Advice to the Government

Heart FoundationEarlier this week I was asked to speak at the Heart Foundation’s Biannual Forum on three things the Government could do to stop heart disease.

While there is a lot of great material in their call for action document Stop the Heartbreak 2014, I chose to speak about the three closest to my heart – which unsurprisingly are related to the food and nutrition space.

They are:

-  objective, good quality data

-  facilitation more communication and collaboration

-  addressing inequity.

My first point addresses the paucity of ongoing good quality data on what New Zealanders are eating and drinking. How can the government possibly form rational and evidence-based policy, programmes and guidelines on food and nutrition when they don’t have quality information about the food supply and what we’re actually eating? This lack of authoritative data has created a space that’s ripe for anecdotal evidence and opinion.

For example: We did once have nutrition surveys that collected gold standard information about our diet – comparable with the best national surveys internationally such as NHANES in the US and the NDNS series in the UK.  Sadly these have been replaced with comparitively inaccurate health and lifestyle questionnaires within the health survey which cannot possibly assess the complete nutritional status of the participants. If you want good quality policy, you must invest in good quality evidence gathering.

Which brings me to my second point of facilitating communication and collaboration.

Part of good leadership is to ensure everyone’s aligned, on the same page, and moving forward as one, to address an issue in the most efficient way possible.  This saves various unaligned factions from wasting time and doubling up on resources – or even worse – working against each other and ultimately achieving nothing.  Sadly the latter is often the case when you consider work being done by the food sector and health sector in New Zealand.

Health officials should have the mandate to communicate and engage with all stakeholders in the food and nutrition area.  In my view, food manufacturers and their suppliers, retailers and food outlets are key stakeholders in determining the food environment and thereby, to some degree, the nutritional health of the population.  But health officials do not communicate with this sector.

This precludes them from impartially recognising important areas of mutual agreement with which to facilitate genuine cross-sectorial engagement and action.  Already, some food manufacturers are driving some impressive health-related change with the programmes they’re implementing: breakfast programmes in schools, workplace health programmes, targeted lifestyle, activity and cooking skills programmes, and reformulation initiatives around nutritional content or serve size.

These types of initiatives shouldn’t occur in isolated pockets – they could be facilitated, coordinated and even partnered with academics and NGOs and other stakeholders to deliver maximum benefits to the population, with a combination of funding sources.

Of course the Heart Foundation are one of the few agencies facilitating some sterling work in this space with food companies, through inititiaves such as HeartSAFE and Fuelled 4 Life. But there’s a huge amount more scope for this type of activity.  In fact there is some promising signs that the Government also recognise this in their initial material regarding the proposed Healthy Families Programme.

And lastly, the absolute MOST important thing which the Government could and should do to stop the Heartbreak is to seriously address the health inequity in our society.  Inequity refers to the uneven distribution of health determinants which may be unnecessary and avoidable as well as unjust and unfair.

Sadly it’s no longer affordable to eat what’s recommended for many people in this country.  While academics argue over whether 5+ or 7+ fruit and veg a day are better for you, people struggle to achieve anything close to 5+ a day. Regardless of Government advice, the main reason why most shoppers don’t pick healthy foods is that they are more expensive.  They’re also often harder to access in some areas.

To buy fruit and vegetables for a family of four costs thousands of dollars more per year than more convenient (and potentially less good for you) food options. When faced with the option of buying apples or sausages for the family within a very limited budget, it’s not surprising that the more filling sausages make it into the trolley.  Good intentions evaporate when faced with the option of paying the electricity bill or having another bag of frozen peas this week so that another serving of vegetables can be part of each meal.

Importantly though, I wouldn’t blame the sausage makers or the electricity companies for that.  Instead I’d question why people are forced to make this decision at all, since all items are necessary for health.

The Government need to intervene, to mobilise communities and make healthy eating more affordable and accessible to those who are faced with unfair choices.

In a country where someone dies from heart disease every 90 minutes – we could all do more to stop the heartbreak.




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