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Obesity in Australia

CHAIR (Mr Georganas) —Good morning, Dr Roberts. Welcome. We will hand over to you for your presentation.

Dr Roberts —Thank you. I am a member of the National Preventative Health Taskforce. I am also one of the nine experts on the task force. In my day job, when I am not involved in the task force work, I am the CEO of the National Heart Foundation of Australia. Thank you very much for the opportunity to spend a bit of time with you this morning. Obviously, the work that is going on through this House of Representatives inquiry is very important and hopefully is going to be very complementary to the work of the task force. I know that you have two or three of our documents. It is not my intention to repeat what is in the documents but simply to highlight some of the key points that we are making in the discussion paper and in our obesity technical paper, and then I would be delighted to answer any questions that you might have for me this morning.

The task force was established in April 2008 by the Minister for Health and Ageing, the Hon. Nicola Roxon. It is an expert group of nine members with expertise that is quite wide ranging, from public health to health systems research, non-government organisations, industry and academic involvement. The main role of the task force is to develop a national preventative health strategy which will be a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco and the harmful use of alcohol in Australia. We are on a reasonably tight time line because the strategy is due to be submitted to the minister in June next year.

As the first step in developing that strategy, we have released a discussion paper which is titled ‘Australia: the healthiest country by 2020’. Underpinning that discussion paper are three accompanying technical papers on the topics of obesity, tobacco and alcohol. Just before we get into the discussion this morning, I will outline our reasons for focusing on smoking, obesity and the harmful use of alcohol. If you look at those factors and lack of physical activity, poor diet and the associated risk factors of high blood pressure and high blood cholesterol, they cause approximately 32 per cent of Australia’s illness. If you look to organisations like the World Health Organisation, they estimate that, for many people, if we could modify these risk factors alone we could help them gain an extra five years of healthy life. So I guess they are the issues that have really occupied the time of the task force.

I think you have a copy of the task force obesity technical paper. I am sure you are very aware from the consultations and discussions that you are having that the prevalence of overweight and obesity in Australia has been steadily increasing over the past 30 years. In only 15 years, from 1990 to 2005, the number of overweight and obese Australian adults increased by a staggering 2.8 million. If this current trend continues unabated over the next 20 years, nearly three-quarters of the Australian population will be overweight or obese in 2025.

From the task force’s perspective, one of the things that we have been greatly concerned about is the life expectancy of children. If these trends continue, by the time children today are about 20 years of age they could actually fall behind our generation in terms of their life expectancy by about two years. That is a legacy that we are very concerned about and that none of us really want to leave to our children.

We have come up with a number of actions that individuals, families, communities and industry can take. We see that there really needs to be a comprehensive approach. There is an obvious role for leadership from Commonwealth government, state governments and local governments, particularly when you get into planning issues. Our suggested actions that are contained in the document cover the fields of health, education, legislation, planning and research. We are also consulting quite extensively across the country at the moment with state government, industry, local government, peak bodies and organisations and with anybody who is really interested in preventative health. We started those consultations in October and we will be continually them until February 2009. We are holding these meetings in state capital centres and in some of the key regional centres, with a series of thematic roundtables where we can bring together groups, put ideas on the table and really look at where the strengths of the evidence lie to grow and develop the strategies that we will require. We have invited public comment on overweight and obesity, so there is an opportunity for submissions to come into the task force as well.

We have put up a set of proposed areas for action. It does not mean that they will be the final areas for action that will be contained in the strategy, but they are the areas where we believe at the moment there is the strongest evidence for us to take action in Australia. They are in several key areas. The first is being able to work with industry to reshape supply and consumer demand towards healthier products. We are very keen to protect children and others from the inappropriate marketing of unhealthy foods and beverages. We want to improve public education and information. We see it as very important to really embed the opportunity for physical activity and healthy eating into everyday life so that it becomes a very easy thing for people to do.

We need to reshape our urban environments in particular towards healthy options. In partnership with this, we need to recognise that we need to strengthen, upskill and support our primary healthcare system to support people in making those healthier choices. This all starts in child health, so a component of our strategy will have a focus on maternal and child health. With disadvantaged communities, particularly Aboriginal and Torres Strait Islander communities, we are very keen to come up with strategies that will help to close the gap.

Along the way we will need to build the evidence base, monitor what is really going on and evaluate the effectiveness of these actions. I think it has been demonstrated quite well overseas that you can really have a ‘learning by doing’ approach. It is about putting the best strategies into place, but it is absolutely critical for us to be able to monitor and evaluate those strategies and learn from them. These priorities have some specific actions that will focus on individuals, people in a community setting, schools and workplaces, as well as health services and industry. As I said before, we really see a role for all tiers of government to take part.

If we look at some of the practical things in a fairly broad agenda, what are some of the practical things that could come through in the strategy? There are things like reviewing the taxation system to enable access to healthier foods and to recreation and to look at ways to provide disincentives for unhealthy foods. We would like to see stronger regulation of the amount of salt, fat, trans fat and sugar content in food and we would like to look at ways to educate people about appropriate serve sizes in terms of food. Obviously the availability of fresh food is important, so how could we possibly subsidise or look at improving the access to fresh foods for people in rural and remote areas? Maybe that is a subsidy around transport, or there may be different models that could be explored.

We are keen to look at curbing inappropriate advertising and promotion. This could include banning advertising of energy-dense/nutrient-poor foods during children’s viewing hours. We would like to see that go hand in hand with effective national media advertising and public education campaigns to improve eating habits for all and to increase levels of physical activity. There are campaigns in quite a number of the states, and also at a national level there is an excellent campaign that has just been put together around healthy weight. I think there is a lot that we can build on, and a lot of knowledge exists at state, territory and federal level that we really could bring to the table in this area.

Another area that I think could play a role is food labelling so that when people are purchasing their food, either in the retail sector in the supermarket or when they are purchasing takeaway food or when they are in a restaurant situation, there is food labelling that supports and helps them to make a healthier choice.

Finally, I think the biggest area, which is quite a challenge but in which local government play a very key role, is consistent town planning and general building design that really encourage greater levels of physical activity. That can be as simple as ensuring that there are footpaths in new housing developments and that footpaths actually exist on both sides of the street rather than on one side of the street. There is a lot of work coming together internationally that shows that barriers for physical activity, such as people not feeling safe so that they cannot simply get out the front door and walk. These are things that can really stop them or is a disincentive to them in terms of physical activity.

One of our very significant challenges, but a very important challenge and one that the task force has really embraced, is that we see the need to work with industry groups as being very important. We see the food industry as being a part of the solution. I think there is a lot that they can do in terms of helping to contribute to the work in Australia for people to be able to make healthier food choices. We also see that there are opportunities through workplaces and other industry groups to look at things like workplace canteens but also promoting physical activity in the workplace as well.

As I have also noted, obesity is of great concern for us in Australia, particularly in disadvantaged groups. Aboriginal and Torres Strait Islander people will be a major focus and we will be working with some other committees that have been established in this area to make sure that we are coming up with complementary strategies. With childhood obesity, I think we need an approach that goes across the life course. I think it is often easy to think that we can just focus on children and educate children, but children live within our quite complex community and I firmly believe that we need to have strategies that can really impact on children within a school setting, in a preschool setting, within their family environment, within their community and then across into workplaces and across the whole of that community. Parents and other people are great role models for their children and so I think it is going to be important for us to have a total approach to this area. The reality too is that it is going to be important to almost turn the tap off in terms of what is going on in terms of obesity in Australia today. In doing that, we have to encourage those people who are at a healthy weight to maintain that healthy weight. We need to look at those who are a bit outside that healthy weight range and are getting into being overweight and try to encourage them to get back to a healthy weight range as well as focusing on growing another generation of young people to be of healthy weight in Australia.

As I have commented a couple of times, I think there is a growing evidence base for interventions in this area. It is not as fully developed as it is, perhaps, in the tobacco and alcohol area. I think that in Australia we have a very proud history of having led the world in many of the public health tobacco control activities that we have undertaken. There are some lessons that we can take from there, but not all of them directly apply to both the alcohol area and the obesity area. I think the task force, as I said, has adopted a very practical approach—that we should not sit on our hands and do nothing. We believe that there is a lot that we can actually do now in a coordinated way right across Australia, and we would really like to learn by doing, which means putting practical programs into place now and then building on them over time. That is a fairly whistlestop tour, I suppose, through our fairly extensive technical paper, but I think it paints the picture of the activities.

CHAIR —Is the committee happy for Mr Bidgood’s staff member to listen in on the proceedings? There being no objection, it is so ordered. Thank you, Dr Roberts. I have a couple of questions if it is okay for me to start off, and then we will open up for some questions and a bit of a discussion. In terms of the actual strategy itself, what is the thinking behind the strategy? I know you have mentioned a few things here.

Dr Roberts —Yes. I think the challenge for us, too, is to be able to come up with a strategy. What we do not want to have is an approach with alcohol, obesity and tobacco totally siloed from each other, so I think there are going to have to be some underpinning components to the strategy, which is going to be really important for us as well. I think one of the key things for us, really, will be that if we look at reshaping industry, supply and consumer demand then there are things that could be done such as, as I said, looking at regulation or the taxation system to be able to look at healthier foods.

CHAIR —How would you look at the taxation system?

Dr Roberts —If we move away from food and look at physical activity, how could we possibly have a situation where we can encourage more people to be physically active? That might be looking at voucher systems; it might be at a local community level, working with local government so that the local gym offers sessions at lunchtime at cheaper rates or is supported in some way so that people who would not normally be able to go to the gym can. I think there are a lot of practical things that could happen at a community level that do not have to be really expensive; it is more about opening up those opportunities for participation.

CHAIR —So, when you say taxation, it is more about rebates for people?

Dr Roberts —It could be in terms of that, or you could also look at the food supply and whether there are things that could be done in that sort of area as well.

Mr BRIGGS —What do you mean by that?

Dr Roberts —There have been some discussions around taxation that could apply against high-energy foods and those sorts of things.

Mr BRIGGS —A fat tax.

Dr Roberts —Yes. I think that is quite a complex and difficult thing to do in Australia. If you look at taxation, it is an approach that has probably worked better in the tobacco area, where we have been able to use tobacco excise. We know that price works very well from a tobacco perspective.

Mr BRIGGS —Is there another country in the world that taxes certain foods because of their health consequences?

Dr Roberts —There have been some suggestions, but at this stage I do not think so. The most recent country that was thinking of doing it was France, and I think they have just pulled back from actually doing that at this particular stage in the context of the economic climate that is going on. There was a lot of discussion and debate about it some years ago, but I think it is quite a difficult thing to really be able to achieve that in a food supply chain in Australia. But one of the things, if you looked at the reverse of that, might be looking at how you can either subsidise fresh food or make it more accessible in rural and remote areas. I think there are a number of things that we really do need to explore.

CHAIR —You mentioned the Healthy Weight campaign, which I think was quite good.

Dr Roberts —Yes.

CHAIR —That is the one where the guy walks down the—

Dr Roberts —The tape measure, yes.

CHAIR —It is very effective and has a very powerful message because you actually see the change of the body shape.

Dr Roberts —Yes.

CHAIR —And then, going back down the tape, he changes again.

—It is a great reminder that it is those little bits of weight that we put on and that add up that are often the problem. What is so appealing to me personally about that advertisement is that it has been very, very carefully developed. It has been very well researched and market tested. It has been done with the cooperation of the states and territories as well. There has been a lot of involvement from NGOs as well. As an NGO community we have seen ways that we can fit around and support a campaign like that. I think it has broad community appeal. It focuses on a male but I think there is a message there for women and a family message as well. We will be able to evaluate that campaign and see how successful it has been. Then it is probably about scaling that up and being able to complement it with other campaigns as well.

CHAIR —I suppose there is a track record, whether it be on smoking or the AIDS campaign back in the eighties. I guess this is similar; it is not gory but it shows the change in a person’s—

Dr Roberts —Yes. And I think there are probably different strategies needed for different things. When we started out in tobacco control I think the advertisements we put together initially were quite a lot softer and then they became a bit more hard-hitting as the community became more accepting of that. I think that is what we will see in the overweight and obesity area as well. It is a different sort of situation because with cigarette smoking there really is no safe level whatsoever, whereas we all actually have to eat. That is the complexity of being able to get that message across. We do not want food to become totally not enjoyable. It is such an important social component of our lives.

Mr BRIGGS —And body image, for that matter.

Dr Roberts —Yes. It is quite a challenge but I am quite confident that we can do it. There are some very good researchers both in Australia and overseas. I think the community is receptive and ready for the message too.

CHAIR —Just touching on overseas, you mentioned earlier that there were some demonstrated programs overseas or some things that were working overseas. Can you go back a little tell us—

Dr Roberts —I think one of the areas that have been very encouraging for us is some of the very early work that was done in Finland with the North Karelia study by Pekka Puska, who worked with the World Health Organisation and now heads up the Public Health Institute in Finland. It was more around healthy weight and it had a cardiovascular disease and heart disease approach in terms of really trying to see whether they could get a message across about reducing saturated fat and encouraging people to look at food labelling. It put campaigns together to work with the food industry. They have certainly been able to drop their heart disease rates in Finland quite dramatically over 20, 30 or 40 years. It is that knowledge about what actually can be achieved that is now being used by other countries. But in terms of the purely overweight and obesity activities it is quite early days. The UK have just put together a strategy. They are only six months into their strategy. Once again it looks to have the right mix of things and activities, but it is quite early days—

Mr IRONS —Did you see this article this morning?

Dr Roberts —No. I did not.

Mr IRONS —You do not need to be obese to go for a stroll in the UK.

Dr Roberts —Yes, and they have a very comprehensive cycling program as well.

CHAIR —That might be an incentive for some people to put on weight!

Dr Roberts —We often think: ‘Well, why would you do that? Why would you pay somebody to walk or to participate in something like that? But if you look at the costs of overweight and obesity to the community, subsidising people into physical activity programs might be one of the best investments we could make. It is going to be very interesting. We are very well placed in Australia to be a part of that leadership group in developing that evidence. I am conscious, because I sit on the board of the World Heart Federation, that our colleagues in developing countries where obesity is becoming an increasing problem are looking to countries like the UK, Canada, the US and Australia to help guide them in the directions that they need to take in the future.

Mr IRONS —I have been involved with junior development in elite sport for quite some time but one of the things that we noticed in setting our programs—I think the key to all of this is physical activity—was that we had a problem getting our message through to the young people. A lot of it was probably ineffectual. First of all we did it through the parents. If the parents do not get involved in the kids’ lives then the kids are starting behind the block anyway. Have there been any programs that might be aspirational and show kids a pathway—how to get to those particular points where you try to set them goals in particular areas? We started pathways for the kids, and once they could see the pathway it all became enlightening for them and there was just a totally different attitude. I think the role of taxing and all that sort of stuff is a really difficult area to go to whereas physical activity to me seems to be the true role.

Dr Roberts —I think in Australia we have moved a long way away from feeling that sport is just about elite sport. It is about participation and we have to be able to break that down. There are programs that are starting to look at that. The Sports Commission has been doing some good work for after school and trying to make those connections between the school, the community and their local sporting group which fits into that community involvement as well. We have probably lost a bit of that with urbanisation in some of our big cities. It is something that is much more common in country areas. There have also been the challenges of upkeep of sporting grounds and insurance problems.

Lots of things that have happened that, when you add them together, have been a significant barrier for that sort of activity and involvement at a community level. I would certainly like to see a focus on that. Along with that, it is a focus on design so that you have open facilities that can be used in different ways—from sport to walking, for different generations, so that older people can go for a stroll and not feel they will be knocked over by somebody zipping along on their skateboard. We need to think about the way we can really assist that process from a planning perspective.

Mr IRONS —In an under-14-year age group, we tripled the participation rate from 40 to over 120 in one year by giving them the pathway. Once they knew the pathway and where they had to go, it tripled the participation rate. It was an amazing result.

Dr Roberts —I think it is the balance between the two in terms of getting children to be active and doing enough physical activity to burn off those calories that they are eating during the day. Coming back to education around serve size and what is an appropriate serve of food for both children and adults, you only have to buy a sandwich just about anywhere at lunch time and you will see that sandwiches are much, much bigger than they used to be. A lot of us were brought up being told to eat everything that is on our plate, and that is a bit of a problem if people start to eat a big meal at lunch time and then they go home and have the same sized meal in the evening.

If you look at the patterns of the ways people eat today, they do not necessarily sit down to have a meal. They tend to have snacks throughout the day. If you add all those up, they are having a lot more calories than they need, so being able to balance that out with some physical activity at every opportunity is really, really important.

Mr COULTON —My electorate is in western New South Wales. This week a diabetes map was released and it was quite frightening. The more isolated towns in my electorate are far above the national average. We talk about planning and urban planning, and I often think that a lot of these infrastructures that are put in around exercise. When I huff and puff my way around the lake in the morning here in Canberra I see healthy-looking, lycra-clad bodies zipping past on the cycleway. Quite often where these cycleways and things are put in, the socioeconomic level of that area is such that they probably do not really need them, whereas they do need them in places like Walgett, Coonamble and Moree, in my towns, where they do not have a gym and they do not have good access to fresh food and things like that.

In your proposals have you thought of the regional aspect of it? If we say, ‘Okay, we are going to put in infrastructure for exercise’, someone who has lived in the bush all their life knows that they are doomed from the start, because they will be whizzing around Pymble and places like that in Sydney and not at Walgett or Coonamble. Have you put any consideration to that aspect of it?

Dr Roberts —That is one of the reasons why we have seen consultation in regional centres as important. There was a consultation in Dubbo recently. We want to try to tap into people’s experiences and understanding of that. One of the key things that can be done in areas like that is to promote walking. There are a number of walking programs that are being promoted across the country. It has been done very effectively in Queensland. It is really about finding a community leader. It might be through the local library or the local council. We have found, particularly with those who are in poorer health, who are a bit overweight and those from lower socioeconomic groups, there has been a lot of social benefit as well as physical benefit from getting involved in a group that might be just walking once a week, for example, as a start. I think we have got to have different strategies for different areas. It is not going to be ‘one size fits all’ solution. It is quite a challenge. I actually grew up in the country, in Western Australia in the south-west, and I know a lot of people who are living in rural regions. So I understand that really quite well.

Mr COULTON —Dubbo is one of my towns, and it is interesting to see in the newer part that there are walking ways—it is a beautiful part of the world; it is like a movie set. But in the housing commission areas and in the shopping centre it is nearly impossible to get around on foot, without being run over, because there are absolutely no walkways. You have got to manoeuvre through the roundabout and through the car park to get to the shopping centre.

Dr Roberts —Which does not encourage anybody.

Mr COULTON —For people at that socioeconomic level, quite often, and with that lack of education and understanding from those young mums about nutrition for their babies, it all just piles up.

Dr Roberts —We have got to look at ways of being able to retrofit some of those sorts of places, and it is really important for people to feel that it is safe for them to walk outside their front gate and be able to do those sorts of things as well. Interestingly enough, it does not have to be about expensive cycleways. It can be as simple as a footpath with lights that can allow people to be able to do that. It is as simple as being able to make sure that you can cross a busy road to get to the shopping centre rather than feeling that getting in your car is the only safe way that you can get there.

Ms RISHWORTH —I just have two questions on two of the elements that you picked up on. The first is the type of food labelling changes you would like to see and some of the elements of that. Obviously the food labelling is not adequate as it is. I never know how much fat or sugar I am eating. The other thing is about advertising junk food to children. We have heard some evidence that although the theme seems to be to ban junk food advertising between 3 pm and 4 pm, when kids are getting home from school, the majority of kids are watching TV in prime time, just like everyone else, around the 6.30 pm timeslot. We have heard evidence that that should be the time. Are you talking about banning, and what types of restrictions are you talking about?

Dr Roberts —I will start there and go back to the labelling. In our discussion paper we have defined children as being a bit older. We have also looked at defining children a bit more like international standards at the age of 16. Therefore we have looked more at the 6 pm to 9 pm timeslot. You are absolutely right. I think there is a level of what goes on in terms of children’s programming, but then there is a lot of influence that happens and broader advertising that is going on. There is strong evidence that for little children, up to the ages of 6, 7 or 8, they really cannot tell the difference between what is advertising and what is programming. I think that, when you get into that next area, the evidence is not as conclusive but I believe it is playing a role. We have seen that with tobacco advertising in the past, and we are starting to see that evidence start to grow. It is really about just being able to have an effective way. Controlling advertising will not solve the obesity problem, but once again it is a package of things that we need. It is really about being able to put a package together in a way that helps to create an environment where there is an opportunity for more positive messages around healthy eating and physical activity to be able to get across to the community, and I think we need to help parents to be able to do that as well. It is quite hard for parents to be the ones who are trying to turn the television off, so I think we do need to look at systems to enable parents to be a little stronger in the family situation and to help them to make that an easier thing to do.

If we go to the food labelling area, there is quite a lot of discussion and different models around food labels, as I am sure you have heard from many people. Once again, I think Australia is in quite a unique position to step back and look at all the research that is there and to think about what it is that we want to achieve with the food labelling system. That is really what our paper has called for—to pull the evidence together and really look at what would be the best model that we could use in Australia.

A lot of people have been very strong advocates for traffic lights. There is no one mandated system anywhere in the world. There has tended to be a bit of a mixture of systems that have come together. I think one of the challenges with the traffic-lights approach is that it is quite a difficult thing for industry to engage with and involve in. It also can be quite confusing for people when you end up with a product that has on it a green light, two oranges and a red light. You have to really make sense of it: ‘Is it low fat that I want today, or is it low this or low that?’ I think we need to think about what we are trying to do with it. Whatever we do with food labelling, once again it will be part of a package. It will need to be supported by really good health education campaigns to be able to explain the context of that.

Ms HALL —Do you have a preference for the type of labelling that you think is most effective?

Dr Roberts —Not at the moment. We have seen the industry come out with their percentage daily intake—and that is certainly increasing—but, once again, it is quite complex. I actually think they are all quite complex. In our document we have also indicated that labelling will not work without some way of setting targets for industry to go for. That is one of the things that I am very impressed about in terms of what they have done in the UK. They have a set some levels around salt. They have been really clear that they want to reduce salt in the food supply. You can only do that by reformulating products or setting salt levels for the industry. What we need in terms of added salt is a very small part of our diet, as am sure you all understand.

So whatever we have with the food-labelling scheme it needs to go hand in hand in a positive way with working with industry to set some agreed standards that we try to achieve. That is quite doable in terms of looking at salt levels in bread and looking at saturated fat levels and trans fat. It is quite feasible as long as the industry has time to modify their products accordingly. You could use a labelling scheme in combination with that in quite a strong manner.

Ms RISHWORTH —I guess, in relation to the labelling, the advantage of the traffic lights is that in schools in South Australian for example they use that to talk about a red-light traffic day being one day a term that they can eat cake and those types of foods.

Dr Roberts —Those occasional foods.

Ms RISHWORTH —Yes, so I guess all these departments are going to have to work together. Whatever the type of labelling, it will have to have a theme that gets pushed in schools and everywhere around the place. That is the benefit I can see in the traffic light system. The kids are already thinking about that at school so it would have to be—

Dr Roberts —That, I think, is the challenge because in the school environment you can easily say, ‘Look, it’s a treat every now and then.’ There is nothing wrong with all of us having treats every now and then. Life would be very miserable if we did not have them. But when you are buying a basketful of food on a daily or weekly basis how do you balance out that red, green and yellow to make up what is going to be your meal for that evening? I think we need to be able to put a lot more assistance and help around it because people need to know what happens when you take that can of this with this and then add it to that. If you add lots of fruit and veggies into whatever your meal is then you might have a perfectly healthy meal but if you add two or three of those cans together, although you have had the best intentions, you might have just put together a meal that is not balanced at all.

Mr IRONS —Yes, if they put one green in their shopping basket they will think they have done the right thing.

Dr Roberts —That is potentially so. When you talk to consumers they like the concept of traffic lights but we do not have good evidence about how it really influences their behaviour, what they really buy, and what they do when they are putting those meals together. There is some work going on in the UK at the moment trying to unpack that a little further.

Mr BRIGGS —Correct me if I am wrong, but you are actually saying that food labelling is probably a side issue. What the taskforce thinks should happen is that governments should regulate the amount of certain products in food.

Dr Roberts —I do not know whether it needs to be firmly regulated or whether it could be done on a voluntary basis by industry. We need to explore that and see what might be possible. Food labelling cannot work just on its own. It is just a tool really that some people will be able to use but they have to be able to understand it. We have to be able to drive down the levels of salt and saturated fats, and also to look at serve sizes. Otherwise you could end up with something that had the right traffic lights but was about this big. It is about trying to get all of that together in a system that will actually work, be of value and really make it easier for people without them having to worry about what salt is. If you look at it now it does not even label it as salt.

Mr IRONS —You cannot read half of it, anyway; it is too small.

Dr Roberts —It is quite a challenging thing, if you are running around the supermarket doing the shopping, to try to pick the healthier products out.

Mrs IRWIN —There is also the cost factor. I talk to people out there in the community. They only have so much per week to budget on and they sometimes go for those products that are a lot cheaper.

Dr Roberts —That is, once again, why I think working with industry is going to be really important to ensure that there are healthier options available. But I absolutely agree with you. In the current economic climate it is quite a challenge. I have a great deal of sympathy for people who go to the supermarket and fill up with the cheaper options. It is a way of feeding a family very cheaply. We have situations where fruit and vegetables can be very expensive. A lot of packaged and preprepared food can be quite expensive. So some of what we have to do, perhaps back in schools and in other environments, is to help people understand how to put together a simple meal quite cheaply.

Mrs IRWIN —I agree with you on that.

Mr BRIGGS —In relation to advertising you were talking about banning advertising to kids at certain hours of the day—you were talking about up to 6.30 in the evening. What about point of sale in supermarkets? From a personal perspective, that is our biggest problem for our toddler. They are just full of chocolates where you stand there. That is, I think, a much more powerful form of advertising—it is there and then—than TV. Would you tell the supermarkets that they cannot do that any longer?

Dr Roberts —I think that is quite a challenge. If you look at what we have been able to achieve in tobacco control, you might be able to go there as a part of a package in the longer term, but starting there is probably quite hard. People do have an opportunity to promote their products. If you think about the advertising of tobacco, we started with bans on the media, in terms of radio and television, and then it moved across into print and then it went further than that. You can still have point of sale advertising.

Mr BRIGGS —As was said before, if you smoke a cigarette for a certain period of time you are likely to get lung cancer.

Dr Roberts —That is the problem. One piece of chocolate a week is not going to be terrible for you but it is if you are eating that every day. I think really that it is probably better to try to work with the retailers to see if there is a way to encourage them to have aisles in the supermarket that are marked up so that you know, as a parent, to avoid them, or perhaps we could encourage retailers to keep things away from the checkouts. A lot of parents get around that by not taking their children but that is not always possible. There are different sorts of things but we really do need to work with industry to come up with solutions.

CHAIR —The reality is that if we all cut down because we should cut down, because all of us—not all of us; some of us—

Dr Roberts —Don’t worry; we all are.

CHAIR —If you weigh it up, if we all cut down we would have a healthier society. But at the same time, sales of chocolates and fast foods would drop. There is a vested interest. It is very difficult. How would you get industry to jump on board and say, ‘Please buy less of my product,’ because really—

Dr Roberts —No, they will just move into the other areas. From some of the work that I am doing internationally it is really obvious that companies like Pepsi and others have made a commitment, for example, to move so that 50 per cent of their products are actually healthier products. I cannot remember the timeline, but it is within the next few years. I think, once you move across into that sort of area—

CHAIR —They have to find other markets.

Dr Roberts —they will move into a different sort of marketplace.

Mr BRIGGS —You are saying ‘healthier’ but they are not healthy, are they? Pepsi still has sugar and salt—

Dr Roberts —No, but they are moving into a whole range of other things like iced tea and fruit juices. They are just moving into production in another whole area. I think the food industry is very creative and if they see genuinely that an area is going to get closed off they will look at other opportunities. I am not for one minute suggesting that we get rid of all unhealthy food because, once again, it can play a role. It is about being able to understand that a treat is okay occasionally; it is not what people should be eating every day. I think it will be a very gradual change, but internationally the food industry is very aware.

If you read the World Health Organisation paper on diet, nutrition and physical activity you would know that they are aware of the sorts of things that are coming down the track. They are aware of the concerns. I think they do not want to be seen as the only people to blame so I certainly believe that they are prepared and willing to have discussions and look at what they can actually achieve.

Ms HALL —The first area I would like to go to is the area that was touched on by Mr Irons, and that is looking at pathways and elite sport. What I would like to throw to you is: do you think that that linking into a pathway of elite sport is the best way to get young people involved in physical activity or do you think that we should be looking at creating a culture where exercise and physical activity is fun and part of life?

Dr Roberts —I think we need both, because there are people that are very interested in sport and there are people who are not necessarily interested in sport. If we could actually bring those together that would be really terrific. I think that it is possible through schools and communities to be able to achieve that. That is why the planning issues are so important in terms of being able to have a whole range of different options and different activities that people can be involved in. It does not always have to focus on sporting facilities but they also play a key role for those young people, and particularly for kids and families that are interested in playing sport.

Ms HALL —I absolutely agree that there should that pathway and the ability for young people to be involved in elite sport but it is the other group that concerns me—the group that has a perception that, ‘Maybe, I’m not so good at sport,’ and therefore does not become involved. What I think is the challenge is to involve that group. The Active After School Sports program is a very good program but it is not available everywhere. I am just wondering whether your taskforce has looked at any other ways to engage the group that does not fit into Mr Irons’s category, which I think is very important. I do not want you to think I was downplaying that—I do think it is very important—but it is the other group that I think is a little bit more difficult to engage. What ideas, strategies, and actions have you come up with to do that?

Dr Roberts —I still think we have some work to do in terms of understanding what might be feasible to do in a broad strategy, and probably what really needs to be done almost at a local community development level, because there will not be one size that fits all. I agree with you; I think it is really about being able to look at what activities can be done either in school or through having facilities where people can go and walk the dog or ride a bike. Even group things can be on. It can be local activities for kids, which might be dance or a million other forms of engagement. Once again, in a national strategy we will be relying on coming up with some broad ideas on that but looking at ways that communities can look at and develop what is required at their local level, because some things will be appropriate for some groups and will not be for others. I think that is always the challenge in this sort of situation and why sometimes it is easier to go with the pathways around sport than it is to put in place that combination of activities that you really want to have so that there is an opportunity for physical activity for all.

Ms HALL —You touched on another area that I want to go to, and that is the planning area and the involvement of all tiers of government—looking at town planning and making communities more exercise friendly. What strategy do you think can be put in place to involve all tiers of government to work together, rather than blaming the other tier of government for the problem that exists? Do you think there needs to be some national town planning guidelines that should be promoted to address the numerous town planning issues such as new subdivisions having footpaths on both sides of the road and sporting—

Dr Roberts —There is some work going on in that area through the Local Government Association, the Planning Institute of Australia and my own organisation, the Heart Foundation, looking at guidelines that would be appropriate to set some of that direction from a town planning perspective. At the Heart Foundation we have worked over the last few years very productively with town planners at a local government level, and at a state level in some of the states. We aim to bring those players together around the table not only to look at new housing developments and what is possible there but more importantly to look at what you can do with retrofitting in some of the older suburbs as well.

I think it is possible. I feel quite positive about that. I think it is an area where there is enormous opportunity to have an influence that can really have a big outcome in the future. If we do not get the planning stage right then it is going to be very difficult to encourage people to be physically active, to have that level of community engagement. You only have to look at some of the things that have happened overseas. If you visit the States and go to some of their big cities and try and walk anywhere it is an absolute impossibility. You cannot even get across the road. We have not done that to the same extent in Australia. I am very grateful and thankful for the fact that we have had some very good planning initiatives, but I think a lot more work can be done in that area.

Ms HALL —And what about the tiers of government?

Dr Roberts —Through the strategy that we are putting together, even though we are producing it for the federal government, it is very clear to us that you really do have to have all of the tiers of government working together. Responsibilities lie at different levels in terms of what can be funded and looked at from a state perspective and what can be done federally and at a local government level. I take great heart from the healthy weight campaign that has just been launched. There has been a fantastic level of cooperation between the states and territories and the federal government to put together a campaign like that.

Having been involved in the national tobacco campaign some years ago, I know that getting everybody to cooperate and put their dollars together and work together in that way is not an easy thing to do, but it can be done. Once again, I think there is a great willingness to participate and an appreciation of the challenge in front of the whole Australia. I think we have a unique opportunity to try to bring people together and to get those different tiers of government to work together.

Ms HALL —I would like to look at the socioeconomic issues now. I do not know if you picked up on a report this week in the media that was talking about poor diet and the influence that that has. It said that it actually leads to DNA changes, which makes people in lower socioeconomic groups potentially even more vulnerable to illnesses. Has your task force looked at addressing the issue? It starts with breastfeeding. That is a cheap option. People from lower socioeconomic groups tend to breastfeed less than other groups. Then it goes through to a whole-of-life approach. You will usually find that obesity is accompanied by tobacco use and other issues. I am very keen to look at strategies that can be put in place. If that report is correct about changes to DNA, then I think that there is enormous incentive for government to address the issue because of the long-term health ramifications and cost to government.

Dr Roberts —I am not aware of the study that you are talking about which mention changes in DNA.

Ms HALL —It was looking at asthma.

Dr Roberts —There is no doubt that the maternal environment, the health of mothers and young babies and all of that area is extremely well documented now. I think it is very important to look at the social determinants of health. One of the reasons why I am here today on my own and not with our chairman, Dr Rob Moodie, is the fact that he is at a large conference of key people internationally that is looking at the World Health Organisation report in this area. We need to look at how we can build a strategy around those sorts of areas because it is going to be incredibly important. If we are going to have a whole-of-life approach and reach disadvantaged people in a meaningful way, I think we have to come up with a strategy that can actually do that. Can I give you all the answers now? No, I cannot. We still have a bit of work to do, but it certainly is a major focus of our activities.

Mr BIDGOOD —I have a couple of questions too. There are a couple of things that I can clearly see. There are the internal personal choices that we can make and, obviously, the external environments and economy that we find ourselves in, which we cannot control. I do agree with what you have said and I am an advocate for regulation on the amount of salt and sugar in diets because, whatever happens, people will buy fast food, whether it is good or bad. My opinion is that when people go shopping, 80 or 90 per cent of the people do not look at the content of food. They rely on their basic knowledge of what they like and what they perceive to be healthy, like fruit. So education is a key. Whether that happens for the next generation through children’s programming time is one thing.

I agree with you that government does need to regulate. It is good to hear that the UK is moving in that direction, and I firmly believe we should. Something which is ironic is that we are victims of our affluent and abundant society. It seems that the human being degenerates to a sedentary lifestyle so we have to create a culture of interest. I picked up on what you said about sport and pathways. I think that is right, so we have to fund these things.

I have also noticed in this report that between 1975 and 1995 the antismoking campaign ‘prevented the premature death of 400,000 people and saved costs of over $8.4 billion’. I was on Mackay City Council in Queensland—the local government. The roads were very poor. It came to the basic thing: people cannot go out at night when the roads are badly made and not lit. Daylight saving is a big issue. It gets dark at six o’clock in winter and seven o’clock in summer. You have the external factors that cannot be changed. So we need well-lit, well-made roads, but ratepayers do not want to pay more rates. However, we see savings of $8.4 billion, so we need economic factors to help influence the external environment. So I am very interested in how you are putting that economic argument: we’re predicting savings over the next 20 years. With hindsight we can say we saved $8 billion since 1975, but how are we going to move those savings into external structures, which will help create a healthy lifestyle and a healthy culture, which enable people to go walking safely at night after work? What sort of economic processes are there?

Dr Roberts —One of the biggest challenges, I think, is to move from seeing it just as a health problem—this is exactly what you are saying—

Mr BIDGOOD —Yes, that is right.

Dr Roberts —into a much broader approach. It is not only to the tiers of government—local, state and federal—that we were talking about; it is across government. That is really where your inquiry is so incredibly important in terms of making recommendations around how you can bring together the various groups. For example, if we look at roads there were things like the Roads to Recovery program in the past and there are the sorts of infrastructure that have not necessarily focused on what could be gained, from a physical activity perspective. When that infrastructure is happening you need to look at ways that people can be physically active—for example, through cycling for leisure or for transport, and other sorts of options.

There is going to have to be more of a whole-of-government approach to achieve that. We are using the UK quite a bit as a model. Interestingly enough, on the other side—not the physical activity side but the nutrition side—they have just put together a fantastic report called Food matters. It came out of their Strategy Unit in July, and it is a fantastic document because it brings together the sort of food journey and everything that you need to do: food safety; how you have an agricultural system in the UK that is still going to be a vibrant UK farming system in the context of Europe; what you do in terms of health and how you have healthy food; what you do about overweight and obesity in that context; and how you work with the food industry and with consumers. It has really gone across a whole-of-government approach. I am very attracted to that idea of food level, but I think also that in terms of physical activity there are ways that we could be working with those in government who are looking at things around the environment, climate change and transport. We have to bring all of those groups together as well, because I think we would find common ground there. I think that is where the economic benefit is going to be; it is not going to be just from a health perspective. If we can get more people physically active and using public transport, we are going to solve a lot of other problems as well.

Mr BIDGOOD —Following on from what you just said—and I appreciate what you said—that leads me to the question: should the role of federal government be to give incentives to local government to create better roads, pathways and things like that. I am thinking—again, from the local government perspective, which is the grassroots—about how federal government can give an incentive to local government. It can say, ‘Okay, you want to build some roads, but you must build pathways, it must be well lit and you must create a bikeway.’

Dr Roberts —Yes.

Mr BIDGOOD —A lot of funding I have seen in local government has been the three tiers—one-third, one-third and one-third.

Dr Roberts —Yes.

Mr BIDGOOD —That seems to work. Would you be advocating that? That sounds like it.

Dr Roberts —It is not the area of my expertise, but it seems like a sensible approach, because I think that what we also do not want to do is to end up building things that people will not use.

Mr BIDGOOD —Precisely.

Dr Roberts —So it is very important, I think, to have local government or community engagement and involvement in some of those decisions, because sometimes it is not building something new. It might be making sure that the swimming pool is renovated or can be kept, or it might be making sure that you can do something else about the sporting ground because there is a drought on. So what can you do about being able to create an environment or look at something else in terms of turf that could be used? There are different things that would be appropriate for different areas, so I do think that level of community engagement and local government is going to be very important in those decisions, because bike paths are not going to be the solution for everywhere. But they will be in some situations.

Mr BIDGOOD —That is right. Thank you.

Mr IRONS —I will ask this quickly because I think we are out of time. Jill, I will just let you know that I was talking about pathways to general activity, not just to sport.

Ms HALL —I think what you were talking about was good.

Mr IRONS —Dr Roberts, there were a couple of statements you made; you said things about community and ‘easier’. To give you an example, I went to two sporting functions for presentations at the end of the year. One, in a high socioeconomic area, had salad sandwiches, fruit and everything at the presentation with all the junior kids there. I went to one in a lower socioeconomic area, and they had Pizza Hut stuff there. I asked, ‘Why did you choose Pizza Hut?’ and they said it was easier, which was another word you said during your talk—about the easiness of it.

CHAIR —Convenience.

Mr IRONS —Convenience. They are setting a poor trend for those people and their lifestyle.

Dr Roberts —Yes.

Mr IRONS —The other point was about town planning. One of the areas we noted was that, particularly in Western Australia, some of the new outer suburban areas are only having a park with a fountain; they are not having a school oval, parks to play soccer or football in or anything like that. Another area with schools was sporting facilities. A school I visited did not have any footballs at the school because they did not want the kids hurting themselves, so the kids who only wanted to play football were not playing any sport at all.

Dr Roberts —Yes.

Mr IRONS —It was a mentality of not hurting yourself, so they did not want to play anything because they did not have the right facilities or equipment to play the sports they particularly wanted to. You talked about this taking a length of time. Is this going to be a generational change, do you think?

Dr Roberts —Once again, going back to tobacco control, I think we are talking about generational change. We have said that we want to halt and reverse it by 2020. To turn the clock right back and have a situation where we go back to much lower levels of overweight and obese people will take time. To achieve behaviour change and be able to put the appropriate mechanisms in place to support that and be successful will mean having a gradual change over time. That does not mean that there is not a lot that can be achieved in terms of helping some of those people who are overweight now to get back to a healthier weight range. A lot of gains can be achieved from that. Having worked in public health and in the behaviour change area for a long period of time, I do not think it happens rapidly. Gradual change is the most effective way. If you think about that, it is often the situation with people who go on quick diets. They will go on a quick diet and lose weight but often they will put it back on again. To be able to achieve that will be about taking the community on a journey over a period of time and really helping and supporting the community to be able to achieve that.

I think that people are much more ready to be able to do things and actively participate in that than they were perhaps a few years ago. Parents are concerned about their kids being overweight and obese, governments are concerned and the food industry is concerned. It is no longer just a health problem. We have a number of other sectors that are very concerned about the impact this will have on their workforce in the future. I think we are in a really ideal situation to be able to seize that moment and put a really comprehensive strategy into place.

CHAIR —It is interesting that we are comparing this to the antismoking campaign, which was a very good and successful campaign. I am an ex-smoker and recall that, when I was smoking and was at home with my family, my kids would hound me to death saying, ‘Dad, give it up,’ and my wife would be doing the same thing. When I was at my workplace and went out to have a durry, people would say, ‘You really should give that up.’ But none of us go to anyone and say, ‘You should really lose weight.’ It plays a big role. Psychologically, it helped me give up tobacco, because everywhere I went I was getting this message. It is a very different thing with food.

Dr Roberts —I agree with you. I think it is much harder.

CHAIR —Should it be acceptable that we go out and—

Dr Roberts —Even for general practitioners it might be quite difficult to say to parents, ‘We think your child is overweight,’ but I think we can change that over time as we did with tobacco. In the tobacco area we were always really clear that we were not anti the smokers, we were anti-smoking, and we really wanted to assist the people who smoked to quit smoking and help our kids to not be smokers. I think we can do the same in the overweight and obesity area. It is not about trying to ridicule or persecute a particular person for being overweight; it is about being able to provide assistance to them in a practical way that does not totally threaten them. If we build those campaigns and that level of education, you suddenly get the healthier choices in workplaces and you have the other options to do X, Y and Z. I think it builds an environment where people feel a bit more personal responsibility, hand in hand with the shared responsibility that we all have to help solve this problem. I might be an optimist but I feel very optimistic that it is possible to do some really good work.

CHAIR —Thank you very much. That was very interesting and that is why we have gone over time.

Dr Roberts —I have really appreciated the opportunity to meet with you and, potentially, it would be good for us to keep in contact as our work develops.

CHAIR —Yes, and I am sure that will be the case.

Dr Roberts —I would be very pleased to do that.

CHAIR —Excellent. Thank you very much, Dr Roberts.

Dr Roberts —Thank you. Have a good day.

Committee adjourned at 9.49 am