Stuff, 29 August 2016
Experts say politics is getting in the way of solving a
serious national health crisis. Philip Matthews
If Auckland University professor and obesity expert Boyd
Swinburn was to look back over the past 15 years, what would he
see? Not much, really. Progress on tackling obesity has been
"What were we arguing for then?" he said in a phone
"Restrictions on junk food marketing to kids. They are still
nowhere to be seen. We were pushing for healthy school environments
which had a bit of an increase under Labour and were mostly wiped
out by National. A sugary drinks tax is still way off the agenda
for this Government. So, very slow progress for something that is
such a disaster for New Zealand children."
Get the numbers on the table first.
Ministry of Health statistics say that 31 per cent of New
Zealand adults are obese. A further 35 per cent are overweight.
Maori and Pacific communities are the worst affected, with 47
per cent of Maori adults obese and 66 of Pacific adults obese.
Turning to children, 11 per cent are obese and another 22
per cent are overweight. For Maori children, obesity leaps to
15 per cent and for Pacific children, 30 per cent.
There are regional variations. Canterbury is lucky to find
itself with the lowest national level of childhood obesity at
just 3.9 per cent, according to 2013 figures. South Canterbury (5.7
per cent) and Nelson-Marlborough (6.5 per cent) are slightly
higher. The highest national levels are in Gisborne (25.1 per
cent), Taranaki (21.9 per cent) and Counties Manukau (18.6 per
The general trend is that obesity is steadily increasing over
time and is more likely to affect people living in deprived
There is no shortage of health experts telling us how we
should fight it and still, as Swinburn notes, there is the same
political unwillingness to do anything much about it. The latest
advice comes from a lobby group called FIZZ
that argues for a
tax on sugar-filled soft drinks.
FIZZ is composed of Auckland University epidemiologists Gerhard
Sundborn and Simon Thorley, marketing lecturer Bodo Lang and New
Zealand Dental Association spokesman Rob Beaglehole. Their
critique of the Government's childhood obesity plan was
recently published in the New Zealand Medical
Journal. They argue that a tax on soft drinks has
become necessary because "evidence shows we cannot educate or
exercise our way out of the obesity epidemic".
Obesity epidemic? David Galler, intensive care specialist at
Auckland's Middlemore Hospital, talks of a diabetes "plague". These
words - epidemic, plague - are not hyperbole. Talking to
Kim Hill on
RNZ this month about his bookThings That Matter:
Stories of Life and Death, Galler said that a tax on soft
drinks would have to be part of any serious effort to combat
"There is clearly going to be a combination of factors that need
to involve government regulation of the food environment," he
And there are many international examples to evaluate and
consider. The UK has committed to a sugar tax starting in 2018.
Mexico put a tax on soft drinks in 2014, and both Galler
and Swinburn cite Mexico in their arguments. In
June Philadelphia became the first major US city to introduce
a tax on soft drinks although the smaller Californian city of
Berkeley applied a tax last year and saw consumption fall in
low-income areas, according to the Wall Street
"We need to look at that kind of evidence, put the ideology
aside and start to look at the outcomes we really want for
ourselves," Galler told RNZ.
So what is holding New Zealand back from taking the advice of
these and other experts in the fight against obesity? Is it simply
FREEDOM OF CHOICE?
"The National-led Government has a strict and naive belief in
individuals' ability to make healthy personal choices in the face
of enormous cunning and deceptive marketing by the food industry,"
says Doug Sellman, director of the National Addiction Centre at
the University of Otago in Christchurch. He has seen this within
his specialist area, alcohol and drug addiction, and noted that,
time and again, the Government has been unwilling to regulate.
"The Government seems allergic to regulation even when it is
clearly supported by excellent science," he says. "Seat belts were
'nanny state' when first introduced, but are now taken as read by
the population and hundreds of lives and an enormous amount of
disability has been averted, as would be the case if stronger
regulation of the commercialisation of highly processed food and
drink was enacted."
Auckland endocrinologist and diabetes specialist Robyn Toomath
spent 15 years in the trenches in the war against obesity and
formed a lobby group called Fight the Obesity Epidemic
(Foe) before she gave up in frustration. How long can you keep
saying the same things while noticing that little on the political
"The campaign which was to try to influence, ultimately, the
Government has been 100 per cent unsuccessful," she says. "The
things we did achieve got reversed."
There was a window of progress in around 2006 and 2007
during the third term of the Helen Clark government that
was mocked as "nanny state" by opponents and critics. All
the chatter about efficient light bulbs and showers, smacking
and healthy tuckshops was turned into the spectre of Clark and her
ministers interfering in the time-honoured Kiwi right to do what
you like in your home and to your children.
As Toomath observes, that has been followed by eight
years of a National government trying to do as little as possible.
Whether the issue is water quality, climate change or obesity, "the
initial stance on everything is 'there's not a problem here'. But
you get the impression the general public is losing patience with
being told that everything is hunky dory when it's plainly
Early on in her time as an advocate, Toomath was told that
"legislation is driven either by politicians, sometimes with the
public reluctantly following behind, or driven by public pressure,
with politicians dragged behind". As Health Minister Jonathan
Coleman and Prime Minister John Key have ruled out a tax on
soft drinks, change in this area would fall into the second
How about the public mood? According to a One News Colmar
Brunton Poll in April, 66 per cent of New Zealand voters
support a sugar tax similar to that which had just been announced
in the UK. Less than a third (29 per cent) were against
and 5 per cent didn't know. Green Party supporters are more likely
to support the sugar tax with 81 per cent backing it. People
in households with an annual income over $70,000 are also above
average supporters, at 73 per cent.
That majority support tells Swinburn that "if the Government had
a mind to get serious on sugary drinks taxes, it could readily
persuade the public to support it".
Going back further, a Foe poll in 2005 found that 71 per cent of
those surveyed agreed or strongly agreed that advertisements for
unhealthy food and drink should be banned during children's
television shows and 84 per cent agreed or strongly agreed
that unhealthy food and drink should be kept out of school
tuckshops and vending machines.
An unregulated food environment means that the public finds
itself in isolated fights with councils and industry. The
Christchurch City Council heard this month from Linwood residents
who want to limit the number of fast food outlets near local
schools. Parent Tracie Charnock, who presented a petition, told
the council: "All you can smell is KFC through the school gates. We
seem to be fighting a losing battle when it comes to the health of
Richard Griffiths, a doctor at Linwood Medical Centre,
urged the council not to put this in "the too-hard basket" and
said: "Day in, day out, we're confronted by adult obesity and, more
concerning, child obesity."
"There are a number of reasons why New Zealand governments have
been very sluggish in the past 10 or 15 years," Swinburn says. "In
part, it's ideology. Individual responsibility is the current
approach and it's not working. Part of it is the enormous
push back from industry. Whenever regulatory approaches are
proposed, they swing into action.
"And there is not a lot of public pressure for change. People
who are overweight or obese, or have kids that are obese, feel a
degree of shame and guilt. Also, it's a chronic thing. It's not
like a drinking water contamination that galvanises all of the
health systems into action. This is a slow boil. It seems to be
more difficult for politicians to react in an urgent way to chronic
When Toomath bowed out of obesity activism, she pictured a
scenario in which the baton would be passed to the obese and
overweight themselves. She is still waiting.
"I keep using the example of the AIDS epidemic. Men with HIV
were initially shamed and silenced and skulked around in the
corners. It wasn't until those guys had the chutzpah to stand up
and demand research and funding that they turned things
around. I would love to empower people who have been afflicted with
obesity to start demanding the changes we've been talking
"In an ideal world, the obese people of the world would rise up
and say, 'We deserve a default environment that favours living
healthily, not a default environment that is stacked against
maintaining a healthy diet'. People who have stayed slim have been
blessed with the right genes. Otherwise people have to struggle so
While that may be a fantasy for now, it aligns with the expert
view that the obese and overweight are not to blame for their
situation. They are up against powerful genetic, physiological and
"It's not because people are lazy, lacking in motivation or
stupid, which are the subliminal explanations as to why people are
overweight," Toomath says.
WOULD TAXES WORK?
Boyd Swinburn thinks there are some good things in the
Government's childhood obesity plan, such as "paying attention
to kids who are already overweight or obese and ensuring services
respond to them", but mostly it was a damp squib. "Nothing new, no
extra money, no serious policies."
When asked what should happen, Swinburn points to
the final report of the World Health Organisation
Commission on Ending Childhood Obesity, which was released in
January. The commission was co-chaired by Sir Peter Gluckman, the
Prime Minister's Chief Science Advisor.
When the report was released, Gluckman said
that "increased political commitment is needed to tackle
the global challenge" that is childhood obesity. Along with
education and exercise programmes, one of the commission's clear
recommendations to governments was to "implement an
effective tax on sugar-sweetened beverages".
Would this work? Otago University public health specialist
Andrea McDonald looked at the Pacific and Mexico in 2015.
The Pacific context was a "non-communicable disease (NCD) crisis".
Nine of the 10 most obese countries in the world are in the
Pacific, according to the CIA's World Factbook. More than half
of Pacific countries and territories have adopted soft drink
policies, ranging from a ban in Tokelau to a tax of NZ$ 9.80 per
kilo of sugar in soft drinks in the Cook Islands, which adds
up to an extra NZ 38c on a can of Coca-Cola. That was the
highest value soft drink tax in the Pacific.
In Mexico, the tax added 10 per cent to the cost when it
was applied in 2014. The result? There was a 12 per cent decline in
soft drink purchases by the end of 2014, and consumption reduced by
17 per cent in poorer households. There was a 4 per cent increase
in the purchase of untaxed drinks, including bottled water.
These early findings were published in the British Medical
Journal in 2016. It noted that "these
reductions became larger over time, while the purchases of untaxed
beverages increased. This short term change is moderate but
important." The background is that Mexico has the highest rate of
diabetes in the OECD and even higher rates of childhood and adult
obesity than New Zealand.
The FIZZ report says that soft drinks are the largest
contributor of added sugar to the New Zealand diet, for both
children and adults. You would expect plenty of opposition
from the industry if a tax was tried here. Ahead of the soft drink
tax coming to the UK in 2018, the industry is "fighting every step
of the way," Swinburn says. The latest volley is the British Soft
Drinks Association's claim that the tax would take 4000 jobs
out of the UK economy. But the idea that soft drink taxes cost
jobs was disputed by the American Journal of Public
Health in 2014.
Claim, counterclaim. The same information wars happen in New
Zealand. The Food and Grocery Council (FGC) speaks for the
industry and is fronted by chief executive Katherine Rich, a former
National government minister. The FGC published a
response to the FIZZ group's report and argued that the
experience in Mexico shows that sugar taxes do not work.
"The Mexican soda tax has generated billions of pesos, and after
a slight decline initially, sales soon returned to pre-tax levels,"
the FGC said.
Tax advocates replied that sales increases reported by
industry could be explained by unusually warm weather, among
The idea that the Mexican tax has been a failure was also
circulated by Right-wing lobby group the Taxpayers Union and
the Right-wing bloggers named in the book Dirty
Politics. It boils down to this: there are conflicting
reports coming out of Mexico.
"The conflict has been developed by the sugary drinks
industry which is taking a page out of the tobacco
industry's play book by creating doubt about the
science," Swinburn says. "When those figures were properly adjusted
for changing populations, seasonality and economic activity, all
the things we know can confound such a result, they turned out
exactly the same as what the researchers had published in
He refers to a book published in 2010 called Merchants
of Doubt. It explained how the tobacco industry
and climate change deniers. These are the same familiar
"One of the quotes was 'Our product is doubt'. This is the
systematic approach of industries under threat."