Community voices vital
In the build-up to the election and with obesity in the spotlight over the past week, Professor Boyd Swinburn, one of the world’s leading obesity and food policy experts, has had heaps of airtime. The Professor of Population Nutrition and Global Health in the School of Population Health at Auckland University who chairs the Health Coalition Aotearoa also found time in his busy schedule to answer some questions from Hauora. Hauora was keen to find out from Prof Swinburn about the progress made by the Coalition since it was launched nearly two years ago, the aims of its 2020 Prevention Brief, and how vital it is that the silent voices in the communities be heard to influence change. HAUORA: It has been nearly two years now since the Health Coalition of Aotearoa was launched with the vision of greater health and equity for all New Zealanders through reduced consumption of harmful products (tobacco, alcohol, unhealthy foods & beverages) and improved determinants of health. How has the progress been and what are some of your achievements? PROF SWINBURN: I think the Health Coalition has made great progress as an organisation, especially in getting ourselves into a strong position to focus on achieving action over the next term of government. We now have all our structures in place in terms of becoming an incorporated society with charitable status, getting more than 50 health organisations on board as members, working with government on several issues related to our kaupapa, and getting all members to define the priority actions needed for action on unhealthy products. Our four Expert Panels on tobacco, alcohol, food policy and public health infrastructure bring huge knowledge and experience to the Coalition’s work. Unfortunately, the Labour-led government over its first three years has achieved disappointingly little in the way of prevention policies, especially for alcohol and childhood obesity. We will really work hard over the next three years to see if greater progress can be made. HAUORA: The Coalition has released its Prevention Brief for 2020. Can you please explain what the main purpose of this is and what it is hoped will come out of it? PROF SWINBURN: This brief was the culmination of considerable work across the membership to pull together the international evidence and experience to create a consensus of what is needed to reduce the burden of preventable diseases. Very few people realise that tobacco, alcohol and unhealthy foods collectively contribute about one third of the preventable health loss – that’s more than 370,000 healthy life-years lost annually. This is massive, and one of our first jobs is to communicate the magnitude of this damage and the trivial public health effort that goes into preventing this harm – less than half a percent of the health budget. I doubt if there would be a single member of the public who thinks that half a percent is a good prevention investment for dealing with products that cause one third of the health damage. HAUORA: You mentioned in an article recently about ‘policy inertia’ and how the unheard voices from the people and communities who are suffering the consequences of harmful products contribute to this. How vital is it to get stories from real people in the community, and what suggestions do you have for how we as health promoters can help get these stories out? PROF SWINBURN: Policy Inertia is the term we use for the situation where there is a stack of evidence-based, effective policies to reduce the harm from unhealthy products but very few of them are implemented. The three reasons for policy inertia are; firstly, the strong opposition from the industries who are profiting from these products; secondly, governments who are reluctant to regulate these industries because of the political effort needed to counter the industry lobby, and; thirdly, the lack of public demand for action. The public and communities tend to be very supportive of strong policies to control this harm, but it is a quiet support. The reality is that unless the stories from people who are suffering from this harm come out loud and clear, along with a demand for action, governments can just continue to ignore the problem. We really need to hear the voices of those people who are demanding change. HAUORA: Do you think Covid-19, which for those with underlying medical conditions can be fatal, will have any/or has had any influence on the need to make healthier choices and the need for more regulation on food, tobacco and alcohol companies? PROF SWINBURN: Yes it is true that Covid-19 can be especially deadly for people with obesity and various chronic conditions, but I think, more importantly, we have seen the very real benefits of implementing policy based on the evidence and expert opinion and clearly communicating that to the public. It was a rocky road to start with building up the public health capacity and response systems to Covid-19. Public health was at a very low ebb after many years of neglect and underfunding, but eventually we have come to the point where the politics is responsive and adaptive, the public health systems are operating well, and the public is largely on board with the Government’s course of action. Wow, if only we could translate those approaches to prevention of our really big killers – heart disease, cancers, diabetes and so on. Listening to the evidence, being bold and clear in the policy action, and making sure that the whole of the country is aware of what the Government is doing and what communities and individuals can do to contribute. HAUORA: Is there anything else you would like to add? PROF SWINBURN: I think there is an enormous readiness for action among communities who are sick and tired of living in neighbourhoods where every second shop is selling cigarettes, discount booze and cheap takeaways. They want the Government to match their own leadership and vision for healthier environments for their children and families. If politicians would only stand up to the lobby forces of the vested commercial interests who sell harmful products, they will be fully backed by the communities who want to build back better after Covid.