Lily Pratt and Professor Caroline Miller
Obesity is a major driver of the rising diabetes rates in Australia, and is responsible for over 55% of the total disease burden of type 2 diabetes.
Around two thirds of Australians currently live with overweight or obesity; further exacerbating existing inequities.
Earlier this month, The State of Diabetes Mellitus in Australia in 2024 report was released after 14 months of inquiry by the House Standing Committee of Health, Aged Care and Sport.
The Committee, led by Dr Mike Freelander MP, investigated the causes and risk factors of diabetes, new research into the prevention, diagnosis, treatment and management of diabetes, the impact of diabetes on the economy, and the relationship between obesity and diabetes.
As Australia’s peak body for public health, PHAA advocates for policies that prevent disease and premature death.
Using our expertise in preventive health, and we made a submission to this Inquiry which focused on what governments can do to prevent Australians from developing type-2 diabetes.
PHAA Vice President (policy), Professor Caroline Miller, appeared at the Inquiry hearing on behalf of PHAA and established the importance of preventing obesity to reduce rates of diabetes in Australia.
“Obesity is about to overtake tobacco as Australia’s leading preventable burden of morbidity and mortality,” Prof Miller stated.
“We’ve got an enormous public health problem on our hands. What it needs is a public health response.”
“What we’ve done with overweight and obesity is we’ve had a disproportionate … focus on individual responsibility and individual determinants. Really it’s a public health issue that’s driven by individual determinants, but it’s also driven by environmental factors, social factors, economic factors. What we need is a response that aligns with the drivers and also aligns with the evidence.”
The causes of obesity are varied but can largely be attributed to the environments in which people live, rather than to individual choices – however the focus remains skewed.
Unhealthy settings work against, not with, people’s efforts to follow healthy eating and physical activity patterns.
A report by The Grattan Institute states that the tripling of obesity rates over the past forty years can’t be explained by people caring less about their health.
These changes have affected most Australians, but disproportionately affect lower socioeconomic groups, further compounding the inequalities that exist.
What we recommend
To adequately address this multifaceted health concern, we, alongside several allied public health and consumer non-government organisations, proposed a package of policies to be delivered.
All organisations argued that without a comprehensive and coordinated approach to creating healthy environments, we will not see meaningful and sustained improvements in the prevention of diabetes and obesity. See our submission and policy package here.
After months of inquiry, we were pleased to see key preventive health policy highlighted at the top of the recommendations in the Committee’s final report.
As well as PHAA’s submission being quoted on several occasions, of the top 10 recommendations, five can be linked directly to PHAA policy positions statements, our submission, and from PHAA’s appearance at the Inquiry hearing.
We’ve outlined below where our policy positions align with the Committee’s recommendations.
Recommendation 2
3.177 The Committee recommends that the National Health and Medical Research Council expedites a review of the Australian Dietary Guidelines, and ensures that the revised guidelines include adequate information for Australians living with diabetes.
PHAA Position
- Inclusion of considerations related to the level of processing of foods as part of the next iteration of the Australian Dietary Guidelines – Ultra-Processed Foods Policy
Recommendation 3
3.179 The Committee recommends that the Australian Government implements food labelling reforms targeting added sugar to allow consumers to clearly identify the content of added sugar from front-of-pack labelling. This food labelling initiative should be separate from the information regarding added sugar potentially being included in the Nutrition Information Panel.
PHAA Position
- Governments must commit to continuing, strengthening, funding, and expanding the use of the HSR system to support public health impact. This should include … Changes to the graphical display to improve consumer use and understanding of the labels – Health Star Rating Policy
- “South American countries have been very aggressive … with a whole range of [front of package] marketing options, for example teaspoon of sugar labelling on various products, so it’s very clear to the consumer when they pick up a product that this has X number of teaspoons… How many people would imagine there would be 15 teaspoons of sugar in a single-serve drink of soft drink? That’s the kind of fundamental information that people genuinely don’t have. So there are opportunities available to us on a number of fronts. One is to properly label the products. The health star rating is one of the other mechanisms that’s available to us.” – Adj Prof Terry Slevin, Diabetes Inquiry Hearing
- “There’s added sugar labelling, … No person will tell you that a bottle of soft drink has got 15 teaspoons of sugar. It horrifies people when they find that out. It’s quite arresting. We’ve done a lot of work looking at what happens when you just put a simple label on the front of packages. … That can be quite powerful in terms of providing consumers with information which lets them say, ‘Well, I probably don’t want to be drinking 15 teaspoons of sugar every day or twice a day or be giving it to my kids.’” – Prof Caroline Miller, Diabetes Enquiry Hearing
Recommendation 4
3.181 The Committee recommends that the Australian Government implements a levy on sugar-sweetened beverages, such that the price is modelled on international best practice and the anticipated improvement of health outcomes. The levy should be graduated according to the sugar content.
- The Australian Federal Government should prioritise and implement an appropriately designed health levy on SSBs, as part of a comprehensive policy package to address unhealthy diets… Advocate for an appropriately designed 20% health levy on SSBs…- Health Levy on Sugar-Sweetened Beverages Policy
- The Australian Federal Government should prioritise and implement an appropriately designed health levy on SSBs, as part of a comprehensive policy package to address unhealthy diets – Involvement of Food Industry in Nutrition Policy
- Implementing a 20% health levy on sugar sweetened beverage manufacturers, with a tiered approach (based on sugar content). The levy should be implemented as an excise tax on companies – PHAA Diabetes submission
Recommendation 5
3.184 The Committee recommends that the Australian Government considers regulating the marketing and advertising of unhealthy food to children, and that this regulation should:
- Focus on children defined as those aged 16 and under
- Be applied to television, radio, gaming and online
- Use definition of unhealthy food that has been independently developed.
PHAA Position
- Develop a national regulatory approach, that includes the use of legislation, to effectively reduce Australian children’s exposure to unhealthy food and beverage marketing
- Ensure TV, radio and cinemas are free from unhealthy food marketing – Protect children from online marketing of unhealthy food – Protecting Children from the Marketing of Unhealthy Foods and Beverages Policy
- “biquity of the marketing of these high-energy, low-nutrient foods has got out of control. Controls with regard to the way that they’re promoted and marketed, but also the entire supply chain and market chain needs to be examined” – Verbal evidence given to the Diabetes Enquiry Hearing by Adj Prof Terry Slevin and Prof Caroline Miller
Recommendation 6
3.186 The Committee recommends that the Australian Government provides its response to the Australian Food Story: Feeding the Nation and Beyond report and considers a dedicated resource within the Department of Health and Aged Care to support access to healthy food to all Australian communities.
PHAA Position
Policies to increase the production and consumption of whole foods e.g., fruits and vegetables, nuts, cereals, and legumes) – Ultra-Processed Foods Policy
- Continue to ensure fruit and vegetables are exempt from goods and services tax
- Subsidise cost of fruit and vegetables for all, including freight costs of produce to rural and remote communities to aid increased consumption
- Social marketing programs for fruit and vegetables, e.g., incentivising stores to promote healthier options over discretionary items – PHAA Diabetes Submission
Recommendation 7
3.188 The Committee recommends that the Australian Government, in consultation and cooperation with state and territory governments, develops a best practice framework to tackle the problem of obesogenic environments, including through better urban planning and the development of physical activity initiatives and supports efforts to increase access to regular exercise in schools and neighbourhoods as a matter of urgency.
PHAA Position
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- Ensure the coordinated engagement of local government, relevant industries (e.g., food manufacturing, retailing and marketing, advertising, media) and non-government organisations, and sport and recreation groups to ensure that action on obesity is high on their agenda – Health Levy on Sugar-Sweetened Beverages Policy
- … key priority action areas: whole-of-school physical activity programmes, improving active transport and land use, healthcare, sport and recreation for all and community-wide programmes – PHAA Diabetes Submission
- … promote physical activity with a multi-sector, multi-disciplinary public health response incorporating researchers, research funders, and practitioners in culture, education, health, leisure, planning, transport, and civil society. This will help to align physical and health objectives with broader social, environmental, and sustainability goals – Physical Activity Policy
PHAA welcomes the prioritisation of public health in the Committee’s recommendations.
We applaud the Committee on including Recommendation 4 (implement a levy on sugar-sweetened beverages), and Recommendation 3 (food labelling reforms targeting sugar on front of pack), despite receiving strong opposition from industry bodies.
However, there were also obesity prevention policies that were not adequately addressed, or not addressed at all.
For instance, Recommendation 5 (addressing unhealthy food marketing to children) does not include prohibiting processed food companies from targeting children with marketing – despite unhealthy food and beverage industries constantly pushing their products to children, negatively impacting their dietary intake and health.
The Committee highlighted the importance of implementing the National Obesity Strategy to address obesity, as it is the leading risk factor of diabetes. However, this was only included in the Committee comments section and was not a formal recommendation.
The Committee also did not call for a hastened implementation of the National Preventative Health Strategy, despite the urgent need to improve the health behaviours and environments of all people in Australia and protect them from chronic diseases, such as diabetes.
What next?
PHAA will continue to advocate the Government to implement the recommendations of the Committee. We will also continue to advocate for the evidence-based policies in our submission that can, when delivered as a package, reduce the risk factors for developing diabetes.
We will continue to advocate for the full implementation, appropriate resourcing, monitoring and evaluation of the National Preventative Health Strategy and National Obesity Strategy.
With the recent packages to address vaping and tobacco, it is time to talk seriously about overweight and obesity in Australia.
Lily Pratt is Policy Officer, and Prof Caroline Miller is Vice President (Policy), at the Public Health Association of Australia.
Image: Supplied
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