Changing our food environment – potential for non-regulatory policy approaches to improve health outcomes (#33)
The food environment provides enormous quantities of cheap and convenient, processed and restaurant foods to consumers. These foods are often high in salt, added sugar and fat and are typically delivered in large energy-dense portions. A predominance of these types of foods has been identified as a key driver of diet-related ill health around the world. This problem is well understood by public health, government, industry and consumers alike. However, while Australian agencies like the National Health and Medical Research Council and the National Heart Foundation have provided specific guidance about optimal dietary intake, there has been little effective action taken to change the diet of the community.
Most programs that have been implemented to date have relied upon interventions seeking to achieve individual behaviour modification. Recent examples include the ‘’Measure up’’, ‘’Swap it, don’t stop it’’, ‘’8700’’ and ‘’FoodSwitch’’ initiatives. All have achieved significant coverage but there is good evidence of improved health outcomes for none. Key issues are unrealistic expectations about the capacity to achieve individual behaviour change, over-optimistic assumptions about uptake, the voluntary nature of the programs and the absence of robust evaluation of key outcomes. While voluntary interventions directed towards individuals can be effective when intensively applied to target groups, there is little evidence that they have a positive impact upon the dietary pattern of the population as a whole.
Interventions that seek to change the food environment, rather than individuals’ behaviours, are widely advocated as more likely to produce real health gains for the community. On this basis, in 2009, the Australian Federal Government established the Food and Health Dialogue as a public private partnership between government, public health and the food industry. The Dialogue seeks to address poor dietary habits and make healthier food choices easier and more accessible for all Australians through a program of work focussed on food reformulation. In theory this approach has significant potential to deliver large public gains but in practice rather little has been achieved. The key challenges to effective implementation have been the entirely voluntary nature of the initiative, the strong commercial disincentives to industry participation and the absence of any clearly defined timelines or metrics for success.
There is an urgent need for more creative thinking about food and health because the current paradigm of individual responsibility and soft touch government is failing the Australian community. Real change is likely to require a more resource-intensive strategy and only limited health gains will be effectively delivered by public-private partnerships. Government will need to consider whether some public funding might be better applied to legislative approaches designed to control the excesses of the food industry in the same way that they are applied to industries marketing products like tobacco, alcohol and automotive vehicles which can also result in a large burden of disease.