tag:theconversation.com,2011:/uk/topics/preventative-health-taskforce-3302/articlesPreventative Health Taskforce – The Conversation2015-12-10T11:17:52Ztag:theconversation.com,2011:article/478952015-12-10T11:17:52Z2015-12-10T11:17:52ZWhen is an aspirin a day to prevent heart attacks too risky?<figure><img src="https://images.theconversation.com/files/102904/original/image-20151123-18233-a5dyg7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's the harm?</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic.mhtml?id=117314986&src=id">Aspirin via www.shutterstock.com.</a></span></figcaption></figure><p>We’ve known for a long time that aspirin can help prevent damage from a heart attack or a stroke if taken during one of those events. In fact, you might have seen ads about how aspirin can be lifesaving during a heart attack.</p>
<p>Research backs that up. For people who have already experienced a heart attack or stroke, a daily aspirin regimen can <a href="http://circ.ahajournals.org/content/130/25/e344">actually prevent</a> future <a href="http://journal.publications.chestnet.org/article.aspx?articleID=1159438">heart attacks</a> and strokes.</p>
<p>But, as helpful as aspirin is to prevent recurrent heart attacks or strokes (this is called secondary prevention), a daily aspirin has long been controversial to prevent a first heart attack or stroke (this is called primary prevention). </p>
<p>To use aspirin for primary prevention, doctors are supposed to assess a patient’s risk of a first heart attack or stroke and decide when benefits of aspirin outweigh risks. But new draft guidelines for aspirin use have created confusion about who, exactly, should actually take aspirin. </p>
<h2>What do the new draft guidelines say about aspirin?</h2>
<p>The <a href="http://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/aspirin-to-prevent-cardiovascular-disease-and-cancer">new draft guidelines</a> from the United States Preventative Services Task Force recommend adults between the ages of 50-59 take aspirin if they have at least a 10% 10-year risk of having a heart attack or stroke as measured by a <a href="http://www.cvriskcalculator.com/">risk calculator </a>.</p>
<p>For people 60-69, the task force says there is less benefit compared to for those ages 50-59, but that aspirin should still be used as long as there is a low risk of bleeding as a side effect.</p>
<p>But for patients younger than 50 or older than 70, the task force decided there was not enough evidence to make a recommendation about using aspirin. This is a major departure from the 2009 recommendation, which suggested use in all adults between the ages of 45-79 with an elevated risk of a heart attack or stroke.</p>
<p>This change happened in part because of a push to make medical guidelines strictly evidence-based. Right now, there are no randomized trials comparing aspirin to placebo in adults older than 70 or younger than 50. Without evidence, you can’t have evidence-based recommendations.</p>
<p>Basing guidelines strictly on evidence makes sense, but clinical trials are rarely perfect, and recommendations on how to use drugs need to make sense to primary care providers in order to avoid confusion.</p>
<h2>What do the data say about aspirin for primary prevention?</h2>
<p>Early trials that treated patients with aspirin during a heart attack or stroke found they were more likely to survive. But these trials <a href="http://circ.ahajournals.org/content/130/25/e344">also found</a> that leaving patients on aspirin for months and years afterwards reduced future heart attacks and strokes. </p>
<p>For every 100 patients who’ve had a heart attack or stroke and stay on a daily aspirin, five recurrent heart attacks or strokes are prevented in the next year. While there is a small risk of serious bleeding with aspirin (mostly stomach bleeding, but also bleeding in the brain), fewer than one in 100 patients experience this. Therefore, everyone agrees that the benefits of aspirin outweigh the risks for people who have had a heart attack or stroke.</p>
<p>But for patients with no history of a heart attack or stroke, the <a href="http://dx.doi.org/10.1016/S0140-6736(09)60503-1">data say</a> that the risk of serious bleeds and the benefit of reducing heart attacks and strokes are about equal for a population of middle-aged and older adults. </p>
<p>According to the new calculations in the task force guidelines, for every 100 men 55-60 years old with an <a href="http://www.cvriskcalculator.com">average risk</a> of a first heart attack or stroke of 1% per year, starting a daily aspirin would have a <em>lifetime</em> effect of avoiding about two heart attacks and one stroke among those 100 men, but causing about three serious stomach bleeds and about one hemorrhagic stroke. </p>
<h2>What do the new guidelines mean for you?</h2>
<p>The draft guidelines from the Preventative Services Task Force might not offer a lot of clear yes’s and no’s about who should and shouldn’t take aspirin for primary prevention. And guidelines from other groups offer differing advice. </p>
<p>Guidelines from <a href="http://www.heart.org/HEARTORG/Conditions/HeartAttack/PreventionTreatmentofHeartAttack/Aspirin-and-Heart-Disease_UCM_321714_Article.jsp">The American Heart Association</a>, <a href="http://content.onlinejacc.org/article.aspx?articleid=1889061">American College of Cardiology</a> and <a href="http://care.diabetesjournals.org/content/33/6/1395.full">American Diabetes Association</a> all endorse aspirin for primary prevention in certain higher-risk patients. However, the Food and Drug Administration <a href="http://www.bmj.com/content/348/bmj.g3168">denied a petition</a> from the aspirin manufacturer Bayer Inc for wording on their label that said aspirin could prevent heart attacks and strokes for people who had never had them.</p>
<p>And the <a href="http://www.escardio.org/The-ESC/Press-Office/Press-releases/Last-5-years/Aspirin-still-overprescribed-for-stroke-prevention-in-AF">European Society of Cardiology</a> does not endorse aspirin for primary prevention for any patient – even those at high risk.</p>
<p>But, the “over-the-counter” availability of aspirin means that Americans, many Europeans and potential patients all over the world can decide for themselves whether or not to take aspirin. And many are deciding to do so. A national survey that <a href="http://www.ajpmonline.org/article/S0749-3797(14/)00661-8/fulltext">we published in 2015</a> showed that nearly half of all US adults without CVD indicated that they “regularly” used aspirin as a preventive therapy. </p>
<p>So what should patients do? If you are over the age of 40 and don’t have a history of cardiovascular disease, check your predicted <a href="http://www.cvriskcalculator.com/">10-year risk of CVD</a>. </p>
<p>If your individual risk is greater than 10%, talk to your doctor about taking aspirin. Patients who don’t have a risk of bleeding could be considered good candidates for therapy, but they should understand that the odds of a serious bleed are about the same as the odds of preventing a heart attack or stroke. Not all patients will want to take the trade-off. </p>
<p>For patients who are under 70 with a CVD risk of less than 10%, aspirin therapy should generally be avoided. </p>
<p>While it is widely believed that these new task force recommendations will cut down on how many people go on an aspirin regimen in the US, that remains to be seen. It depends whether busy primary care providers read and agree with the guidelines, and then translate them into clinical practice.</p><img src="https://counter.theconversation.com/content/47895/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Craig Williams does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New draft guidelines for using aspirin to prevent heart attacks have created confusion about who, exactly, should actually take it.Craig Williams, Professor of Pharmacy, Oregon State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/215342014-02-17T19:44:57Z2014-02-17T19:44:57ZCommission of Audit should know costs but appreciate value<figure><img src="https://images.theconversation.com/files/41680/original/b62hkxbm-1392611355.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Four of the five members of the Commission of Audit during a Senate hearing at Parliament House in January. </span> <span class="attribution"><span class="source">AAP Image/Lukas Coch</span></span></figcaption></figure><p>The Senate Select Committee into the <a href="https://theconversation.com/five-member-audit-commission-to-be-led-by-businessman-19408">Commission of Audit</a> is holding its third Hearing in Canberra today. Witnesses include the Consumers Health Forum and Australian Health and Hospitals Association, so health is clearly the order of the day.</p>
<p>Instituted by the Abbott government soon after it came to power, the Commission is charged with finding savings by eliminating waste and duplication of functions, and the consolidation of Commonwealth agencies. And the <a href="http://www.anpha.gov.au/internet/anpha/publishing.nsf">Australian National Preventive Health Agency</a> (ANPHA) is widely held to be an easy target for it. </p>
<p>The agency was established as part of the raft of reforms under the 2011 <a href="http://www.federalfinancialrelations.gov.au/content/npa/health_reform/national-agreement.pdf">National Health Reform Agreement</a>, to lead in preventive health through surveillance and monitoring, policy advice, national social media campaigns, and by sponsoring research.</p>
<p>Eliminating the ANPHA would, of course, look like a positive contribution to the savings and agency reductions needed to justify the Commission of Audit. But the 40 or so ANPHA staff will not contribute significantly to the Commission’s targeted reduction of 12,000 public servants. </p>
<p>But let’s assume the Commission is less concerned with justifying its own existence and more focussed on the wise investment of government resources (that’s our taxes). In that case, there are a number of issues it should bear in mind.</p>
<h2>Neither easy nor quick</h2>
<p>The goal for the ANPHA is to reduce the prevalence of preventable disease. According to the <a href="http://www.aihw.gov.au/publication-detail/?id=10737422172">Australian Institute for Health and Welfare</a> (AIHW), 32% of the current national burden of disease is due to preventable risk factors. And that’s set to grow with rising national levels of obesity and falling fitness. </p>
<p>One could say preventable disease is a big target, so it shouldn’t be that hard to make an impact. Unfortunately, what’s preventable in theory is not so preventable in practice. </p>
<p>Take one of the top risk factors of preventable disease according to the AIHW – intimate partner violence. It’s one thing to say there’s a significant national burden of injury and disease due to violence in relationships; it’s quite another to actually stop the dominant partner acting violently.</p>
<p>Much the same applies to obesity, lack of physical activity and poor diets. To paraphrase Shakespeare’s Brutus from Julius Caesar (I,ii, 140-141):</p>
<blockquote>
<p>the fault lies not in our health system. But in ourselves…</p>
</blockquote>
<p>In many areas, Australia has done well in reducing the prevalence of preventable disease and, to some extent, that’s now reflected in our improving life expectancy and expected life years without disease or disability. </p>
<p>Clearly, action on prevention didn’t start in 2011 with the establishment of ANPHA; the 2008 COAG National Partnership Agreement on Preventive Health committed A$872m over six years, which is a pretty serious investment. </p>
<p>The problem is the payoff period for such action is long – it takes a lifetime of good habits to enjoy their health consequences. Investment and performance in one period will influence performance in later periods. </p>
<p>The issue for the Commission, then, is what value has been added by the existence of a national agency, and how can that be judged when it’s barely three years old. </p>
<h2>Better than cure?</h2>
<p>Recent inquiries and reviews, such as the <a href="http://www.health.gov.au/internet/nhhrc/publishing.nsf/content/submissions-1lp">National Health and Hospitals Reform Commission</a> and the <a href="http://www.preventativehealth.org.au/">Preventative Health Taskforce</a> have made the case for stronger investment in prevention, as they have in other developed countries, including the United Kingdom and the United States. And in much policy development, there’s an implicit view that “prevention is better and cheaper than cure”. </p>
<p>But systems research from the 1970s shows while that may well be the case, <a href="http://www.oxfordhandbooks.com/view/10.1093/oxfordhb/9780199238828.001.0001/oxfordhb-9780199238828-e-23">prevention often increases costs</a> because it must be directed toward large groups, if not the whole population, while treatment is targeted at relatively few. </p>
<p>What’s more, not all preventive strategies are cheap, and their success will be reflected in a growing elderly population.</p>
<p>The policy issue then isn’t whether there should be more investment in reducing preventable disease, but which programs are “good buys” when considering both effectiveness and cost. And effectiveness must reflect the very human goals of adding years to life and life to years.</p>
<p>Both the National Health and Hospitals Reform Commission and the Preventative Health Taskforce recommended that preventive strategies be subject to economic evaluation in much the same way that new medical procedures and pharmaceuticals are. </p>
<p>But the evaluation of broad-scale prevention is more challenging than therapeutic interventions. There are significant issues around which benefits to select for evaluation and what value to assign them, and modelling risk factors with multiple effects (on several diseases), as well as modelling the multiple risk factors for many chronic diseases. </p>
<p>So it’s not clear that the guidelines that have served so well for appraising immediate treatment effects will work as well for long-term preventative programs.</p>
<h2>Things to keep in mind</h2>
<p>The Commission’s terms of reference stress that its role is to find efficiencies and savings that will reduce duplication and improve the budget position. For this, it’s important to remember that Commonwealth doesn’t equal national; this country has six state and two territory governments, as well as the Commonwealth government. </p>
<p>Successful public health campaigns require political agreement, sufficient funding and national campaigns backed by local initiatives and action. The Commission must distinguish complementary efforts from duplication.</p>
<p>The Commission’s terms of reference also mention the need to improve value for money – it would do well to remember that while knowing the cost of agencies and programs is simple, appreciating their value is considerably more complex.</p><img src="https://counter.theconversation.com/content/21534/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Hall receives funding from the NHMRC and APHCRI. She has not received any funding from ANPHA.</span></em></p>The Senate Select Committee into the Commission of Audit is holding its third Hearing in Canberra today. Witnesses include the Consumers Health Forum and Australian Health and Hospitals Association, so…Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/67142012-07-05T20:07:59Z2012-07-05T20:07:59ZIndustry-sponsored self-regulation: it’s just not cricket<figure><img src="https://images.theconversation.com/files/12580/original/dyv8hbnw-1341361492.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Powerful bodies benefit from sponsorship by junk food companies, making regulation more difficult.</span> <span class="attribution"><span class="source">David Gardiner</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today Rob Moodie and Kate Taylor talk about how little the Australian government is doing to stop the epidemic while Kerin O'Dea <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">considers measures that could work</a>.</em></p>
<hr>
<p>The world keeps getting fatter and no country has yet successfully managed to reduce adult rates of overweight and obesity. Rates are levelling in a few countries – sometimes at low levels as in Japan, Korea, and Switzerland and sometimes at levels comparable to Australia, as in Hungary and England. Australia has also seen instances of flattening in trends (but at high levels) in <a href="http://www.nature.com/ijo/journal/v35/n7/full/ijo201164a.html">pre-school children</a>, but adult rates continue to rise.</p>
<figure><table><thead><tr><th>Country</th><th>Year</th><th>Prevalence %</th></tr></thead><tbody><tr><td>USA</td><td>2008</td><td>33.8</td></tr><tr><td>Mexico</td><td>2006</td><td>30</td></tr><tr><td>Scotland</td><td>2008</td><td>27</td></tr><tr><td>New Zealand</td><td>2007</td><td>26.5</td></tr><tr><td>Ireland</td><td>2007</td><td>25</td></tr><tr><td>Australia </td><td>2007</td><td>24.5</td></tr><tr><td>Canada </td><td>2008</td><td>24.2</td></tr><tr><td>England</td><td>2009</td><td>23</td></tr></tbody></table><figcaption>Ranked rates of measured obesity 2010</figcaption></figure>
<p>Countering obesity should be a government priority, because excess weight creates a significant drag on countries’ health budgets and productivity. And the role governments can play was the focus of a <a href="http://www.srfood.org/images/stories/pdf/officialreports/20120306_nutrition_en.pdf">recent report</a> by the <a href="http://www.srfood.org/">UN Special Rapporteur on the right to food</a>, Olivier De Schutter. The report outlines <a href="http://www.srfood.org/index.php/en/component/content/article/1-latest-news/2054-five-ways-to-tackle-disastrous-diets-un-food-expert">key policy actions</a> to improve health and nutrition.</p>
<p>They include:</p>
<ul>
<li><p>Taxing unhealthy food, including soft drink, and subsidising fruit and vegetables; </p></li>
<li><p>Regulating foods high in saturated fats, salt and sugar; </p></li>
<li><p>Regulating to reduce unhealthy food advertising to children, as recommended by the World Health Organisation (WHO).</p></li>
</ul>
<p>Interventions like these are important because they protect the most vulnerable in society – the poorest and the young.</p>
<h2>Local efforts</h2>
<p>In Australia, the <a href="http://www.preventativehealth.org.au/">Preventative Health Taskforce</a> has provided a <a href="http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lp">blueprint for action</a> against obesity. It recognised governments’ key role in reducing unhealthy food marketing to children, improving labelling, and investigating tax and pricing strategies. </p>
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<p>Sadly, such measures have yet to be implemented or seriously considered. Rather, the government has focused on elements such as policies in children’s settings around food supply and active play, <a href="http://www.coag.gov.au/.../national_partnership/national_partnership_on_preventive_health.pdf">funding for community interventions</a> and <a href="http://swapit.gov.au/">social marketing campaigns</a> – all softer options favoured in the political satire, <a href="http://www.abc.net.au/tv/hollowmen/#/home">The Hollowmen</a>.</p>
<p>At the same time, there’s been a focus on <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/food-health-dialogue">partnership with industry</a>. While this is important, it has also led to a clear reluctance to <a href="http://www.abc.net.au/am/content/2010/s2898084.htm">leverage regulatory</a> and fiscal measures because of lobbying by the many industries that profit from high and growing consumption of their products.</p>
<p>This is a significant lost opportunity because tax and pricing measures result in the largest health gains in the shortest time frame. Australian research has shown that they are also the <a href="http://www.sph.uq.edu.au/bodce-ace-prevention">most cost-effective interventions</a>, with a <a href="http://www.nature.com/ijo/journal/v35/n7/full/ijo2010228a.html">10% tax</a> resulting in large health gains, particularly for low-income groups. A number of countries – including Denmark, Hungary, Finland, and France – have legislated to tax fat or sugar.</p>
<p>Labelling of packaged food has also been considered. Former health minister Dr Neal Blewett led a <a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/content/labelling">review</a> that recommended traffic-light labelling on the front of packs, among other things. In a surprising move, however, the Australian <a href="http://www.foodlabellingreview.gov.au/internet/foodlabelling/publishing.nsf/Content/ADC308D3982EBB24CA2576D20078EB41/$File/FoFR%20response%20to%20the%20Food%20Labelling%20Law%20and%20Policy%20Review%209%20December%202011.doc">government argued</a> that there was not enough evidence to justify this system. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12570/original/jjms9nyb-1341299376.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A number of countries have legislated for a fat tax.</span>
<span class="attribution"><span class="source">Jun Seita</span></span>
</figcaption>
</figure>
<p>Instead, it has established a working group of food industry and public health organisations to develop options for an alternative scheme. Yes Minister, anyone? It appears we haven’t learnt anything from Europe, where industry spent more than <a href="http://www.corporateeurope.org/news/red-light-consumer-information">one billion Euros</a> fighting against traffic light labelling.</p>
<p>One of the key battlegrounds in Australia remains unhealthy food marketing to children, a major driver in normalising poor diets for life. With marketing becoming increasingly sophisticated and <a href="http://www.lifelessserious.com.au/">integrated over a range of platforms</a>, direct targeting of children and adolescents is easier and cheaper than ever before. And social media makes it ever more effective. Advertisements masquerading as games, for instance, are increasingly popular, moving from television to the internet into mobile phone apps.</p>
<h2>The dangers of self-regulation</h2>
<p>This is what is happening under government-endorsed, industry-formulated self-regulation – marketers are way ahead of any weak, industry-sponsored controls. Despite calls for a national approach, the <a href="http://www.acma.gov.au/WEB/STANDARD/pc=PC_410243">Australian Communications and Media Authority</a> and Australian health ministers have treated the issue as a hot potato, <a href="http://www.anpha.gov.au/internet/anpha/publishing.nsf/Content/communique-20110822">currently vesting responsibility</a> with the Australian National Preventative Health Agency. This group has been asked to do yet another review of the evidence, organise a seminar and undertake some monitoring. At best we might see stronger self-regulation.</p>
<p>All over the world, governments fear the power of the many industries associated with the obesity epidemic. It’s not just the producers, manufacturers and retail giants, but also the advertisers, public relations companies and media. All have major economic interests in marketing of unhealthy foods and beverages, including alcoholic drinks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12581/original/7ygdb7c3-1341363542.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Numerous industries have economic interests in marketing unhealthy foods and beverages.</span>
<span class="attribution"><span class="source">Tom Lawrence</span></span>
</figcaption>
</figure>
<p>And, of course, a country as interested in sport as Australia also has to contend with powerful bodies, such as Cricket Australia, who benefit from the sponsorship of junk food companies and from the money made by leading players who relentlessly promote such products to Australian children. In this light, the <a href="http://www.katelundy.com.au/2012/06/23/australian-sport-tackles-binge-drinking/">recent move by the government</a> working with a range of sporting groups to reduce the influence of alcohol should be welcomed and expanded. </p>
<p>We have a lot of experience in good public health policy we could build on. Successive Australian governments have strong records in tobacco control, particularly the current government. It must use these experiences in its efforts to drive down overweight and obesity. It’s unfortunate but unavoidable that the long-term benefits of managing obesity require taking a political stand in the short term. The action the government is taking on tobacco is tremendous. We need similar determination in the face of the obesity epidemic.</p>
<p><strong>This is part fifteen of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part six: <a href="https://theconversation.com/preventing-weight-gain-the-dilemma-of-effective-regulation-6284">Preventing weight gain: the dilemma of effective regulation</a></strong> </p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rob Moodie receives funding from Department of Health and Ageing.</span></em></p><p class="fine-print"><em><span>K Taylor declares no conflicts of interest.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today Rob Moodie…Rob Moodie, Professor of Public Health, The University of MelbourneKate Taylor, Visiting Fellow at Nossal Institute for Global Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/62842012-06-28T20:05:40Z2012-06-28T20:05:40ZPreventing weight gain: the dilemma of effective regulation<figure><img src="https://images.theconversation.com/files/12287/original/b3n3jrz4-1340780668.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Government attention is diverted away from the problem during the regulatory reform process.</span> <span class="attribution"><span class="source">Kristina Alexanderson</span></span></figcaption></figure><p><em>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic.</em></p>
<p><em>Today, we look at whether we can regulate to curb the epidemic. Here Fiona Haines discusses the barriers to regulations that would help end the obesity epidemic while Bebe Loff and Helen Walls argue <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">there’s a “gap” in regulation waiting to be filled</a> with government action.</em></p>
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<p>The burden of obesity is costly to individuals whose health is poor and who are often stigmatised. And it’s costly to governments through increased health costs. So, why isn’t more being done?</p>
<p>Tackling obesity effectively will involve increased regulation, such as requiring clear labels on food to make sure people know what is healthy (so-called traffic light labelling) and prohibiting junk food advertising to children during peak viewing hours. Both of these measures are recommendations of the 2009 <a href="http://www.health.gov.au/internet/preventativehealth/publishing.nsf/content/tech-obesity">Preventative Health Task Taskforce</a>. And both make sense. But, getting effective regulation in place is hard. Why is it so difficult?</p>
<p>Firstly, regulatory reform is challenging for government. During the process of regulatory reform, government attention is diverted away from the problem at hand (in this case obesity) to responding to business concerns with their profitability. And to reassuring the population at large (often in the wake of some public pressure) that the government really is taking the problem seriously. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=460&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=460&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=460&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=578&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=578&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12283/original/g5gxt24w-1340779005.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=578&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Front-of-packet traffic-light labelling would be an effective way to signal what foods are healthy.</span>
<span class="attribution"><span class="source">Ian Clark</span></span>
</figcaption>
</figure>
<p>Dig a little deeper and what is at issue is political legitimacy that must be maintained (and preferably enhanced if you are the incumbent government) through the reform process. </p>
<p>Regulatory reform always takes place in the context of maintaining political legitimacy. In turn, political legitimacy (or political risk as I call it in <a href="http://www.e-elgar.co.uk/bookentry_main.lasso?id=13769">The Paradox of Regulation</a>) rests on the horns of a dilemma between “keeping the economy going” (which often translates into responding to business demands) and “making people feel safe” (essentially, reassurance). </p>
<p>But a government tending to its legitimacy cannot simply be dismissed as engaged in a cynical political ploy. It may be, but without legitimacy governments struggle and ultimately fall. Legitimacy is critical to any government – of whatever persuasion.</p>
<p>It does mean, though, that regulatory reform is fraught – and the loser is too often a potentially effective measure to deal with a social problem. Governments across the world – including our own – have swung into action against obesity at least at the level of inquiries, recommendations and policy initiatives. But how well these translate into action depends on how a government manages its political risk. </p>
<p>The bargaining process often sees businesses taking some steps to appease government and public demands, such as putting labels on food, but not ones that communicate clearly and effectively, or a voluntary (and small) reduction in television advertising of junk food to children. It also sees governments reassuring us, by such measures as public campaigns with cute figures encouraging us to “exercise more”. Measures such as these are unlikely to make much of an impact in reducing our collective waistlines.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=428&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=428&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=428&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=538&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=538&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12284/original/r25tfqqm-1340779159.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=538&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Limiting junk food advertising to children during peak viewing hours would be an effective measure.</span>
<span class="attribution"><span class="source">RichardBH/Flickr</span></span>
</figcaption>
</figure>
<p>Decisive action by governments – the oft-cited “strong political leadership” is critical to effective regulation. This must be based on weighing up available evidence and not just showing strength for the sake of it. Evidence is tricky, though. Pushing for “more research” is a common stalling tactic.</p>
<p>And there are additional challenges. Even if measures supported by the best available evidence (such as traffic light labelling on the front-of-food packaging and removing advertising junk food to children between 6am and 9pm as recommended in the <a href="http://www.health.gov.au/internet/preventativehealth/publishing.nsf/Content/taking-preventative-action">Government’s response</a> to the National Preventative Health Taskforce) are implemented, regulation is no panacea. </p>
<p>Regulation suggests that you can reduce a problem (such as obesity) while keeping all the benefits (to individuals, companies and governments) that have led to higher rates of obesity. These benefits are part of a very long list that includes cheap takeaway food, sprawling suburbs with affordable housing but little public transport or amenities, short meal breaks, long working hours, quick treats for ratty kids when you’re tired from a long day’s work, high profits in the food processing industries, foods that are transportable and keep for long periods without spoiling and so on. </p>
<p>Regulation acts a bit like a “surgical bombing raid” – it promises much, but often delivers less.</p>
<p>The Commonwealth Government was wrong in rejecting traffic light labelling. But, comprehensive measures to tackle obesity will not come in a single convenient package. Tackling obesity in a serious manner will bring considerable public benefit. But it creates losers – both powerful businesses and ordinary folk – in the short term. That is our dilemma.</p>
<p><br></p>
<p><strong>This is part six of our series <em>Obese Nation</em>. To read the other instalments, follow the links below:</strong></p>
<p><strong>Part one: <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">Mapping Australia’s collective weight gain</a></strong></p>
<p><strong>Part two: <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a></strong> </p>
<p><strong>Part three: <a href="https://theconversation.com/explainer-how-does-excess-weight-cause-disease-7061">Explainer: how does excess weight cause disease?</a></strong></p>
<p><strong>Part four: <a href="https://theconversation.com/recipe-for-disaster-creating-a-food-supply-to-suit-the-appetite-3218">Recipe for disaster: creating a food supply to suit the appetite</a></strong></p>
<p><strong>Part five: <a href="https://theconversation.com/whats-economic-growth-got-to-do-with-expanding-waistlines-6260">What’s economic growth got to do with expanding waistlines?</a></strong></p>
<p><strong>Part seven: <a href="https://theconversation.com/filling-the-regulatory-gap-in-chronic-disease-prevention-6127">Filling the regulatory gap in chronic disease prevention</a></strong></p>
<p><strong>Part eight: <a href="https://theconversation.com/why-a-fat-tax-is-not-enough-to-tackle-the-obesity-problem-6443">Why a fat tax is not enough to tackle the obesity problem</a></strong></p>
<p><strong>Part nine: <a href="https://theconversation.com/education-wealth-and-the-place-you-live-can-affect-your-weight-7941">Education, wealth and the place you live can affect your weight</a></strong></p>
<p><strong>Part ten: <a href="https://theconversation.com/innovative-strategies-needed-to-address-indigenous-obesity-7099">Innovative strategies needed to address Indigenous obesity</a></strong></p>
<p><strong>Part eleven: <a href="https://theconversation.com/two-books-one-big-issue-why-calories-count-and-weighing-in-6372">Two books, one big issue: Why Calories Count and Weighing In</a></strong></p>
<p><strong>Part twelve: <a href="https://theconversation.com/putting-health-at-the-heart-of-sustainability-policy-7914">Putting health at the heart of sustainability policy</a></strong></p>
<p><strong>Part thirteen: <a href="https://theconversation.com/want-to-stop-the-obesity-epidemic-lets-get-moving-7233">Want to stop the obesity epidemic? Let’s get moving</a></strong></p>
<p><strong>Part fourteen: <a href="https://theconversation.com/fat-of-the-land-how-urban-design-can-help-curb-obesity-6445">Fat of the land: how urban design can help curb obesity</a></strong></p>
<p><strong>Part fifteen: <a href="https://theconversation.com/industry-sponsored-self-regulation-its-just-not-cricket-6714">Industry-sponsored self-regulation: it’s just not cricket</a></strong></p>
<p><strong>Part sixteen: <a href="https://theconversation.com/regulation-and-legislation-as-tools-in-the-battle-against-obesity-6550">Regulation and legislation as tools in the battle against obesity</a></strong></p><img src="https://counter.theconversation.com/content/6284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fiona Haines received funding from the Australian Research Council for her work in book The Paradox of Regulation: what regulation can achieve and what it cannot.</span></em></p>OBESE NATION: It’s time to admit it - Australia is becoming an obese nation. This series looks at how this has happened and more importantly, what we can do to stop the obesity epidemic. Today, we look…Fiona Haines, Professor of Criminology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.