The Ministry of Health and Health Minister have spent months working up the Government’s new plan to reduce child obesity. Frankly, it is hard to see what they have been spending that time on. The policy has been self-proclaimed as “wide-ranging”, but contains not much that is new and certainly nothing that will shift the needle for kids. The whole thing is a bit like an early re-gifted Christmas present – like Santa took all the presents that got chucked away last year and re-wrapped them. So far the only groups to cheer the policy are the Taxpayer’s Union and Food and Grocery Council.
There is nothing new to see here, apart from a target and a public information campaign.
Targets have proven to be a favourite tool of this Government, because it allows them to look like they are doing something without spending money. But before you get too excited that our health sector will suddenly shift its focus to obese children, have a look at the target:
By December 2017, 95 per cent of obese children identified in the Before School Check (B4SC) programme will be referred to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.
So the target isn’t actually to reduce child obesity, simply to get most of the fat ones to the doctor. Then what? The only option the doctor has is to give them a Green Prescription, which is mostly about encouraging the family to exercise. We know that exercise is only 20% of the problem – changing diet is the real issue.
Note that not every kid gets the Before School Checks – they offer a free health check to all four year olds before they go to school. As with most interventions, it is often the poorest people that don’t get them, mainly because they don’t know about it, can’t get time off work or can’t get to the provider.
As for information campaigns, a comprehensive OECD study indicated they only have a tiny impact, and New Zealand work suggests that without other actions at the same time they could have no impact at all. Despite being ineffective they are very popular; governments around the world tend to like ad campaigns because they are inoffensive and keep the ad agencies busy.
A big part of this package is also guidance. Has anyone out there ever read any of the government guidance on diet, exercise and weight gain? Exactly.
Do we know what works?
This morning Minister Coleman reiterated his claims that the evidence for a soft drink tax is not strong enough to justify action. The same could be said for every part of his package, as confirmed by officials from the Ministry of Health.
Is this true? There are certainly different levels of evidence and even with the best studies, science is never 100% certain. If you held all interventions to this standard, we’d never do anything. At what point does the mounting evidence justify action?
This lack of evidence becomes clear in other areas of the plan. The Health Minister and Prime Minister’s Science Adviser have both made a big deal about the importance of pregnancy on the future health prospects of a child in the past, yet the package contains nothing new for pregnant mothers, just some guidance.
This is an admission that they don’t know what to do, because they don’t know what works. Targeting women when they are already pregnant is too late – action needs to begin before then, but that would require much broader initiatives across the whole population. Any Minister or doctor trying to tell a pregnant mother what to eat would be pretty brave, especially if she is struggling to keep her food down.
What would work?
So what would work? From the available evidence, the two most effective and cost effective policies are tax and regulation, just as they were for smoking. Trouble is that the Government has ruled out the two most effective interventions – junk food taxes and stopping junk food companies targeting kids with their advertising – some time ago. Instead the Minister has asked the industry to review their standards governing advertising to kids.
We’ve commented on the Minister’s attitude to junk food taxes previously, so won’t repeat ourselves. Suffice to say the evidence for the impact of junk food taxes (such as a soft drink tax) is mounting as summarised by this study:
Finally, while recognizing that the evidence of harm on health against SSBs [sugar sweetened beverages] is strong, we should avoid the trap of waiting for absolute proof before allowing public health action to be taken.
In terms of pregnancy and early child development, which is a vital area, the one thing that we do know works is increasing breastfeeding. There is a lot of work to do to in this area but it is not easy or cheap to solve – breastfeeding rates start high but fall off pretty quickly. Shifting this would require things like longer paid parental leave and breastfeeding support.
However, the real surprise in this package is that the Government haven’t picked up the one intervention that fits with their idealogy and actually works – there is still no funding for teaching kids about nutrition in schools. Despite the claim that we need to educate people rather than tax them for poor dietary choices, we’re doing neither.