Sustainability and equity concerns should have been front and centre in the new dietary guidelines

(This post was updated on 22 Feb with a response from Professor Amanda Lee, chair of the Dietary Guidelines Working Committee).

As previously reported at Croakey, the long-awaited Australian Dietary Guidelines have now been released.

The document is structured around five broad guidelines:

1. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs.
2. Enjoy a wide variety of nutritious foods from these five groups every day (vegetables and legumes, fruit, grain, lean meats etc, dairy).
3. Limit intake of foods containing saturated fat, added salt, added sugars and alcohol.
4. Encourage, support and promote breastfeeding.
5. Care for your food; prepare and store it safely.

Only when you get to the appendices of the report does the focus really turn to some of the critical issues affecting the relationship between the population’s diet and health. (Journalists might call this “burying the lead”.)

Appendix A (from p 101) examines the links between socioeconomic disadvantage, poor eating, physical inactivity, an unhealthy food supply and poor health, and says “there is clear evidence of a social gradient for the distribution of diet-related chronic disease”.

It says: “Analysis of Australian household food expenditure data suggests that a substantial proportion of the population is severely restricted in its capacity to make nutritious food choices and to achieve a healthy diet.” (my emphasis).

Furthermore:

“In Australia, the cost of a nutritious diet has been estimated to account for about 40% of the disposable income of welfare-dependent families, compared to only 20% of an average family’s disposable income. Health professionals should be aware of the budget challenges healthy food habits may pose for people who are welfare dependent and should note that checking and comparing the price of food products can reduce the weekly food cost by about 13%.”

Meanwhile, Appendix G (from p 130) examines the relationship between food, nutrition and environmental sustainability, and says:

“It is suggested that changing consumer food choices can make a bigger difference to overall household sustainability than reducing water and energy use. Therefore, avoiding overconsumption of food and food wastage should form the primary areas of focus by health professionals in communicating sustainable food consumption habits.”

This section says overconsumption should be avoided and is unsustainable, that an overweight population has a greater environmental impact, and notes that food wastage (not including packaging) accounts for about 10% of food purchased. It also recommends drinking tap rather than bottled water, and eating seasonally.

In the article below, Michael Moore, the CEO of the Public Health Association of Australia (PHAA), says concerns about the environment and social equity should have been front and centre in the document instead of being “sidelined” into the appendices.

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Sustainability and equity should be core business for dietary guidelines

Michael Moore writes:

On the one hand the Public Health Association of Australia (PHAA) has welcomed the thrust of the Australian Dietary Guidelines (ADG) and the Australian Guide to Better Eating (AGBE) as launched by the NHMRC on Monday.

On the other hand, the PHAA is concerned about the way the environmental principles and social equity have been sidelined in the appendices.

Environment and social equity are integrally involved in the way people eat.  Advice given by the NHMRC in the ADG is not only used by individuals and health professionals but by governments in making key decisions around setting policies.  The most obvious area is around dietary related illness.

However, unless our governments consider the relationship between diet and climate change, food security, affordability, water distribution and food production, they will be developing policies with their heads in the sand.

It is not enough for the NHMRC to relegate the environment to an appendix of the ADG.  The ADG ought to be part and parcel of the thinking and understanding of a modern diet.  Food, health and the environment form an integrated system.  As such it is critical that the guidelines integrate the role of the environment.

Our food choices do impact on the environment.  It needs to be a key consideration of dietary advice in Australia, as it is in other countries.  If we destroy the environment that sustains our food supply we will not be in a position to produce good nutritious food and such advice will become redundant.  Appendix G of the ADG provides some insights into the role of environmental sustainability, including an excellent graphic of the food system.

The appendix does identify the importance of waste management, overconsumption, processing and packaging, transport and retailing as key elements in relation to the environment.  The reality is, however, that these issues should make use of the high level of evidence required by NHMRC to influence broader recommendations on how our community should eat.

When the United Kingdom released dietary guidelines recommending two serves of fish per week it became apparent that there was a tension with the long-term viability of fish stocks.  Monoculture production has considerable impact on the local environment and sometimes uses a disproportionate amount of the water that is available in our country.

Dietary recommendations need to take into account considerations of the water and energy costs and environmental sustainability issues associated with food production and dietary choices in Australia.

There is a growing debate in Australia around food security. This is nowhere more obvious than amongst those who are socially disadvantaged – and who also suffer the highest rates of most diet related illness.  In Australia the most obvious examples of this have been in Indigenous communities, the unemployed and single parents.

Appendix A that considers the issues of equity and the social determinants of health starts with a quote from the World Declaration on Nutrition (1992) “access to nutritionally adequate and safe food is a basic individual right”.

This appendix in the dietary guidelines recognises that employment, income, education, cultural influences, lifestyle, language, sex and other genetic differences, geographic, social or cultural isolation, age and disability, the security and standard of accommodation, and the availability of facilities and services, all influence diet, health and nutritional status.

The question is why are these factors not integrated into recommendations throughout the main document that comprises the Australian Dietary Guidelines?

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Response from Professor Amanda Lee, School of Public Health and Social Work & School of Exercise and Nutrition Sciences at the Queensland University of Technology, and Chair of the Dietary Guidelines Working Committee.

The purpose of the Dietary Guidelines is to answer the question “What should Australians Eat?”

The primary focus is on the promotion of health and wellbeing and prevention of diet-related chronic disease. They are based on the best available scientific evidence about food, diet and health relationships.

To be effective it is essential that the recommendations are realistic and practical. That is why they are based on foods, food groups and dietary patterns, and not on food components.  Most of us don’t choose to eat nutrients – we eat food.

For the guidelines to be practical and realistic, these recommended foods also must be acceptable, affordable and available to the Australian population.

To this end the social determinants of food choices are very important considerations, as detailed on page 2 of the recently launched document. That is why the modelling for the Dietary Guidelines was based on the most recent information about what Australians are currently eating.

The dietary patterns recommended are also very flexible. There are numerous ways for Australians to achieve the recommendations- not just one dietary prescription. Within each of the five food groups there are many possible choices to suit a range of cultural, religious, cost and individual food preferences. For example, the grain (cereal) group includes many nutritious varieties consumed in all parts of the globe which are now readily available inexpensively in Australia, as are fruit and vegetables in season or in frozen or tinned forms.

Also to ensure the guidelines are practical and realistic, the recommended foods have to be available not just now, but into the future, which is where environmental sustainability comes in.

Equity and environmental sustainability issues were considered throughout the development of guidelines, and have been specifically detailed in the appendix.

It would be ideal if they were given greater prominence. Environmental sustainability issues in particular could be expanded.

However, it should be remembered that the dietary guidelines are a policy tool, not policy per se. It remains to be seen how they are translated into policy and practice. Examples range from the practical tips to be included in materials for the general public, to uptake in national food and nutrition plans and policies, and potential regulatory strategies in areas including food labelling, advertising and pricing.

Both the opportunity and the challenge now is to work together to ensure the guidelines are strongly promoted within a context that supports more nutritious and sustainable food choices within all groups, but particularly the most vulnerable, in our community.