National Preventative Health Strategy – the roadmap for action

The National Children’s Nutrition and Physical Activity Survey 2007 provides the most recent measurement of Australian data on the prevalence of overweight and obesity among children. Overall, this survey indicated 17% of 2–16-year-olds were overweight and 6% obese.[10]

Further examination by the National Heart Foundation[11] of this survey data, and data from previous studies, clearly shows a disturbing upward trend in overweight and obesity rates in children over the last 20 years.

For children aged 7–15 years, levels of overweight and obesity have increased for both girls and boys. For girls, rates have risen from 12% in 1985 to 22% in 1995, reaching 26% in 2007. Similarly for boys, levels have increased from 11% in 1985 to 20% in 1995, rising to 24% in 2007. Figure 1.2 below shows the prevalence of overweight and obesity in Australian children aged 7–15 years, 1985–2007.

Figure 1.2:

Prevalence of overweight and obesity in Australian children aged 7–15 years, 1985–2007

* Data weighted for age, gender and region.

Source: Roberts L, Letcher T, Gason A et al. 2009[11]

A 2009 Organisation for Economic Co-operation and Development (OECD) report further predicts that there will be continued significant rises in overweight and obesity levels in Australia over the next decade across all age groups to around two-thirds of the population.[12]

A vast range of reports have been published since the Taskforce released the Discussion Paper. Reports cover issues such as:

• The consequences of active and passive smoking

• The effectiveness of various tobacco control strategies and progress in the implementation of new tobacco control measures, both internationally and nationally

• Guidelines developed and recently adopted to assist parties to the Framework Convention on Tobacco Control (FCTC) with the implementation of various articles of the treaty

• The importance of packaging in communicating positive imagery about smoking and reinforcing false ideas about the relative harmfulness of various products

• Recent studies show that tax on tobacco is highly supported and likely to disproportionately benefit lower SES smokers.(12)

• Strong public support for a wide range of tobacco control measures

Four major reviews published in 2009 have shown:

• Alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol[14]

• There is a causal link between exposure to alcohol commercials and role models on acute alcohol consumption[15]

• Among young people who had previously not drunk alcohol, ownership of alcohol branded merchandise is independently associated with susceptibility to and initiation of drinking and binge drinking[16]

• An Australian study has questioned whether there is in fact any safe level of alcohol consumption for those aged under 18,[17] and the National Health and Medical Research Council (NHMRC) released its low-risk drinking guidelines in 2009

Other broad trends with a continuing impact on the health and wellbeing of Australians and on our health system include:

• 
  The ageing of the population has important implications for health services usage and labour force participation.
  
• 
  Increasing levels of disability, chronic illness and injury will continue to increase and challenge health services, workplaces, communities and families.
  
• 
  Increasing discrepancies in health status and outcomes for some population groups must be a high priority, particularly the needs of Indigenous communities, whose life expectancy at birth is around 17 years less than that of non-Indigenous Australians.
  
• 
  Other disadvantaged groups including rural and remote Australians, recent immigrants – especially refugees and those escaping conflict – those on limited incomes, people with disabilities and people with low levels of education.
  
• 
  Climate change and sustainability: this Strategy does not address climate change, but recognises it as an area of the utmost importance for health as well as the national and global community, requiring urgent action. There are also many areas where improving health is entirely compatible with increasing sustainability; for example, promoting walking and cycling as a means of transport.
  

• If we reach the targets for alcohol, the proportion of Australians who drink at short-term risky/high-risk levels will drop from 20% to 14%, and the proportion of Australians who drink at long-term risky/high-risk levels will drop from 10% to 7%. This will result in the prevention of over 7200 premature deaths and some 94,000 fewer person-years of life lost. The impact on morbidity would approximate 330,000 fewer hospitalisations and 1.5 million fewer bed days, at a cost saving of nearly $2 billion to the national health sector by 2020.[18]

• If current upward trends in overweight/obesity continue, recent projections indicate there will be approximately 1.75 million deaths at ages 20+ years and more than 10 million years of life lost at ages 20–74 years caused by overweight or obesity in Australia from 2011 to 2050.[19] Each Australian aged 20–74 years who dies from obesity in 2011 to 2050 will lose, on average, 12 years of life before the age of 75 years.[19]

Building capacity for preventative health policy and actions is a vital component of the Strategy. The COAG National Prevention Partnership has already committed to the establishment of a National Prevention Agency (NPA). In addition to coordinating and developing action, the agency will facilitate a national prevention research infrastructure to answer the fundamental research questions about what works best, as well as providing resources and advice for national, state and local policies, generating new partnerships for workplace, community and school interventions, assisting in the development of the prevention workforce, and coordinating the implementation of a national approach to social marketing.

4 What we know: prevention works

‘The new preventative program, drawing on a broad constituency, can catalyse population-level thinking and wellbeing so that the health of the 21st-century population is improved and sustained’ (Quote from submission)

The World Health Organization (WHO) defines prevention as:

Primary prevention reduces the likelihood of the development of a disease or disorder. Secondary prevention interrupts, prevents or minimises the progress of a disease or disorder at an early stage. Tertiary prevention focuses on halting the progression of damage already done.

While acknowledging the vital importance of secondary and tertiary prevention, it should be noted that the Taskforce has been specifically asked to focus on primary prevention.

Effective prevention brings significant benefits to society as a whole, including improved economic performance and productivity.

Prevention works. Well-planned prevention programs have made enormous contributions to improving the quality and duration of our lives. The public health revolutions of the 19th century led the way, and in recent years we have seen major improvements in areas such as tobacco control, road trauma and drink driving, skin cancers, immunisation, cardiovascular disease, childhood infection diseases, Sudden Infant Death Syndrome (SIDS) and HIV/AIDS control.

In the 1950s three-quarters of Australian men smoked. Now less than one-fifth of men smoke. As a result, deaths in men from lung cancer and obstructive lung disease have plummeted from peak levels seen in the 1970s and 1980s.[2]

Deaths from cardiovascular disease have decreased dramatically from all-time highs in the late 1960s and early 1970s to today.

Road trauma deaths on Australian roads have dropped 80% since 1970, with death rates in 2005 being similar to those in the early 1920s.[2]

Australia’s commitment to improving immunisation levels has resulted in much higher immunisation coverage rates, eliminating measles and seeing a drop of nearly 90% in sero-group C meningococcal cases in only four years. These have come about as a result of a 34-fold increase in funding over the last 15 years.

Deaths from SIDS have declined by almost three-quarters – dropping from an average of 195.6 per 100,000 live births between 1980 and 1990 to an average of 51.7 per 100,000 live births between 1997 and 2002.[2, 22]

A study commissioned by the Department of Health and Ageing in 2003 showed spectacular, long-term returns on investment and cost savings from prevention – in tobacco control programs, road safety programs and programs preventing cardiovascular diseases, measles and HIV/AIDS.[23] For example, this report estimated that the 30% decline in smoking between 1975 and 1995 had prevented over 400,000 premature deaths,[24] and saved over $8.4 billion – more than 50 times greater than the amount spent on anti-smoking campaigns over that period.[23, 24]

A recent US study, Prevention for a Healthier America, shows that for every US$1 invested in proven community-based disease prevention programs (increasing physical activity, improving nutrition and reducing smoking levels), the return on investment over and above the cost of the program would be US$5.60 within five years.[25]

5 Taking action

There is no denying the enormity of the tasks that lie ahead in implementing the Preventative Health Strategy. However, this represents the required response that is in proportion to the severity of the problems Australia faces with obesity, tobacco and the harmful use of alcohol.

5.1 A phased approach

What follows are the most important actions in each of the areas of obesity, tobacco and alcohol. Detailed implementation plans for obesity, tobacco and alcohol, describing a full set of actions, responsibilities, phasing and measures, are included in the accompanying chapters of this document.

The actions are phased and sequenced over time, as it will not be possible or appropriate to initiate all actions in phase one.

The first phase of four years sets in place the urgent priority actions. The second phase builds on these actions, learning from new research, the experiences of program implementation and the national trials carried out in the first phase. The third phase ensures long-term and sustained action, again based on learnings from the first two phases.

As a means to encouraging and supporting action across Australia the Taskforce proposes the establishment of an online national forum for organisations, local governments, businesses and industry, community groups, families and individuals to share their commitments and plans to making Australia the healthiest country.

This will be complemented by the development of a national recognition and award scheme for outstanding contributions, large and small, to making Australia the healthiest country by 2020.

• 
  Establish a Prime Minister’s Council for Active Living and develop and implement a National Framework for Active Living, encompassing local government, urban planning, building industry, developers and designers, health, transport, sport and active recreation
  
• 
  Develop a business case for a new COAG National Partnership Agreement on Active Living
  
• 
  Conduct research into economic barriers and enablers, policies and tax incentives to inform a national active living framework and actions
  
• 
  Australian and state governments to consider the introduction of health impact assessments in all policy development (for example, urban planning, school education, transport), using partnership models such as the Health in All Policies (HiAP) approach in South Australia
  

• 
  Develop and implement a comprehensive National Food and Nutrition Framework
  
• 
  Commission a review of economic policies and taxation systems, and develop methods for using taxation, grants, pricing, incentives and/or subsidies to promote production, access to and consumption of healthier foods
  
• 
  Establish a Healthy Food Compact between governments, industry and non-government organisations to drive change within the food supply; develop voluntary targets
  
• 
  Work with industry, health and consumer groups to introduce food labelling on front of pack and menus to support healthier food choices, with easy to understand information on energy, sugar, fat, saturated fats, salt and trans fats, and a standard serve/portion size within three years.
  

Fund, implement and promote comprehensive workplace programs building on the COAG Healthy Workers initiative:

• 
  Develop a national accord to establish best practice workplace programs, including: protecting the privacy of employees, workplace risk monitoring, risk assessment or risk modification programs
  
• 
  Establish a voluntary industry scorecard, benchmarking and award scheme for workplace health
  
• 
  Establish nationally agreed accreditation standards for providers of workplace health programs
  
• 
  Establish a national action research project to strengthen the evidence of effective workplace health promotion programs in the Australian context
  
• 
  Establish a national workplace health leadership program and a series of resources, tools and best practice guidelines
  
• 
  Commission a review of potential legislative changes to promote the take-up of workplace health programs, including options such as:
  

• 
  Changes to Fringe Benefits Tax Assessment Act and Income Assessment Act to provide incentives
  
• 
  Employer commitment to a percentage of annual payroll allocated to workplace health programs (similar to the former Training Guarantee Levy)
  

• 
  Investigate the feasibility of rewarding employers – through grants or tax incentives – for achieving and sustaining benchmark risk factor profiles in their workforce
  

Fund, implement and promote school programs to increase physical activity and healthy eating:

• 
  Establish a partnership with the education sector
  
• 
  Incorporate Health and Physical Education (HPE) for all Australian children into the second stage of National Curriculum development
  
• 
  Australian and state governments to establish a national program to support implementation of the new curriculum, including teacher curriculum guidance and professional development opportunities
  
• 
  Education sector to encourage all schools to develop, implement and evaluate health, nutrition and physical activity policies
  
• 
  Establish system to monitor the policy requirement of at least two hours of physical activity per week for all students K–10
  
• 
  Expand the coverage of out-of-school-care health programs such as Active After School and Eat Smart, Play Smart
  
• 
  Education sector to examine how to build the capacity of schools and teachers to promote health and resilience more effectively
  

• 
  Establish, as part of the COAG Healthy Communities initiative, a national series of comprehensive five-year intervention trials in 10 to 12 communities (including low SES and Indigenous communities)
  
• 
  Establish partnerships with the Australian Local Government Association (ALGA) to develop programs that support and encourage local councils to adopt Healthy Spaces and Places planning guidelines
  
• 
  Develop, pilot and implement a new Healthy and Active Families initiative as an additional intervention to the activities proposed for Healthy Communities sites; begin with the intensive intervention sites and roll out successful program elements as results become available
  
• 
  Develop strategies to mobilise and engage local communities including, through the NPA, the development and delivery of a national healthy community leadership and education program
  

• 
  Develop and work with Australian, state and territory governments to implement a comprehensive, sustained social marketing strategy to increase healthy eating, physical activity and reduce sedentary behaviour, building on Measure Up and state campaigns such as Go for 2&5, Find Thirty and Go for Your Life.
  
• 
  Choose messages most likely to reduce prevalence in socially disadvantaged groups and provide extra reach to these groups
  

Phase out the marketing of energy-dense nutrient-poor (EDNP) food and beverage products on free-to-air and Pay TV before 9pm, and phase out premium offers, toys, competitions and the use of promotional

• 
  Development and adoption of an appropriate set of definitions and criteria for determining EDNP food and beverages
  
• 
  Monitoring and evaluating the impact of voluntary self-regulation in reducing children’s exposure to unhealthy food advertising
  
• 
  Identifying any shortfalls with the current voluntary approach, and addressing this through the introduction of a co-regulatory agreement; monitor, evaluate and report on the effectiveness of co-regulation
  
• 
  Introducing legislation within four years if these measures are not demonstrated
  to be effective
  

• 
  Expand the relevant allied health workforce
  
• 
  Improve access to services that provide physical activity, weight loss and healthy nutritional advice and support
  
• 
  Fund and implement evidence-based clinical guidelines for health and community workers
  

• 
  Establish and implement a national program to alert and support pregnant women and those planning pregnancy to prevent lifestyle risks of excessive weight, poor nutrition, smoking and alcohol consumption
  

• 
  Fund, implement and promote multi-component community-based programs in low SES communities
  
• 
  Fund, implement and promote effective and relevant strategies and programs to address specific issues experienced by people in low-income communities
  
• 
  Specific actions are also referred to in key action areas 3 and 4
  

• 
  Fund, implement and promote multi-component community-based programs in Indigenous communities
  
• 
  Strengthen antenatal, maternal and child health systems for Indigenous communities
  

• 
  Implement the expanded National Risk Factor Survey funded under the COAG National Partnership Agreement and ensure that this:
  

• 
  Becomes a permanent national periodic collection
  
• 
  Ensures coverage of adults and the Indigenous population
  
• 
  Forms part of a comprehensive national surveillance system focused on the behavioural, environmental and biomedical risk factors for chronic disease, including capacity to track changes in health inequalities
  

• 
  Ensure the National Children’s Nutrition and Physical Activity Survey is repeated on a regular basis to allow for the ongoing collection of national data on children
  
• 
  NPA to work with national research agencies to establish a National Research Agenda for obesity
  
• 
  Support ongoing research on effective strategies to address social determinants of obesity in Indigenous communities