Policing parenting: is the Family Court going to punish you for having a drink?

Sascha Callaghan, University of Sydney

News outlets have pounced on a Family Court “order” for parents of a six-year-old boy to not smoke around the child and to limit their alcohol consumption while caring for him. Readers commented that the case represents an unacceptable “intervention by the courts into the personal space of the individual”, and that it was an attempt at “social engineering” . The idea of a court intervening in family life to prevent what might seem like fairly ordinary activities, such as occasional tobacco smoking or having a glass of wine or two, might seem like evidence of an overreaching “nanny state”. And perhaps it would be if that’s actually what happened – but it didn’t. It is true, though, that the “right to parent” according to one’s own values and proclivities isn’t actually unfettered. The state can and will intervene in family life in various circumstances.

A definite jurisdiction

State Supreme Courts have powers to make orders under their protective jurisdiction to allow important medical treatment to go ahead if parents won’t consent, for instance. The NSW Supreme Court did exactly that in a 2013 case where a Jehovah’s Witness parent refused a life-saving blood transfusion on behalf of their child. State agencies can also intercede in family life under child protection laws when a child is at risk of significant harm. This kind of coercive intervention is reserved for serious cases where the child’s basic needs are not being met. And it generally requires much more than a parent who smokes or drinks too much from time to time to trigger intervention. But child protection laws have also been invoked when parents of a severely overweight boy didn’t go to hospital for treatment, or appropriately manage his diet (the ten-year-old boy later died from heart failure associated with obesity). And when a father, who believed HIV was an invention of pharmaceutical companies, refused to give his child the antiretroviral medication prescribed by doctors. Not everyone will agree on the limits drawn around decisions parents are allowed to make. But most will agree that the public interest in protecting children means limits must be placed somewhere. And “risk of significant harm” doesn’t seem like a bad starting point. In addition to child protection laws, the Family Court will intervene in the parenting of children when asked to do so by parents who cannot agree on the relevant decisions themselves. In settling these disputes, the guiding principle is that the court will act to protect the “best interests of children”. But how do courts interpret this rather wide concept, and where do the limits of personal parental prerogatives lie when a court tries to strike a balance between the strongly held views of parents who bitterly disagree?

The particular case

In the case that has provoked so much comment, the Family Court decided that despite the fact the child’s mother was his primary carer and was “utterly dedicated to the child’s needs”, it would be in his best interests to live with his father.

The Family Court will make parenting decisions when asked to do so by parents who can’t agree on the decisions themselves. from shutterstock.com The orders were influenced by the mother’s preference for the advice of her naturopath over an accredited medical practitioner, which the court found was to the detriment of the child; her “conscientious objection to vaccination”; and her “clear and unwavering belief that the child obtains nothing from an ongoing relationship with his father”. The father, on the other hand, appeared to the court to have a better view of the child’s medical needs and was “the parent more likely to support [the child] in his relationship with his mother”. Among the 45 orders the court made were two proposed by the mother – that both parents be “restrained from smoking in the presence of the child” and that they will refrain from consuming alcohol “to excess”, or at least to the point of being unable to drive, while the child is in their care. The father agreed to these, in a suite of orders in which his interests mostly prevailed. These are known as “consent orders” – and they’re quite different to coercive interventions under child protection laws. In fact, health-related agreements are becoming a common feature of consent orders in a culture that increasingly values health and wellness, and in which many parents are likely to want assurances from the other that their child will be in a “healthy” environment when not in their care. These kinds of concessions are negotiated in families every day of the week – “take Harry to the physio”, or “please can we not have pizza again because last time Sam got sick”. In this sense, consent orders reflect familiar family compromises and the parents’ own values – rather than an out-of-control nanny state imposing orders on passive parents. It’s just that these fairly unremarkable agreements have been written down and stamped by the court because goodwill has evaporated and parents no longer trust each other to honour everyday deals.

The long arm of the law?

Indeed, the most interesting aspect of this case is perhaps not the agreement by both parents not to smoke in front of their child or get so drunk that they can’t drive, but that in determining a child’s best interests, the overriding priority for the court was securing “the benefit to the child of having a meaningful relationship with both of the child’s parents”. To many people the idea that a father who had never been in a stable relationship with the mother and had little previous involvement with him should be entitled to a relationship with the child to the extent that his mother’s role as primary carer was lost, would seem ludicrous. But the Family Law Act takes the position that a relationship with both parents will, in the absence of risk of harm to the child, be considered paramount. With regard to smoking and drinking, there was agreement between the parents with the imprimatur of the court – rather than an order being “imposed”. The most serious issue that remained in dispute was the child’s right to a relationship with both his parents – and this was where the court really did impose the values of the Family Law Act. Otherwise, unilateral state intervention is reserved for much more serious cases where significant harm is in the offing. So, you can still have a smoko while your child is at home without fear of being touched by the long arm of the law. The Conversation

Sascha Callaghan is Lecturer in Health Law & Bioethics at University of Sydney.

This article was originally published on The Conversation. Read the original article.

Immigration department breaches the privacy rights of asylum seekers

Picture of facilities at Nauru Detention Centre, available from: https://www.humanrights.gov.au/publications/forgotten-children-national-inquiry-children-immigration-detention-2014/12-children
Picture of facilities at Nauru Detention Centre, available from: https://www.humanrights.gov.au/publications/forgotten-children-national-inquiry-children-immigration-detention-2014/12-children

An article in The Guardian today claims that the Department of Immigration has sought access to confidential medical records of asylum seekers for ‘political purposes.’

The article reports on a briefing document written by a senior clinician at International Health and Medical Services (which delivers health services at mainland and offshore detention centres), which appears to show that the IHMS has disclosed asylum seekers’ health records to the immigration department for reasons not related to the health and welfare of individuals in detention.

As the article points out, this practice potentially breaches the Commonwealth Privacy Act, which prohibits the disclosure of health information to third parties (without the consent of the individual concerned), unless the disclosure is directly related to treatment of the individual (or in certain permitted circumstances, such as preventing a threat to public health or safety).

Further, the disclosure breaches clinicians’ duty of confidence towards their patients, and may also violate professional guidelines and codes of practice, such as the Medical Board of Australia’s Good Medical Practice code of conduct for doctors. Under the code, good medical practice includes protecting patients’ privacy and confidentiality, and ‘appropriately sharing information about patients for their health care.’

Disclosure of asylum seekers’ health records may seem like a relatively minor issue considering the many documented abuses perpetrated against individuals in detention.   But, privacy is an important underpinning to personal autonomy, and the right to control information about one’s self is key to self-determination. The unauthorised disclosure of asylum seekers’ medical records represents a significant infringement of asylum seekers’ rights, and forms part of a broader trend towards dehumanising people in detention centres.

In part, the Privacy Act was enacted to give effect to Australia’s obligations under article 17 of the International Covenant on Civil and Political Rights, which states that ‘No one shall be subjected to arbitrary or unlawful interference with his privacy, family, home or correspondence, nor to unlawful attacks on his honour or reputation’ [sic]. The unauthorised disclosure of asylum seeker’s health records puts Australia at odds with its international human rights commitments, as well as breaching domestic privacy laws.

The disclosure of medical records for ‘political purposes’ (whatever that may mean) illustrates the Catch-22 situation faced by clinicians working in detention centres. Health professionals working in these centres must deal with the tension between their ethical and legal duties to patients, and pressure from government and private employers to act in ways that compromise the health and wellbeing of asylum seekers. This issue also raises serious questions about the immigration department’s approach to privacy and its management of highly personal, and potentially very sensitive, health information.

World Health Organisation publishes new report on overweight, obesity, diabetes and the law

Posted by Jenny Kaldor and Roger Magnusson

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This is the view when you look out the front gates of the World Health Organisation’s regional headquarters in Manila.

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A few blocks away, in the processed food aisles of the supermarket, parents are encouraged to purchase “nutrition power for kids”.

The Western Pacific Region, which includes Australia, is home to 138 million adults with diabetes, and includes a number of Pacific Island countries where more than one third of the population have diabetes, and around one half of the population are obese.  [See separate blog post]

In response to these issues in our region, Manila was the venue for a consultation on 9-11 April 2014, on overweight, obesity, diabetes and the law, co-hosted by the University of Sydney (Sydney Law School and the Boden Institute), and by the International Development Law Organisation (IDLO).  The consultation brought together public health practitioners, community leaders and academics from around the region, including Fiji, Singapore, New Zealand, Indonesia, Cambodia, South Korea, Mongolia, PNG, the Philippines and more.

The consultation was co-chaired by Professor Stephen Colagiuri (Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders), Professor Roger Magnusson (Sydney Law School), and Mr David Patterson (IDLO).  The background paper and meeting report were written by the rapporteur for the consultation, Ms Jenny Kaldor, who is a PhD candidate at Sydney Law School.

The Western Pacific Regional Office of the World Health Organisation (WHO – WPRO) was the co-sponsor and convenor of the consultation, and has just published the meeting report, which is available below:

WPRO CONSULTATION ON OVERWEIGHT OBESITY DIABETES AND THE LAW – 9-11A APRIL 2014 – FINAL REPORT – RS_2014_GE_66_PHL_eng.

The report illustrates the variety of legal issues that overweight, obesity and diabetes are causing for countries within the Western Pacific WHO region, as well as how law might be used to improve health outcomes.  These include the problems of diabetes-related disability discrimination, discrimination in access to diabetes medications, and good practices in legislation to improve food environments and opportunities for physical activity, from across the region.  The report discusses the opportunities for, and obstacles to, using law effectively, as well as the challenge of ensuring that trade agreements and trade laws do not work at cross-purposes to health policies on obesity and diabetes.

The meeting report highlights several important conclusions:

  • There is a strong need to build the evidence-base on legal interventions relating to obesity, diabetes and population diets.  Case studies, feasibility studies, guidelines, summaries and other tools can assist countries to share their knowledge and experience with legal and regulatory interventions.  Researchers and academics have an important role to play.  Networks need to be built across the region to better facilitate information sharing.
  • Developing local expertise in public health law and in particular, law related to obesity, overweight and diabetes, is a priority.
  • In-depth technical advice is needed on promising interventions.  These include a tax on sugar-sweetened beverages; restrictions on unhealthy marketing of food and beverages to children; requirements for interpretive, front-of-pack labelling; and legislation to create environments that facilitate and encourage physical activity.
  • Civil society has a vital role to play in the development, implementation and enforcement of innovative legal approaches to overweight, obesity and diabetes.
  • Addressing the interference of the food and drinks industries in policy development and implementation in countries across the region is a priority.  Clear guidelines are needed to avoid conflicts of interest and to ensure that government interactions with the food industry are transparent and constructive, and do not jeopardise public health goals.
  • Law needs to be better integrated into the agenda of the World Health Organisation.  Law is central to advancing the goals of WHO, and can enable countries to protect, respect and fulfil the right to health.

Fanta ad falls flat before the Advertising Standards Board

An image from the Fanta ad that Coke was forced to pull, taken from: http://www.abc.net.au/news/2015-07-15/coca-cola-forced-pull-fanta-tv-ad-app-for-breaching-guidelines/6619424
An image from the Fanta ad that Coke was forced to pull, taken from: http://www.abc.net.au/news/2015-07-15/coca-cola-forced-pull-fanta-tv-ad-app-for-breaching-guidelines/6619424

Coca-Cola has been forced to remove advertisements for Fanta after the Advertising Standards Board found that the promotions breached the Responsible Children’s Marketing Initiative, a voluntary code on responsible food marketing to children.

The rulings came after the Obesity Policy Coalition laid three complaints about the ‘Fanta Tastes Like’ campaign, which included ads during prime time TV programs, a website, and a tablet application. All three promotions featured the Fanta Crew, an animated group of teenaged characters, who engaged in activities like catching fruit, riding roller coasters, and landing in a pool filled with bubbles.

Coke, who owns Fanta, argues that it does not market any of its products to children under 12 years of age, and that the Fanta Crew characters were designed to represent 17 year olds and to reflect older teen culture. However, the Advertising Standards Board held that the characters were more likely to appeal to younger children who aspire to be teenagers, rather than being of interest to teenagers themselves, and therefore were most strongly directed to children in the 9-11 year age bracket.

Considering the overall effect of the themes, visuals and language used in the ads, the Board held that the app and the TV promotions were directed primarily to children under 12 years of age, particularly considering the simplicity of the app’s games, and the depiction of the Fanta Crew on roller coasters and jumping into a pool filled with bubbles in the television ad.

Given that Fanta was not a ‘healthier dietary choice’ that was suitable for marketing to children, the Board upheld the complaints in relation to the app and the TV ad. However, it dismissed the complaint about the website, holding that key elements were designed to appeal to adults, including the factual descriptions of the product flavours and the inclusion of nutrition information.

These decisions represent a solid win for the public health community, despite the Board dismissing the third complaint. Of particular note is that the Board held that an app fell within the scope of the Responsible Children’s Marketing Initiative, despite apps not being explicitly included in the wording of the code.

However, it is relatively rare for the Advertising Standards Board to uphold complaints under the Responsible Children’s Marketing Initiative, because of the numerous loopholes in the code’s terms and conditions. For example, the complaints tested whether Coke breached the code by placing the Fanta ad in prime time television programs, including My Kitchen Rules. However, the Board held that these programs were not directed to children because they did not have an audience share of more than 35% children (as per the code’s rules), despite My Kitchen Rules being one of the most-watched programs by children under 12.

Other critical problems with the code include a lack of independent oversight and enforcement, inadequate reporting on compliance, and limited membership. These complaints show that it’s time to junk industry self-regulation of food marketing to kids, and implement stronger restrictions that put children’s interests before those of the food industry.

Picture from the Fanta Fruit Slam 2 app game, with scores displayed as a thermometre full of soft drink. Taken from: http://www.smh.com.au/nsw/cocacola-reprimanded-over-fanta-ad-that-targets-children-20150714-gibxrs.html
Picture from the Fanta Fruit Slam 2 app game, with scores displayed as a thermometre full of soft drink. Taken from: http://www.smh.com.au/nsw/cocacola-reprimanded-over-fanta-ad-that-targets-children-20150714-gibxrs.html

It’s time for the government to stop shooting the messenger

The constant attacks on Professor Gillian Triggs represent attacks on the human rights and civil liberties that Australians value. Since 1986, the Human Rights Commission has been the watchdog for human rights for Australia.  The President and her Commissioners are necessarily independent of government and have a duty to fearlessly advocate for human rights protections and to criticise laws and policies that undermine the rights and freedoms Australians enjoy.

The current barrage of orchestrated attacks on Triggs is supposedly on the basis that her comments are politically motivated. Of course they are. Human rights lie at the core of our political system: they require government to protect their population and provide a political environment in which they can flourish. If human rights weren’t political they would make no sense at all.  The problem for the government is that it wants to ignore human rights yet remain immune from criticism.

The real criticism of Triggs is that she has been biased and is playing party politics. This is an absolute furphy. Party politics is about contested concepts but no one can contest the evidence of abuse of human rights that were raised in the Commission’s report. The timing of the report is irrelevant. What we need is a response from government that explains what has been happening and what will be done to protect the vulnerable children and adults that we are detaining. Instead the government’s response have been to shoot the messenger, call for her resignation and criminalise the release of further information about the detention of asylum seekers.

The government’s treatment of children in detention deserves particular censure, and in time may appropriately become the subject of a Royal Commission.  Children in detention are vulnerable and voiceless.  As fathers we are appalled by the failure of the government to provide minimum conditions for their safety and welfare.  Yet because the abuse is happening behind barricades, under secrecy, and in the name of national security, accountability is lacking.  If our politicians lack the parental instincts and moral convictions to take steps to protect children from harm, then we call on parents everywhere to hold them to account.  This goes beyond political differences.

The true strength of conservatism is its adherence and protection of our basic political institutions, particularly civil liberties, ministerial responsible government and the rule of law. Another important principle is that the Attorney General, as first law officer, should protect the officers that make that legal system work (like the President of the Human Rights Commission). A further traditional convention is for the Speaker of the House to stay out of political debate.

The government has turned its back on all of these bedrock principles of Australian politics. Minister Dutton’s refusal to engage with the report in any meaningful sense mocks the principle of ministerial responsibility. The Attorney General’s treatment of Triggs in and outside of parliament shows a complete dereliction of his duty. Speaker Bronwyn Bishop‘s criticism of Triggs as being biased on Q&A was bitterly ironic given her record breaking performance in Parliament. Given its complete abandonment of traditional values, this government no longer can call itself conservative.

The only reasonable criticism of Gillian Triggs that can be made is that she is doing her job too well. Moreover, she is the only one actually doing her job. Rather than question her position, we need to ask how much of the traditional architecture of responsible democracy this government is prepared to trash to get its own way. It is time for the government to return to the traditional values of Australian government before the damage done to the polity becomes irreversible.

 

Cameron is Professor of Health, Law and Ethics at Sydney Law School

Roger is Professor of Health Law and Governance at Sydney Law School

Ian Kerridge is an Associate Professor at the Centre for Values, Ethics and the Law in Medicine

Muzzling health and welfare professionals in the name of national security: Australia’s Border Force Act 2015

Posted by Roger Magnusson and Cameron Stewart

This is the view from the top of Table Mountain in Cape Town, South Africa.  Take it in.  It helps to have a sense of perspective.

The view from Table Mountain, Cape Town (1)
The view from Table Mountain, Cape Town (1)

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The view from  Table Mountain, Cape Town (2)
The view from Table Mountain, Cape Town (2)

It’s now more than 21 years since apartheid ended.  These days, few people would criticise anyone for having broken those racially motivated laws that were part of South Africa’s statute book during the period of white minority rule.  But why do people feel that way?

For some, it may be the patent absurdity of discriminating against entire classes of people based on the colour of their skin, or whether or not they passed the “pencil test” .

For others, it may be the fact that laws constructing systematic racial discrimination were inconsistent with a higher moral law, or with international human rights instruments that give protection from discrimination on grounds such as race, colour, sex, language, religion, and national or social origin .

With apartheid in mind, let’s return to Australia.  The Box below describes some key features of the Australian Border Force Act 2015 (Cth).  The application of this Act to health and welfare professionals caring for children in immigration detention has attracted a great deal of attention.

Rightly so.

As law professors, health law specialists, and parents, we know we are not alone in believing that whatever sense of obligation we feel to obey the law is eclipsed by the moral imperative to protect children from harm.  Some of the worst abuses of children, causing lifelong harm and distress, are the result of institutional indifference to instances of abuse.  If you think you care about children, or if you have any children of your own, then consider how the Australian Border Force Act will impact on them.

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The Act creates the Australian Border Force, integrating immigration and customs functions into a single entity within the Department of Immigration and Border Protection.

Amongst other things, the Act appears designed to improve the control of information, to prevent leaks, and to reduce unwelcome media scrutiny of the operation of immigration detention facilities arising from public disclosures by Immigration and Border Protection workers.

The Act creates an offence, carrying a penalty of imprisonment for 2 years, if an “entrusted person” makes a record of, or discloses “protected information” (s. 42).

An “Immigration and Border Protection Worker” includes government employees, as well as consultants – doctors, nurses, social workers – engaged by the Department to work inside immigration detention centres.  “Protected information” means “means information that was obtained by a person in the person’s capacity as an entrusted person”.

The Act authorizes the Secretary of the Department to authorize an entrusted person (let’s say a doctor) to disclose protected information (let’s say allegations of sexual assault against a child in immigration detention) to the Department, to police, or to any other authorized body or person.  However, the Secretary may attach written conditions to the permission to make such disclosures (s. 44).

The Act does authorize disclosure of protected information to “prevent or lessen a serious threat to the life or health of an individual” (s. 48).  However, this would not extend to disclosures to the media relating to the systemic conditions in which children are living in detention, or the impact of incarceration on their mental and physical health and wellbeing.

In summary, the Act appears designed to muzzle health and welfare professionals from reporting any information they obtain in the course of their duties (extending, for example, to allegations of sexual assault against children in immigration detention), except with the permission of a bureaucrat.

The culture operating within the Department of Immigration and Border Protection is likely to mean that Secretarial permission will rarely, if ever, granted.

The likely result of the Act is that it will become more difficult for the government’s accountability for the health, welfare and protection of children in immigration detention to be tested in the political arena.

Whatever you think about the merits of mandatory detention of the children of asylum seekers, the constraints on health and welfare professionals appear to strike at the heart of freedom of speech.  The Act might well infringe the implied constitutional freedom of political communication that all Australians enjoy.  No doubt this will be tested soon.

The Australian Border Force Act does not mention the Public Interest Disclosure Act 2013 , but if – as the government asserts – the former Act is subject to the latter , persons speaking out would need to navigate a thicket of statutory conditions in order to escape prosecution.  The intent of the Australian Border Force Act is to change the culture within which services are delivered to persons in immigration detention: that much seems clear.

It is not surprising that health and welfare professionals have pointed to the contrast between the Australian Border Force Act and the protections that apply to Australian children outside immigration detention.

In NSW, the Children and Young Persons Care and Protection Act 1998 imposes mandatory reporting on health and welfare professionals when they have reasonable grounds to suspect a child is being abused or is at risk of significant harm .  On the other hand, unless the Secretary gives their permission, doctors and welfare workers could be committing a criminal offence if they reveal anything at all about the conditions in which children in immigration detention are living.

Writing in the Guardian, over 40 “entrusted persons” have called for civil disobedience:

“We have advocated, and will continue to advocate, for the health of those for whom we have a duty of care, despite the threats of imprisonment, because standing by and watching sub-standard and harmful care, child abuse and gross violations of human rights is not ethically justifiable”.

As law professors employed by one of Australia’s oldest law schools, we live and breathe law, and care about the rule of law.  Frankly, however, we don’t care about it enough to stand by while government tries to muzzle dedicated professionals working in difficult conditions to protect the safety and dignity of children.

Parliament makes the rules.  It decides what is lawful and unlawful.  But when the moral compass goes astray and laws are designed to ensure that the public never even gets to hear about the harm that children are suffering in immigration detention, then that is a step too far.

The President of Australia’s Human Rights Commission, Professor Gillian Triggs, points out that Australia is alone in the world in indefinitely locking up the children of asylum seekers. The Commission’s Forgotten Children report found that this practice violates the right to health that children enjoy under the Convention on the Rights of the Child.  It also ignores the substantial body of evidence of the harm that immigration detention is causing to children.

“Entrusted persons” face difficult choices in the months ahead.  In deciding how to reconcile their professional ethics, moral intuitions and legal obligations, they can at least stand assured that there can be no moral obligation to stand by and do nothing while children are being harmed.

The Australian Border Force Act 2015 needs a radical overhaul.  Otherwise it belongs in the bin.  Both parties ought to think again.

Take another look at the view from Table Mountain.  In the distance you can see Robben Island, where Nelson Mandela spent 18 of his 27 years of imprisonment.

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Does Coca Cola have a role in delivering Pacific aid?

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Posted by Roger Magnusson and Alexandra Jones

The Foreign Minister, The Hon. Julie Bishop MP has announced that Australia will partner with companies like Coca-Cola to distribute essential medicines to Pacific Island recipients of Australian aid.

The Minister is right about one thing: tobacco and fizzy drink companies have strong distribution networks that reach into the remotest parts of low income countries around the world.  And they would welcome the legitimacy that comes from “being part of the solution” – from “helping to save lives”.

But conflict of interest looms large.  In some islands of the Pacific, more than a third of the population have diabetes (See the table at the bottom of this post, drawn from a recent paper on non-communicable diseases (NCDs) in the Pacific.  The table is worth reproducing in full, since it illustrates just how bad everything is). Combined rates of overweight and obesity among men and women in some Pacific island recipients of Australian aid reach or exceed 80%.  In some countries obesity rates alone exceed 45% (in Tonga, the rate of obesity in men and women > 20 years is 59.5%).  Do these countries really need Coca Cola?

There might well be novel ways of partnering with the private sector to improve aid performance.  Results matter: the Minister is absolutely correct on this point.  But this applies at home as well.  For example, under-performing public health initiatives such as the stalled Food and Health Dialogue – which was supposed to deliver a healthier food supply with less salt and saturated fat – also need to be overhauled.  (A recent paper by Roger Magnusson and Belinda Reeve illustrates how “regulatory scaffolding” could be used by government to strengthen the performance of this vital initiative while minimising the need for direct, statutory regulation).

In Pacific Island Countries and Territories, partnering with the multinationals that are driving risk factors for obesity and diabetes makes no sense.  Australian Aid wouldn’t partner with a tobacco company like Philip Morris, so why partner with a fizzy drink company selling empty calories to some of the most obese and diabetic countries in the world?

Unlike, say, Unilever, which can diversify into healthier products and create healthier brands, Coca Cola and Pepsico have a real problem: their leading brands are soft drinks.  It would be economic suicide to sacrifice the full-sugar variants, and yet this colours every positive contribution they might otherwise seek to make to development or public health.  People who want to move towards a healthier weight – not to mention better dental health – need less soda, not more, and yet reducing consumption is bad for profits.  Suffice it to say that Coca Cola would surely be delighted at the prospect of becoming integrated into the public health infrastructure in these fragile island states.

It’s worth asking: just how did Coca Cola get inside the Minister’s head?  Why is its name bobbing up now?

At the Joint Forum Economic and Pacific Health Ministers Meeting in Honiara in July 2014, Economic and Health Ministers from Pacific Island Forum countries agreed that non-communicable diseases (NCDs) are ‘financially unsustainable’.  They committed to develop country-specific roadmaps covering the following five priorities (Joint Economic Forum and Pacific Health Ministers Meeting 2014). These priorities are:

    • Strengthening tobacco control;
    • Considering an increase in taxation of alcohol products;
    • Reducing consumption of unhealthy food and drink;
    • Improving efficiency of existing health expenditure; and
    • Strengthening the evidence base to ensure optimal use of resources.

These commitments take place against the background of the World Health Organisation’s Western Pacific Regional Action Plan on NCDs  and the World Bank’s NCD Roadmap Report.  Both documents identify “best buys” and other policy priorities that countries should adopt in order to reduce death and disease from NCDs.

Let’s be honest here: the commitments of Joint Economic Forum and Pacific Health Ministers are not only a business risk to Coca Cola, but to tobacco multinationals and other junk food and beverage companies that operate in the region.  Other risks loom on the horizon.  For example, the World Health Organisation has established a Commission on Ending Childhood Obesity, which has already released an interim report which identifies a number of policy options for reducing intake of unhealthy foods and non-alcoholic beverages by children.  The Commission is holding a hearing in Auckland for the Western Pacific Region within the next few weeks.

Is Coca Cola really part of the solution?  If you have any lingering doubts, just ask a dentist.

Readers may also be interested in a recent paper by Jenny Kaldor and Roger Magnusson (from Sydney Law School) and from Stephen Colagiuri (from the University’s Boden Institute of Obesity, Nutrition Exercise, a WHO Collaborating Centre) on how law and regulation could contribute to efforts to wind back Australia’s epidemic of diabetes.

Selected risk factors for non-communicable diseases in Pacific Island Countries and Territories, compared to Australia 

Obesity rates % (2013)a
Country Men>20 years Women >20 years Men & women >20 years
Kiribati 39 56 47.5
Samoa 46 69 57.5
Tonga 52 67 59.5
Australia 28 30 29
Smoking prevalence % (2011)b,c
Country Men >15 years Women >15 years Men & women> 20 years
Kiribati 67 37 52
Papua New Guinea 55 27 41
Solomon Islands 45 18 32
Tonga 43 12 28
Australiad   18 14 16
Diabetes prevalence % (2013)e,f
Country Total adult population
Cook Islands 26
Federated State of Micronesia 35
French Polynesia 22
Kiribati 29
Marshall Islands 35
Nauru 23
Tokelau 38
Vanuatu 24
Australiag 4

a Statistics sourced from Ng M, Fleming T, Robinson M, et al (2014) Global, Regional and National Prevalence of Overweight and Obesity in Children and Adults During 1980-2013: A Systematic Analysis for the Global Burden of Disease Study 2013. Lancet 384, 766-781.

b Statistics sourced from World Bank (n.d.) World Development Indicators: Health Risk Factors, viewed December 2014 <http://datatopics.worldbank.org/hnp/HNPDash.aspx&gt;.

c Statistics for Australia sourced from Australian Bureau of Statistics (ABS) (2012) Australia’s Health Survey: First Results, 2011-2012, Tobacco Smoking. 4364.0.55.001, 29 October 2012, viewed December 2014  <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/73963BA1EA6D6221CA257AA30014BE3E?opendocument&gt;.

d Australian data are for daily smoking rates among adults aged >18 years, for 2011-2012.

e Statistics sourced from Chan J, Cho N, Tajima N, Shaw J (2014) Diabetes in the Western Pacific Region – Past, Present and Future. Diabetes Research and Clinical Practice 103, 244-255.

f Statistics for Australia sourced from ABS (2012) Australia’s Health Survey: First Results, 2011-2012, Diabetes Mellitus. 4364. 0.55. 001, 29 October 2012, viewed December 2014 <http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/D4F2A67B76B06C12CA257AA30014BC65?opendocument&gt;.

g Australian data are for the period 2011-2012.

As part of its Master of Health Law program, Sydney Law School offers several units of study that consider global health, law and development.  These include Critical issues in Public Health Law; Law, Business and Healthy Lifestyles; Global Health Law; and Trade Regulation, Health and the Environment.

[Thanks to Alexandra Jones for references and for information about Australia’ health aid program]