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STANDING COMMITTEE ON HEALTH AND AGEING
06/11/2008
Obesity in Australia

CHAIR —I welcome the representatives of the Cancer Council of Western Australia to give evidence. Do you have any comments to make on the capacity in which you appear?

Mr Slevin —I hold responsibilities with Cancer Council Australia, our federated body. Up until recently I have been chair for eight years of the Cancer Council Australia’s nutrition and physical activity committee and through that I have been involved with a variety of national organisations, including the Australian Chronic Disease Prevention Alliance, so I have a few hats to wear.

Mr Pratt —I chair the Western Australian branch of the Dieticians Association. I am an accredited practising dietician and an accredited exercise physiologist.

CHAIR —Thank you. Although the committee does not require you to speak under oath, you should understand that these hearings are formal proceedings of the Commonwealth parliament. Giving false or misleading evidence is a serious matter that may be regarded as a contempt of parliament. On that note, I will ask you to make a brief introductory statement and then we will proceed to questions.

Mr Slevin —I will be brief. This covers an extraordinarily broad range of territory as we have already seen from the discussion this morning. The main issue that I am keen to ensure goes on the record in relation to the inquiry is the very clear and growing body of evidence connecting obesity with cancer risk. We know that cancer as a contribution to chronic disease in Australia is growing at a disturbing rate. Even in the absence of growth in relation to obesity, we will expect to see a 30 per cent increase in colorectal cancer and a 25 per cent increase in breast cancer over the next 30 years. If we add the current trends that we are seeing in relation to obesity, although we do not have a precise estimate of what that will mean, it no doubt will be a significant contribution.

There are a range of other less common cancers associated with overweight and obesity. Those include endometrial cancer, oesophageal cancer, kidney and gall bladder cancers; and, with the ongoing research effort into what is contributing to the burden of disease in relation to cancer, there is expectation that more will be added to that list. The single most important message I am keen to leave behind is that, unless we do tackle successfully the growing obesity rates that we are seeing in Australia, and we are seeing those rates around the world, then the price that we will pay amongst other things will certainly be an increase in the burden of cancer and, with that, in terms of the discussion that is the responsibility of this committee, of coming up with some recommendations for progress.

Probably the single, simple message that I could leave you with is to throw support as strongly as we can behind the national Preventative Health Task Force in its recent recommendations. The report from the task force, we think, was a very thorough summary of the available evidence, with some sensible and credible recommendations to tackle what we know is a very substantial and very complex public health problem, from the restrictions in relation to junk food marketing to investment in research, investment in programmed interventions with the appropriate evaluation, both in the area of physical activity and healthy diet. As a simple summary, I will leave you with that.

Mr Pratt —I do not have anything to add at this stage.

Mr COULTON —My question to you is probably a little bit of your submission.

Mr Slevin —Sure.

Mr COULTON —One of the things that has been coming through is a way of dealing with it as a community-wide thing. It may be more successful than a nationwide approach. The Cancer Council possibly, I think, has been the most successful national organisation at engaging people a community at a time, and I am thinking Relay for Life. Have you put any thought, or done any work, into using your Relay for Life model where you engage local champions and involve the whole community? My own small town last year raised $40,000 in 24 hours, a town of 1,200 people. Have you thought of using that model in approaching community health issues such as weight and that sort of thing?

Mr Slevin —Firstly, congratulations on $40,000 of Relay for Life in Dubbo. That is great news.

Mr COULTON —No, Warialda.

Mr Slevin —Warialda?

Mr COULTON —Dubbo has about 40,000 people. I think Dubbo raised about $150,000.

Mr Slevin —That is fabulous. Only two weekends ago I came back from the Relay for Life in Geraldton. Relay for Life is a growing and very successful fundraising program for the Cancer Council. For those who are not familiar with it, teams sign up and do essentially a relay around a track in a community centre or sporting field mostly. And mostly it is people who do that by way of honouring members of their family who have died from cancer or had a cancer diagnosis, and it is a very emotional journal for many of the families involved and an important fundraiser to help the cancer effort in terms of the kinds of programs I am responsible for: funding research, community interventions and so on.

In terms of the analogy between how we work Relay for Life and how we can tackle obesity, it is a fascinating interplay, and in fact it creates some challenges for us. Relay for Life is a microcosm of the community in which it operates. So people would like to do the event and during the evening have a few beers; want to have a sausage sizzle in the morning, breakfast of bacon and sausages and all the rest of it, and have catering through the day.

As the Cancer Council, we have a responsibility to raise the funds, but we also have a responsibility to send a healthy message, so one of the efforts we are making in relation to Relay for Life is trying to have public health messages built into Relay for Life. The committees, who are members of the community—they are not run by Cancer Council staff; they are run by members of the community—have to wrestle with exactly those issues. That is one of the challenges we face internally. The challenge is to try and encourage folks who run Relay for Life, rather than just having sausages and bacon and so on on the barbecue in the morning, to make sure there are some vegies available to go on the barbecue and, in terms of alcohol, to try to tone down the degree to which people see it as a night out, and a camping night out, with plenty of beer and wine and so on to jolly things along. For those who are not familiar with it, it is a 24-hour event, so there are team members going around the track at three o’clock in the morning. It is that kind of a challenge.

I think the question is a good one because it is a very nice illustration of the challenge that we face. We take the norms in the community, we put them into a very specific and confined environment, and then we try and change some of the norms in that environment and lead by example by encouraging the committees to give thought to the sun protection messages that we are responsible for. You, I am sure, know the challenge in your relay for doing that right, but there are also catering issues and, obviously, physical activity. People by definition walking around a track are being physically active for that period. But it is particularly the food aspect that is quite a challenge.

To go on and answer your question in more detail, the example that has been run by Deakin University as an intervention in Colac is probably the best example of an ongoing program that is specifically designed to tackle obesity, but of course you do not do it overnight and you do not do it over 24 hours, you do it over a generation, and so the programs they put in place in Colac involve a whole range of things, from healthy food initiatives to physical activity initiatives, for both children and adults, so it is a whole-of-community event. The early data from Colac that I am aware of is suggesting encouraging results, but of course it is a change that does not happen overnight, so it is an ongoing, long-term commitment to each of the various policy and practice changes in terms of programs—also in terms of policies and what becomes the norm in that community—that is going to gradually reduce the level of obesity that we are currently seeing.

Mr COULTON —I was thinking, too, you put together quite a representative group in the community and probably, if you have them in the smaller places every two years, it is something that you could keep going in between. But you would be pleased to know that at the Moree Relay for Life they totally humiliated their local member by putting him on a rowing machine for two minutes and seeing how far he could go, so they were promoting exercise as well—and I had to pay $2 for the privilege!

Mr Slevin —It sounds like a good plan.

Mr Pratt —In terms of community implementation and public health programs, I think there are a few good examples from Western Australia, one of which is the Guinness world record challenge which the Physical Activity Taskforce here—an intergovernmental agency—organised. For a while we held the world record for the most people simultaneously walking one kilometre. The Canadians then took that off us and we had another go at doing it this year. Unfortunately, we could not get enough people in Western Australia, so we tried to go national, but we did not manage to beat it. So that is a good example of local schools arranging to walk all at the same time.

Another thing that we have done that works quite well, which is not necessarily in this area, is local funding grants. This year we ran the Pink Ribbon Day. We funded some women’s refuges and those types of places to run breast cancer awareness morning teas, where we required them to speak about breast cancer but also to have healthy catering and all those health promotion messages. So that is another good example of that community based approach. The final one where there is some reasonably good evidence is Go for 2&5, which is the fruit and vegetable promotion, where, at times when there is no television advertising, we still see quite high awareness in regional areas because there is often greater nutrition capacity in those areas, and they are doing local promotion and really interacting with the community; so the local communities in regional areas are much more aware of Go for 2&5 fruit and vegetables.

CHAIR —In your submission on pages 4 to 15, I think it was, the Cancer Council advocates the restriction of junk food advertising to children, and from other witnesses we have heard evidence for and against this type of implementation. Is there any evidence based success on coming up with something like this or are you aware of any evidence that might indicate that restricting areas of advertising will reduce obesity?

Mr Slevin —The specific evidence about definitively providing you with a randomised control trial style design to prove that reducing advertising will reduce obesity is not available. That is the truth. We should not pretend that it is. But based on experience, particularly in the tobacco world, and based on a very simple and fundamental argument that advertising’s purpose is to increase the sale of the product that is being advertised, I would argue to you that it is a pretty straightforward story—that is, that there is a big investment in advertising for the purpose of selling more product. We are seeing more products that are unhealthy being consumed by kids. That is an accelerator for obesity and I think we should take our foot off that accelerator. In terms of the tobacco model, I was working in the Quit campaign in the Hunter region in the early 1980s. Newcastle is my home town, Jill.

Ms HALL —Very good.

Mr Slevin —I studied in the university in your electorate, and in those days, when I was in my early 20s, I faced a very similar inquiry, a parliamentary inquiry looking into what options we had in relation to tackling tobacco, and we had this exact same discussion. The discussion was simple: prove to me that stopping advertising of tobacco will reduce smoking. The answer is we cannot, because there are so many other factors that drive smoking.

We have tackled advertising and the many other factors. We have had social marketing campaigns that have been successful. I am pleased and proud to have been part of some of those, and I would like to think that there are some people in Jill’s electorate who are alive today who would not otherwise have been unless we did some of that work, but they do not know me and I will not meet them, and they will not send me a bottle of whisky at Christmas time thanking me for saving their life. That is how public health works. So we have taken the foot off the accelerator in relation to tobacco and done a lot of other things: community based interventions, tax related levers that we have pulled in terms of making the price of tobacco greater, the other kinds of programs we have run to help people to quit smoking. That combination of factors has made a difference and we can show the curve not only in terms of reduction of smoking but reduction in the incidence of mortality from lung cancer, and we can show that trend around the developed world, where taking the foot off the accelerator was a fundamental first step. I think this scenario is a very clear example of a very similar circumstance.

Mr COULTON —In my electorate the communities that struggle with obesity and ill health are the smaller towns that do not have the fast-food chains. I have one city, Dubbo, which has got the whole lot. But in others areas where I have large Aboriginal populations, like Coonamble and Walgett, places that do not have those restaurants, and even some of the smaller ones that do not have a shop at all, the level of obesity is the highest. How do you weigh that up against the advertising bit?

Mr Slevin —What you might do is think of it in terms of relative disadvantage. We know from population data across a whole range of health industries that larger towns, cities, tend to do better. They have access to better services, access to better resources in general terms, and the more remote a population is in general terms, the poorer the health across a whole range of factors. With the larger population centres, by definition come some of those retailers that require certain volume, and that is why you are always going to have representation. The bigger the population centre, the larger the number of those junk food outlets—let’s be straightforward about it. So it is probably a false association to suggest that, because you have got more junk food places and a more healthy population, therefore more junk food equals healthy.

Mr COULTON —No, I was not saying that. I am not forming an opinion either way.

Mr Slevin —Sure.

Mr COULTON —But I am wondering whether the focusing should be of a more positive nature that would affect everyone—for instance, how to deal with the choices that are put in front of you.

Mr Slevin —Yes, I think that is an important issue. We are funded by the WA Department of Health to run the Go for 2&5 campaign that Steve mentioned and one of the things that we do as the Cancer Council in Western Australia is to promote fruit and veg consumption. We work hard at that and use the resources we have to try and encourage positively an increased consumption of fruit and veg, but we do that in the context of a marketing effort that is in the hundreds of times greater than our own that is promoting the unhealthy food.

Let’s put it in political terms. If you are in a party and your electorate is running a campaign for election and you have $5,000 for your electioneering budget and your opposite number competing for the same seat has $500,000, you are going to do it tough to do well. In those simple terms, I would argue that a greater investment in health promotion and taking away one of the arms of promotion of the thing that you are effectively trying to combat is a sensible societal option.

CHAIR —That was in very simple terms that we all understood.

Mr BRIGGS —It would be fair to say—and correct me if I am wrong—that there is a direct link between smoking cigarettes and cancer.

Mr Slevin —Yes, there is a direct link between smoking cigarettes and cancer. Lung cancer and a range of other cancers are clearly associated with smoking cigarettes, and we understand the biological mechanism that connects most of them, but there is an ongoing research effort to further clarify that.

Mr BRIGGS —Yes, it is pretty well known that if you smoke for 20 years you are likely to increase the likelihood of cancer.

Mr Slevin —Absolutely.

Mr BRIGGS —Is there a particular food or foods that are linked to causing cancer?

Mr Slevin —That is a really good question. The reason I brought this report was to wave it around in relation to that specific question. This is the World Cancer Research Fund’s 2007 report into diet, nutrition and cancer prevention. It is probably the most authoritative summary of the answer to your question that the world has at the moment. In chairing the committee as I have for Cancer Council Australia, I faced those questions from journalists about once every week for that whole period of time, whether it was, ‘Does broccoli prevent cancer?’ or, ‘Does eating chips cause cancer?’ or, ‘Does acrylamide’—a particular component of baked and high-fat foods—‘cause cancer?’

Unfortunately, the answer is very rarely simple. The way in which we know what causes cancer now is that large-scale long-term studies have followed large populations of people. Let us take everybody who lives in Canberra, a population that size, which is about 350,000. These studies take numbers of people of that order and then collect information from them every two years about what they eat, what exercise they do, what they smoke et cetera. You can imagine the challenge of collecting that much information with precision in that larger population.

Then they follow that population—let’s call it Canberra—for 20 or 30 years and then keep tabs on who does and does not get cancer and specifically what kind of cancer and at what stage. Then they can connect the data of those who do get cancer with those who do not get cancer and retrospectively look at the data they have on those people to determine what is different between what was reported, and it invites them to ask questions about—let’s take red meat as a good example. There is a very big scientific debate about red meat’s contribution to cancer. As the information gets more mature and it is longer, we get more cases of cancer and it gives us greater power to make the assessment and gives us more confidence to think that a diet increasing in red meat probably contributes, not to an enormous degree but to a significant and measurable degree, to the risk of colorectal cancer, for example—processed meats slightly more so. There is no evidence of white meat having any increased risk. There is even a suggestion that a high-fish diet might reduce the risk of colorectal cancer. I use that as one example.

But they are categories of food which are a large part of the diet. If you take a small part of the diet—let’s pick at random a Mars bar—we do not have the precision of information about how many people ate Mars bars how many times over what period of time to then blame the Mars bar. So the level of information we have in this report, which involved 21 systematic peer review processes and cost—and I spoke to one of the board members responsible for the exercise—in excess of £7 million, is the best summary of that evidence. It is full of uncertainty, but it gives the best we know about where the trends are.

One of the things that it has most strongly reinforced is that the growing number of studies that have been published are clearly telling the story that overweight and obesity is becoming more strongly linked with cancer and perhaps more importantly—and the reason I am sitting here today—diet, physical activity and weight combined are the most powerful risk factors for cancer for nonsmokers. Given that we are, more of us, becoming nonsmokers, it is becoming a more important issue when it comes to cancer prevention for our kids’ generation in particular.

Mr Pratt —One of the important words that you used in your question was ‘risk’. It is a question of risk. Does everybody who smokes get lung cancer? No.

Mr BRIGGS —No, but a high majority do.

Mr Pratt —With diet, it is a degree of risk. It is not as high as the risk from smoking, but there is still a risk.

Mr BRIGGS —But it also varies.

Mr Pratt —Yes, and the more of those different factors—physical activity is an independent risk factor to body weight, diet is an independent risk factor to body weight and body weight is a risk factor for increasing cancer risk. All of those are heterogeneous behaviours. It is very hard to compare what any two people eat, let alone populations.

Mr BRIGGS —Exactly, but my point is that it is an easy example to use, restricting cigarette advertising and reduction. We have to eat.

Mr Slevin —Absolutely.

Mr BRIGGS —There is clearly a linkage with obesity—I do not deny the research and I know what you are saying—but there are different causes for obesity and so forth. I do not think it is as easy as saying that because we have restricted the amount of cigarette advertising we have reduced cancer. I agree we have—absolutely, that has been part of it—but you cannot say the same for food, because some people can eat McDonald’s all the time and not be obese and some people can eat it occasionally and be obese.

Mr Slevin —Sure. Some people know blokes who have been smoking for 85 years and who do not have lung cancer, but those are the extremes. I understand the point you are making, and in general terms the thing I am keen to reinforce is that this is not simple. We had a trial run with tobacco. We had a crack and we learned a lot from it, but it is not going to give us all the answers. To ignore the signals that it sends us in the face of the complexity of this issue would be madness.

Mr COULTON —You are saying that being overweight makes us vulnerable to cancer.

Mr Slevin —Yes.

Mr COULTON —How we get to be overweight is another matter.

Mr Slevin —Yes.

Mr COULTON —But you are saying that being overweight means we are more vulnerable to cancer.

Mr Slevin —Yes, that is right. Yes, absolutely. I think that is a very good summary.

Ms HALL —Thanks very much. I noticed that you were present when we had the representatives from Telethon Institute for Child Health Research here.

Mr Slevin —Yes.

Ms HALL —They presented a theory or a proposition that the actual input and output of food does not lead to a reduction in weight. Would you like to comment on that?

Mr Slevin —Thanks for putting us on the spot, Jill!

Ms HALL —Any time.

Mr Slevin —My answer is that I understand the technical argument, but we are dealing with populations. There is a story we can give you about which we can be pretty confident—I would think the researchers from the Institute of Child Health Research would agree with it—and that is, as a community, the more we eat and the less we exercise, the more we are going to put on weight. I do not think what they said, in my hearing of it, disputed that. My understanding of what they said was that there are individuals whose story becomes far more complex.

In that context I would not disagree with what they said, but in relation to the take-home message in terms of whole-of-population—when you have to make decisions for whole-of-population in policy setting and resource investment—it seems to me that you can reliably proceed on the basis that a community that eats more and exercises less will gain weight. The levers that we all have available to us to turn that around are to eat more healthy food, probably less food, and be more physically active. So the challenge for the committee is to find the levers to encourage things in that direction.

I think in simple terms there are a whole bunch of things that need to happen. The community needs to take responsibility and individuals need to take responsibility, and I do not think there is any doubt about that, but there are very clearly things that government can do. I wrote this down because I did not want to get it wrong. There are three things, and one of them has not received much attention. Industry regulation got some attention, and I think that is necessary and we could make the analogies of the financial crisis that we have been seeing and some paucity in industry regulation in other parts of the world that has cost us dearly. I think government has a responsibility to regulate, and there are opportunities for regulation in this issue.

The second thing is that government needs to fund what I call, in simple terms, good stuff: good programs. Christine talked about some of the opportunities in terms of funding in her remote community and I think that is a very important microcosm and example of the things that need support. But good programs at population level, things like the social marketing programs that we are running, are underpowered. There is no doubt in my mind about that.

The other things that government need to support are monitoring and research, so we can better understand the problem and better systematically tackle it. That is where I agree entirely with my friends from the Institute of Child Health Research. That research is essential for us to get the policy settings right. The one thing I would disagree with them on is that I do not think we need to do the research first, before we do something. My argument is, we do something—and we have got some lessons from other areas of public health—and we measure it responsibly, sensibly and rationally.

There was a question you put to them about what do we do? In the research world, can I offer you a model. The HIV-AIDS issue came up in Australia in an enormous way in the early 1980s. Neal Blewett was the Minister for Health. What he did was set aside a substantial amount of funds—and there is still a remnant of that today in the National Health and Medical Research Council’s research funding program—to specifically focus on HIV-AIDS. That is a health disaster prevention story that does not get a lot of attention these days because it worked, and that is how prevention works: if you stop the problem, people do not hear about it as much.

But that significant and ongoing investment in research in relation to HIV-AIDS has been one of the great success stories in the Australian health system. I would argue that now is the perfect time for exactly the same kind of program in relation to obesity. That investment in research in relation to HIV-AIDS was not at the cost of running programs, interventions and services; that was in addition to. That is something that government can do.

There was a third thing that I offered to you that I have not heard much about in relation to this inquiry, and that is government setting an example. Government is a very big employer, a big influence on the community in terms of being a buyer of goods and services. My example to you is the one that was committed to by the British government in its cabinet document. I do not have 10 copies of this, so I apologies to the organisers. It is a hefty tome and I can certainly give you the reference for it.

One of the things that the British government has committed to is, ‘Serve healthy food.’ If all the Australian government instrumentalities, whether it be at Parliament House or government departments, had a policy in place of serving healthy food, (a) it would reach the people that you have direct contact with and (b) it would drive an important market signal. The people in your electorate would suddenly see an increase in demand for the healthy stuff that they are growing, get a better price, be encouraged to push more of that product and more of that healthy stuff and that will have a flow-on effect. So leading by example is the third thing that I suspect has not been as much reinforced to the work of this committee.

CHAIR —You spoke about three different things and what governments should be doing. One was implementing some good programs. What would be the most immediate good program that a government could implement?

Mr Slevin —This is where I play my, ‘There is no one magic bullet.’

CHAIR —If you had the choice to implement a program, what would it be?

Mr Slevin —There are two things, and there are some good examples of success in Western Australia that we could point to. The Go for 2&5 campaign is one that we have mentioned a couple of times. We saw an increase in consumption of vegetables based on self-report in the data that we collected over the period of time the campaign ran, particularly in the mid part of this decade. But, with ongoing population monitoring in terms of self-report of what people are consuming in relation specifically to vegetables, we see that that tails off when our campaigns are off-air but we know that, if you want to think of it in those terms, our competitors are continuing to market their products.

So there needs to be an ongoing effort to sell the good stuff. Programs that sell the good stuff, and that relates to physical activity as well as healthy food consumption, are things that you can fund. I have got a page of examples of good things that are happening in Western Australia. One, off the top of my head, is a thing called the Crunch&Sip program. I am very keen to get that on the record. Crunch&Sip is a program born in the Great Southern region of Western Australia, out of a town called Albany, and has grown throughout Western Australia. We have the responsibility of promoting that.

It is aimed at primary schools. It provides an opportunity for primary school kids to have a crunch—healthy fruit or vegetables—and sip—water—in the classroom during the school day, mostly in the afternoon session of school when primary school kids are needing a little break for five minutes; but every day. The school does not provide the fruit and vegetables, the family does. The family gets into the habit of doing that. The kids get exposed to more variety of fruit and vegetables. They see things that they might like to try, that their mates have brought along, particularly with an ethnic mix where kids get greater exposure to it; and it becomes the norm. That is what they do every day.

We have got 238 of the 965 primary schools in Western Australia who have signed up, about 25 per cent, and we are working hard to increase that percentage. But can I tell you through randomised control trial evidence that it is increasing fruit and veg consumption? No, I cannot, because our funding allows us to do it. It has face validity. I would love to be able to run a randomised control trial to test whether that worked and there was no substitution—that is, there was no experience of kids who were in Crunch&Sip schools had their fresh fruit or vegies at school time rather than after school. We want to try to avoid that kind of effect. We want to see that there is a total increase in consumption of fruit and veg in those kids, but that takes a much bigger investment than what we have to run the program. To run a properly controlled research program of that kind would cost between four and five times more than we have to run the program.

We are very thankful to the health department for supporting that program but again, we can do what we can with the resources that we have. To see it go to the next level, the program I talked about earlier provides a fund which allows us to do the kinds of things that our friends from the Institute for Child Health Research recommended—and that is, more closely examine the impact of these programs, so we can calibrate, change and develop our programs to be more effective. If I may, I will refer you to Steve to talk about some of the effective programs in relation to physical activity.

Mr Pratt —I will just finish off on Crunch&Sip. We know that, at the last survey that came out, the children and adolescent physical activity and nutrition survey that was done here in 2003, on the day of the survey 40 per cent of children did not eat any fruit; so by having a Crunch &Sip break, you can join the dots together there without having to use a randomised control trial evidence.

Physical activity in Western Australia has been a success; not wholesale—we have not won the war—but certainly we are on the right track. In or around 2000, the Premier’s physical activity task force was set up. That is an intergovernment agency comprised of senior people from each of the large agencies that have a stake in physical activity. One of the things that the task force has done over time is made a lot of agencies realise for the first time that they have a stake in physical activity. Now we are seeing really strong involvement from the transport sector, because greenhouse gas and global warming is on their agenda. By getting people walking, we can solve two problems at once: we are getting people more physically active and we are cutting down on those emissions.

There are a bunch of others. Education is a reasonably obvious one with physical activity and we have got the health department on there. Crime prevention is another one where we are starting to see some effects. If people are more active in their neighbourhood, it means that there are eyes on the street. Increasingly, agencies are engaging in the physical activity task force. Between 1999 and 2002 we saw a decrease in the number of people doing what we call ‘sufficient’—that is, 30 minutes of physical activity a day. Since then we have seen it come back up to that 1999 level. Can we identify what it was that made it go back up? No, because there were lots and lots of things that happened. There were lots of people pulling in the same direction. That is part of the complexity of these things. We have to do a whole lot of things because the drivers are different for different people.

Other successful physical activity programs: the two hours a week of mandated physical activity in schools is a good thing. I think that that certainly puts it on the agenda. The Active After-School Communities program, a federally funded one, is another example. Find Thirty Every Day is the local social marketing campaign, and certainly that has good awareness. They are the ones that spring to mind.

Ms HALL —Leading on from that, in Western Australia has there been a whole-of-government, whole-of-community and, for those organisations involved in this area, whole-of-organisation approach to addressing obesity? If so, how? If not, what needs to be done?

Mr Pratt —Interestingly, we had a discussion with the incoming government here in the context of that about where the physical activity task force goes. That is one of the things that came up: does the physical activity task force address obesity? A model certainly evolves from that. We have had that joined-up thinking for physical activity. For nutrition, it is a different story and I do not think that there has been that joined-up food strategy. We have certainly had nutrition strategies and we have Eat Well Australia, which is the national strategy that is due to run out soon. The next step is food.

As I talked about with physical activity, we have engaged all these other sectors that have a stake in it. Nutrition is not just nutrition. It is about food. We have growers and industry and all of that. Transport is an important one, and we have heard about the difficulties in regional communities. I spent some time doing fruit promotions in Warburton in Central Australia—a bit further out than Laverton—so I am acutely aware of those problems, having paid $2 for a tomato. So transport becomes an issue there.

The other problem is making nutrition and physical activity solely about obesity. We know that there are a million other things that physical activity is good for and similarly with nutrition. I think you need to then have a join-up of those two main driving factors to get that community thinking.

Mr Slevin —To add to that, the Cancer Council, along with the Heart Foundation, has some funds from the state health department to run a healthy weight program and, in a social marketing campaign, a range of things that go around that. Its target is not so much weight loss but preventing weight gain. That is a change in thinking and it is about not saying, ‘You’re fat; lose weight.’ The first port of call is, ‘Don’t gain weight from where you are now.’ That is in the development phase and it is working very closely with ABHI—the Australian Better Health Initiative—that was introduced only very recently.

That is very much a health education style of approach that talks about people as they get older, finding it easier to put on weight et cetera. This campaign is going to be very much about trying to prevent that weight gain and the 20 or more decisions we make every day that influence our weight. They are all very small but are things we can do in a positive direction—the fruit instead of the biscuits, the stairs instead of the elevator et cetera. It is those kinds of behavioural prompts that we are working on.

In terms of where we are going in relation to obesity control in Western Australia, we are doing okay, and I think we are probably doing a little bit better than some other states. It is not perfect by any stretch of the imagination, but I think there is a very clear focus on trying to work in a cooperative manner towards the kinds of goals that you are sharing as well.

Ms HALL —I have asked a number of other witnesses about labelling. What are your thoughts on the best and most effective approach to labelling?

Mr Slevin —I chaired Cancer Council Australia’s nutrition and physical activity committee when the proposal came up to support the research that came out of Cancer Council New South Wales and Choice, which you are probably familiar with—the recent comparison in supermarkets. It was an intercept survey comparing the percentage DI with the traffic light labelling system. Essentially, the findings of the study were that people liked percentage DI but, when they were tested on discriminating between healthy and unhealthy food, the traffic light system performed better.

Based on that evidence, I would argue that the traffic light system is simpler and is more readily able to be used. I would also suggest to you that it is likely to influence the constituency of, particularly, processed food, because manufacturers will aim to get as few red lights on their packaging as they can. Therefore, some of that reformulation of the food supply will have probably the single most important benefit when it comes to that. I think the percentage DI is too complex. It is too hard for most people to work out.

Ms HALL —Thank you.

CHAIR —Thank you very much. The committee appreciates your submission.

Mr Slevin —And we appreciate the opportunity.

[12.34 pm]