Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 24
by being highly visible and “ shining their light ” far
and wide.
Monitoring and feedback systems: Many countries
are relying on infrequent (in the case of Australia,
every decade or more) surveys to monitor the changes
in obesity prevalence and even then, they are usually
not fine - grained enough to give meaningful data by
locality, ethnicity and socio - economic disadvantage.
Arkansas instituted through legislation an annual BMI
check on every child in the state 27 with the information
going back to parents in the form of a Health
Card Report 28 and aggregate data going to each school
and district. This feedback loop of regular, fine -
grained monitoring to the change agents seems to
have raised awareness and sparked community action
throughout the state such that the rise in obesity prevalence
has now flattened out. 29
Fiscal interventions: The concept of a system of taxes
and subsidies to increase the price of unhealthy foods
and reduce the price of healthy choices has often been
proposed. 30 This would certainly influence food purchasing
behaviors if the price changes were significant,
but to offset the regressive nature of such taxes, the
revenue raised would be needed to support the healthy
food choices. More modeling work is needed on this
concept., 31 It could not only change food choices
towards the healthy options, but the extra revenue
raised could be used to lift the overall funding of
population prevention of chronic diseases beyond the
0.5% of the health budget, where most now languish.
At the very least, the existing tax, subsidy and price
control systems should be examined to see if there are
perverse incentives operating, which are artificially
depressing the prices of energy - dense foods (such as
sugar and plant oils) and raising the prices of healthy
foods (such as fruit and vegetables). Fiscal interventions,
such as congestion taxes or public transport
fare subsidies could have significant effects on patterns
of transport, including active transport modes
of walking, cycling and public transport.
Health (obesity) impact assessment: The concept of
health impact assessments have been around for some
years but have found footholds in only a few jurisdictions.
Since many urban planning and transport infrastructure
decisions have substantial impacts on the
built environment and its “walkability” and “cycleability
”, 32 they need to take health outcomes (including
obesity) into account. Other policy and funding
decisions such as taxation regimes, social policies and
benefits, and education policies may also have important
health outcomes that need prior assessment.
Conclusion
Policy has an integral role in community - based obesity
prevention. With the increasing availability and
quality of evidence of the obesity epidemic and effective
interventions to tackle this epidemic, there are
ongoing calls for government action to translate the
evidence into policy and practice. Policy demonstrates
government commitment to obesity prevention and
provides a road map for planning, implementing and
evaluating interventions.
Despite the calls for evidence - based policy, we have
shown it does not occur of its own volition or necessarily
as a rational process. Policy is political. There
are contested views over the evidence associated with
the prevalence and distribution of the obesity epidemic,
its causation and its consequences. Critically,
from a policy perspective, there is heated debate over
how and why the available evidence should be translated
into policy activities to tackle the obesity
epidemic.
Into the future, particular features of the policy -
making process will be critical to support the evidence
— policy relationship, namely: political will;
policy - making structure; policy - relevant evidence;
and policy development process. As the prevalence of
obesity among children around the world increases,
the need for policy will become more urgent. The five
policies we have outlined represent examples of “ low
hanging fruit ” that could be relatively easily “ picked ”
as policy activities without further delay.
References
1 Lawrence M : Policy and politics . In: Lawrence M , Worsley
A , eds. Public Health Nutrition: From Principles to Practice .
Sydney : Allen & Unwin and London : Open University Press ,
2007 : 450 – 476 .
2 Lang T , Heasman M : Food Wars: The Global Battle for
Mouths, Minds and Markets . London : Earthscan , 2004 .
3 Moodie R , Swinburn B : Childhood obesity — a sign of commercial
success but market failure . Int J Ped Obes 2006 ;
1 : 133 – 138 .
4 Nestle M : Food Politics — How the Food Industry Influences
Nutrition and Health . London : University California Press ,
2002 .
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