Heather Roy's Diary
Heather Roy's Diary
Diabetes, Obesity and "lifestyle" diseases have been in the news a lot recently - the question being what action should government take to address these problems. I gave the following speech to the Human Nutrition Department, Otago University, this week in response to this question.
"Nutrition, Health and Politics"
As an ACT MP I am frequently tackled about standards of decorum in the parliamentary arena but I have to say that nutritionists can have some battles that put MPs in the shade. In the political field they pretty much leave you alone once you are dead, but as Dr Robert Atkins' family found last year, death is no escape from controversy in the field of nutrition.
For those of you who didn't follow the case of the low carbohydrate diet man, Dr Atkins died last year either from a fall on an icy road or from a heart condition brought on by morbid obesity -depending on which camp you are in. Dr Atkins' supporters favoured the diagnosis of accidental death while his opponents favoured the cardiac diagnosis and so his post mortem results were eagerly awaited and fiercely contested. Parliamentary debate is civilised by comparison. In fact, it is only necessary to retire in order to gain cover from criticism. Former ACT leader Richard Prebble was constantly under attack until he announced that he was stepping down as leader and leaving Parliament after the next election. He was immediately beatified and except for Green MP Rod Donald nobody has criticised him since.
I have several reasons for taking an interest in nutritional issues. In a former life as a physiotherapist, I worked in Cardiac Rehabilitation and prior to being elected to Parliament I worked as a clinical research coordinator, both of which included some basic dietary information being imparted to my patients. One of my contracts was with Bristol-Myers Squibb and the Australian Heart Foundation for the LIPID (Long Term Intervention with Pravastatin in Ischaemic Disease) study. The aim of the study was to demonstrate that there is a total decrease in mortality when blood cholesterol is lowered in patients with ischaemic heart disease. It was a study that ended up being extremely unpopular with our pharmaceutical regulators at the time because it suggested that there was a good case for cholesterol lowering agents to be publicly funded.
The debate was over cholesterol levels in blood and what should be done about them. Some experts recommended cutting back on eggs whilst others said it made no difference. For many years it was a debate that generated more heat than light.
I am pleased to say that the debate on cholesterol has subsequently become a lot more scientific and considerably less strident. In this situation the dietitian is able to give specific advice to individual patients based on their specific problems.
Regrettably the same cannot be said about diabetes and the debate at the moment is both very political and very strident and the science part of the equation not well represented. It tends to be the case that when the scientific basis for a view is weak the debate is very heated, but seldom enlightening.
The argument goes something like this: there is an epidemic of maturity onset diabetes caused by rampant obesity that is in turn caused by an intake of high fat foods and the answer to all of this is for the government to take more control of what we eat. It is an argument that fills me with dread, but it is gaining considerable traction. My own feeling is that if the production and distribution of food came under direct government control then we would be talking today about malnutrition rather than obesity.
Heavier taxes on some food items is the suggestion that is on the table at the moment.
Other suggestions have been made - an excise tax on soft drinks and fast foods; GST removed from fresh foods; subsidised milk; a ban on soft drink and snack vending machines in schools and a fast food advertising ban from children's TV programming. A Ministry of Health discussion document produced some plainly bizarre ideas - the one that sticks in my mind was that all dairies should be banned from within a 1 km radius of schools.
Many of the suggested "remedies" above are distinctly authoritarian and ACT generally opposes them on both practical and philosophical grounds - they just don't work. The first issue is one of practicality. Changing the tax system to have varying degrees of taxation for different foods would greatly complicate calculating GST and would make no difference to the incidence of diabetes. It can also lead to some preposterous situations. Australia recently introduced GST, but lacked the courage to apply it equally to all sales. The result was that groceries didn't attract GST, but takeaway foods did. So a hot chicken attracted GST, but a cold one didn't. The question then became: "at what temperature does a chicken attract GST?"
Policies to make food more expensive have been tried in the European Community but the levels of diabetes are still rising. This policy was more at the instigation of the farming lobby to protect their incomes, but the point was made nonetheless.
It is also important to remember that not everyone with diabetes is overweight.
There is a common misconception that we eat more than our grandparents. Careful historical analysis has shown that we consume fewer calories, but exercise far less. Only a few jobs nowadays incorporate a lot of exercise.
There are few seriously overweight farmers, but most people, including me, drive to work to perform desk jobs and shop in malls with plenty of parking so that there is little need to walk any distance. The exercise side of the equation is usually left out of the diabetes discussion, although it is at least as important a factor as diet.
In fact, there is an impressive body of evidence that our diabetes epidemic is brought on by inactivity. A person doing a lot of hard physical training can eat a lot of calories without concern. The problem of the government trying to legislate people's calorie consumption is that it is authoritarian and inevitably lacks finesse. It is simply impossible to legislate for all people and all conditions. There are too many factors to be handled by government edict and patients are best served by being given personalised advice.
I mentioned before that when it comes to diet everyone is an expert.
Another problem is the disconnect between information and action. Many people do have the correct information, but find it difficult to turn it into action. The nature of the problem was nicely encapsulated by a quote I heard recently: "thought leads to a conclusion, but emotion leads to action." With diet we are often dealing with people who are poorly motivated.
This brings me to the philosophical objections to government taking charge of people's diets. New Zealanders generally have a poor opinion of politicians, but as some observers have noted we have a huge enthusiasm for government. There is a contradiction because government is run by politicians.
If we look at successful countries around the world we see that the things they have in common are a defined role for government, restrictions on the powers of individuals and methods for holding people accountable for their actions. In New Zealand we have leant rather too far towards authoritarianism in the past and the current government is bossier than most.
So, what does ACT want to see happen?
Firstly, we believe in evidence based medicine. Science and scientific research are the way forward and our future decisions regarding medicine and treatments, including diet and nutrition, must be based on sound science. Government has a large role to play here - this is both a public good and an area that is too expensive for individuals to be able to afford. ACT believes that current funding for research is hard to access and maintain and this should be addressed.
Secondly, it must be remembered that the only way to change people's habits, including their eating habits, is to convince them that this is to their benefit. People have to want to change. Education programmes are the best way of achieving this. Easy to say and hard to do I know, but we have in fact made significant progress. Just because it's tricky doesn't mean we shouldn't persevere. The Heart Foundation tick on packaging has made it easier for people to identify the foods they should eat when they are confronted with a choice. We have to find innovative ways of marketing our wares.
Realism rather than idealism is what we must aim for. Incentives are the things that speak to people and the best example I know at the moment is the move the health insurance companies are making to encourage and reward the right behaviour in their clients. For example: active gym membership = lower premiums.
Personal Responsibility is something we are big on in ACT. People do need to take responsibility for the foods they eat and parents for their children. They need to accept that the consequences are frequently of their own making.
And finally the health and personal wellbeing of each of us involves complex issues that are different for all. The best politicians can do is make it easy for people to behave in the right way and easy for those preventing and treating lifestyle diseases.
Better to decide what you eat yourself and to carry the
responsibility for your own actions. After all nutrition is
science and theories and fashions are apt to change over
time. It is perfectly acceptable for scientists to change
their views as evidence changes, but it is a bad basis for