Experts say politics is getting in the way of solving a serious national health crisis Monday, 29 August 2016

Source: Stuff, 29 August 2016 

Experts say politics is getting in the way of solving a serious national health crisis. Philip Matthews reports.

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 painfully slow.

"What were we arguing for then?" he said in a phone interview.

"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 cent). 

The general trend is that obesity is steadily increasing over time and is more likely to affect people living in deprived areas. 

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 obesity.

"There is clearly going to be a combination of factors that need to involve government regulation of the food environment," he said. 

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 Journal.

"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 ideology? 

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 landscape changes? 

"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 not". 

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 category. 

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 our children."

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 problems." 

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 about.

"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 hard."

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 economic factors. 

"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 other factors.

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 the BMJ." 

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 tactics.

"One of the quotes was 'Our product is doubt'. This is the systematic approach of industries under threat."