Balneus

Australian Lefty on Politics, Governance, Science and Info Management

The Hollowmen National Preventative Health Strategy

Posted by Dave Bath on 2009-09-03


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

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

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

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

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

What about the percentage that are overweight but not obese?

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

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

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

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

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

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

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

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

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

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4 Responses to “The Hollowmen National Preventative Health Strategy”

  1. Jacques Chester said

    Two problems.

    First, the BMI is not a very good index. It very poorly summarises health condition at an individual level and its usefulness in population studies is debatable. It was calibrated to 19th century Belgians. Under the standard BMI tables Brad Pitt is overweight and George Clooney is obese.

    Second, regulating food is pointless because the science of nutrition is not settled at all. The evidence for the effects of tobacco and alcohol are very well established and of high quality. The studies for nutrition are not well established and generally not well-constructed. It would be stupid to start regulating what people eat — quite aside from the moral objections — based on flimsy science.

  2. Dave Bath said

    JC@1

    Agreed, BMI has flaws, but it can be a useful first pass guess for those with basic maths.

    The waist size is another quicky (as used by recent cardiac health ads).

    Much better is a three-point pinch test, measuring skin fold thickness at the back of triceps, just under the scapula and low on the side of the back, I think (it’s thirty years since we did that prac).

    Getting good data would require making this part of a GP visit – especially if an annual preventative health check was fully funded by government.

  3. FXH said

    BMI has a lot of flaws but isn’t too bad as a proxy. Same with the waist size.

    There is a lot of excitement about obesity – mainly driven by the direct correlation with diabeties and heart problems.

    However in the rush to “do something” there isn’t a lot of evidence available as to what works as a solution either on an individual level, local level or national level.

    We know it’s a mixture of lifestyle, excercise, nutrition (mostly more and better food enabling people to grow bigger and also “bad” food), opportunities to exercise, infrastructure, etc etc

    We are willing to throw million$ at “commonsense ” solutions with little evidence that they work. Sure some of them are good things anyway, bike paths, safer walking environment, more nutritional info on food, but its not clear what, if any, impact they will have on “the obesity epidemic”

    And its certainly not clear what the cost/benefits and priorities should be. All spending is rationed, limited and competing. $3m locally for more bike paths for 60 year olds for diabeties (when only .003% of sfa will use it) or would it be better to have $3m for diabeties educators to go around and coach people (evidence not even clear here)or better to have $3m more diabeties screening or $3m worth of free diabeties medications for locals or $3m to station fingerwavers outside every chip and hamburger shop or ….

    We do know that a very large percentage of morbidity and mortality is down to genetics and who your grandparents and parents were.

    Heart disease is the biggest killer – but it isn’t really a disease – it’s a collection of problems and in the end most of us die because our heart gives out one way or the other.

    Colon/Bowel cancer is in the top 5 killers. It’s a disease. And a bloody awful one. Too a large extent determined by family history. It’s not preventable. We don’t know what causes it. (Theres some correlation with diet and grog etc but no causation).It won’t do any harm to eat a decent diet and broccoli but it will neither cure it nor prevent it.

    However bowel cancer is very amenable to early intervention – that is screening, then investigation and cutting of young, small growths. Essentially a clinical, surgical intervention.

  4. FXH said

    I stopped mid stream because it was getting into a long (evidence based) rant.

    Longevity and health is strongly correlated with socioeconomic status.

    Its not just money but education too. The socio as well as the economic. Its possibly better to be educated middle class with not a lot of $ than a wealthy non-tertiary educated working class background. In general. There are many individual exceptions.

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