Adjunct Professor Terry Slevin, CEO PHAA
“The commercial determinants of health are defined as factors that influence health which stem from the profit motive. In addition, these also encompass the strategies and approaches used to promote products and/or choices that are detrimental to an individual’s health. There are four main ways that corporate influence is exerted: marketing and advertising; corporate political activities (i.e. lobbying); corporate social responsibility strategies; and supply chains.”
Or put another way, before we can put the foot on the brake when it comes to the consumption of unhealthy products, be they tobacco, alcohol, unhealthy food or gambling, we need to take our foot off the accelerator.
As the Australian Government turns to framing its final Budget for this term of Parliament, we made the case to focus strongly on preventing chronic disease for all Australians.
PHAA’s pre-Budget submission, The Public Health Crisis Budget, gives clear advice on several chronic disease prevention measures that Australia should adopt. The submission outlines recommendations that would both improve the health of all Australians, and at the same time restore public confidence and bolster Commonwealth revenue to help repair the Government’s finances.
Investing in chronic illness prevention and control, through affordable, cost–effective, high-impact policies and legislative measures will deliver the greatest possible health effects by reducing illness, disability, and premature death. Chronic diseases such as cancer, diabetes, heart disease, chronic respiratory diseases and cardiovascular disease have a major influence on health and wellbeing, and are responsible for around 89% of deaths every year.[i] These diseases and the major risk factors that contribute to them (tobacco use, alcohol use, unhealthy diet and lack of physical activity) also have significant negative consequences on economic productivity and financial stability for individuals, households, and society as a whole.
The present pandemic will also trigger significant additional health problems, both directly from COVID-19 infection but also from the indirect impact of many delayed preventive treatments for other forms of disease, including the often-unseen impact of chronic diseases. Diabetes, heart disease and hypertension, cancer, lung diseases, and obesity all significantly worsen the effects of COVID-19, increasing the risk of serious illness or death.[ii]
The opening quote above from the National Preventive Health Strategy (NPHS), released only last December, indicates that it will be followed by an implementation plan for program initiatives, with a 10-year timeframe. The roll-out of public health measures should begin immediately through the 2022-23 Budget, with commitments to programs including:
- Cessation and reduction of tobacco use
- Reduction of alcohol consumption, especially for those consuming alcohol at risky levels
- Reduction of sugar-added beverage consumption
- Reduction of junk food consumption
- Promotion of healthy diets and dietary patterns
- Reduction of harm associated with gambling
- Better maternal and childhood health.
The strategy also states (on p40),
“Consistent with the WHO Global Action Plan for the Prevention and Control of Non- communicable Diseases, public health policies, strategies and multi-sectoral action must be protected from undue influence by any form of vested commercial interest. Real, perceived or potential conflicts of interest must be proactively identified, acknowledged and managed for all aspects of preventive health work, not just in the space of preventing and managing chronic conditions. An evidence-based approach to monitor and address these conflicts will be integral to a strong prevention system.”
Cost estimates of chronic disease in Australia continue to mount. As noted above, estimates of the annual productivity loss that could be attributed to individual risk factors relating to obesity, tobacco, alcohol, physical inactivity and dietary risks totalled in aggregate up to $47 billion.[iii]
2022-23 Budget measures should also address strategies and approaches used by the private sector to promote products and choices that are detrimental to health.
In 2020, the WHO-UNICEF-Lancet Commission on Child Health noted that commercial marketing of products that are harmful to children is one of the most underappreciated risks to their health and wellbeing. It concluded that “industry self-regulation does not work, and the existing global frameworks are not sufficient”. Industries selling unhealthy products are highly active in trying to shape individual behaviours towards the consumption of these unhealthy but often highly profitable products.[iv] All too often, such marketing practices do not affirm individual freedom of choice, but instead seek deliberately to manipulate and undermine real personal choice. Arguments about commercial ‘freedom’ are often simply justifications for unhealthy product suppliers to manipulate consumers and dominate marketplaces.
A far stronger and more comprehensive approach to regulation is required to protect children from unhealthy product marketing, including from gambling, formula milk, alcohol and tobacco industries. It is also required to protect children from industries improperly using their personal data, and to protect from possibly harmful social media.[v]
Sustained programs to help people make healthy consumption choices have proven effective in many domains in the past. Effective and sustained social marketing campaigns and related programs have helped people to achieve reductions in harmful consumption habits (tobacco, alcohol, sugar-added beverages, junk food, etc), and increase healthy activities (physical activity and promoting healthy eating).
The 2022-23 Budget will be assessed by whether it embraces the measures needed for such an investment in all of our health.
See other Budget-related posts:
- Where will the 2022 Budget take us?
- Public health measures can help balance the Budget
- Building a national approach to preventive health investment
[ii] Council on Foreign Relations (2021) Noncommunicable Diseases Kill Slowly in Normal Times and quickly in COVID-19 times https://www.cfr.org/article/noncommunicablediseases-kill-slowly-normal-times-and-quickly-covid-19-times
[iii] Crosland P, Ananthapavan J, Davison J, et al. The economic cost of preventable disease in Australia: a systematic review of estimates and methods. Australian and New Zealand Journal of Public Health 2019;43:484-495.
[iv] For example, Cairns G, Angus K, Hastings G, Caraher M. Systematic reviews of the evidence on the nature, extent and effects of food marketing to children. A retrospective summary. Appetite. 2013;62:209-15
[v] Clark, Helen, et al. “A future for the world’s children? A WHO–UNICEF–Lancet Commission.” The Lancet 395.10224 (2020): 605-658. Available from: https://www.thelancet.com/commissions/future-child