The current level of obesity in Australia is properly called an epidemic and the associated costs of around $60 billion a year are a growing drain on the healthcare budget and the economy as a whole. Under such circumstances it makes no sense to invoke the idea that obesity is the result of individual irresponsibility and lack of resolve in making choices about diet, lifestyle, and even parenting.
“The only person responsible for what goes into my mouth is me,” says the prime minister, “and the only people who are responsible for what goes into kids’ mouths are the parents.” It wasn’t always thus. In 2006, as Minister for Health, Mr Abbott said “If we want to keep living longer, better lives then we have to tackle the obesity crisis” and went so far as to lash Coca- Cola for its role in driving childhood obesity. Back then, about 22 per cent of adults were obese.
Today, the adult obesity rate is 29 per cent and growing faster than anywhere else in the world. But the Abbott Government has dismantled the Australian National Preventive Health Agency and scrapped the National Partnership Agreement on Preventive Health, ripping $377 million from the major federal programs that were addressing alcohol, tobacco and obesity.
There have been implicit and explicit criticisms of government initiatives in obesity as “nanny state” or “paternalistic”. The basis of these arguments is that individuals are the best judges of their own interests and people have the right to make their own choices, including bad choices. It ignores the fact that many choices are made on the basis of inadequate knowledge or poor reasoning, or even that choice may be removed by circumstances such as poverty or access.
Those who invoke warnings of a nanny state generally have some vested interest in problem products such as junk food and sugary drinks. And concerns about paternalism and the right to choose are usually more about “when” rather than “whether” as seen by this government’s push for welfare reforms.
By resorting to the personal responsibility argument, the debate about obesity is reduced to a simplistic equation about controlling consumption and promoting physical activity. It also means accepting that Australia has doubled its obesity levels over the past two decades due to a lack of responsibility. This denies the complex reasons involved and in particular, ignores the impact of manipulative marketing, which is offset by minuscule efforts and resources.
We all pay the price – directly and indirectly – for the government’s lack of leadership in this area. In 2005 it was estimated that overweight and obese Australian adults cost the Australian economy $21 billion in direct healthcare and non-healthcare costs, plus an additional $35.6 billion in government subsidies. It’s shocking that we don’t have a more up-to-date estimate. But if there are concerns about unsustainable healthcare budgets, growing waiting lists for surgery and access to crowded emergency departments, one obvious solution lies in tackling obesity.
Canberra Hospital has its own budget story in this regard. In recent times, to facilitate the provision of safe care to the two-thirds of Canberrans who are overweight or obese, the hospital has had to replace toilets, provide bigger beds, widen doorways, install lifting equipment and buy new ambulances. Some rooms have now been refurbished to cope with patients weighing up to 500 kilograms.
Australia is now up there with the United States in the obesity stakes. However, as the annual State of Obesity report from Trust for America’s Health and the Robert Wood Johnson Foundation shows, the US now has some optimistic news. While obesity rates are above 30 per cent in 20 states and not below 21 per cent in any, adult obesity rates seem to have stabilised over the past two years and childhood obesity rates have not just levelled off but begun to decline in some places. Importantly, there’s a downward trend in obesity rates among young children in low-income families.
Its easy to read this report and see only the continuing bad news, but increasingly, the US is doing what Australia is not – successfully tackling obesity. It’s an effort led by the federal government across a range of departments and involves partnerships with state and local governments, community groups, schools and churches and business. These efforts are backed by detailed annual reports that highlight both the shameful statistics and the progress.
Meanwhile, obesity rates in Australia continue to climb and the consequence is that healthcare costs and productivity losses will continue to grow along with Australians’ waistlines.
Dr Lesley Russell is adjunct associate professor at the Menzies Centre for Health Policy, University of Sydney.