Indigenous Peoples’ Inclusion in Food Governance

For NAIDOC Week, Dr Mark Lock speaks to Dr Belinda Reeve about championing health equity for First Nations Australians and their meaningful inclusion in all dimensions of food governance. 

Reposted with permission from the Sydney Environment Institute website: https://sei.sydney.edu.au/qa/indigenous-peoples-inclusion-in-food-governance/

Red native fruit plant.
Santalum acuminatum, desert bush tucker peach quandong, Australian native fruit via Shutterstock, ID: 734790040.

Industrialised, corporatised food systems contribute to some of the most urgent challenges facing the planet. These include climate change, the depletion of environmental resources, rising food insecurity, high rates of non-communicable diseases, and poor working conditions in the food and agricultural sectors. The dominant food system – and the policies, laws, and practices that govern it – has also marginalised, oppressed, and ignored the voices, perspectives, and participation of Indigenous Peoples, Black People and People of Colour. This occurs even at the highest levels: the recent United Nations Food Systems Summit has been criticised as privileging corporate, agro-industrial, and Global North interests at the expense of human rights, the Global South and Indigenous food systems.  

In light of growing interest in Indigenous food sovereignty, anti-racism and decolonising the food system, The Charles Perkins Centre’s Food Governance Node will be hosting an event on Wednesday 27 July on the ‘Inclusion of Indigenous Peoples in Food Governance in Australia and Aotearoa/New Zealand’. Here, we speak to Dr Mark Lock, Senior Lecturer at the University of Technology Sydney, Research Fellow at Deakin University, and one of the event’s panellists.   

Dr Belinda Reeve: Could you please tell us a bit about your background?  

Dr Mark Lock: I’m from the Ngiyampaa mob and with ancestry from the First Fleet (on the maternal side) and from Latvia and England (on the paternal side) but grew up with ridgy-didge Koori experience in rural NSW, before moving to Newcastle 30 years ago. I study committees and governance because it was invisible people on secret committees who made decisions about Aboriginal people, without Aboriginal people. That’s from the experience of my Nan, a Stolen Generations survivor. She is also why I continue to do research on the participation of Aboriginal people in policy​making processes, such as food and nutrition policy. It’s also why I research cultural safety because Indigenous people are diminished, demeaned and disempowered through poor governance. I currently work as a Research Fellow with the Murnong Health Research Mob (at Deakin University, School of Health & Social Development, Faculty of Health), and I’m also Senior Lecturer at the School of Public Health, University of Technology Sydney. 

Your current research focuses on the Commercial Determinants of Indigenous Health. Could you please explain this research lens to us? 

​Commercial activities influence our society in many ways. It can be advertisements on social media platforms, sponsorship of sporting teams, funding research activities, lobbying politicians, to bringing jobs and products to local communities. So, if business activities are a normal part of our society in many positive ways, then it also holds true that there are negative influences on health and wellbeing. However, it is only recently that Indigenous health policy makes specific mention of commercial determinants of health. In other words, governments have focused on behaviour change programs, health promotion activities, and legislation that influences public services to be health promoting, and ‘businesses and the market’ operate outside of healthy public policy. This means concepts such as health equity are not included in the governance of commercial activities. 

It is inequitable that Indigenous peoples have the highest food prices in communities with lowest incomes and less access to education and employment opportunities – combined with low quality housing and health hardware. But put a mine in the ground and everything changes – fuel subsidies, extraordinary wages, low taxes, and incredible infrastructure to generate wealth for the nation, and massive profits and revenue for a few people. It’s in these very different comparisons (nutrition inequity and mining equity – pun intended) that shows the potential for commercial determinants of health.

“It is inequitable that Indigenous peoples have the highest food prices in communities with lowest incomes and less access to education and employment opportunities – combined with low quality housing and health hardware.”

You’ve also explored the themes arising in submissions to the Australian Government’s 2020 Inquiry into Food Pricing and Food Security in Remote Indigenous Communities. What were some of your findings? 

I’ve analysed 83 submissions from different organisations. I’m thinking about how commercial activities influence food security. There’s some interesting themes coming out as cultural norms, such as the absence of a framework for commercial determinants of Indigenous health; that health equity is excluded from corporate governance; that Indigenous people (and cultural knowledge) are mostly excluded from participating at decision-making tables; and that there is an enduring norm of hardship expected for Indigenous people in rural and remote communities. However, the great things to see and build on are themes such as cultural resilience where Indigenous peoples use commercial activities in an innovative way, that many commercial activities benefit from the inclusion of cultural knowledge, and of course the theme of ‘collaboration nation’ where Indigenous communities proactively form partnerships – between communities and businesses – to leverage reforms at the local level. 

“Commercial activities influence food security. There’s some interesting themes coming out as cultural norms, such as the absence of a framework for commercial determinants of Indigenous health; that health equity is excluded from corporate governance.”

The most illuminating aspect of the research is to make visible what is currently invisible. That’s the culture of commercial determinants, by which I mean to uncover the hidden pattern of values, norms and behaviours underlying the link between commercial activities and nutrition equity. Why is it normal for rural and remote Indigenous communities to suffer enduring nutrition hardship? How can the value system of Western monetary wealth be reconciled with Indigenous sovereignty? How can business behaviours towards equity be supported and rewarded? One thing is a clear theme, with this being the third inquiry on this topic, it’s time get on with actions that are aligned with a dedicated commercial determinants of health framework. 

“Inclusive governance is more than a principal and deserves to be empirically investigated. I know that’s not a simple ‘one-page’ answer, but food policy and governance are complex and nuanced with many stakeholders vying for a profitable wedge into the system. Simple policy​ on the run will not work.”

The focus of this event is on the inclusion of Indigenous peoples in food policy and governance. What do you think truly inclusive food governance looks like? 

I think about how Indigenous peoples can influence every ‘point and pathway’ of governance. So, I a) yarn with relevant Indigenous people from the beginning, b) map the governance system, c) identity every point and pathway where Indigenous people should influence the system, d) ethically research and gather knowledge, e) develop a system design where the process includes all stakeholders, f) build in evaluation, measurement, and monitoring, and g) close the loop by ensuring good ongoing governance with Indigenous communities.

Therefore, inclusive governance is more than a principal and deserves to be empirically investigated. I know that’s not a simple ‘one-page’ answer, but food policy and governance are complex and nuanced with many stakeholders vying for a profitable wedge into the system. Simple policy​ on the run will not work. Finally, thinking about my Nan and Stolen Generations as we come into NAIDOC Week 2022, I’d like to see the food and nutrition industry “Get Up! Stand Up! Show Up!” for nutrition equity with First Nations Australians. 

To hear more from Dr Mark Lock, register for the panel discussion, ‘Inclusion of Indigenous Peoples in Food Governance in Australia and Aotearoa/New Zealand’. 


Dr Mark J Lock is a Ngiyampaa First Nations Australian. He combines both cultural rigour and scientific rigour through a culturally safe research methodology. He has published on Aboriginal holistic health, participation in health policy, nutrition and food policy, and cultural safety in paediatric emergency departments, and cultural safety in research and policy. He is an ARC Discovery Indigenous Research Fellow (2013); Co-chair of the NSW Agency for Clinical Innovations Aboriginal Health Working Group on Patient Reported Outcome Measures; and Vice President of the Hunter Writers Centre. His advocacy – through Freedom of Information – resulted in the release of the Evaluation of the National Aboriginal and Torres Strait Islander Nutrition Plan, and in the release of the Scoping Study for an Australian National Nutrition Policy. 

Dr Belinda Reeve is a Senior Lecturer at the University of Sydney Law School and one of the co-founders of the Charles Perkins Centre’s Food Governance Node, a platform for interdisciplinary research on the role of law, regulation, and policy in creating a healthy and sustainable food system. She is also the lead researcher on an ARC Discovery Project investigating the role of Australian local governments and communities in strengthening food system governance at the local level.  

Despite industry objections, alcohol and pregnancy warnings will be mandatory in Australia and New Zealand

The food regulator, Food Standards Australia New Zealand (FSANZ) has finalised the form of the alcohol and pregnancy warning label that will be mandatory on packaged alcohol sold in both countries.

Assuming the States do not request a further review, the new warning will be added as an amendment to Standard 1.2.7 of the Food Standards Code and will become mandatory after a two year transition period (see pp 6, 78 here).

Here it is.

It’s been a long time coming

In 2011, the Australian and New Zealand Food Regulation Ministerial Council commissioned a review of food labelling law and policy, chaired by Neil Blewett AC.

The committee’s report, co-authored by Australian public health law pioneer Chris Reynolds, is a terrific document, although increasingly difficult to locate online.

The Committee saw no reason to exempt alcohol from labelling requirements, in view of evidence relating to the risks of binge drinking and longer-term over-consumption.

(In 2015, alcohol use was responsible for more than 6,300 deaths in Australia, or 4% of total deaths – see AIHW, Australian Burden of Disease Study 2015, Table D2, p 167)

Amongst many sensible recommendations, the report recommended that “generic alcohol warning messages should be placed on alcohol labels” as part of a broader, multifaceted, national campaign addressing alcohol-related harm [recommendation 24].

Secondly, it recommended that a mandatory warning about the risks of drinking while pregnant should be included on “containers of alcoholic beverages and at point of sale for unpackaged alcoholic beverages” [recommendation 25].

Thirdly, it recommended that alcoholic beverages should not be exempt from energy labelling requirements that apply to packaged food under Standard 1.2.8 of the Food Standards Code [recommendation 26].

The Government’s response to the review is here.

Added momentum for a warning label about the risks of drinking while pregnant came from a Parliamentary inquiry in 2012 into the Prevention, Diagnosis and Management of Fetal Alcohol Spectrum Disorders.

The Foreword to this report, from the House of Representatives Standing Committee on Social Policy and Legal Affairs, states:

“FASD [fetal alcohol spectrum disorders] is an entirely preventable but incurable condition caused by a baby’s exposure to alcohol in the womb. The consequences are expressed along a spectrum of disabilities including: physical, cognitive, intellectual, learning, behavioural, social and executive functioning abnormalities and problems with communication, motor skills, attention and memory.”

The lifetime cost of for one person with FASD in the United States is at least UD$2 million (see FASD Strategic Action Plan 2018-2028, p 8).

The Standing Committee recommended that the Commonwealth implement – by 1 October 2013 – a mandatory warning label advising women not to drink when pregnant or planning a baby on packaging of all pregnancy test kits (Recommendation 7).

This recommendation has not been implemented.

The Committee also recommended implementation – by 1 January 2014 – of a warning label for all alcoholic beverages advising women not to drink while pregnant or planning pregnancy (Recommendation 11).

FSANZ has now finalized this warning – for packaged alcohol.  A warning about drinking while breastfeeding was outside the scope of this work.

It should have been a non-brainer

The Australian Institute of Health and Welfare reports that in 2016, around 35% of Australian women drank while pregnant.  One in four women who were unaware of their pregnancy continued to drink after they found out.

In this age of personal responsibility, alcohol and pregnancy warning labels ought to be a no-brainer, but it has taken until 31 January 2020 for Food Standards Australia New Zealand to approve a mandatory health warning and graphic for alcoholic beverages that contain more than 1.15% alcohol by volume.

For detail of the amendment to Standard 2.7.1, which governs labelling of alcoholic beverages, see here (pp 100-104).

The Australian and New Zealand Ministerial Forum on Food Regulation, which is responsible for developing food regulation policy, had earlier, in October 2018, requested FSANZ to consider options for mandatory alcohol and pregnancy warning labels.

Getting FSANZ involved was a good idea – long overdue.  FSANZ is a technical, a-political agency that reviews evidence, considers options and develops the mandatory technical standards that make up the Food Standards Code.

A methodical, evidence-based, bureaucratic process has significant advantages in areas of regulation prone to lobbying and interference from well-resourced industries.

The internet remembers

Draft (updated) National Health and Medical Research Council (NHMRC) Guidelines clearly state:

“A To reduce the risk of harm to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol.

B For women who are breastfeeding, not drinking is safest for their baby.” (p 47)

In 2018, DrinkWise, a responsible drinking campaign largely funded by the alcohol industry, distributed a poster to hospitals and GP clinics around the country that said: “It’s not known if alcohol is safe to drink when you are pregnant”.

This was widely criticised; even the New York Times ran a story.

DrinkWise re-phrased its poster (see below).

DrinkWise now has a new campaign called “The internet remembers”.

Indeed.

Alcohol industry objections

The Approval Report for the new warning label lists the concerns raised by the alcohol industry, together with FSANZ’ response.  The warning FSANZ chose was: “Alcohol can cause lifelong harm to your baby” – which performed better in consumer testing than “Any amount of alcohol can harm your baby”.

For its part, the alcohol industry suggested that the text of the warning should be “It’s safest not to drink while pregnant” as “medical knowledge is not settled whether drinking small amounts [while pregnant] has a bad influence [on the foetus] (see p 44 here).

Industry was also concerned that the words “HEALTH WARNING” were “misleading, inflammatory and may alarm consumers” (p 26).  It recommended changing “HEALTH WARNING” to “DRINK RESPONSIBLY” (p 28).

FSANZ noted, unsurprisingly, that such a change would “not meet the intended purpose of the pregnancy warning label to reinforce public health advice and messaging not to drink alcohol while pregnant”.

Industry also objected to the red font required for “HEALTH WARNING”, on the basis that it would inflate costs.  It requested a monochromatic label (p 44).  It wanted the label to be smaller (p 29).  It felt the cost of the label was not proportionate to the benefit (pp 33-34).

Industry sought a longer phase-in period of up to 5 years, rather than the 2 years proposed by FSANZ (p 36).

Overall, while the alcohol industry was “fully supportive of interventions that are proportionate, well evidenced and shown to be effective at changing harmful consumption behaviours”, it was “concerned about the lack of rigour of the proposal in this regard” (p 43).

Its objections even extended to the ponytail in the graphic of the woman (p 24).

Overall, the impression you get is of an industry keen to reduce the consumer impact of the warning, keen to delay its implementation, and far more interested in revenue than the harm its products can cause the next generation.

No surprises there, unfortunately.

International Guidelines on Human Rights, Healthy Diets and Sustainable Food Systems: could they make a difference?

The BMJ has published an Opinion calling on the Director-General of the World Health Organisation, Dr Tedros Adhanom Ghebreyesus, and the United Nations High Commissioner for Human Rights, Dr Michelle Bachelet, to jointly initiate a process to develop International Guidelines on Human Rights, Healthy Diets, and Sustainable Food Systems.

180 signatories from 38 countries have supported this Open Call – experts in global health and development, human rights, food systems, and HIV.

You can join the Call and add your name in support here, at the Healthy Societies 2030 website.

Healthy Societies is also hosting supporting documents, including a suggested process for strengthening links between human rights and healthy diets at the global level, and moving towards international guidelines.  (You can contribute to the discussion form, follow on twitter, and join the mailing list).

But pausing for a moment.

How would International Guidelines on human rights and healthy diets make a difference?

The Open Call published in BMJ draws on the example of the International Guidelines on HIV/AIDS and Human Rights (1998), which clarified the legal obligation of States, under international law, to respect, protect and fulfill human rights in the context of HIV.

These Guidelines helped to consolidate the framing of global strategy for HIV prevention and treatment in terms of the human rights of those affected by HIV.

And they provided language and conceptual tools for civil society organisations to hold governments to account.

In the BMJ Opinion, we argue that joint WHO/OHCHR guidelines could have a similar effect, by putting people at the centre of food systems, and strengthening the protection of health in global and national policies.

 

Framing global strategy effectively: the example of HIV

Getting global strategies right matters because they affect national strategies, actions and budgets.

These days, human rights are at the centre of the global response to HIV.

A focus on human dignity, preventing discrimination, empowering those with, or at risk of HIV, and ensuring that no one is left behind – these human rights values lie at the core of global strategies to prevent transmission and treat infection.

It wasn’t always that way.

In Australia, in the 1980s and early 1990s, public debate about rising rates of HIV infection was often framed by prejudice and fear.

HIV was the “gay plague”.  As a PhD student, I remember seeing a call by the Queensland Association of Catholic Parents to brand homosexuals in order to “stop AIDS”.

In Australia at that time, otherwise sane people were arguing that everyone in the country should be tested for HIV, and those with HIV should be removed from society or quarantined in the desert somewhere.

Fortunately, a kinder, more rational and humane approach – a human rights approach – prevailed.

By working with and through those affected by HIV – rather than against them – HIV rates have remained low in Australia.

It didn’t happen by accident.  It took a great deal of effort to ensure that national strategy was framed in such a way as to make it effective.

(The Honourable Michael Kirby, a former Justice of the High Court, and tireless advocate for a human rights approach to HIV – especially during the critical decades of the 1980s and 1990s – is one of the signatories to this Open Call).

 

Why a human rights frame for healthy diets and sustainable food systems?

So human rights have played an honourable role in the global response to HIV.

But how could they have a similar positive impact on nutrition, diet, and health around the world?

Some of the most urgent public health problems today revolve around the interlinked crises of obesity, poor nutrition, hunger, and climate change.

The starting point is that in many countries, market forces are failing to deliver healthy diets, adequate nutrition and sustainable food systems.

If framing food purely as a commodity, and if framing food systems purely as business networks supplying commodities in response to market demand – was effective, then countries wouldn’t be buckling under the strain of a massive, preventable burden of diabetes, obesity and chronic, diet-related diseases.

The Lancet Commission on Obesity called for “a radical rethink of business models, food systems, civil society involvement, and national and international governance” to address these problems.

While many actions will need to be taken, the BMJ Opinion argues that human rights concepts and language are powerful, under-used tools.

Interested in supporting breast-feeding, and preventing the predatory corporate practices that undermine it?  Try doing that without the moral support of human rights concepts.

Interested in the quality of food and drinks served in schools?  Or the stealth marketing of unhealthy foods and drinks to children using online platforms?  You could, of course, revert to the well-worn concepts of parental responsibility and consumer choice.  How’s that working out?

International human rights law provides a powerful way to frame these, and other challenges.

States owe an obligation to respect, protect and fulfil the right to health, as recognised in Article 12 of the International Covenant on Economic, Social and Cultural Rights.

Amongst other things, this requires States to protect the right to health from interference by others, including corporations pursuing economic interests without reference to the impact on health or the environment.

Joint WHO/OHCHR guidelines could help to push human rights concepts and language beyond the “UN human rights silo”.

The subtle form of forum sharing and coalition building that we advocate, through joint WHO/OHCHR guidelines, is increasingly recognised in other areas of the global health response, such as the Global Strategy to Accelerate Tobacco Control (2019), adopted by the Conference of the Parties to the WHO Framework Convention on Tobacco Control.

Many new ideas appear surprising at first glance.  And action at the global level may appear indirect, and abstracted from reality.

However, International Guidelines on human rights and healthy diets could help to mobilize multisectoral action, strengthen the accountability of States and the private sector, and deepen community engagement in the urgent task of developing healthier, fairer and sustainable food systems.

Let’s leave no one behind.

You can join the Open Call on Dr Tedros and Dr Bachelet here.

 

 

Strengthening law’s role in improving Australia’s diet

Food_Governance_Conference

Alexandra Jones and Belinda Reeve

This post originally appeared in MJA Insight and is re-posted with the MJA’s kind permission. The original article can be found at this link.

THE law can be a powerful tool for improving population health, but remains underutilised in addressing Australia’s huge burden of diet-related disease.

Taken in a broad sense, the law includes legally binding rules found in constitutions, statutes (or legislation), regulations, and other executive instruments, international treaties, and cases decided by the courts. It also includes the public institutions responsible for creating, implementing and interpreting the law.

Countries around the world are using law in innovative ways to improve nutrition, with a growing body of evidence demonstrating their effectiveness. Many of these innovations will be discussed when experts in the field gather at the University of Sydney’s Law School from 3 to 5 July for the 2nd Food Governance Conference. The conference will explore how law, policy and regulation address food system challenges or contribute to them at the local, national and global levels. The conference opens with a free public oration on Wednesday 3 July from Hilal Elver, the United Nations Special Rapporteur on the Right to Food.

To tackle high rates of obesity and sugary drink consumption, Mexico introduced a 10% tax on sugar-sweetened beverages in 2014. Evaluations of the tax found a 5.5% decline in the purchase of taxed beverages in the first year after its introduction, and a 9.7% decline in the second year. Over 40 countries have now introduced similar taxes on sugary drinks, with more likely to follow suit.

One of the most straightforward measures for improving dietary health is removing industrially produced trans fats from the food supply. Trans fat bans have been introduced by countries such as Denmark, Singapore and Switzerland, and research demonstrates these bans have virtually eliminated trans fats from the food supply. They are also more effective than voluntary measures in reducing trans fat levels in food.

The success of trans fats bans has prompted calls for similar laws to be used for nutrients such as sugar and salt, with South Africa and Argentina taking the lead on setting mandatory limits for salt in a range of commonly consumed foods. Saudi Arabia has recently announced its intention to set similar maximums for added sugar.

It’s not just national governments that are taking legislative action on dietary health. Legal innovations are taking place at the local and global levels.

Local or municipal governments often lead the way with laws or regulations that aim to improve nutrition. London has banned unhealthy food marketing on the underground, train, tram and bus services, following concerns about high levels of childhood obesity. New York City’s attempt to ban large servings of sugary drinks received widespread media and public attention; less well known is the Minneapolis Staple Foods Ordinance, which requires grocery stores to stock a minimum number of staple foods, such as fruits, vegetables and cereals.

At a global level, countries including Australia have ratified international human rights treaties that obligate them to take national action on unhealthy diets. The nature of these commitments has been explained in comments from international treaty monitoring bodies and the UN Special Rapporteurs on the Right to Food and the Right to Health. The monitoring committee for the UN Convention on the Rights of the Child, for example, has expressly called for restrictions on marketing of unhealthy food to children to protect child rights.

This last example illustrates that while legal interventions targeting the food system are important, other areas of law play a profound role in shaping the social determinants of diet-related health. Planning law can be used to ensure easy access to stores selling healthy, affordable food. Social welfare laws address barriers to food security such as poverty, poor quality housing and homelessness. Consumer protection laws shape the information environment (among other things) and provide protection against misleading and deceptive food marketing.

Australia needs strong national leadership on diet-related health, particularly considering our high levels of obesity (nearly two-thirds of adult Australians are overweight or obese) and diet-related non-communicable diseases, combined with rates of food insecurity that are unacceptably high in such a wealthy country.

Yet to date, the federal government has relied on voluntary measures and collaborative partnerships with industry to deal with issues such as marketing of unhealthy food to children, salt reduction, and the Health Star Rating front-of-pack nutrition label.

Evidence shows that these initiatives tend to suffer from limited uptake by food businesses, significant weaknesses in their design and implementation, a failure to manage commercial conflicts of interest, and a lack of transparency and accountability in governance processes.

The Health Star Rating, for example, has now been in place for 5 years but appears on less than one-third of all products, mostly those that score at the upper end of its five-star scale. This limits its value in guiding consumers towards healthier choices.

The benefits of legislation, in contrast, include mandatory compliance, with legal penalties available for non-compliance, and formal, transparent processes of enactment and amendment. The law can reach entire populations and create healthier environments in a way that is significantly more difficult for voluntary measures. This is one reason why 10 countries, including recent adopters Chile, Peru, Israel, Sri Lanka and Uruguay now have mandatory front-of-pack labels.

Australian state governments have taken important steps towards improving nutrition at a population level, for example, through kilojoule information on fast food menus, and removal of sugary drinks from schools and hospitals, but there is more that could be done. For example, legislative frameworks for city planning lie within state control, but tend not to support obesity prevention objectives.

Local government action on diet-related health is also typically overlooked in thinking and decision making on nutrition policy. However, Australian local governments possess a range of functions and powers that could be used to leverage access to healthy food, particularly within a framework of supportive state legislation, and many already have in place initiatives that have an impact on nutrition, for instance, policies on community gardens and urban agriculture.

Australia is a world leader in the use of law to regulate the manufacture, sale and marketing of tobacco products, and won significant victories against tobacco manufacturers in domestic and international courts. Australia now has some of the lowest smoking rates in the world, but we lag behind in using law to improve diet-related health.

The federal Health Minister recently announced the government’s intention to develop a national preventive health strategy. This is a rare window of opportunity to bring Australia to the forefront of action on diet-related health. Legal innovations overseas demonstrate that the re-elected federal government should give serious consideration to more hard-hitting – and effective – measures on nutrition. Now more than ever we need legal change that supports Australians in living longer, healthier lives.

Alexandra Jones is a public health lawyer leading the George Institute for Global Health Food Policy Division’s program on regulatory strategies to prevent diet-related disease. Her current research interests include Australia’s front-of-pack Health Star Rating system, fiscal policies to improve diets (e.g. taxes on sugar-sweetened beverages), product reformulation, restrictions on unhealthy marketing, and the interaction of international trade law and health.

Dr Belinda Reeve is a Senior Lecturer at the University of Sydney Law School and is co-founder of the Food Governance Node at the Charles Perkins Centre. Her research interests lie in public health law, with a particular focus on the intersections between law, regulation, and non-communicable disease prevention.

Upcoming event: the 2019 Food Governance Conference

Food_Governance_Conference

Sydney Health Law is hosting the second Food Governance Conference from the 3rd to the 5th of July this year.

The Conference is a collaboration between Sydney Law School, the University’s Charles Perkins Centre and The George Institute for Global Health. The 2019 Conference will explore how law, policy, and regulation address (or contribute to) food system challenges such as sustainability, equity and social justice in global food systems, and malnutrition, obesity, and diet-related diseases.

The Conference will open on the 3rd of July with a public oration by the UN Special Rapporteur on the Right to Food, Professor Hilal Elver. Also speaking will be Ronni Kahn, the founder of Ozharvest, and Mellissa Wood, General Manager, Global Programs at the Australian Centre for International Agricultural Research. You can register for this free event here.

The main days of the Conference will take place at Sydney Law School on the 4th and 5th of July. Keynote speakers at the Conference include Professor Amandine Garde, Director of the Law and Non-Communicable Diseases Unit at the University of Liverpool, and Dr Juan Rivera, Director of Mexico’s National Institute of Public Health.

Further information about the Conference, including the draft program, can be found here.

 

Beyond the “hot tub”: Australia’s runaway obesity epidemic

How sure are you that you won’t lose your feet or toes to diabetes?

According to a new report by the Obesity Collective, based at the Charles Perkins Centre at the University of Sydney, obesity in Australia is getting much, much worse.

Between 2014-15 and 2017-18, the obesity rate in Australian adults rose from 27.9% to 31.3%.

In other words, over the past 3 years, an additional 900,000 Australians became obese.

Sixty-seven percent of Australian adults are now either overweight or obese (2017-18), an increase from 63.4% in 2014-15.

That’s astonishing.

Astonishingly bad news.

Australia now ranks 5th out of 44 OECD countries in the obesity stakes – it’s a race we shouldn’t be trying to win.

If this trend persists, how will we look in 2027-28?

By that time, nearly nine million Australians will be obese.

Think of the cost – not only costs to our taxpayer-funded health care system, but premature deaths from cardiovascular disease, obesity-related cancers, limbs, feet and toes amputated due to our runaway diabetes epidemic.

According to Diabetes Australia, 4,400 diabetes-related amputations already occur each year in Australia.

That’s set to get worse.

 

Australia’s runaway obesity epidemic needs to become an election issue

How long till we see concerted national action that is not choreographed by the big food lobby?

Did you know that the Australian Food & Grocery Council seeks a “constructive and collaborative response to obesity”?

They’ve been saying stuff like that for years.

I call it the “hot tub approach”.  Let’s all jump into the hot tub together and soap each other’s backs, and see what we can achieve…together.

This “constructive and collaborative approach” – characterised by voluntarism, and weak accountability structures – has been official policy in Canberra for years.

It would be great if it actually worked.

But if it was going to work, wouldn’t we be seeing positive results by now?

 

Life outside of the “hot tub”

There is life beyond the hot tub.

Feasible policy options to halt Australia’s obesity epidemic have been identified.  We know what we could and should do.

The “Australian Obesity Prevention Consensus” sets out an evidence-based policy agenda for the federal government.

Implementing the (surprisingly strong and certainly welcome) recommendations of the Senate Select Committee into the Obesity Epidemic in Australia would also be a good place to start.

The INFORMAS Network monitors the actions of state and federal governments and has issued scorecards on the performance of Australian governments, with priority recommendations.  (Watch out for the 2019 Food Policy Index Progress report, to be launched on 2 April 2019).

These reports include recommendations for legal and regulatory changes that the processed food industry will resist.

Like implementing credible – as distinct from voluntary, weak and loophole-ridden – standards to protect children from exposure to unhealthy food and drink marketing.

Like setting ambitious, time-sensitive and independently-monitored targets for reformulation to be met by food manufacturers, retailers and caterers.

Like a health levy on sugary drinks.  (Remember folks, at the end of the day, it’s only sugar water, not holy water).

Like making the Health Star Rating system mandatory.

No one likes sharing hot, soapy water with the folks from “big food” more than me, but the statistics speak for themselves.

Over the last 10 years, the number of Australians with obesity has more than doubled, from 2.7 million (2007-08) to 5.8 million in 2017-18.

It’s time to get out of the hot tub, and to implement long-recommended, evidence-based policies to create healthier food environments.

Cracking the Codex: the new frontier for nutrition labelling

Alexandra Jones, Global health lawyer and PhD Candidate at The George Institute for Global Health and the University of Sydney
Dr Anne Marie Thow, Senior Lecturer in Health Policy at the University of Sydney
Dr Carmen Huckel Schneider, Senior Lecturer, Health Policy at the University of Sydney and co-lead of the Health Governance and Financing Group and the Menzies Centre for Health Policy

Food labels hit the New York Times recently when leaks from North American Free Trade Agreement negotiations suggested the US was being urged by big American food and soft-drink companies to limit the ability of the pact’s three members – Mexico, Canada and the US – to implement warning labels on unhealthy foods.

There is no escaping the health imperative here. Obesity has nearly tripled since 1975 worldwide: 41 million children under 5 are now overweight, while 1.9 billion adults are overweight or obese. Spiralling health and economic costs mean governments are turning to evidence-based policies to prevent and control diet-related diseases like obesity, heart disease, stroke, diabetes and dental caries.

Better nutrition labelling – including front-of-pack labels that interpret nutrition information through symbols, colours or words – are part of the comprehensive package recommended by the World Health Organization. Over 20 countries already have policies in place – they include the UK’s traffic lights, France’s Nutriscore, Chile’s ‘stop sign’ warnings (which Peru appears set to follow), and Australasia’s Health Star Rating.

This proliferation and diversity poses trade and commercial challenges, and calls for some degree of consistency in global approach have been made.

Cracking the Codex (Alimentarius Commission)

This is where the international food standards body – the Codex Alimentarius Commission – comes in.

A UN body created by the WHO and UN Food and Agriculture Organization, Codex has a dual mandate: to protect consumer health, and promote fair trade practices.

Codex standards and guidance are voluntary, but in practice frequently act as a touchstone for countries looking to develop national policies. As Codex enjoys recognition as an international standards setting body by the WTO, guidance it develops also has potential to show up in trade discussions around food.

In short: what happens at Codex matters for public health nutrition.

Done well, Codex could bolster countries to take action. Left unchecked, there’s a risk outcomes could deter countries’ from implementing policies desperately needed to stem the rising global tide of non-communicable diseases.

As Codex is also notoriously slow – there’ll be a general meeting 2-6 July in Rome, and a further discussion paper for feedback later this year – it’s critical that the process itself not be used as a ‘brake’ on growing global momentum to implement strong front-of-pack labels.

Time for public health to assume a seat at the Codex table

Industry Observers have been quick to jump on opportunities to provide input into new Codex work on front-of-pack labelling. The first working group included representation from 13 international organizations representing the food industry, particularly the sugar and beverages sectors. Only two consumer groups were there.

It’s now critical we ensure public health bring their perspective to the table.

What you can do:

Read our briefing note for more information, and

  • Get involved – contact your national Codex Contact Point or join an Observer organization
  • Speak up about the public health priorities, like:
    • the importance of a definition of ‘front-of-pack nutrition labelling’ that supports schemes most likely to be effective in achieving public health objectives – and not, for example, industry preferred options such as the Guideline Daily Amount that aren’t backed by evidence
    • preserving policy space for strong and innovative measures – evidence is rapidly evolving but currently suggests for informing consumers and improving diets, this may include mandatory labels that use interpretive elements like colours, symbols or words, underpinned by robust and transparent criteria for scoring foods
  • Encourage continued action at a national level – remember, nothing in the current process prevents interested countries from pursuing front-of-pack labelling

Want to read more?

 

This piece was originally posted on the PLOS Global Health Blog on 25/06/2018, and has been re-posted with author consent.

 

Upcoming events: The Food Governance Showcase

Food-Governance-Hand-berries

On Friday the 3rd of November, Sydney Health Law is co-hosting the Food Governance Showcase at the University of Sydney’s Charles Perkins Centre.

The Showcase will present new research from University of Sydney researchers and affiliates, examining the role of law, regulation and policy in creating a healthy, equitable, and sustainable food system. The Showcase will feature presentations on a wide variety of topics, including food safety law in China, Australia’s Health Star Rating System, and taxes on unhealthy foods and micronutrients.

The Showcase will open with a panel event featuring three legal experts, who will speak on a specific area of law (including tax law, planning law and international trade law), and how it impacts on nutrition and diet-related health.

Later in the day, a speaker from NSW Health will discuss the Department’s new framework for healthy food and beverages in its health facilities.

Further information about the Showcase, including the program, is available here.

The event is free, but registration is essential.

Any questions about the Showcase can be directed to Belinda Reeve (the co-organiser): Belinda.reeve@sydney.edu.au

 

Excluding bottled water, only 1.3% of food and beverage advertising across the Sydney train network is consistent with a healthy diet

New research from the Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders at the University of Sydney, and Sydney Law School, has investigated the quality of nutrition of food and beverage advertising on every station of Sydney’s metropolitan train network.

Judged by revenues, outdoor advertising of food, on billboards and other advertising spaces, is on the rise.

Sydney Trains generated over $12 million in advertising revenue in the 2013-14 financial year, and this was expected to increase to at least $100 million over the subsequent 5 years.

A research team, led by Emma Sainsbury, collected data in February (summer) and July (winter) of 2016, photographing a total of 6931 advertisements across the 178 stations in the network.

Each advertisement was coded as core (a healthy food or beverage recommended for daily consumption), or discretionary (high fat, sugar and/or salty food not recommended for daily consumption), based on the Australian Guide to Healthy Eating.

The results tell you what you probably already know: Sydney train stations are a great place to advertise junk food and beverages.

Just over a quarter of total advertisements (1915/6931, or 27.6%) promoted food and beverages.

Of the food and beverage advertisements, 84.3% were for discretionary foods/beverages, 8% were for core foods/beverages, and the remainder (7.6%) were miscellaneous advertisements, mostly brand-only advertisements that did not mention specific products.

Significantly, the core foods/beverages category consisted mostly of bottled water vending machines (74.4%), and billboard advertisements for bottled water (11%).  When advertisements for bottled water were excluded, only 1.3% of food and beverage advertising on the Sydney train network was for core foods.

The most commonly advertised discretionary products were potato chips (25%), sugar-sweetened beverages (23%, mostly flavoured milks and soft drinks), and intense or artificially-sweetened beverages (18.7%).

Despite food advertisements comprising just over a quarter of all advertisements, Coca-Cola and PepsiCo (which includes PepsiCo beverages and The Smith’s Snackfood Company) were the largest advertisers overall, contributing 10.9% and 6.5% of total advertising across the network.

Advertisements for alcohol made up over 6% of food and beverage advertising, and about 2% of total advertising.

There is obviously a total disconnect between foods and beverages advertised on Sydney trains and the kinds of foods and drinks that make up a healthy diet.

What do advertisers have against healthy food and beverages, I wonder?

A large number of self-regulatory initiatives ostensibly regulate food and beverage advertising in Australia.

However, these have failed to achieve a healthy food advertising environment, probably by design.

The results of this study support the case for government to pressure industry to shift the mix of food and beverage advertising towards products that are more consistent with a healthy diet.

The paper reviews some of the regulatory approaches that might be used, from outright bans, to interim and longer-term targets for reductions in the overall volume of unhealthy food advertising, based on a credible nutrient profiling system that evaluates the quality of nutrition of the product.

Restrictions on the volume of particular kinds of advertising, as a percentage of total advertising, do exist in other jurisdictions.

In Ireland, for example, the General Commercial Communications Code limits the volume of television advertising of foods high in fat, salt or sugar, to a maximum of 25% of sold advertising time across the broadcast day (para 16.10).

However, much of the impetus for constraints on unhealthy food advertising arises from the belief that children are particularly vulnerable and deserve to be protected.  Unlike, say, television programs that are made specifically for children, the train network is used by substantial numbers of both adults and children.

Another approach could be to significantly increase the proportion of train station advertising allocated to the promotion of healthy, core foods and beverages, perhaps through higher pricing strategies for advertising of junk foods and sugary drinks.

The food, beverage and advertising industries ought to be taking the lead here, but how likely is that?!

The prevailing ideology, shared by the food and beverage industries, their allies and lobbies, is that you get the health you deserve.

If you can beat temptation and eat a healthy diet, you deserve to be healthy.

But if you eat a poor diet, if you routinely consume the diet that is overwhelmingly advertised, then you get what’s coming to you.

That’s personal responsibility.

It’s great for business (there’s great margins on nutritionally poor foods), but not great for the health budget, nor for individuals and families.

Maybe that’s why the food and beverage industry needs round-the-clock lobbyists in Canberra to explain to politicians and the rest of us how the world works.

Because otherwise someone might start asking crazy questions…like…Why shouldn’t the mix of advertising across the Sydney train netework be better aligned with a healthy diet?

The paper can be downloaded free of charge here.

Upcoming events: Engaging with Advocates

Advocates 1

On Friday the 28th of July, Sydney Health Law is hosting Engaging with Advocates, along with the Food Governance Node and the Healthy Food Systems Node at the Charles Perkins Centre.

This event aims to connect early career researchers with leading civil society advocates in order to foster collaboration and increase the impact of research. Representatives of organizations working on the sustainability of food systems, promoting healthier diets, and championing consumer rights will share personal experiences of using research in their efforts to improve policy, and offer insights for academics looking to strengthen the practical relevance of their research.

This event will feature keynote presentations by:

  • CHOICE
  • The Live Lighter Campaign (Heart Foundation Western Australia); and
  • Sustain: The Australian Food Network

The keynote presentations will be followed by a session where participants workshop “live” policy issues, and the event will conclude with networking drinks.

While the event is targeted at early-career researchers, academics at every level are welcome to attend, as are members of civil society and government organisations, and others who are interested. Further information can be found at this link.

We hope to see you there!