Proof of the pudding: health campaigns don't work
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There is slim support for the belief that preventive public health policies have brought obesity and lifestyle disease under control, or that they are likely to in the future. (File photo) (ABC News: Cate Grant)
Public health experts routinely advise governments that the best way to address the long-term challenges facing the health system is to 'invest' more taxpayers' money in public health education and promotion policies. The latest version of this advice is that governments should invest more money in 'preventive' primary care to control the prevalence and contain the cost of 'lifestyle disease'.
The differences between classic preventive medicine and public health education and promotion raise important questions about the case for more spending on prevention as an effective method of controlling lifestyle disease. When one elaborates on these differences, it helps to make sense of the evidence-based story told by decades of failed public health policy.
The experts and lobby groups tacitly admit what rising obesity levels amply demonstrate: that public health education campaigns have not been as universally successful as it was hoped they would be.
What they tend to suggest, though - to obscure just how unsuccessful these policies have been - is that the evidence does not yet show what works. They also like to suggest that rising rates of obesity show that not enough of the health budget goes to prevention.
The latest version of these diverting arguments is displayed in the Rudd Government's policy document: individuals are absolved of their primary responsibility for the unhealthy lifestyle decisions they continue to make, and the lifestyle disease 'epidemic' is blamed on a lack of government-funded entitlement to preventive primary care.
Rarely considered are the real reasons - the limits of government authority over individual behaviour, and the importance of personal qualities in regulating it - why nearly 40 years of health promotion has coincided with ascending rates of lifestyle disease.
War on smoking
Instead, advocates of more spending on lifestyle disease prevention often draw false parallels with the success of the campaign against tobacco smoking. Yet the war on smoking is a special case. Bans on smoking in public places, and higher and higher tobacco taxes, are more of an example of public health regulation than health promotion.
The war on smoking has been more like traditional public health measures and the way governments have intervened to compel seatbelt use and attack drink-driving through enforced legislation. There are also huge differences between the kinds of behavioural change that anti-smoking and diet and exercise campaigns have each aimed to induce.
Anti-smoking campaigns have targeted a specific behaviour and cajoled individuals to decide to quit one bad habit. A similar example of behavioural change is the campaign to encourage condom use to prevent the spread of AIDS.
Diet and exercise campaigns, by contrast, require people to actively do a series of things to change their lifestyle and to sustain those changes over the long term. The success of the anti-smoking campaign compared with the relative failure of healthy diet and exercise campaigns points to the real and demonstrated limits of the effectiveness of 'prevention.'
It is simply very difficult to induce people to initiate and sustain a series of changes to complex and often longstanding behaviours, and to continually decide to make healthy decisions about diet and exercise - no matter how hard, or in what form, governments push the healthy lifestyle message on those unwilling to act on that advice.
Merry-go-round
Nevertheless, prevention lobby groups such as the Australian Chronic Disease Prevention Alliance (ACDPA) - a combination of non-government prevention organisations formed in 2005 to press the governments for greater spending on prevention - continue to promise that 'investing in promoting increased levels of physical activity and healthy eating in Australians would reduce the burden of chronic disease now and in the future.' Hence a recent report by the Australian Centre for Health Research calls for a greater emphasis 'on personal lifestyle and wellbeing (preventative care)' and 'on public health programs that keep people out of hospital,' which the report assumes 'should result in medium to long term reductions in overall expenditure,' as if this process is sure and seamless.
It is worth pausing to consider just what is riding on this assumption: ensuring the cost of Medicare does not become an unsustainable burden on future generations, as this report puts it.
Despite what is at stake, the key question - perpetually glossed over and subsumed beneath the mantra that governments should spend more on prevention - is the only one that counts: does 'prevention' actually work?
It is therefore timely to review the evidence. Because when the assumptions are questioned and the evidence examined with a clear eye, what is revealed is that there is actually slim support for the belief that preventive public health policies - be they 'community-wide' or 'high-intensity' lifestyle interventions - have in the past brought obesity and lifestyle disease under control, or that they are likely to in the future.
Dr Jeremy Sammut is a research fellow at the Centre for Independent Studies. His paper The False Promise of GP Super Clinics, Part 1: Preventive Care is available at the CIS website.
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Comments (108)
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Bullfrog:
09 May 2008 9:42:23am
Many people would agree that prevention is better than cure. However, the current process doesn't seem to work (according to the good Doctor). I note that it doesn't specify that he is doctor of medicine, just a research fellow . . .
In any case, if prevention is not working, what other solutions do we have?
Truly draconian policy on what food, and how much we can buy? Down to a calorie (kilojoule) type card, tracking the number of calories purchased by a family, and then applying a strong encouragement (read fine / tax) for those who exceeded the recommended amount?
Alternatively, making not attending some form of regular exercise a tax burden? And how to sort out the proof? How to drive employers to allow such time to be available (as a person who works in major industry, during overhauls you work some seriously long hours, and have no interest in anything other than eat and sleep).
Or do we go down the path of tuning the health care system, so that those who self-inflict the damage (through smoking, excess alcohol, or poor diet to name a few), are depriotised in the treatment list.
None of the above options seem feasible to me. It may be that an education campaign, as ineffective as it is, is the only palatable solution. And there may be ways of improving the process. An example may be to have many more bike tracks made, so that people aren't dodging murderous drivers (as per Sydney yesterday).
So you not only educate, but make the facilities available.Agree (0) Alert moderator
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John:
09 May 2008 10:14:38am
The solution to obesity is simple, though unpopular: convert every road to a bicycle path.
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toby:
09 May 2008 11:25:11am
It's simpler (and cheaper) than that: eat less, eat right. Of course, the chances of this happening are about as likely as everyone riding a bicycle to work.
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JayR:
09 May 2008 12:03:02pm
And perhaps make health care for obesity related illness USER PAYS.
Its preventable, so you can avoid it, its your choice.Agree (0) Alert moderator
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toby:
09 May 2008 12:16:04pm
There are many, many illnesses that come down to lifestyle choice; your suggestion is a slippery slope.
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james:
09 May 2008 1:15:18pm
Should be the same system for active people, buggers keep injuring themselves with all that physical activity. Wait...
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Greg:
10 May 2008 8:33:59am
No it's not. It's in our nature and the way we are designed, for people to exercise and exert themselves physically.
We were not designed for substances or over eating. People have accidents doing things. That's natural. People who abuse themselves through substances & over eating is their wrong choice.
We should not be paying for their health care.Agree (0) Alert moderator
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Ann:
11 May 2008 5:14:18pm
Don't forget the idiots who get skin cancer from going out in the sun. I don't want to pay for them. What about people who have high cholesterol, shouldn't have to pay for their treatment either. Now let's see, smokers with their lung cancer, athletes and their injuries, car accident victims if they caused the accident, drug addicts, old people because they grew old, people with liver cirrhosis. Gosh, I think I've just saved the public health system.
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Jamie:
09 May 2008 1:32:55pm
I have to agree with a user pays but I will add user pays in advance. A tax on cholesterol in food would be perfect to fund the heart attack services. Once a few studies have been linked a food with a high incidence of cancer (red meat for example) they should also be taxed appropriately.
People still have choice, they can always go to a country where there is no public hospitals.Agree (0) Alert moderator
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Daniel McCusker:
09 May 2008 8:50:35pm
Yes. A tax on red meat because some people link it to cancer, except a tax exemption from anyone who suffers from anaemia, because red meat is the best source of iron for them, and they'll cost the health industry more if they don't get their iron. Oh and a tax on nuts, because there are some people who get VERY sick when they eat nuts, but special exemptions if you can prove you aren't allergic... Similarly, if you can prove you are a virgin, you are given a tax offset because you can't get cervical cancer.
User pays is a completely stupid approach to healthcare. Everyone should be given the best health care we can give them with modern medicine, regardless of who they are, what their background is or what their lifestyle is.Agree (0) Alert moderator
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Greg:
11 May 2008 7:09:33am
Yeh Right. I am sure the guys down at the emergencey wards will say that when their services are over stretched because dingbats come in who are OFF THEIR FACE ON SUBSTANCES.
Once again you have to differentiate between normal activity and abusive activity. Someone eating nuts (my son with cashews) and someone abusing themselves on substances are poles appart.
Differentiation is not discrimination. Why should my son sit in an emergency ward after consuming a cashew by mistake and going into shock waiting for treatment because some idiot has driven his car into a pole drunk & on drugs. Same with cervical cancer and virgins. It's normal activity in this case.
Discrimination is dead wrong, but differentiation is correct. Let the buggars wait if they are abusing themselves with substances.Agree (0) Alert moderator
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Daniel McCusker:
11 May 2008 10:21:31pm
Of course someone with an accidental issue is different from someone who has caused themself harm through negligence or even intentionally.
My point is simply that we should be treating everyone who needs medical care. We shouldn't have waiting rooms with lengthy waiting times. Picking red meat, or lollies, or anything like that as the new scapegoat is missing the point. People will get sick.
We've got a big country that's facing a lot of issues in how it can provide healthcare. Fixing it is going to be costly and difficult, and is a nasty political hot potato. But blaming the guy having a cardiac arrest because you think he's had too much red meat, or because he's overweight is a cheapshot, and misses the complexity of the medical issues. It's probably also because of his genetics (I don't think we should tax people for having risky genomes either), his environment, his stress-level and a bunch of factors we aren't even aware of yet.Agree (0) Alert moderator
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peter:
09 May 2008 7:55:40pm
The US system of healthcare is based , essentially, on the user pays principle. It is the world's most obese nation. This debate rumbles on in the UK too and recently a good deal of attention here has been focused not only on the impact of the fast food giants on shaping consumer's choices, but also on our major supermarket chains and the tempting and ubiquitous '2 for 1' offers etc. and how these too influence consumer choice. I'm no Marxist, but global capitalism has much to do with this phenomenon. Somehow, and I don't pretend to know how, we've got to realise we really don't 'need' this stuff: capitalism, however, does need us to need this junk.
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vicr:
09 May 2008 12:28:30pm
As someone once said "not may fat people came out of prisoner of war camps fat"
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Adsama:
09 May 2008 1:09:51pm
Just do what airlines do for extreme obese people, make them buy two plane tickets.
Start charging people in places based on weight (or BMI to be more specific).
"the scotch fillet will be $12.50 for you Madam, for you Sir it will be $25 because your rather large, although we can offer you the salad at a discount!"
and of course I believe a lot of the problem is the workload people face, that includes school kids too.
Maybe a rebate on bikes? I'll take twoAgree (0) Alert moderator
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toby:
09 May 2008 1:43:37pm
BMI isn not a good measure for obesity
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Andrew:
09 May 2008 3:29:10pm
Indeed - I know people who are 6' who are 54kg and 88kg, both of whom are in shape, one of whom is supposedly anorexic by BMI, the other supposedly overweight leaning obese. It ignores build factors, genetics and also muscular development (as muscles weigh more than fat).
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Harmony:
09 May 2008 2:53:06pm
I always thought, given the calibre and personality of airline passengers these days, that a simple "price per kilogram" of person would be a great thing to have. It is then not up to someone else's view of whether a passenger is a "lardybotts" or not.
Having said that, I am beginning to think an inverse price scale for IQ might be a good thing to...Agree (0) Alert moderator
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Terry:
11 May 2008 2:53:16pm
These ignorant proposals are usually made by people who are fortunate enough to live their whole lives never exercising and eating junk food, and who yet through good fortune in genetics and metabolism never gain wieght.
Similarly, there are plenty of obese people out there who live on salad and vegetables, and exercise every day. My best friend falls in this catagory. I am not suggesting there is no overall relationship between AVERAGE body size and diet/exercise, but the emphasis here is on AVERAGE- there are plenty of lucky and unlucky out-lyers at both ends.
So don't make assumptions about how overwheight people treat thier bodies, based purely on their appearance- or seek to discriminate against them financially, when many of them are obese through no fault of thier own and already bear an unfair share of life's misfortunes.Agree (0) Alert moderator
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L:
09 May 2008 3:21:46pm
Nice one John......I'd love to hear your export policy.
Public health needs to have evryone engaged; government (all levels), providers, NGO's community groups etc. Policy devised and implemented by beaurecrats will probably be 100% effective because it's only actually available to 4 people (the rest get choked by red tape).
We like being fat arses. If we didn't we wouldn't choose to be so fat. Each one of us chooses the way we are. Sure there are other factors that influnce our life, but it's essentially about consuming as much as we can as quickly as we can. We choose to go into considerable household debt (on top of the mortgage, the education, the car, and the higher purchase furniture and plasma).
We want to be fat, but pay for the gym. We buy books about healthy diets, but we'd prefer to develop diabetes and be looked after.Agree (0) Alert moderator
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Felix:
09 May 2008 8:14:59pm
I disagree in some respects. Financial disincentives are imposed on others so why can't it be used in obesity. By way of comparison, cigarettes are subject to a hefty tax and smokers pay for their own health costs plus that of some others no doubt. So why not impose additional tax on obese people. It would only require a doctor's certificate obtained at the end of every tax year to indicate weight against ideal weight for height. For every kilo over you must pay an extra $100 in tax. So eg. if someone was 10 kilos overweight they would pay an extra tax levy of $1000 per annum.
In addition the graphic images on cigarette packets have also had some impact. Similarly graphic pictures could be included on all high calorie foods eg. chocolate bar wrappers should contain images of a doctor having to slice through layers of fat to find organs. Let's not forget the calories in soft-drinks. So all soft-drinks should contain images of pimply obese teenagers. Alcochol of course is high in calories too so cans of beer should contain graphic images of drunks throwing up in gutters. Wines should contain graphic images of sclerosis of the liver etc etc.
Let's not discriminate against smokers only and only subject them to these types of tactics. If harsh tactics are justifable in the case of smokers, equally graphic and costly ones should be imposed on all others in the community who add to the cost of the health system.Agree (0) Alert moderator
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Joan:
09 May 2008 5:11:34pm
I find your remark "it doesn't specify that he is doctor of medicine, just a research fellow . . ." both offensive and ignorant. It is a myth that medical doctors are the 'real' doctors. If you're going to get picky about it:
Studying medicine at university takes 6 years and at the end you are awarded an honorary doctorate. To become a scientist with a Doctorate takes at least 7 years study (degree 3 years, Honours 1 year, PhD minimum 3 years of research).
He could be a medical doctor, but what sort of doctor you are shouldn't make a difference when you're doing research like that (except MDs usually get paid more).Agree (0) Alert moderator
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H.C.:
09 May 2008 10:08:48am
People will change their lifestyle if and when they feel they personally want to change their lifestyle. Wether a smoker, drinker, drug user or overweight person, people will change when they want to. All these programs do is hound people and ostracize them. They dont encourage change.
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John R:
09 May 2008 11:50:55am
If we get the predicted $200/barrel oil costs and rising, we may not have much option but belt-tightening. With the ensuing inflation, driving, smoking and even food to some extent, will both become expensive "luxuries".
The high oil prices may yet save us from our indulgence.Agree (0) Alert moderator
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Tiggerz:
09 May 2008 10:16:00am
I really find the whole trend toward draconian measures quite scary. Currently the obese are being targeted, and all sorts of feral do gooders are offering forward ideas to tackle the nations perceived problems of obesity.
Just remember folks any measures we bring in to force obese folks to be more accountable for their weight will inevitably flow over to any perceived social/lifestyle that is deemed unhealthy.
So Drinkers be warned! Smokers already know they are being ostracized, whats next? Can we tax out of existence people who spend too much time in the sun? they might get cancer and cost society untold millions? Who else can we target? Where does it stop? Welcome to Australia where you WILL be fit and healthy, wether you like it or not.Agree (1) Alert moderator
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JayR:
09 May 2008 12:20:57pm
Drinkers and smokers already pay high taxes for their indulgences. Its high time the fatties pay for their triple by-passes and time spent in hospital for strokes, bowel cancer etc etc etc.
People jump up and down at the mere thought of a piddly amount of tax going toward supporting new parents with maternity leave "because i didnt get it" or "I saved the money myself". Fine, I choose to exercise and eat properly and not clog up the health system with what is easily preventable, so why I should i subsidise the lazy fat section of the population?!Agree (0) Alert moderator
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Tiggerz:
09 May 2008 12:54:50pm
You shouldnt! I am not speaking about cost, I am refering to enforcment and pressure society put on people who are already being ostracized.
Overwight kid gets bullied at school, kid looses all self esteem, kid endsup more overweight, kid grows into an adult with a confidence issue and a eating disorder, society condems adult for being obese, that same adult see's it all as just so much more crap just like they took as a kid. it's a vicious circle and societies -it's okay to punish the fat guy- attitude doesnt help. If you want people to get off the obesity merry-go-round you need to encorage possative action and not put these people down by punishing and ostracizing them. Calling them lazy fatties just shows how ignorant you really are. it's people with attitudes like you who start these sort of problems when these obese adults were kids.
if you had an ounce of understanding you would appreciate that society creates these problems and therefore society should share the burden for them.Agree (0) Alert moderator
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Andrew:
09 May 2008 3:35:24pm
The people we should be punishing are the companies that make and advertise this trash, and I would support subsidies for people wanting to access services of companies which educate people about food and health. I was overweight several years ago and ended up concluding my health would not improve unless I lost some. I didn't know how to, though. I've never been a sports type person and got put off it for life at school (at a time when I was normal or even under weight). But I went with Weight Watchers and bought their optional points book (they generally don't recommend you start with this, but I like to be informed). I got so scared off fast food by what I read in there that I have not touched it since (a single Big Mac or Whopper "value meal" has the points for an entire day!) - and that's in almost 6 years. Also started using a LOT more fresh vegies to fill out meals as they're zero-point on WW - bok choi is a personal favourite. Just knowing more about food helped me a lot, in a way that penalising or ostracising would never have done. It's empowering.
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JayR:
09 May 2008 3:51:17pm
Society? Spare me the sob story!
Frankly, I think that is weak in the extreme. Like i said elsewhere - people jumped up and down at the mere suggestion of a society-subsidised maternity leave scheme (which only has the benefit of helping society as a whole with the next generation growing up to be well adjusted people) because it was all about 'me' this or 'i didnt get it' that.
Obesity is a controllable affliction, not a disease like cancer. Those who suffer should pay for it themselves and stop expecting eveyone else to subsidise their waistline!Agree (0) Alert moderator
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munno:
09 May 2008 4:37:20pm
The 'wot about me' and 'i did not get it ....' are in some cases quite valid.
Currently everyone wants to be subsidised for something or another and it costs all of us whether we like it or not.
back to the debate, it is controllable and it is an individual choice about what we eat and who we are and were an individual chooses to be a smoker, a drinker or eat inappropriately then they should pay.
An equitable solution maybe to provide some reimbursement for attempts such as dietician advice, surgical or chemical treatment but only for a set number of attempts, it then becomes a user pays by increased levy via fast foods, sugar drinks etc same as smokes and drinks.
It is necessary sometimes to be cruel in order to be kind.
as the for the cyclists and greenies they are all wonderful ideas but you may find that there are issues with overweight people undertaking exercise that is not right for them and i know I would not want to administer to some people I know who are overweight, I know what went that body!
I like the airline policy and think that it should be stringently applied and extended to health care via a pay as you eat process for those of us who are less than 75, I say 75 because they probably have not been subjected to FF for as long as everyone else.Agree (0) Alert moderator
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Geoff:
11 May 2008 9:04:34am
You have no idea.
I look after a disabled person. She wasn't overweight until someone who had no idea where they were, smashed into her on a four lane highway. She went from being normal, to being grossly overweight. She doesn't eat all that much.
There's nothing she can do to reduce her weight, repeat nothing ...Agree (0) Alert moderator
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spewbag:
09 May 2008 10:16:57am
I think one of the greatest tragedies is the lack of commitment from GPs and their grant greedy lobby groups such as the AGPN. My attendance at the local practice seems to be more about billing incentives rather than lifestyle counselling or chronic disease prevention - any longer than a level C consult and the GP starts getting twitchy as tho optimal through put has been achieved and you best vacate now so GP can make more money. Similarly, the AGPN et al are little interested in supporting GPs and even less worried about patient care - there MO is to lobby hard about the doomed state of primary care yet a major part of their income is directed more towards increasing their little empires and funding social occassions - just ask any GP and they'll tell you they have little to do with AGPN as they are unreliable, stifled by internal conflicts and ever ready to recieve accolades but not responsibility.
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Neal:
09 May 2008 10:36:09am
With children, how about we make progressing from grade to grade conditional on the passing of a fitness and skin fold test as well as the academic standards? And on top of that have an hour of physical training prior or after school.
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Waryofitall:
09 May 2008 12:17:06pm
I agree with the hour of physical activity before school. We were involved in some government program when I was in primary school, and it involved our class spending an hour each morning playing games and sports before morning tea. It was great fun, and usually led to us continuing these games at lunch time with the whole grade, on our own initiative. I have stayed fit and healthy based on my own standards of living.
And the fitness test isn't a bad one either - but not too sure about the skin-fold test... theres remnants of the young Nazis in that one...
But at the end of the day, mandating through reward and punishment is social engineering. I prefer the government to play less of a role in my life, not more. Personal responsibility seems to be less and less required from individuals these days, everyone looks to the government, the government senses the need to act, and so they come up with blanket initiatives that are draconain and one size fits all. Why don't we all just get off our butts and live an active life, instead of looking to them for solutions!Agree (0) Alert moderator
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Neal:
09 May 2008 2:20:10pm
Obviously the nazism comparison is a bit extreme, but child rearing has always been dictatorial to an extent. Obviously you give a child more say and decision making responsbility when they can demonstrate they are capable of doing so. A skin fold test is one of the best measures of health in terms of weight management. I would suggest applying pressure on children to maintain healthy weight would be beneficial.
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JayR:
09 May 2008 12:21:56pm
This is the first time I think Ive ever agreed with anything you've said Neal.
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John R:
09 May 2008 12:22:27pm
Perhaps relevant is the video games story running today, which states: "They found that playing video games was a near-universal activity among children, and was often intensely social." and "video games are a measure of social competence for boys."
Not to blame video games in particular, but ongoing change to emphasise on success in activities in a virtual, physically passive, world, rather than the real world, could become an obstacle to health.Agree (0) Alert moderator
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Andrew:
09 May 2008 3:37:12pm
Totally against it. Sport is humiliating and embarrasing for those who just can't do it - and they're at the highest risk of becoming obese. Until we deal with teachers and students who bully anyone who is different to themselves, I am dead against anything mandatory. My experience in school sport put me off all sports for life - I'm almost 30 now and was almost relieved when I hit year 11 and never had to do it again. Since I started losing weight 6 years ago, walking and situps have been my sole exercises.
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cecily:
09 May 2008 10:37:05am
This is written as is we have freedom to make our own choices. In reality, we are caught in the grip of powerful advertising and marketing measures. Health promotion and prevention advice won't work while companies promote a beautiful feeling and sense of freedom and life in their advertising. We think we are choosing freely, but in reality we are caught in a tug of war to control our minds. Let's not blame individuals here - corporations and their greed are at the root of much of our lifestyle health problems. And just as we are stuck in a rut of fossil fuel consumption, so we are caught in the trap of convenience and junk food. Our lifestyle depends on quick, easy meals full of fat and salt... we have stuffed up and it is all too hard to change now.
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Alex:
09 May 2008 11:45:44am
I'm sick of this view of passing the buck on to corporations again and again. The only problem with capitalism is it allows people to do things and then pass on the blame to some faceless corporation. Capitalism is the best form of government we have it puts the power in everyones hands. The problem isn't capitalism it's individuals. McDonalds wouldn't exist if people didn't eat there, yet time and time again billions of people decided that they want to eat at McDonalds and buy shares in McDonalds. People have access to fair trade shops yet they continue to buy the cheaper alternatives which exploit third world countries. Also everyone is free to set up their own companies with their own company ethos but they decide to put their efforts into forming a constant background noise of whinging and passing the buck.
The big problem with capitalism is the people who blame corporations rather than placing the blame squarely where it deserves to be, on each and every one of us. Capitalism is about freedom, dont complain if you dont like the way you look in the mirror.Agree (0) Alert moderator
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cecily :
09 May 2008 12:18:31pm
Spoken as only a true capitalist could say it.
I sit somewhere towards the centre of the capitalist/socialist spectrum, though increasingly I lean towards the socialist end. I believe in freedom, free choice, the right of individuals to make money, but we live in a society where this has gone mad. To suggest any of us are truly free in such a society is just as biased as someone else suggesting we have no choice at all. Of course there is an element of both.
But go hang out with some poor people. I do this a couple of times a week, and I am ashamed of the liberty I have to think for myself and the opportunities I have. These people eat junk food because they don't know any better and it almost isn't a choice for them.
I know you will tear holes in this (and I admit my response is half baked, tapped in between other important duties), but capitalism is no great, faultless wonder. It can be blamed for many things, and I believe our diet is one of them.Agree (0) Alert moderator
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Bertrand:
09 May 2008 1:21:26pm
The problem with capitalism is that everyone is responsible for themselves, and some people cant, or believe they cant, take care of themselves. I dont actually see that as a problem, merely darwinism.
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Alex:
09 May 2008 2:29:16pm
Not true, that is why we have a welfare state, we're still a capitalist country, along with most of Europe.
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Alex:
09 May 2008 2:23:21pm
Firstly you missed the point that my final comment was figurative in that the freedom capitalism gives us causes us to see ourselves as who we are and that its not a very pretty site. The holes in capitalism are mainly due to the way people choose to live their lives. You can buy or not buy, its your choice and no one forces you either way. Of course your argument is based on thinking that people are too ignorant to make their own choices. Well I'm afraid they're intelligent people who know what they're doing and its their choice and this is the way they choose to live their lives. These people are quite happy to continue to make bad choices because they are told that they can cleanse their conscience by blaming it on corporations. There is no such thing as corporate greed, only human greed hiding behind a corporate facade. If you want to give people an alternative you are free to do so. Look at the Body Shop, a corporation which decided it wasn't happy with animal testing so it gave people a choice rather than whinging on the picket line and its done great things in reducing the use of animals for cosmetic testing. The only safe way to implement socialist ideals is through a capitalist framework as we do very successfully. And thanks for assuming the high ground with your 'hanging out with poor people' remark but I'm afraid youre not the only one who does that so please refrain from outlandish assumptions. I don't eat fast food because the stuff is terrible, it's a waste of so many resources and I don't think its sourced responsibly, no matter how many adds I see for it I never feel the least bit inclined to partake. On the other hand many of my left wing friends can be found chomping down on one of McDonalds deli choices or at subway.
If you have a better system than a welfare state designed to help the least fortunate implemented within a capitalist system which doesn't leave all the power concentrated within the government then please enlighten the rest of the world with your revolution.Agree (0) Alert moderator
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andy b:
09 May 2008 5:22:40pm
Re the Body Shop and whinging picketers-
How did the consumers know how bad it gets for the animals and so look for and want a more ethical choice if it was not for that horrible old PETA making sure we were aware with its quite shocking in-your-face stunts? Everyone has their place, don't you agree?
We get to make the best choices when we are informed, so education is the key. The public education campaign on health is a perfect "power" for the Governement to hold.Agree (0) Alert moderator
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cecily :
09 May 2008 12:19:14pm
Oh, I forgot to say. I weigh 54kg and I love the way I look in the mirror. I'm just having a bit of empathy for those who are dumped on all the time for their weight.
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Joe:
09 May 2008 2:18:55pm
But we can easily ban fast food advertising. How often do you get cravings due to a carefully designed add, then feel rubbish after eating it. Ok, I can control that, just like I can resist smoking adds. But there are plenty of people who can't.
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Alex:
09 May 2008 2:30:03pm
That argument goes along the line of 'Your not intelligent enough to choose for yourself so the state will do it for you'.
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toby:
10 May 2008 12:16:16pm
I agree, Joe, that junk food advertising should be restricted or even banned, just as smoking commercials were. At the very least they should ban junk food ads during children's programs.
If we are to assume that advertising campaigns work at all (and the sheer amount of expenditure in this area seems to show that it does), one of the reasons that government health campaigns don't work is because they cannot begin to compete with the masses of air time devoted to junk food commercials -- any health message is just drowned out in a sea of fat, sugar, and salt.
And Alex, while I really would like to agree with you, realistically many people don't have the self control to curb their terrible eating habits. In effect, junk food, cigarette, or even toy commercials reinforce the habit of many consumers, rather than presenting them with a choice. It's not about levels of intelligence or free will under attack, it's about irresponsible practice of allowing habit-forming substances to be dangled in front of its many abusers.
Furthermore, people are also ignorant about what constitutes a healthy diet -- a situation that advertisers often exploit. To this end government initiatives that inform people about diet are important, and so too would be initiatives that limit such exploitative advertising.Agree (0) Alert moderator
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Atari:
11 May 2008 11:20:30am
Since when did fair trade stores become accessible for all individuals?
Last time I visited a suburb outside of an inner city in Australia, I was inundated with "500m til next McDonald's" road signs but didn't spot any fair trade stores...
In addition to there being fewer "healthy options" in suburban Australia (while on the topic of suburban Australia try cross referencing postcodes with overweight and obesity prevalence), I would argue that fair trade stores would struggle to compete with a $3.00 happy meal that takes 30 secs to prepare, let alone the multi million dollar marketing budgets of fast food companies.
Yep, it's certainly the fault of corporations at all...they aren't (or shouldn't be) held accountable for the impact of their goods or services.Agree (0) Alert moderator
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Felix:
11 May 2008 8:21:38pm
If cigarette packets can carry help warnings so can junk food. What about advertising junk foods on Children's TV? The problem with the previous government is that they were more concerned about pandering to business making big bucks out of it but if they thought about the cost to the health system they'd take a more resposible approach to advertising. Tony Abbott wouldn't even consider some constraints around advertising geared at kiddies in case Big Corporations making megabucks had a quiet word in Johnnie Howard's ear about job losses if sales dropped. Frankly, there should be a better balance in priorities and I'm sure job losses in one area can be made up in others (maybe healthier foods and activities).
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Jezza:
09 May 2008 10:42:34am
Everyone agrees we need to educate the population. We keep targeting the wrong population. It needs a long approach starting at primary school and inforced at every level through the education system. For those of you who say we do, are wrong. Education has been watering down health and fittness for years, for all the wrong reasons.
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the pope:
09 May 2008 11:19:23am
Not everyone agrees. There are still some individualists in the world, despite all the best attempts of people like Dr Sammut. I never learnt a thing at school and I certainly don't take any notice of doctors. I would like to see a study on how these people got their credibility in the first place. A spiritual approach to life can't taught, you have to discover it for yourself.
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Matt F:
09 May 2008 10:42:48am
Obesity and lifestyle diseases do indeed pose a risk to the tax-payer.
The reduction in smoking rates was successful not due to government ads on television but higher taxes and changes in societal attitudes towards smoking. The same needs to happen to unhealthy eating.
We need taxes on 'junk' food and to publicly ridicule fat people. While it is now considered ok to jibe smokers and tell them it is gross, the same needs to happen with the obese.
Smokers are no longer allowed in many public places, the same needs to be done with fat people. Not only with it remove such unsightly patrons from the view of the healthy community, but, when they realise their place as outcasts, they will very quickly move to adopt a healthier lifestyle.
Like advertising was banned for tobacco, similar things need to happen with unhealthy lifestyle. Fat people should be removed from television and 'healthy weight' (what an oxymoron) models banned. It is not healthy to be fat, it is not normal to be fat. The fat whale lobby has too much influence under it's deceitful guise of raising self esteem and promoting healthy body image. It is a sham. To be fat is to be shamed.Agree (0) Alert moderator
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Roland:
09 May 2008 11:54:19am
Ok... Perhaps a bit of an extreemist opinion, but if were to back up the truck a bit and look at other option before the public give them a sign shame game comes in...
How about Body Mass Index (BMI) figures and put in some sort of luxury/lazy tax?
On both sides... if your way under or way over...
Also look at changing how society does stuff... the 30 minutes a day campain is a great start... can we do more?
The lap band thing is a bit of a cop out but it works... can we do more?Agree (0) Alert moderator
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Paul:
09 May 2008 1:05:17pm
The BMI is a terrible instrument for measuring people's level of health.
As an elite level sportsperson, I am considered obese, even though my skinfold measurements show that I have less than 10% body fat. Muscle weights more than fat....Agree (0) Alert moderator
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Alex:
09 May 2008 2:32:17pm
Interestingly enough its been shown that the BMI is in fact wrong, and the people who conceived it have admitted that it is wrong, but of course re doing it so it is right would involve getting up of the couch :P
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John R:
09 May 2008 12:00:44pm
Great comment. It just breaks so many of the "correctness" rules.
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Bertrand:
09 May 2008 1:29:17pm
Exactly right. The tax idea is obvious. We tax alchopops for the social harm that it does but not fatty or sugary foods.
Just in general the social ridicule idea is obvious too. Then we need to bombard the TV (because all the rejected fatties will go home and watch TV) with self help ads.Agree (0) Alert moderator
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SFA:
09 May 2008 2:53:42pm
"We need................to publicly ridicule fat people......."
What would you suggest - that we bring back the stocks and throw tomatoes at them?Agree (0) Alert moderator
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Marie:
11 May 2008 8:33:12pm
I smoke, am slim and based on regular remarks from others - attractive).
I can remember having a cigarette outside one day when a grossly obese woman walked past and made derogatory remarks towards me for smoking. No I don't think it's right to be rude to anyone just because they smoke. Frankly I did feel tempted to call her a big fat ugly bitch. I wouldn't swap places with her for anything in the world so am happier being me.
I didn't do it and figured she was probably just jealous and bitter because she was so fat and unattractive that she felt compelled to take it out on others.Agree (0) Alert moderator
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FSM:
09 May 2008 10:43:53am
Speaking from my point of view - I do find it helpful to hear health messages to remotivate my attempts to live a reasonably healthy lifestyle. I still remmeber the "life be in it" and the "slip slop slap" campaigns. They definitely raised the issue to social consciousness and that is a good thing - to get people talking about it. However, I do agree that people will not change unless a number of criteria are met for them personally according to their own values and health promotion messages broadcast through mass media are not likely on their own to produce significant change in the population. By itself it wont work and if we as a nation decide the burden of lifestyle diseases is to great, then it is likely that regulatory methods employing the 'stick', such as higher taxes on snack foods, will be one of the tried and tested means of inducing change.
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Mark:
09 May 2008 10:48:44am
The Centre for Independent Studies aka right wing think tank
Jeremy is another who wants to bash away without offering any constructive alternative, he also offers no evidence base despite referring to it.
All in all it is a right wing whinge that goes back to Blame the Individual as its main form of public policy
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DB:
09 May 2008 11:00:29am
A lot of preventative campaign work is undone by false advertising suggesting that anything associated with fruit is healthy. Fruit contains sugar but also contains a lot of fibre, so that you would have to eat six oranges or so to get the equivalent sugar from one glass of fruit juice. So only have a glass of fruit juice if you're hungry enough to eat six oranges.
The GI is another misleading advertising tool. It is the glucose released into the bloodstream per calorie, so that pure sugar compares quite well to vegetables on such a scale.
Information campaigns may or may not work, but you would have to stop the misinformation campaigns before giving up.Agree (0) Alert moderator
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Another View:
09 May 2008 12:22:59pm
DB you are quite wrong about the GI.
The GI is a measurement of how quickly or slowly a carbohydrate is absorbed as glucose into the bloodstream.
For several reasons I have been on a low GI diet for six months, and in that time I have lost over 12 kg.
The key with the low GI diet is to recognise that we need to fundamentally change the "what" factor of our diet.
I could, for example, literally eat as much fruit and vegetables as I wanted. (There are some exceptions, such as certain types of rice and potato), but let's say green vegies - the down side of eating just green vegies is that you would be constantly hungry - a balanced diet must include carbs and protien.Agree (0) Alert moderator
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DB:
09 May 2008 7:11:36pm
Sugar has a low GI, lower than that of a carrot. That's because it's a disaccharide that breaks down into 50 percent fructose, which techically makes you fat as well as glucose. The timing doesn't make a difference to the GI. The index is used to sell things like nutella, which consist largely of oil and sugar. It might indicate a slower release of glucose, but it doesn't have to. And if your system is glycogen-full already, you'll release insulin anyway, and the timing won't prevent that.
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toby:
09 May 2008 11:19:59am
Well if health campaigns don't work, can we have all of those stomach-churning anti-smoking and skin cancer commercials removed from the dinner time slot?
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Paul:
09 May 2008 11:35:13am
The most successful way of reducing smoking levels is to increase their cost. No other health promotion campaign has been as successful as purely raising the price.
This can be transferred over to diet and exercise. Increase taxes on fast food, reduce taxes on fresh fruit and vegetables.Agree (0) Alert moderator
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Roland:
09 May 2008 11:58:49am
I have to agree with Paul... having been a smoker for 15 years the price of the durries was going nuts...
What got me to give up was the fact I had close to $100 a week habit!
That drove me round the bend rather than the health issues...
14months now off the little evil suckers... :)Agree (0) Alert moderator
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John R:
09 May 2008 12:08:54pm
Beware that "fast food" is such a poor indicator of "bad food". Fast food can be healthy, and slow food can just as easily be unhealthy - and in the case of slow food at restaurants, nutritional information is even harder to come by.
In many cases too, it's simply the amount of food consumed, and not the fault of the food itself. So while the idea of taxing "bad food" is reasonable, the task of regulating what food is bad or not is much harder. Simply using the catch-cry of "fast food", is nowhere near good enough.Agree (0) Alert moderator
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toby:
09 May 2008 1:59:21pm
I think we all understand what is implied by "fast food"
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John R:
09 May 2008 4:59:02pm
Understanding what is implied is very different from having a strict definition that can be used in taxation regulation.
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Joe:
09 May 2008 2:23:21pm
Before complicated taxes, I'd advocate a ban on advertising of fast foods, the adds are everywhere when you watch the TV - try watching a day of cricket without craving KFC - and I hate it.
It is a problem though that the price of Maccas and Hungry Jacks isn't increasing with the price of healthy food. It is actually quite a cheap "meal" for one or two now - which is scary. Doesn't influence my eating decisions but I can see the temptation.Agree (0) Alert moderator
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HOWIE:
09 May 2008 11:56:01am
We seem to be blaming the past and present goverment on what they should have done and should do now. The reason obesity is out of control is because the lack of supervision of our children in homes across Australia in both what they eat and how much exercise they get. Stop blaming others and take responsability for our own actions.
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andrew:
09 May 2008 12:09:21pm
What about SIDS awareness? The public awareness campaign to sleep babies on their back, keep the sheets short and ensure they're not too hot has dramatically reduced the number of SIDS deaths. Can Dr Sammut find a way to dismiss this, as he does with other successful campaigns, as not being a relevant counterexample?
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Neil H:
09 May 2008 1:34:23pm
Andrew,
I have to completely agree with you.
In fact, I think that a lot of health campaigns targetted at new parents are successful. When combined with quality district nurses and child health specialists babies are well catered for.
It's when children start growing older, and get to school, with tuck shops selling chips, and a lot of parents buying unhealthy fast food that the problems kick in.
Do a comparison though between buying steak and salad or vegies, and feeding four people, with buying McDonalds. McDonalds almost always comes out cheaper, and that I think is what the problem is. Buy in bulk and save times the thousands of franchises of McDonalds and Burger King/Hungry Jacks and Pizza Hut and Dominoes and all that ilk. Milk is expensive, and bread is expensive and vegetables are expensive, and increasing in price, and yet a Big Mac meal still costs $5 or so.
NeilAgree (0) Alert moderator
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