o u n t o t r a n s a t s

, s a t u r a t e d a t ,

s a l t a n d s u g a r c o n t e n t i n o o d s

F o o d s u p p l y i s c h a n g e d

, a n d a m i l i e s h a v e

a c c e s s

t o o o d s w

h i c h a r e l o w

i n l e v e

l s o t r a n s a t s

,

s a t u r a t e d a t s

, s a l t a n d s u g a r

n

n

n

P r o v i

d e s u b s i d i e s o r r u r a l

a n d r e m o t e a r e a t r a n s p o r t

o r e s h o o d s

H e a l t h y

o o d

i s a v a

i l a b l e o n a r e g u

l a r b a s i s

t h r o u g

h o u t A

u s t r a l i a a t r e a l i s t i c p r i c e s . F a m i l i e s

i n a l l a r e a s i n c l u d i n g r e m o t e a n d r u r a l l o c a t i o n s

h a v e

e q u

i t a b l e a c c e s s t o p u

r c h a s i n g a v a

r i e t y o

a o r d a b l e h e a l t h y

o o d p r o d u c

t s

n

n

n

n

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r o m i n a p p r o p r i a t e m a r k e t i n g o

u n h e a l t h y

o o d s a n d b e v e

r a g e s

C u

r b i n a p p r o p r i a t e a d v e

r t i s i n g a n d p r o m o t i o n ,

i n c l u d i n g b a n n i n g a d v e

r t i s i n g o e n e r g y

d e n s e

,

n u

t r i e n t p o o r o o d s d

u r i n g c h i l d r e n s v i

e w

i n g h o u

r s

H e a l t h y

e a t i n g i s r e i n o r c e d a n d n o r m a l i s e d o r

A u

s t r a l i a n c h

i l d r e n , w

h i c h e n a b l e s t h e m t o m a k e

h e a l t h i e r o o d c h o i c e s

n

n

n

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r c h a s e h e a l t h y

o o d c h o i c e s

w i t h l e s s p r e s s u

r e r o m c h i l d r e n o r u n h e a l t h y

o o d o p t i o n s

n


34/8016

P r i o r i T i e s

A

c T i o N s

b e N e f i T s

i n d v d u a a n d f a m e

c o m m u n t e h o o &

w o r k p a e

H e a t h e r v e

i n d u t r y

c w t h , s t a t e & l o a g o v e r n m e n t

I m p r o v e

p u b l i c e d u c

a t i o n

a n d i n o r m a t i o n

D e v e

l o p e e c t i v e n a t i o n a l m e d i a a d v e

r t i s i n g

a n d p u

b l i c e d u

c a t i o n c a m p a i g n s t o i m p r o v e

e a t i n g h a b i t s a n d l e v e l s o p h y s i c a l a c t i v i t y

T h e c o m m u n

i t y i s b e t t e r i n o r m e d a b o u

t t h e

i m p o r t a n c e o h e a l t h y

e a t i n g a n d r e g u

l a r

p h y s i c a l a c t i v i

t y i n a c h i e v i

n g a n d m a i n t a i n i n g a

h e a l t h y w

e i g h t

. S t a t e a n d t e r r i t o r y g o v e

r n m e n t s

c a n e n h a n c e a c t i v i t y t h r o u

g h a d d i t i o n a l m e d i a

c a m p a i g n s a n d o t h e r t a r g e t e d p u

b l i c e d u

c a t i o n

o r p r i o r i t y

p o p u

l a t i o n g r o u

p s . F u n d i n g s h o u

l d b e

a v a

i l a b l e o r l o c a l a c t i v i t i e s t h a t b u

i l d o n m a s s

m e d i a m e s s a

g e s

n

n

n

E

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