Coleman: We'll tackle obesity but no tax or legislation

Coleman: We'll tackle obesity but no tax or legislation

Speaking to Q+A’s Corin Dann this morning, health minister Jonathan Coleman said tackling obesity was at the top of the Government’s priority list, but there was “no evidence” a sugar tax worked, and further regulation was unnecessary.

“Marketing is an issue but we’ve got to work with the industry to turn that around, and if you look at the Advertising Standards Authority guidelines, which the industry has signed up to, there’s been major changes over time,” he said.

Dr Coleman said of more interest to the Government, which is currently preparing a programme to deal with obesity, was exercise, portion control and the diets of pregnant women.

“All my discussions with [Chief Science Advisor Peter Gluckman] have been around the intervention around the perinatal period … and that’s what the medical evidence is starting to show is very important – that, exercise and education,” he said.

“Not this fixation with advertising and sugar taxes.”

Q + A

Episode 18

JONATHAN COLEMAN

Interviewed by CORIN DANN

CORIN Good morning.

JONATHAN Good morning, Corin.

CORIN Why is it at the top? How serious is this problem?

JONATHAN Well, it’s at the top because it’s one of the major drivers of morbidity and mortality in New Zealand, and, look, our nation is getting larger –especially our kids, especially certain demographics. So if we don’t do something to intervene, we’re going to be actually paying the price down the track, not only fiscally, but actually more importantly, it’s going to really impact the lives of individuals and their families, so it is really important.

CORIN So, you’ve been in this job for quite a while now. How are you going to make your mark and be the one to turn this around?

JONATHAN Well, I’m really interested in what works, so evidence counts. I’ve been looking at all the evidence globally. What it does show is that actually it’s really important just to get some action underway, and that’s why we’ve got $40 million going into Healthy Families, which works with one million people across the country. We’re rolling it out across the country. It’s about lifestyle change, about getting people into those habits early. Also very interested, obviously, in exercise. We’ve brought the Sport and Health portfolios together. We’re interested in what actually works, not on what gets media attention.

CORIN Your government has made targets and making, you know, measurements a big focus, under Bill English particularly, and across the government. Will you make obesity a target, a formalised target for your government?

JONATHAN Well, that’s up for discussion, but what we will do, we will invest in quality programmes that work. And so what we’re doing at the moment is reviewing all the evidence and formulating a package, which I want to be able to announce later in the year.

CORIN But surely if you’ve identified it as the number one priority… All the advice I’ve seen suggests this is going to cost our country millions in health and the costs of the government. Why wouldn’t you make it your number one target?

JONATHAN Well, look, we’ve got a range of targets already. A target of itself won’t actually guarantee that we’re going to turn around what is a massive, long-term problem. What we’ve got to do actually is start taking action, and that’s why we’re getting the action underway. But there’s going to be ongoing work and ongoing discussion around the target. But in the end, we want to actually deliver stuff that will work.

CORIN So you’re not ruling it out that it could be one of those? Because you’ve got rheumatic fever and immunisation as your two health targets.

JONATHAN Well, those are Better Public Service targets. We’ve got six separate Health targets. Now, the discussion is would we make it one of the Health targets. We may; we may not. But I can’t announce on this programme today whether we will or not. What I can say is we’re going to continue with action around education, around exercise, and we’re also looking at Peter Gluckman’s work around the perinatal period to actually do what works. And the evidence shows it’s around things like encouraging people, educating them around portion control, around exercise, around actually changing their attitudes to food and exercise in the long term.

CORIN Just tell me, what does the evidence you’re seeing tell you? Because from what I can see, there is some call here for regulation. You can’t just do it— You can’t just encourage people and tell them, you know, ‘You’ve got to live a healthier lifestyle.’ There needs to be some regulation as well. That’s what the evidence seems to say.

JONATHAN Not necessarily. No, the evidence doesn’t show that. If you look at the evidence for sugar tax, right, it shows actually it’s very low in terms of disability-adjusted life years lost, so that’s basically saying that, look, there’s no evidence that it’s going to end up with people living longer, healthier lives. What there is evidence for is actually eating less and exercising more, and so I’m focusing my efforts on education, getting people to actually live more healthy, active lifestyles. Sugar taxes get a lot of attention. No evidence that it works.

CORIN Yeah, but I think the sugar tax thing is a bit of a red herring here.

JONATHAN Good. So do I.

CORIN Aren’t we actually talking about things such as marketing children with unhealthy food? And if you look at the WHO – ‘Unequivocal evidence that unhealthy food, non-alcoholic beverage marketing is related to childhood obesity.’ I mean, your own science advisor was involved in this work. So there’s clear evidence there that you’ve got to do something about that marketing, don’t you?

JONATHAN Look, you’re true about that effect, but actually the ASA already has guidelines around that. Industry has signed up to those. Things have changed markedly over the years. I also think Industry is a big part of solving this problem. I called together a forum right across the food and drink industry recently. They’re very enthusiastic about helping tackle that.

CORIN Will there be any restrictions on marketing of fizzy drinks, of sugary foods at kids?

JONATHAN Well, there already are voluntary accords, which Industry have signed up to and are actually— they are making sure that those work. So they’re not breaking those accords. Those things are actually already in place.

CORIN But, I mean, we’ve got a system—You reversed the rules on the tuck shops, on the canteens at schools, so there’s sugary foods and all that sort of stuff gone back in there.

JONATHAN That’s because they weren’t working.

CORIN OK. I mean, then you’ve got supermarkets. You know, you go to the aisle, there’s food— there’s sugary food everywhere there. The marketing is specifically targeted at children. All the evidence that we’ve read and we’ve prepared for this interview suggests it is a major problem.

JONATHAN Marketing is an issue, but we’ve got to work with the industry to turn that around, and if you look at the Advertising Standards Authority guidelines, which Industry is signed up to, there’s been major changes over time. You’re talking about product placement in supermarkets – separate issue.

CORIN Yes, but Peter Gluckman says— Advertising— I mean, Peter Gluckman will say, ‘Yes, you do have to work with the industry.’ It’s a food industry. Of course we do.

JONATHAN That’s right.

CORIN But it’s not enough. You have to have some regulation as well.

JONATHAN No, he doesn’t say you need regulation. What he says you’ve got to focus in that perinatal period, where the hard drive for human beings is actually set. So a lot of it is around what mothers are eating and feeding their babies around the time of birth and in those early weeks onwards. So, back to the advertising, there are ASA guidelines. Product placement in supermarkets is a totally separate issue.

CORIN But wouldn’t he argue that by allowing marketing of young children, you’re hardwiring them into those sugary habits?

JONATHAN Actually, he doesn’t argue that. All my discussions with him have been around that intervention around the perinatal period, so how you work with mothers and babies, how you make sure that mothers breastfeed their babies, how you make sure that children are weaned on to the right types of food when they come off breast milk. And that’s what the medical evidence is starting to show is very important – that, exercise and education. Not this fixation with advertising and sugar taxes.

CORIN All right. You seem to be suggesting that’s something you’re not interested in as part of your obesity package.

JONATHAN What I’m saying is actually there’s already very good measures there, which Industry is complying with.

CORIN So marketing’s off the table. What about actually flipping it around? So for sugary foods, say, take tomato sauce, which any mum will tell you is packed full of sugar. Why wouldn’t there be a label on there saying how much added sugar there is, or a traffic light label to say, ‘Hey, this is something you need to go easy on’?

JONATHAN Yeah, and that’s our healthy food star rating, which Industry is taking part in. So it’s a voluntary scheme across Australia and New Zealand, but Industry is signing up to that.

CORIN Again voluntary, and the whole issue is is it enough just to sort of gently prod the industry, or do you need to actually get tougher?

JONATHAN Well, in the end, industry is going to act in its shareholders’ interests, and those shareholders, they want a return value. The consumers now want that sort of information, and so industry is moving into that space. So you’re seeing a real change in behaviour over time. I mean, if you look at salt-

CORIN But that’s taking too long. That’s the issue. We wait for the marketing to work. We see Coke bringing in their new non-sugary fizzy drinks or whatever, but it takes an awful long time. In the meantime, we know a whole lot of kids are getting hooked on sugar.

JONATHAN The point about obesity, though, Corin, is it’s going to take a while to turn this around, and there’s a whole lot of actions that need to be taken. Focusing on one thing is not going to going to do the job, so that’s why exercise is important. Nutrition, education and actually changing people’s attitudes to food and drink over time. There’s no silver bullet. If there was a silver bullet to it, it would have been done internationally. Everyone is struggling with it.

CORIN What about asking the industry to limit the amount of sugar in their products?

JONATHAN Oh, we’re working with industry on all these issues, and they’re actually starting to take measures around formulation, and they want to.

CORIN Have you asked?

JONATHAN I haven’t met with industry myself to say, ‘Take sugar out,’ but if you get industry people on here, they can tell you exactly what they’re doing. They are taking all sorts of things out of their products, actually, to make them more acceptable to consumers.

CORIN I’m guessing, though, that you are preparing a programme to deal with obesity. All the evidence is saying it’s a massive problem. It’s going to cost- You must be meeting with the industry. What are they telling you?

JONATHAN They’re saying that they’re very keen to take part. It’s not me meeting with them. I’ve addressed them via video link, but, look, I’ve said to the officials, ‘Let’s find out what industry is doing. Let’s work with industry to formulate part of a programme that will really address that.’ But, look, no single thing is the answer. I’m also very interested in sport and exercise - how we can get our kids more active, away from the iPads and the screens. More children participating in sport. And so I’m very keen to use the sports portfolio to leverage what we do in sport for better health outcomes.

CORIN There will be critics, though, who will say, ‘Well, that’s just ignoring the bigger problem, which is around the food.’ And there is a perception that your government is too cosy with the food industry and is simply going to railroad this, to not do it.

JONATHAN Well, that’s not true. But what is true is you’ve got to work with the food industry if you’re going to tackle this problem. So there’s no point demonising the food industry, and they’re actually really keen to work on this, because, you know, ethically they know they have to. But also, as I said, they want to provide what the consumers want, and the big bulk of consumer buying power is held by people who want healthier formulations.

CORIN But some of the scientists feel as though they’re being demonised if they put their head above the turret and start to say, ‘Hey, you’ve got to do something about this.’ They’re getting shot down.

JONATHAN No, I don’t think that’s true at all. I mean, science is a very important part of the debate. It’s actually the most important part, because we’re focusing on evidence and what works. And so all the interventions that I’m supporting will be around the science and what will actually deliver the results.

CORIN So when the science says you need to have some regulation, though, you’re going to ignore that.

JONATHAN I don’t know that the science does say that. The second thing is, actually, as I said, through the Advertising Standards Authority,…

CORIN Well, it says it pretty clearly in the Lancet Report, WHO.

JONATHAN …there’s voluntary accords there which are delivering. Now, if voluntary accords weren’t delivering, it might be different. But they are actually delivering, and industry is signed up to that.

CORIN What about the message it sends allowing Katherine Rich to stay on the Health Promotion Agency when she also represents the Food and Grocery Council? A number of New Zealand medical professionals have raised concerns about that. Are you comfortable with that?

JONATHAN Katherine is not seeking reappointment.

CORIN Is there any reason for that? Has she given you any reason for that?

JONATHAN Oh, look, she will have a range of reasons, but the point is industry, actually, is an important part of the answer overall. It’s important, actually, to have them at the table in these discussions. Katherine actually did a very good job. She’s a person of very high integrity, but she’s decided she’s not going to seek reappointment.

CORIN Did you make it clear to her that she wouldn’t be reappointed?

JONATHAN No, no, absolutely not at all. She said her term was up and she was moving on to other priorities.

CORIN So do you think that’s a good thing that she’s not on there, or would you be comfortable for someone else from the agency-? I’m just trying to get a sense of what’s going on.

JONATHAN I think it’s actually important that we have a balanced health promotion agency and that industry is represented in some form there.

CORIN Let’s move on to funding. You’ve got the Southern DHB obviously in crisis. You’ve got the Canterbury DHB now with some alleging that there’s bullying going on by the Ministry of Health and they’re under funding pressures. Is there going to be a commissioner put in at the Canterbury DHB?

JONATHAN No, there won’t be a commissioner there. Look, there hasn’t been any allegation, apart from one board member on CDHB of anything to do with bullying. What I can say is we’ve got excellent public servants at the Ministry of Health. I totally back them. We’ve had a huge increase in funding over time. So, we’ve raised health funding by 33% under this government. But the key thing is, look, it’s not the total quantum of funding; it’s what outcomes we’re delivering.

CORIN The growth of funding hasn’t increased, though, has it?

JONATHAN 2.5% increase on baseline this year ahead of inflation, and we’re delivering better results. So, an extra 50,000 appointments a year. Extra 45,000 operations.

CORIN But $320 million across the four years for the DHBs - okay, the CTU criticises that, says it’s not enough. But it’s not just the CTU. PricewaterhouseCoopers in their note after the budget said it’s not enough, and you’re going to have gaps and things are going to suffer.

JONATHAN No, well, they’re not. The question is not the total quantum of funding; it’s what that delivers. Look, Labour put funding up by 60%. They delivered 2000 fewer operations and 7000 fewer appointments. So it’s how you use that. We’re actually increasing operations, increasing appointments. No one’s going to Australia for cancer treatment. We’ve got 5000 more doctors and nurses in the system, and, actually 80% of New Zealanders are saying they’re very happy with the system. So we’ve totally turned it round. We’ve been focused on targets. We’re delivering faster cancer treatment. Shorter A & E waiting times. We’re immunising more kids. We’re actually doing a really good job delivering the services that count for people. Our political opponents will always try and pick it apart at the side, but you can see health is actually largely moving off the table as a political issue because we’ve focused on delivering-

CORIN Well, some might argue it’s been off the table and it’s coming back on the table.

JONATHAN Well, some may want it to come back on the table, but we’re focusing on delivering outcomes, and you can’t argue with those statistics. More docs, more ops, better cancer treatment, more immunisations, attacking rheumatic fever, bringing that result down-

CORIN And maybe obesity. We’ll have to wait and see.

JONATHAN We’ll have to see.

CORIN Thank you very much, Jonathan Coleman.

JONATHAN Thanks, Corin.

Transcript provided by Able. www.able.co.nz

ENDS

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