WHO Commission on Ending Childhood Obesity presents final report and recommendations

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The World Health Organisation’s Commission on Ending Childhood Obesity, appointed by WHO Director-General Dr Margaret Chan in 2014, has now formally presented its final report.

The Commission was co-chaired by Sir Peter Gluckman, the Chief Science Advisor to the Prime Minister of New Zealand, and Dr Sania Nishtar, the founder and President of Heartfile, a health policy think tank based in Pakistan.

The Commission held hearings in all 6 WHO regions, and was supported by two technical working groups: the Ad Hoc WG on Science and Evidence, and the Ad Hoc WG on Implementation, Monitoring and Accountability.

In 2014, an estimated 41 million children under 5 years of age were either overweight or obese (this is defined as the proportion of children whose weight for height scores are more than 2 standard deviations, or more than 3 standard deviations, respectively, from the WHO growth standard median).

The Commission’s strategic approach rests on three categories of interventions:

  • interventions to tackle the obesogenic environment in order to improve the healthy eating and physical activity behaviours of children;
  • interventions targeting critical stages of the lifecourse; ie (i) preconception and pregnancy; (ii) infancy and early childhood; and (iii) older childhood and adolescence;
  • interventions to treat obese children in order to improve their current and future health.

A number of the Commission’s recommendations addressing the obesogenic environment, and critical stages of the lifecourse, in particular, confirm the role for law and regulation in improving the food and physical activity environment for children.

In a move sure to thrill the fizzy drinks industry, the Commission has called on countries to implement an effective tax on sugar-sweetened beverages, and noted that some countries may also consider a tax on foods high in fats or sugar.

Noting “unequivocal evidence that the marketing of unhealthy foods and sugar-sweetened beverages is related to childhood obesity”, the Commission has called on countries to implement the WHO’s Set of Recommendations on the Marketing of Foods and Non-alcoholic Beverages to Children.   It has also called for cooperation between Member States of the World Health Assembly to reduce the impact of cross-border marketing of unhealthy foods and beverages.

The Commission has called for a standardised global nutrient labelling system, as well as the implementation of interpretive front-of-pack nutritional labelling supported by public education to improve nutritional literacy.  Interpretive food labelling has consistently been a highly contested area of food law and policy.  For example, the European Food Industry reportedly spent 1 billion euro to ensure that front-of-pack traffic light labeling did not become a Europe-wide standard.  Traffic light labels interpret the quality of the nutrition of food by means of highly visible red, amber and green symbols that correspond to the amount of saturated fat, salt and added sugar in the product.

The Commission’s recommendation that schools, child-care settings and children’s sports facilities should be required to create healthy food environments may also require legislation or regulations for successful implementation in some countries.  The Commission has also specifically recommended that countries eliminate the sale or provision of unhealthy foods, such as sugar-sweetened beverages and energy-dense, nutrient-poor foods, in schools.

In the United States, the federal government subsidises the provision of breakfasts and lunches served at school to children from low-income families.  This has enabled the US Department of Agriculture to issue regulations  requiring schools that participate in the national school lunch and breakfast program to improve the nutritional quality of the foods that are served.   However, these standards have faced relentless opposition from the junk food industry and from Congress.  Mandatory standards to improve the nutritional quality of school food have been introduced in a number of jurisdictions, including England and Scotland.

Other recommendations that may require legislative or executive action include the enforcement of the International Code of Marketing of Breast-milk Substitutes and subsequent resolutions of the World Health Assembly (WHA).

The Commission’s report will be presented to the members of the WHA in May 2016, where further actions may be taken to support the implementation of the Commission’s recommendations.

Those with an interest in obesity should also keep an eye out for the report of the Lancet Commission on Obesity, co-chaired by Professor Boyd Swinburn (University of Auckland), and Professor Bill Dietz (George Washington University).  In this paper, Professors Swinburn and Dietz outline the work of their Commission.

 

 

Victoria’s new “safe access” law for abortion services

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When I lived in inner Melbourne I often saw anti-abortion protestors picketing one particular medical practice on Swanston Street that provided abortion services.

On a number of occasions I would see a car pull up and (what looked to be) a teenage girl hopping out, trying to shield her privacy with a jacket held over her head, hurrying into the sanctuary of the practice past a huddle of protestors who tried to engage her in conversation or pass her leaflets.

From where I stood, the behaviour of the protestors served only to compound what was already a sad situation.

Anti-abortion protestors who picket fertility control clinics will be held to a significantly higher standard of conduct as a result of the Public Health and Wellbeing Amendment (Safe Access Zones) Act 2015, passed by the Victorian Parliament in November.

Victoria joins Tasmania, which also has safe access provisions in its Reproductive Health (Access to Terminations) Act 2013  (Tas).

 

Helpers of God’s Precious Infants

The “Safe Access Zones” Bill was introduced by the Victorian Government in August 2015.  It is modelled on a Bill by Sex Party MP Fiona Batten, who acted in response to a pattern of conduct by anti-abortion protestors picketing an East Melbourne Clinic.

A Parliamentary Research Note on safe access zones in Australia  points out that over a 20-year period, the Melbourne chapter of an international anti-abortion organisation, Helpers of God’s Precious Infants, have protested for up to six mornings a week outside the Fertility Control Clinic in East Melbourne.

The Hon. Fiona Batten MP told ABC that:

“This weekend they were yelling to people attending a clinic, ‘you are going into a slaughterhouse’,” she said.

“They film and photograph people to try and intimidate them, to try and intrude on their privacy.”

The Bill was introduced just as the Fertility Control Clinic lost a Supreme Court application against the Melbourne City Council arguing that the Council had failed to exercise its duty “to remedy as far as is reasonably possible all nuisances existing in its municipal district” (Public Health and Wellbeing Act 2008 (Vic) s 60) [see Box below].

 

Obligations imposed by the “Safe Access Zones” Amendment

The aim of the Act is to provide safe access zones around the premises of medical practices providing abortion services (for the benefit of persons seeking abortion services, as well as employees of the practice) and to prohibit the publication and distribution of recordings taken by anti-abortion protestors outside abortion clinics.

The key provision is s. 185D, which says that a person must not engage in “prohibited behaviour” within a safe access zone.

A “safe access zone” exists 150 metres in all directions from premises where abortions are provided.

“Prohibited behaviour” includes harassing and obstructing, as well as “communicating by any means” in a manner that is able to be seen or heard by a person accessing or leaving the premises and which is “reasonably likely to cause distress or anxiety” (s. 185B).

Employees of practices where abortion services are provided are protected from harassment and obstruction and from being recorded, but not from communications by protestors about abortion (s 185B(2)).

The Act contains an offence for publishing or distributing a recording of a person which both identifies them and identifies them as a person accessing premises at which abortions are provided (s. 185E).

Police officers are authorised to apply for a search warrant to enter premises to sieze recordings of people entering or leaving premises where abortions are provided (s. 185F-185H).

“Abortion bubble legislation”, as it is sometimes called, needs to balance the interests of people providing or accessing medical procedures with the freedom that people in democracies have to object to actions and practices which they regard as immoral.

The “Safe Access Zones” Act would not appear to prohibit silent vigils or all forms of communication with those seeking abortion services.  However, protestors will over-step the mark if their communications are considered (ultimately by a court) to be “reasonably likely to cause distress or anxiety”.

Box: Fertility Control Clinic v Melbourne City Council  [2015] VSC 424 (26 August 2015)

Fertility Control Clinic claimed in a Supreme Court application against the Melbourne City Council that the actions of protestors (people affiliated with Helpers of God’s Precious Infants) constituted a nuisance as defined in the Public Health and Wellbeing Act 2008 (Vic) s 58, and that the Council had failed to exercise its statutory duty under the Act.

The Public Health and Wellbeing Act 2008 (Vic) imposes on local Councils a duty “to remedy as far as is reasonably possible all nuisances existing in its municipal district” (s 60).

The Court held that “nuisance” under s 58 is not limited to interferences with the enjoyment of land (private nuisance).  Referring to evidence of the conduct of the protestors, the Court said: “Prima facie, such conduct is a private nuisance by reason of impeding the Clinic’s enjoyment of its property and a public nuisance by reason of the elements of annoyance, inconvenience or hurt to members of the public” (para 31).

However, the Court concluded that the Council had not failed to exercise its statutory duty under the Act.  The Council had concluded that the best way of settling the dispute between the Fertility Control Clinic and anti-abortion protestors was for aggrieved persons to refer the matter to police.  In the Court’s opinion, this did not amount to advice to settle the matter privately (one of the options available to the Council under the Act); however, the Court concluded that the Council had not misdirected itself as to the questions it needed to consider, and had not misconstrued the nature and scope of its duty under the legislation.