THEO MURPHY (AUSTRALIA) HIGH FLYERS THINK TANK
Preventative health: Science and technology in the prevention and early detection of disease
University of Sydney (Eastern Avenue Complex), Thursday 6 November 2008
Preventative Health Taskforce
Chair: Professor Paul Zimmet AO FTSE
Paul Zimmet is director of the International Diabetes Institute, director emeritus of
the Baker IDI Heart and Diabetes Institute, and an honorary professor at Monash
University, Melbourne. He co-chairs the International Diabetes Federation Task Force
on Epidemiology and Prevention. He designed and leads the team carrying out the
AusDiab Study, the first national diabetes and obesity study in Australia. He is also widely
recognised for his studies in Indian and Pacific Ocean populations, providing insights
into the genetic and environmental contribution to type 2 diabetes and obesity as well
as the role of sociocultural change. Paul has received several international awards for
his research, including the 2007 International Novartis Award for accomplishments in research that have had a major
impact in diabetes. He received the national award of Officer of the Order of Australia for distinguished services to medicine,
nutrition and the biotechnology industry. He has recently been appointed for a three year term to the new Australian
Government’s Prevention Taskforce for Obesity, Tobacco, and Alcohol.
Paul Zimmet has an international record in diabetes and obesity research, particularly in the field of epidemiology and molecular biology. His research in Australian, Pacific and Indian Ocean populations provided new insights into the genetic and environmental and behavioural determinants of type 2 diabetes. These studies also brought to attention the global epidemic of diabetes. He led the team that carried out the first ever national diabetes and obesity study in Australia (AusDiab) in 2000, and its five year follow-up in 2005. He has published over 650 scientific papers, chapters and reviews in peer reviewed journals and books. He is co-editor of the widely used text on diabetes, International Textbook of Diabetes Mellitus and is also co-editor of The Epidemiology of Diabetes.
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I want to start off with this flier from 2003 in the Age reporting our paper in the Medical Journal of Australia on the fat epidemic in Australia.
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It was based on the AusDiab [Australian Diabetes Obesity and Lifestyle Study] results, which we carried out in about the year 2000, noting the increase in obesity prevalence between the Busselton [Busselton Population Medical Research Foundation] and National Heart Foundation studies in the early eighties: almost a 300 per cent increase in obesity prevalence and a similar increase in diabetes prevalence, going back from the original Busselton survey in Western Australia and heralding what we then saw as the beginning of the 'diabesity' epidemic in Australia.
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I think this expresses it all. This epidemic is not only in Australia; it is in the United States. You can see the response on the Treasury bank notes as to what they face: a disease burden of obesity and diabetes and its consequence – cardiovascular disease. It can cripple the health budgets not only of developed nations such as Australia and previously the United States – which may be a developing nation now – but also certainly the developing nations.
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All of a sudden obesity and diabetes came on to the national political agenda. The COAG [Council of Australian Governments] meetings in 2007 of our state premiers and prime minister highlighted that climate change, diabetes and obesity were the national agenda items for COAG.
Partly through this, when the Rudd government came in, one of its first priorities was to set up the National Preventative Health Taskforce.
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Rob Moodie leads it and, as was mentioned, Mike Daube is the vice-chairman. A group of distinguished people in the fields of public health, health insurance and food, constitute the group.
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The taskforce, which was announced in April 2008, has a threeyear brief. The initial brief is for obesity, tobacco and alcohol related disorders. This is an opportunity for you to provide input in that area. It is one of the things that we would like you to think about in your discussion groups today, because by June 2009 we have to deliver the strategy for those conditions and we then have to focus on what other areas of prevention should be addressed by the taskforce. As I mentioned, it will focus on alcohol, tobacco and obesity and be directed at primary prevention. It will address all relevant arms of policy and all of the available points of leverage in both the health and the non-health sector in formulating the recommendations.
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The taskforce will also provide advice for policymakers on what strategies work. It is going to provide advice on the most effective strategies for targeting prevention in disadvantaged groups and in our indigenous communities, the Aboriginal and Torres Strait Islanders, particularly people in remote locations.
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This is the slide that hits my heart the most. I know that I am in rugby league territory here but, in Australian rules football, this was the 1958 Rovers premiership team – the Aboriginal team. When this photo was published a couple of years ago, all of them, except one, were dead; whereas with the equivalent European team – the Collingwood premiership team of 1958 – all of them were still alive. I think that bears testament to the burden of morbidity and mortality invoked by lifestyle, alcohol and tobacco on our indigenous community.
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Three weeks ago in the back area of the West Footscray Primary School in Melbourne, in the vegetable garden funded by the Stephanie Alexander fund, health Minister Nicola Roxon launched the discussion paper that you are going to be talking about today.
That discussion paper was prepared by our taskforce in record time – it was pushed along by Rob Moodie and Mike Daube – and at the same time three technical reports were issued: on obesity, tobacco control in Australia, and the prevention of alcohol related disorders.
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Again, we are asking you now to input – based on what is in those technical papers – ideas not only in the research arena but in a much wider community sense.
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The consultations are now in process. A number of us are going around the country to different areas; I was in Tasmania last week. We are asking people to look at our report and to say whether the ideas are reasonable – whether you support them, whether you have better ideas.
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So, just looking at the first topic – obesity – this is an advertisement for a superannuation fund placed on the bus stations in Melbourne. You will note that they are prepared to boast about the Australian beer gut in our advertisements.
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We know from the data I showed earlier that there has been an increase in the number of people with obesity and overweight in this country. It is over five million people now; something like 25 per cent of children in Australia are obese or overweight. The mean waist circumference of Australians has increased between 2000 and 2005.
An Access Economics report a couple of months ago pointed out that obesity was costing Australia something like $58 billion in medical costs plus loss of productivity; the medical costs being about $8.3 billion.
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These are the data from our fiveyear follow-up of the AusDiab study showing you the increase in weight gain in the various age groups. You can see a quite significant increase in weight, particularly in the younger groups and particularly in young women, over a five-year period.
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This slide about physical activity has been shown millions of times around the world. But what is even worse is that this is the American diabetes meeting earlier this year, at which some of you would have presented. These are the physicians in the health community and there is not one person on the stairs. These are the sorts of things that we are battling against in this situation.
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In the report – I hope some of you have already seen it – a number of priorities for action are listed: reshaping industry supply of food; protecting children from advertising. These are all things that I am sure you are already aware of; you've thought about them and have read about them in the paper. We certainly want to close the gap on disadvantaged communities. There is going to be a need for urban planning changes. Of course, while we have very good evidence of what to do about tobacco and alcohol, we are still not certain what the right strategies are for obesity. Again, this is something which I believe you can contribute to.
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This would be a simple solution plus increasing the price of petrol, which was happening, but now we are going the other way. So we have a bit of a dilemma and a paradox there.
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You can see here the complexity of addressing the obesity problem. When you start to see how everything links together, it is like a spaghetti-gram, so it is hard to know where to start. One place where we certainly could be starting is in the home environment, with better urban planning.
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In the good old days, we would play baseball or cricket in the back yard. Today the kids have the family room near the kitchen; they can get to the fridge and take snacks and pop and what not, and it is very sedentary.
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In the good old days, if Bruce Armstrong wanted to play cricket or football with Mike Daube, he would just jump over the back fence [pointing to adjoining houses on slide]; it was easy.
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Today, with urban planning and cluster developments, Mike lives there and Bruce lives there [pointing to distant houses on slide].
'Let's stay home and watch television.'
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These are the questions that we are asking about obesity. Are the targets that the taskforce has set realistic? Who are the key players? What are the best combinations? Which high risk groups should we be looking at? What are the appropriate actions?
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Tobacco we know is the single most preventable cause of death in Australia. Smoking rates among our indigenous community are double those of the rest of the community. Also, we do have a problem in that pregnant women are smoking, which is not good for themselves nor the foetal outcome.
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Some priorities are listed for action in the report. The strategies are really meant to build on the big success rate that has already been achieved in Australia to take smoking down below something like 15 or 16 per cent, and the aim by the year 2020 would be to get it to less than eight or nine per cent.
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Rob Moodie reminded me of the battle we faced with the advertising industry.
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Even doctors aren't the best people to be involved – 'More of them smoke Camel.'
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You can read two things into this, I suppose. There are two messages there.
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I don't know whether the discussion groups have these questions put out for them for when you get into your working groups. It may not be a bad idea actually for us to make some copies of those: what sorts of actions we should take and what new ideas you may have.
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With alcohol, we know Australians are great drinkers. We know that we are one of the biggest-drinking nations in the world; we are certainly in the top 30. Rob Moodie makes the point that in Victoria every week there are two new liquor selling outlets being approved. So it is really a huge problem. We know of the problems on the road. We know of the problems with drinking during pregnancy. There are a whole lot of issues relating to alcohol on which we would very much value your opinions.
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We are battling the advertising industry again – the sexy advertisements of young people – and, of course, the pubs are becoming waterholes, which is equating beer with water and such like, but that is another story.
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There are some priorities for action which the taskforce have listed in the discussion paper with respect to this.
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Again, I emphasise the disadvantaged community story. These are data that Kerin O'Dea has put together against our AusDiab data showing the frequency of diabetes by age groups from the AusDiab in gold and the Aboriginal green and Torres Strait Islanders pink. You can see that for every age group there is something like a two- to three-fold higher prevalence of diabetes in the indigenous community. What is particularly dramatic is the drop-off in the Aboriginal group, which is almost certainly due to mortality.
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The question is: will you support the strategies that we have outlined in the discussion paper? Would you propose some other issues that will halt the toll of disease relating to these three conditions? Issues that can engage support from different sectors of the community is very important. Also, what prevention strategies may work best in the high-risk groups of young people and indigenous community?
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There are two things that we think are critical to the success of a national preventative health strategy. One is the setting up of a national prevention agency which will have a scientific wing, a health promotion wing and, obviously, a data monitoring section. In addition, Australia is behind the rest of the world in monitoring disease and risk factor trends and we should have, as one of the recommendations, that every five years we will have a national health study whereby at least, if Australia can afford interventions in this current economic environment, we can actually monitor those trends.
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Finally, we are interested to know how you will respond to the questions raised in the discussion paper. Have we omitted anything? What should be included? What could be dumped? This is a think tank for innovative ideas and, as a taskforce, I am sure that Mike and I will be absolutely delighted to carry back any ideas from either today or the reports you prepare after the meeting. Thank you.
