Tobacco Control: What can we learn for promoting nutrition?

Transcription

1 Tobacco Control: What can we learn for promoting nutrition? Dr Louise Signal & colleagues from the Health Promotion & Public Health Policy Research Unit Presented at School of Population Health, 16 November 2006

2 Differences between tobacco & food Tobacco Hazardous to health & highly addictive Food Nutritious food - essential for health Limited consumption patterns and products Tobacco a less significant part of NZ economy Very strong evidence base for adverse health associations Collaboration with the industry has not helped Greater diversity of food consumption patterns and of nutrients/products Food production large part of the NZ economy Evidence base for adverse health associations not as strong, more complex Collaboration with some food industry sectors may help

3 Similarities between tobacco & food Much processed food also nonessential /even hazardous Both are fast moving consumer goods Both contribute to disease & death (heart disease & cancer) Māori, Pacific and low-income New Zealanders bear the brunt of the negative health consequences Both contribute to inequalities in health esp between and non-māori

4 Industry similarities tobacco & food Both profit maximising Both minimal social good concerns (except for PR) Both market irresponsibly Both seek to avoid regulation and taxation (favour weak voluntary agreements, self-regulation) Both include multi-nationals (& some overlap eg, Kraft)

5 Similarities justification for government intervention Imposition by industries of external costs (health & wider society) Social goal of reducing inequalities Information failure in marketing Protecting the rights of the child

6 Lesson 1 Act more quickly

7 Progress on tobacco control in NZ 1950s: 3 key studies Public health campaigns from the 1950s 1964: first US Surgeon General report Graduated tobacco advertising restrictions (1970s to 2004) Gradually larger and more explicit warning labels (graphic images 2008) Tobacco taxation (ad hoc) Banning of industry sponsorship (1990 to 1995) Controls on sale of tobacco to minors, single cigarettes, vending machines Smoking restrictions in offices (1990) Smoking bans in indoor workplaces including hospitality venues (2004)

8 Timeframes Tobacco control has taken 50 years to get to where we are today: having in place a reasonably comprehensive tobacco control programme, albeit an under-resourced one and one with significant gaps. Along the way the industry has utilised a range of strategies to slow effective action The process has been resource-intensive with each and every measure requiring substantive effort on the part of government, policy-makers and advocates. With food we are starting at least 30 years later so let s move faster

9 Lesson 2 Tackle inequalities in health

10 Prevalence of cigarette smoking (%) (15+ years) by ethnicity, Source: ACNielsen (NZ) Ltd 60 Percent Mäori Pacific European/Other Year

11 Unable to afford to eat properly by NZDep96 Households that can only afford to eat properly sometimes % people I II III IV NZDep96 Males Females

12 Unable to afford to eat properly by ethnicity Households unable to afford to eat properly sometimes % people NZ M aori Pacific People NZ European and Other Ethnic group Males Females

13 Lesson 3 A Treaty-based approach is critical for health promotion

14 Treaty-based approaches in tobacco control Failed to hear Māori e.g. smoking cessation Late in funding by Māori for Māori services Late in ensuring that mainstream services also meet the needs of Māori Leadership has been critical e.g. work of Te Reo Marama Māori Smokefree Coalition Highly effective initiatives Aukati Kai Paipa Te Hotu Manawa Māori Māori focused social marketing campaigns It s about whanau

15 Treaty-based approach in nutrition Treaty-based approach essential to best practice in promoting healthy nutrition the right to health is everyone s right Ottawa Charter health promotion is the process of enabling people to increase control and to improve their health TUHANZ document aid to this Considerable capacity amongst Māori but essential we build the Māori workforce

16 Lesson 4 Avoid information failure information is critical

17 Tobacco information failure The tobacco industry knew about the health effects & the addictive potential of tobacco but continued to deny them for decades Obviously evidence accumulated to indict cigarette smoke as a health hazard is overwhelming. RJ Reynolds senior scientist, RJ Reynolds document, 1962

18 Nutrition information failure

19 Simple Traffic Light logo

20 Lesson 5 Protect children s rights

21 Protecting the rights of the child to be smokefree Tobacco control has focused on protecting children Banning sales to minors Sales of single cigarettes Removing nearly all tobacco marketing Smokefree promotions Smokefree Rock Quest/Smokefree Netball Smokefree homes campaign

22 Cigarettes & Candy

23 United Nations Convention on the Rights of the Child With food we have the added support of the UN Convention Ratified by New Zealand government & monitored regularly by the UN Currently exploring the development and application of the recent review of children s and food advertising codes by the Advertising Standards Authority Children s Code mentions the Convention referring, for example, to Article 3 that states that the best interests of the child shall be a primary consideration. The code continues that therefore there is a need to extend a duty of care to protect children. Examining how the UN Convention on the Rights of the Child was applied in the review and how the new codes are being interpreted

24 Lesson 6 Carefully consider collaboration with industry

25 Collaborating with industry Collaboration is working together for a common goal Collaboration with the tobacco industry was not helpful because the interests of the tobacco industry are totally inconsistent with public health interests Manipulated evidence Stalled the policy process Attacked the credibility of policy makers & advocates Much debate about whether to engage with the food industry & how and when to engage & with whom The primary interest of the food industry is profit The primary interest of the public health sector is health There may be areas for cooperation e.g. United Fresh with 5+ a Day But also areas of the industry where there is little if any room for collaboration that would meet public health goals e.g. energy-dense, nutrient-poor food Careful consideration of the ethics of collaboration and develop guidelines for the sector

26 Lesson 7 Restrict marketing

27 Tobacco promotion

28 Food promotion

29 Lesson 8 Remember that we are dealing with global products produced by global industries

30 Global context Tobacco and food companies are global corporations We need to work together as nations to understand their influence and to maximise health benefits Now have the Global Strategy on Diet, Physical Activity & Health WHA57.17 (2004) FCTC a potentially good model for international response

31 Lesson 9 Health promotion is political

32 Politics of tobacco & food Too slow to analyse the politics of tobacco Who are the key interests? What are their tactics? How are political institutions framing what is possible in the nutrition arena? E.g. role of MoH, Treasury? What are the broad political and economic factors that determine the overall policy direction? E.g. What does it mean that NZ earns significant income from meat and butter? We have the opportunity to analyse the politics of food right now. I think we will be much better at promoting healthy nutrition if we do.

33 Lesson 10 Critique the arguments of those who oppose measures to promote healthy nutrition

34 Arguments about smokefree hospitality venues in NZ Groups in opposition to smokefree hospitality venues in NZ argued that the social context in New Zealand was so different from other jurisdictions that smokefree hospitality venues would simply not work

35 Figure 5.3.3a Support for smoking bans in bars from April 2001 to March 2006 in UMR Omnibus Surveys SFEAA passed SFEAA implemented 80 % Support or opposition Bars support Bars oppose 10 0 Jan- 01 Jul- 01 Jan- 02 Jul- 02 Jan- 03 Jul- 03 Jan- 04 Jul- 04 Jan- 05 Jul- 05 Jan- 06 Jul- 06

36 "We don't smoke that shit, we just reserve the right to sell it to the young, the poor, the black, the stupid." - RJ Reynolds Tobacco Executives

37 Lesson 11 Focus on creating a supportive environment

38 Create a supportive environment One of the key successes of tobacco control in New Zealand has been the creation of a supportive environment for being smokefree Making the healthy choice the easy choice Do New Zealand children live in a world that supports healthy eating?

39 TV Advertising (Wilson et al, Prev Med, 2005) Nature of food advertised during children's viewing hours 1997 & 2005 in NZ % Foods counter to improved nutrition Foods with mixed nutritional profiles Foods favouring improved nutrition TV3 (2005) TV2 (2005) TV2 (1997)

40 Exposure to food advertising on TV (Wilson et al, Prev Med, 2005) Annual exposure from TV (2h viewing per day) Food advertisements Food imagery & wording in programme promotions & non-food adverts

41 Food Advertising Around Schools (Maher et al, NZ Med J 2005) Other, 29.8% "Unhealthy", 70.2%

42 Food Available Around Secondary Schools (Maher et al, NZ Med J 2005) Top 3 categories: -Soft drinks -Frozen confectionary -Savoury snacks

43 Sponsorship on NZ websites for top 8 sports for 5-17 year olds (Maher et al BMC Public Health 2006) (Includes unhealthy food, alcohol, gambling) Junior level combined Touch Tennis Soccer Rugby Netball Cricket Basketball Athletics % of all sponsorship listings Unhealthy Health promoting

44 Food available at Council Pools & Libraries in the Wellington Region Type and mode of delivery Count Unhealthy Healthy 0 Total food Total drink Café food Café Drink Vending food Type and site vending drink

45 Food and Health Advertising in Council Pools & Libraries in the Wellington Region Food and Health related advertising Obesity Promoting Neutral-food related Health Promoting

46 Do New Zealand Children Live in an Environment that supports Healthy Nutrition? No, they live in an obesogenic world, one that promotes obesity as a normal response to an abnormal environment Tobacco control has focused on creating a supportive environment with smokefree environment, banning sales to under 18s, banning vending machines, banning marketing, tobacco sponsorship replacement The government must seriously explore legislative and regulatory options to make the healthy nutrition choice the easy choice Our research alone suggests advertising restrictions, marketing restrictions, zoning bylaws around schools, council policy on food in council facilities

47 Can New Zealand be a world leader for healthy eating? We can be world leaders - Treaty of Waitangi, women s emancipation, welfare state New Zealand has been a world leader in tobacco, Smokefree Environments Act 1990 NZ is one of the most unchecked political democracies in the world Degree of political will Increasing concern among the public about nutrition Strong & co-ordinated advocates e.g. Agencies for Nutrition Action, Obesity Action Coalition, National Heart Foundation, Cancer Society Considerable knowledge & skill in health promotion especially amongst our Māori & Pacific providers Considerable research and teaching expertise If we take note of the lessons from other areas we have a better chance

48 Lessons from tobacco for promoting healthy nutrition 1. Act more quickly 2. Tackle inequalities in health 3. A Treaty-based approach is critical for health promotion 4. Avoid information failure information is critical 5. Protect children s rights 6. Carefully consider collaboration with industry 7. Restrict marketing 8. Remember that we are dealing with global products produced by global industries 9. Health promotion is political 10.Critique the arguments of those who oppose measures to promote healthy nutrition 11. Focus on creating a supportive environment

49