Surveys to measure success are critical in the obesity battle
THE Rudd Labor Government has said it will make obesity a national health priority. This is a welcome first step towards concerted national action to address this growing, costly health problem, but it is a long way from putting in place longterm initiatives to tackle obesity and its causes.
Obesity costs Australia around $21 billion every year in health and disability costs, premature death and productivity losses. A study by Medibank Private puts the cost of unhealthy workers at $7 billion a year, and overweight people are, on average, 15-20 per cent less productive because they have more days off work and higher rates of disability.
Obesity now afflicts 3.24 million Australians, and this could double to over 7 million people within 20 years if current trends persist unabated and unaddressed. A quarter of Australian children and adolescents are overweight or obese, and this is often linked to dental disease, emotional and behavioural problems, bullying and learning delays. Recent studies published in the NewEngland Journal of Medicine highlight that today’s overweight adolescents are increasingly likely to die as relatively young adults of coronary heart disease. A commentary which accompanied these studies warned that if steps were not taken to reverse the problem of obesity, the children of each successive generation were destined to be fatter and sicker than their parents, and that by 2050 obesity could shorten life expectancy by two to five years.
Obesity is a major contributing factor to the increasing rates of a raft of costly chronic diseases, such as type 2 diabetes, heart disease, stroke, musculo-skeletal problems and cancer that currently cost the health care system an estimated $873 million a year. A recent Foresight Report says that being obese reduces life expectancy more than smoking, and that the obesity crisis in Australia could take at least 30 years to reverse.
The warning signs have been clear but largely ignored for over a decade. The Australasian Society for the Study of Obesity issued its national obesity strategy in 1995. There have been more than a dozen reports, strategic plans and guideline documents since then, and countless summits, workshops and conferences. The Council of Australian Governments announced that obesity would be tackled as part of the Australian Better Health Initiative in February 2006, and the Australian Health Ministers’ Conference announced an Obesity Action Plan in April 2006.
To date, action at the federal level has been limited. Current federal spending on tackling obesity is less than $25 million annually, and efforts have been hampered by a reluctance of government to enter certain areas, such as advertising, where it seems real gains could be made. The states have been more willing to make larger investments and quicker to recognise the pay-offs. In December 2006, Victoria kicked off a $110 million plan to tackle obesity and diabetes, which the Victorian Treasury estimates will return $3.5 billion in budget benefits.
However, there’s a major problem because we currently have no way to know if any of the initiatives implemented — after-school activities, lifestyle scripts from doctors, advertising campaigns, and private health subsidies for gym memberships — are making a difference, because we have no relevant, regular national surveys. The last Australian Schools Health and Fitness Survey was conducted in 1985, and the last National Nutrition Survey in 1995.
These must become ongoing studies so that there is data to inform new policies and measure the impact of those in place. It is only through repeated surveys, done by the same people using the same survey instrument, that we are able to assess progress and evaluate the success of individual initiatives.
Obesity is due to a raft of causes that funnel down to eating too much and moving too little. We can no longer afford the luxury of regarding obesity as a private thing, a matter of character that could be solved if people just took action. As with smokers, the majority who are fat wish to quit their habit, but cannot.
This is not a problem to hand to the churches and self-help groups (on the grounds that being fat is due to lack of character and self-discipline) or the schools (on the grounds that it is an educational problem) or the parents (because they don’t switch off the TV enough and aren’t at home enough to supervise afternoon snacking and computer games). This is not about who is to blame, it’s about who can help fix the problem.
There needs to be community ownership of the obesity problem and a willingness to see a partnership between government, business, the food and drink industries, media, consumer and health groups as the way to tackle its causes. National leadership to co-ordinate a whole-of-government approach across all levels of government and long-term investments commensurate with the size of the problem are essential.
The take out lesson is clear: if Australians are to live long, healthy lives and Australia is to have a sustainable health care system, a sound economy and a productive workforce, then we must act now. Making obesity a national health priority can make this happen, but ensuring that it happens will be a key responsibility of the new federal government. Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy at the University of Sydney / Australian National University