Political action on obesity- how do we get there? (#109)
Australia has a system of federal government. The commonwealth raises 80% of government revenue, and the states and territories are responsible for 60% of the spending, a non-productive and sometimes toxic power imbalance. Although historically governments may have led, today policies are largely (but not entirely) reactive, with options which are both practical and of obvious benefit to Australia as a whole sacrificed on the basis of sectional or media opposition. For this reason the mission of Obesity Australia is to drive change in the public perceptions of obesity, its prevalence and its treatment.. This change requires evidence-based community education on the drivers of obesity - genetic, epigenetic and environmental; the key change agents are GPs and the media.
In driving change, it is important to realize that governments look not for problems but solutions, costed solutions; that they are by nature gradualist, interested primarily in incremental change that can be audited and validated; and that having advocates within government is a prerequisite for any initiative to gain traction. The ~30 year time course of the epidemic of obesity and associated disorders is acknowledged as a reason for action, most of which at the level of government has been ineffective exhortation, leaving open the door for pragmatic and previously validated alternatives.
Many in the obesity area long for sweeping change - legislation, regulation, targeted educational and health funding; unlike disabilities, this will not happen in Australia today, however desirable. We need a ten year plan, with the steps clearly enunciated (and initially chosen as electorally popular), progressively audited and providing subsequent community support for additional necessary measures, some of which are not politically feasible without building a step-by-step community consensus.
We have a proud record of persuading governments to act in key heath areas - seat belts, slip slop slap, cochlear implants for profoundly deaf neonates, and smoking ( by a classical gradualist process). There is no reason why we cannot extend this record to the area of obesity.