The Hollowmen National Preventative Health Strategy

by Dave Bath

Monday, September 28, 2009 at 06:28 AM EDT

I was looking through the National Preventative Health Strategy Report, made public (after pressure) with a media release by Nicola Roxon, which doesn’t point directly to Overview and the more detailed Roadmap, but the home page of the www.yourhealth.gov.au site – which doesn’t exactly help anyone find it easily.

Some of it is good, with obesity identified as the number one issue, followed by smoking and alcohol, along with admissions that markets can stuff up social outcomes.  The thrust of the "active neighborhood" push, identifying town planning and public transport as key elements of health policy is great – but the state governments and councils won’t like it!

However, looking at the fine print of the targets for the three main problems, and the way it tiptoes around things that might offend the food giants, I’m worried that we are going to end up with an obesity strategy that, in the style of "The Hollowmen", will be an extremely watered down version, like turning mandatory controls on junk food advertising into a voluntary and self-regulated code.

There is the hint already, by looking at the targets, that obesity, despite being the biggest problem, will have a low bar set.

When you look at the target metrics for smoking and alcohol, they are quite detailed.  For obesity, it’s not so prominently placed, and boils down to a halt of the rise in obesity and overweight (yep, a noun and an adjective… great!) by 2020, with hopeful noises about a drop, with the only hard metrics relating to the percent of the population that is within the healthy range, and not in the obese range.

What about the percentage that are overweight but not obese?

It’s almost as if the aim is to get a good headline figure (very far down the track when it is the problem of other politicians – I cannot see why action against such a costly problem shouldn’t get such a result in 5 years), rather than improve health of the majority of the population.

Despite a good grovel (but not a close read), I couldn’t find any hard metrics for the percentage of the population that is overweight, but not obese.

If there are lots of people that are merely shifted from being obese to overweight, that’s still a huge health problem, but the food (especially junk food) giants are still making a killing if you’ll pardon the pun.

There are basically 5 weight-range categories: severely underweight (needing intense action by doctors), underweight (lifestyle change), healthy (maintenance), overweight (lifestyle change) and severely overweight a.k.a. obese or morbidly obese (again needing intense action by doctors).

If those who are morbidly obese simply move to being overweight, and few move from overweight to healthy ranges, the long term health budget doesn’t benefit much, the economic damage of ill-health doesn’t benefit much, the human impact remains high.

It’s difficult not to be cynical about the lack of definition of the appropriate percentages of the population to be in each of those five categories, with the targets for each year defined.

There are similar problems with the active neighborhood strategy, unless there are much more detailed metrics defined soon:

• Range of services needed on at least a monthly basis within walking distance (e.g. not worrying about consumer durables), or better still, armload of shopping walking distance, and maybe further broken up into armload of shopping in the dry or in the wet?  Nope.  Little-old-lady-with shopping walking distance?  Nope.
   
• Metrics for safe bike lane density?  Nope.
   
• Metrics for public green space, with and without playground equiptment (including adult stuff like a basketball ring and key – a full court isn’t necessary)?  Nope.  Only schoolgrounds being used by the public outside school hours is mentioned – and those are being consolidated with larger catchment areas.
   
• Frequency and density of public transport within walking distance?  Nope.

In other words, a major tool of change (active neighborhoods) is reduced to motherhood statements, with no ideas how to implement them past the barriers of short-term financial considerations of states and councils that control such things, and the major culprit, the overconsumption industry, isn’t really being made to do much because of the target metric design.