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POSTED: Tuesday 1 September 2009 (updated Thursday 3 September 4:25pm AEST)

RAPID ROUNDUP | ONLINE BRIEFING: National Preventative Health Strategy - Experts respond

The Federal Government has today released the first ever National Preventative Health Strategy – essentially three strategies at once that aim to reduce the huge real and potential burden of disease due to obesity, tobacco and the harmful use of alcohol.

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Professor Elizabeth Elliott is Professor of Paediatrics & Child Health at University of Sydney, Children's Hospital Westmead and Director of the Australian Paediatric Surveillance Unit.

Dr Alex Wodak is Director of the Alcohol and Drug Service at St. Vincent’s Hospital, Sydney.

Professor Mike Daube is Deputy Chair of the Preventative Health Taskforce and President of the Public Health Association of Australia

Michael Moore is CEO of the Public Health Association of Australia

Associate Professor David Crawford is from the School of Exercise and Nutrition Sciences at Deakin University

Professor Fiona Stanley is Director of the Telethon Institute for Child Health Research.

Todd Harper is the Chief Executive Officer of VicHealth

Dr Kaye Mehta is a Senior Research Fellow at Flinders Public Health and a Senior Lecturer in Nutrition and Dietetics at Flinders University.

Vicki Briggs is the Manager of the Centre for Excellence in Indigenous Tobacco Control at the University of Melbourne

Dr Peter Clifton is the Director of CSIRO’s Nutrition Clinic which Preventative Health Flagship and is a Affiliate Professor of Medicine and Biomedical Science University of Adelaide

Professor Rob Moodie is Chair of the National Preventative Health Taskforce and is also Chair of Global Health at the Nossal Institute for Global Health at the University of Melbourne

Professor Simon Chapman is Professor in Public Health at the University of Sydney. He is a sociologist with expertise in tobacco control, media discourses on health and illness, and risk communication.

Professor Ian Olver is Chief Executive Officer of Cancer Council Australia and Chair of the Australian Chronic Disease Prevention Alliance

Professor George Rubin is President of the Australasian Faculty of Public Health Medicine of the Royal Australian College of Physicians.

Anne Jones is Chief Executive of Action on Smoking and Health



Professor Elizabeth Elliott is Professor of Paediatrics & Child Health at University of Sydney, Children's Hospital Westmead and Director of the Australian Paediatric Surveillance Unit.

"I commend the recommendations of the preventive taskforce regarding alcohol use, which also apply to alcohol use during pregnancy. Pregnant women commonly drink alcohol during pregnancy, posing a risk of adverse outcomes for the unborn child - including low birth weight, prematurity, a range of birth defects and problems with growth and development. The recommendations to improve liquor control regulations (this might include labelling alcoholic beverages), increasing public awareness of the potential harm of alcohol (in this case for the unborn child), attempts to change attitudes to drinking alcohol in Australia (including during pregnancy) and reform to taxation and pricing arrangements will all impact on womens' attitudes and drinking behaviour during pregnancy."



Dr Alex Wodak is Director of the Alcohol and Drug Service at St. Vincent’s Hospital, Sydney.

“This is an important exercise for many reasons: improving the already good health of Australians will improve our well being and will also help to reduce the (rising) costs of health care.

The targets are all important and achievable. These three issues are the major threats to Australian health and well being.

Working with the food industry to try and reduce obesity sounds logical. But whether the food industry has the capacity to put the public interest first is very doubtful. Based on past experience, I am not hopeful. It is worth trying. But if after a year or so the food industry has shown that it pursues its own interests before the interests of the community, then the government will have to act without the food industry.

I support the strategies chosen to reduce smoking prevalence, especially increasing the price (relative to income). That is the most effective measure.

Australia has been more successful in increasing smoking cessation than reducing smoking initiation. Low cost, high impact measures to increase population quit rates should be expanded.

The prevalence of smoking among several groups in the community is still at the levels that we saw in the general community in the 1960s. These groups include Aboriginal and Torres Strait Islanders, people with severe alcohol and drug problems, people with severe mental illness and prison inmates. Equity demands that these groups should have additional assistance with smoking cessation.

Comprehensive alcohol tax reform is the single prevention strategy best supported by evidence of effectiveness. But it only receives half hearted support in these recommendations. Notwithstanding the political difficulties involved in alcohol tax reform, this is the single reform offering greatest benefit and should therefore be the highest priority.

The support for a sustained social marketing and public education strategy is support for a feel good intervention unsupported by evidence of effectiveness.

It is hard to know whether the recommendation on alcohol outlets will result in change. The evidence is clear. Reducing outlet density and restricting the conditions of sale generally results in a reduction of alcohol related harm. This is what we should be doing. But it is very hard for the public health David to overcome the might of the alcohol beverage industry Goliath in the present structures. What is needed is a level playing field so that community and industry representatives can make their case equally.

Improving assistance to people who are having difficulty with alcohol is well worth doing. Most people manage using self help groups and other informal assistance. Treatment services are poorly funded – the quality and quantity of treatment services should be raised to the same level as achieved for other common chronic conditions. The RACP should support supervised disulfiram being considered for the PBS. The emphasis on primary health care an improved services for indigenous Australians is very welcome.”

Professor Mike Daube is Deputy Chair of the Preventative Health Taskforce and President of the Public Health Association of Australia

“This is a blueprint for action to save hundreds of thousands of lives. The report is much more than the usual series of recommendations. The strategy set out to reduce our national toll from obesity, tobacco and alcohol is practical and pragmatic, seeking action not only from governments but from all sectors of the community.

It is time to remove the ‘Cinderella’ tag from prevention. We know what needs to be done and how it should occur. The targets in the report – reducing daily smoking to under 10%, reducing short-term harmful drinking to 14% and longer term harmful drinking to 7%, halting and reversing the rise in overweight and obesity; and contributing to Closing the Gap – are all feasible by 2020 if there is a genuine national commitment.

There are enormous benefits from prevention. Halting the rise in obesity alone will save half a million premature deaths by 2020. The action on smoking proposed will prevent the premature deaths of more than 300,000 Australians now alive. And acting on alcohol not only saves lives, but will also save the health system nearly $2 billion over the next decade. The potential for benefit is staggering.

The Government is to be applauded for the commitment it has already shown to prevention, through the Taskforce, funding through COAG and facing down drinks industry interests over the alcopops tax. There is now an overwhelming case for acting. The evidence is in. We know what needs to be done. We know that the only real opposition will come from commercial interests, but surely the health of the community – and preventing the deaths of nearly one million Australians now alive – is more important than the interests of tobacco companies and other commercial lobby groups.”

Michael Moore is CEO of the Public Health Association of Australia

“Prevention still attracts only 2% of all health funding. We hope that this report will mark a real commitment to providing the funding that prevention needs so that we can make a real impact on the burden of chronic disease that threatens to overwhelm our health systems.”
“We welcome the comprehensive nature of this report. The staged approach to implementation is especially important – the timelines are all feasible, if there is commitment and support from the Government and the community. We know that there is strong public support for action on prevention, and hope that there will be cross-party support for the program of action proposed.”
“There are also important workforce implications from this report. There is a pressing need to ensure a strong prevention workforce to implement the approaches recommended, and we will wish to play a part in ensuring that this occurs.”
“The time for action is now. We commend the Government for establishing the Taskforce, and urge that the strategies proposed be implemented as speedily as possible.”

Associate Professor David Crawford is from the School of Exercise and Nutrition Sciences at Deakin University

“The Preventative Health Taskforce report represents the most comprehensive approach to the prevention of life threatening chronic disease we have seen in this country for at least the past 20 years. Without a strategy such as this the numbers of people affected by diseases like cancer, heart disease, diabetes and obesity will spiral out of control, as will the costs to our health care system. Once implemented this report has the potential to impact the lives of Australians for generations to come. The Federal Govt is to be commended for initiating this work and for the leadership they have shown in relation to health reform. “

Professor Fiona Stanley is Director of the Telethon Institute for Child Health Research.

“What is very clear from this report is that we know what to do and how to do it. It’s now a matter of getting on with it without delay. Alcohol, obesity and tobacco all profoundly affect child development and wellbeing from the womb through to adulthood. As a nation – governments, corporates and communities – we must now commit to making it happen.”

The current approaches are unsustainable – we cannot continue to absorb spiralling costs when many of the most burdensome health conditions are lifestyle based and preventable. There is a history of industry opposition to these types of initiatives, but now is the time to stand firm and commit to a pathway that will bring real quality of life to so many people, particularly our children.

Unless we make these changes, there is the real likelihood that our children will have a lower life expectancy than their parents – that cannot be our legacy.”

Todd Harper is the Chief Executive Officer of VicHealth

“There has never been a better time to secure significant and sustained health reforms. The Preventative Health Strategy represents an exciting vision and our best chance in decades to deliver a healthier future for all Australians. We would urge the government not to delay in implementing the taskforce recommendations.

Today, more than ever before, there is a need for good public health strategies. Our current course is unsustainable - with increasing demands on the health system and the worrying rise in chronic disease and an ageing population.

There is no one silver bullet to tackling the rising health burden in Australia caused by tobacco, alcohol and obesity. The multi-faceted approach proposed in the Preventative Health Strategy is crucial to reversing the tide of chronic disease in this country. The strategy details a raft of initiatives that support healthy choices. It’s time now for action.

A National Prevention Agency is a key plank in the reform of our public heath system. Such an agency presents a great opportunity for this country to build on the evidence of what works in health promotion and ensure improved health outcomes for all Australians.

We know that health promotion and prevention works and is cost effective. Australia’s leadership in tobacco, road safety and HIV/AIDS prevention are proven examples of this. The Preventative Health Strategy is based on a robust process of consultation, good evidence and a keen eye on preparing for the future health needs of Australians. We all need to get behind it.”

Dr Kaye Mehta is a Senior Research Fellow at Flinders Public Health and a Senior Lecturer in Nutrition and Dietetics at Flinders University.

“The National Preventive Health Strategy is timely in addressing the serious health problems of obesity, tobacco and harmful use of alcohol. The report provides a comprehensive framework for action at the individual as well as societal level, as indeed have many other similar reports.

The 'proof of the pudding' will be in the implementation of the strategies and the establishment of a National Prevention Agency in 2010 provides a structure in which to do this. This agency needs to be adequately resourced to be able to deliver on its ambitious goals.

On the matter of marketing energy-dense nutrient poor foods to children, and its relationship with childhood obesity, it is disappointing to see the continued reliance on 'soft strategies' (industry self-regulation) with the promise of government regulations in 4 years time, if this is not effective. We have already had many years of industry self-regulation, during which Australian children have been exposed to unacceptably high levels of 'junk' food marketing, and childhood obesity has escalated. Surely NOW IS THE TIME FOR STRONGER ACTION.

There is no sign of industry abating its marketing practices, only a shifting from television advertising to other media, such as the Internet, supermarket sales promotions, sports sponsorship, product placement, etc etc etc. This point is not adequately picked up by the Report, which still focuses on restrictions of TV advertising. In four years time we may indeed see a voluntary decrease in TV advertising, but this will be more than compensated for, by increases in marketing on other media, and our children will still be exposed to high levels of 'junk food' marketing. If we are serious about decreasing childhood obesity, then the new National Prevention Agency will have to get much tougher on marketing of energy dense nutrient poor foods to children.

Notwithstanding these criticisms, the recommendation to phase out advertising of energy-dense nutrient-poor foods and beverages before 9pm is positive indeed.”

Vicki Briggs is the Manager of the Centre for Excellence in Indigenous Tobacco Control at the University of Melbourne

“Tobacco is directly related to 20% of all Indigenous deaths in this country. Raising the price of cigarettes will make smoking less accessible to Indigenous young people and in my opinion that’s a positive thing. A drop in the prevalence and incidence of Indigenous tobacco smoking will make a substantial contribution to improving health in communities and to closing the gap.”

Dr Peter Clifton is the Director of CSIRO’s Nutrition Clinic which Preventative Health Flagship and is a Affiliate Professor of Medicine and Biomedical Science University of Adelaide

“It is good to see they are going to set up a national prevention body that will fund long term research and also good they will legislate within 4 years to ban children's advertising if voluntary targets don't work”

Professor Rob Moodie is Chair of the National Preventative Health Taskforce and is also Chair of Global Health at the Nossal Institute for Global Health at the University of Melbourne

“This is the first ever National Preventative Health Strategy – providing the Government with a road map of guidelines to address these significant health issues.

The Strategy provides recommendations to firstly establish volunteer approaches to educate and change community behaviour before introducing regulatory, pricing and taxation approaches. This is the best opportunity we have had in a generation to significantly improve the health of Australians. Implementation is the key, but it must be implemented over several phases.

This requires progressive, comprehensive, and determined action over the next ten years. We must not let up. We must not sit on our hands. This is the key role of the new proposed National Prevention Agency which will be established in early 2010. It endorses progressive, comprehensive, determined and sustained action.”

Professor Simon Chapman is Professor in Public Health at the University of Sydney. He is a sociologist with expertise in tobacco control, media discourses on health and illness, and risk communication.

"It's ironic that we package prescribed drugs -- which save lives -- in plain boxes with just the brand name; require users to go to a doctor to get a temporary ‘license’ (a prescription) to obtain a limited supply, while we package cigarettes -- which kill 15,000 Australians a year -- in beautiful boxes and sell them from every conceivable outlet. It's time Australia legislated to put cigarettes in plain packaging.

Tobacco company internal documents have said it plainly: ‘A high cigarette price, more than any other cigarette attribute, has the most dramatic impact on the share of the quitting population’ and ‘The most certain way to reduce consumption is through price’. Australian cigarettes cost just $13 a pack. In Ireland they are $20 and in Norway $23."

Professor Ian Olver is Chief Executive Officer of Cancer Council Australia and Chair of the Australian Chronic Disease Prevention Alliance

“Cancer Council Australia and the Australian Chronic Disease Prevention Alliance welcome the final recommendations of the Preventative Health Taskforce as a blueprint for action to improve prevention of cancer and other chronic diseases attributed to smoking, obesity and excessive alcohol consumption.

The Government must put the health of Australians first and act immediately to implement the national prevention strategy recommended by the Preventative Health Taskforce in its final report so we can begin to enjoy the long-anticipated population health benefits.

While a number of the taskforce’s recommendations would need to be phased in over time, some - such as raising tobacco excise, restricting advertising of unhealthy foods and beverages to children and simplifying food labelling to help people make healthier choices - should be fast tracked, regardless of vested interests.

Cancer Council Australia also welcomes the establishment of the National Health Promotion and Prevention Agency to implement the national prevention strategy, provided it is given the independence and authority it needed to get the job done.”

Professor George Rubin is President of the Australasian Faculty of Public Health Medicine of the Royal Australian College of Physicians.

“The Report was well worth the wait. It provides a sturdy framework to improve the health of Australians, with the added advantage of reducing the burden on our health care system.

Australian governments have taken a long time to acknowledge the value of prevention, despite the evidence of successes such as the mandatory use of seatbelts. This Report provides the opportunity for a true commitment to a health system based on wellness and prevention. It’s an opportunity that Australia cannot afford to miss.

Increases in taxation for both alcohol and tobacco will be a positive move given the huge body of evidence that increasing price and availability reduces consumption and related harms. Bringing Australia’s tobacco prices in line with countries such as Ireland and the United Kingdom is a much warranted and long overdue step.

Banning smoking in cars where children are present and enforcing plain packaging for tobacco products are excellent moves. As is banning TV advertising of junk food and soft drinks when high numbers of children are viewing. Taking these actions will make Australia a world leader in the field of health and prevention.

The centrepiece of the proposals is the National Prevention Agency. It is essential that the Agency is established with the broad remit recommended in the Report to ensure that the impetus for prevention maintains its energy. The minimalist version in the 2009 Budget papers just won’t get the job done.

My only real criticism is that I am disappointed that the Taskforce stopped short of recommending mandatory traffic light labelling on food and beverages. Traffic light labelling is popular with both the general public and health professionals. Evidence indicates that it helps people across the socioeconomic spectrum to make decisions about healthy food.”

Anne Jones is Chief Executive of Action on Smoking and Health

“Australia has fallen behind other countries in tobacco taxation, without a real increase in a decade. A tobacco tax increase offers the Rudd Government an ideal opportunity to raise funds for health reform in a way that is popular with the community, and will itself help drive smoking rates down – to the benefit of all Australians, particularly those in greatest need.

Tobacco is still our leading cause of preventable death and disease – killing over 15,000 people a year and draining our economy of more than $31b a year in health and social costs. Investing in the fight against tobacco is the single most cost-effective health measure the government can take. We fully support the recommendations of the Taskforce towards extending tobacco public awareness media campaigns and ending all forms of tobacco advertising, promotion and sponsorship.

After such a long process of consultation, we urge that all these recommendations be implemented without delay. We congratulate the Rudd Government and the Health Minister for their vision – the first step is to fund this health revolution with an urgently-needed increase in tobacco tax.”