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What I recently told Minister Roxon’s office: Stephen Leeder

Professor Stephen Leeder, director of the Menzies Centre for Health Policy at the University of Sydney, weighs in with some comments on Tim Gill’s recent post raising concerns about the Feds’ plans for nutrition and physical activity surveys:

DESPITE the enormity of the obesity epidemic, astonishingly Australia still lacks information about trends in weight, physical activity and what we eat.

We have collected this basic intelligence only sporadically and inconsistently, in bits and pieces, so that we cannot accurately detect trends in body weight, calories consumed or exercise taken by Australians.

Way back in 2007, the federal budget contained the occasional piece of good news!  One of these pieces $10.6 million for the first four years of a regular survey program of Australian nutrition and physical activity.

The program was proposed to conduct rolling surveys of different groups over time, starting with adults in 2008 and moving presumably on to other groups, and then returning to each group regularly to measure trends over time.

Young children and indigenous groups are surely high priorities because we know next to nothing about their dietary patterns, although more now, following the recent childhood nutrition survey, than before.

At the time, I proposed that three important conditions must be met for the $10.6 million to be spent to best effect.

First, the surveys would be conducted by the same agency from year to year. Variations in survey method, as would follow if different agencies did the different surveys, would make it extremely difficult to interpret trends.

The Australian Bureau of Statistics (ABS) has a splendid track record for the conduct of surveys that provide dependable information on which trends in many demographic and social variables are used to guide macroeconomic and fiscal management. Although the budgetary allocation does not specify what agency will do the surveys, wisdom suggests a major role for the ABS.

Second, the surveys would best go beyond the measurement of dietary behaviour and physical activity.

Actual measurements of body weight and height would help in determining whether we are on top of the obesity and overweight epidemic or whether we are continuing to grow dangerously. New machines allow us to measure blood pressure relatively easily. Blood samples would enable us to be clearer about the current state and trends in diabetes and what is happening to cholesterol across the nation.

These measures would be feasible if done on a small sample of people who participate in the wider dietary and physical activity survey.

Third, the interpretation of the data derived from the surveys must be in good hands. The establishment of a unit within the Australian Institute of Health and Welfare (AIHW) to interpret the data from the surveys and to apply them in the development of policy would be a wise move.

The AIHW, with its good relations with states and territories as well as the Commonwealth, is in a position to supplement the information provided by the national surveys by compiling, interpreting and disseminating data from the states and territories, ABS commodity statistics on apparent consumption of foodstuffs, data from the food regulators about food composition, and consumer surveys.

Some of these data will be more dependable than others and reconciling them would be an important function of a nutrition and physical activity monitoring unit within the AIHW.

Our intelligence on nutrition and physical activity at present is piecemeal and discontinuous. As well, important groups have not been covered with any dependability. The national surveys, funded through the recent budget allocation, might well survey the nutritional status, and food behaviour, of children aged 0-2. It is in this group that nutritional foundations are laid. Recent studies have pointed to high energy intake among them from supplementary snack foods rather than from nutritionally valuable core foods in children in this age group. We must know more about food habits among these children.

There are many conflicting interest groups concerned about overweight and obesity control, and the management of the politics among them will be a challenge in spending the $10.6 million wisely.

In actual fact, little has happened with the allocation to date. The food industries are major players and their lobbying power is vast. Nevertheless, spokespeople for industries have been highly supportive of the move to establish a nutrition survey program because of its value to a changing food industry as a market overview.

Public health agencies, deeply concerned about the epidemic of obesity, have endorsed the nutrition and physical activity survey program. Cathy Mead, who was the president of the Public Health Association of Australia in 2007, said she “strongly supports the conduct of these surveys in the pursuit of information that might then find its way into national nutrition and physical activity policy”. Professor George Rubin, president of the Australasian Faculty of Public Health Medicine, says to get “regular information on these vital attributes, diet and physical activity, would be a fantastic move forward”.

The current concern, as articulated by Tim Gill, is this: jockeying interest groups will put plausible cases to the federal health department for ‘outsourcing’ the surveys to them to conduct.

The biggest reason for institutionalising these surveys in a major government instrumentality such as ABS or AIHW is to secure continuity of survey methods and survey rigour: otherwise measurement errors will mislead us from survey to survey.  Recently I communicated these concerns in detail to Minister Roxon’s office.

With attention to detail, especially the nomination of strong institutions to conduct and analyse on-going survey data, Australia can look forward to a much clearer picture about how we fare in our battle against the bulge.

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