The National Rural Health Alliance has joined a growing number of health organisations calling for a tax on sugary drinks. In its recent submission to the Senate Inquiry into Australia's obesity epidemic, the Alliance supports all eight priorities outlined by the Obesity Prevention Coalition, including a tax that would raise the price of sugar sweetened drinks by at least 20%.
The Alliance is also calling for greater restrictions on marketing unhealthy food to children, including a ban on free to air TV advertising until after 9.30 at night.
The submission says "Children in rural and remote areas of Australia are more likely to be obese than those living in major cities, particularly for children who are Aboriginal or Torres Strait Islanders or are socio-economically disadvantaged."
Significantly more children in rural and remote areas are obese or overweight than in major cities. The Australian Bureau of Statistics reports that in major cities 25% of children aged 2-17 years are obese or overweight. That figure blows out to 36% of children in remote areas.
Obese children are more likely to develop certain cancers, cardiovascular disease, asthma, back pain and problems, chronic kidney disease, dementia, diabetes, gallbladder disease, gout, and osteoarthritis. They are also more likely to develop these conditions at an earlier age.
The Alliance considers the current system of self regulation is not working, and the Federal Government needs to intervene.
The Federal Government has just released a consultation paper considering options for stronger labelling. The Alliance supports stronger labelling, particularly pictures showing the amount of sugar in a product.
Increased regulation must be part of a broader approach, and the Alliance is also calling for a National Obesity Prevention Strategy which addresses the lack of access to healthy food in remote areas, that increases education and awareness efforts, and which involves all stakeholders in a combined effort to curb the obesity epidemic.
Programs aimed at preventing obesity are currently in place in many rural and remote areas. These programs focus mainly on changing individual and family behaviours like increasing physical activity and promoting healthy eating. Many of these programs have good participation and community support. They have been in place for some time, some a decade or more. Yet, the rate of obesity in remote areas remains higher than in major cities. This is because the cause of obesity in rural and remote Australia is far more complex than children's physical activity and eating behaviour.
The submission highlights that obesity is a “canary in a mineshaft” (Egger and Dixon 2014). It is a signal to us that there are significant problems in Australia’s social, economic and environment policies, that are broader than any single individual’s control and behaviour (Hruby and Hu 2015). These policy areas include (but are not limited to) agriculture and the food system, including processing, distribution and marketing of food and drinks; transport; urban planning; and education (World Health Organization [WHO] 2018a)."
The National Rural Health Alliance submission can be found here: http://www.ruralhealth.org.au/sites/default/files/submissions/NRHA_obesity_epidemic.pdf
It makes six recommendations.
1. Australia needs a National Obesity Prevention Strategy as a matter of urgency. The strategy needs to focus on eradicating obesogenic environments in rural and remote Australia. It needs to target inequalities and inequities in education, income and access to affordable quality fresh fruit and vegetables and physical activity. Priority should be given to ending obesity inequalities for children in lower socioeconomic groups, particularly Aboriginal and Torres Strait islander children and children in remote Australia.
2. Government research programs need to prioritise research that will improve understanding of food environments (particularly consumer nutrition environments) in rural and remote Australia.
3. Increased funding for additional resources, infrastructure and workforce should be made available to improve the access of rural and remote communities to appropriately trained early childhood educators, teachers and multi-disciplinary health professional teams.
4. State-wide programs such as the Healthy Together, Tackling Childhood Obesity and OPAL should continue to be funded and even enhanced to enable them to have a broader reach and achieve what they have set out to do. However, given there is a greater need in rural and remote places, particularly where there are higher proportion of Aboriginal or Torres Strait Islander children, these programs should be prioritised for additional resources.
5. Planning systems across critical areas such as the location and density of convenience restaurants and the design of areas for physical activity for recreation, leisure and exercise should explicitly incorporate health as a core component to protect and promote the population’s health and wellbeing.
6. Agricultural policies need to incorporate health outcomes. At a time of increasing change to meet the multifaceted challenges of climate change, the modernisation of production methods and the market concentration of supply chains, sustainable nutritious food is the foundation of health and wellbeing.
The Alliance also supports the eight policy actions recommended by Obesity Prevention Coalition ‘Tipping the Scales’ campaign.
1. Legislate to implement time-based restrictions on exposure of children (under 16 years of age) to unhealthy food and drink marketing on free-to-air television until 9:30pm.
2. Set clear reformulation targets for food manufacturers, retailers and caterers with established time periods and regulation to assist compliance if not met.
3. Make the Health Star Rating System mandatory by July 2019.
4. Develop and fund a comprehensive national active travel strategy to promote walking, cycling and use of public transport.
5. Fund high-impact sustained public education campaigns to improve attitudes and behaviours around diet, physical activity and sedentary behaviour.
6. Federal government to place a health levy on sugary drinks to increase the price by 20%.
7. Establish obesity prevention as a national priority, with a national taskforce, sustained funding, regular and ongoing monitoring and evaluation of key measures and regular reporting around targets.
8. Develop, support, update and monitor comprehensive and consistent diet, physical activity and weight management national guidelines (Tipping the Scales 2017).
However, the Alliance also recommends that these policy actions are adapted to the rural and remote context, particularly policy action number 4 for active travel and public transport solutions.