5a Rayner Obesity

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  • 5a Rayner Obesity

    1. 1. Tackling obesity: an ecological public health approach Geof Rayner, PhD Associate Professor of Public Health, Brunel University UK Visiting Research Fellow, City University UK Director, GRAssociates consultancy [email_address] 18th Consumers International World Congress, Sydney
    2. 2. Questions to address <ul><li>Is there a policy consensus on what causes obesity? Is obesity a ‘medical’ issue or just a ‘lifestyle’ issue? </li></ul><ul><li>Why can’t the individual just act alone and change their behaviour? </li></ul><ul><li>What would an ‘ecological’ approach to obesity look like? </li></ul><ul><li>What policy interventions would be necessary if this approach was taken? </li></ul>
    3. 3. A simple model for weight gain <ul><li>Eat more + do less = gain weight </li></ul><ul><li>Political response: “It’s their own fat fault” (Boris Johnson, MP, The Times) </li></ul>
    4. 4. This presentation <ul><li>1 Background </li></ul><ul><li>What’s the problem? Where is the problem? Who is the problem? </li></ul><ul><li>2 Science, evidence and policy </li></ul><ul><li>Obesity science – very simple or very complicated? Lessons from UK’s Foresight review </li></ul><ul><li>Societal transitions in diet, environment and culture </li></ul><ul><li>3 Rethinking public health and consumerism </li></ul><ul><li>Why are current approaches failing? </li></ul><ul><li>What is an ‘ecological public health’ approach? </li></ul><ul><li>What can the consumer movement do? </li></ul>
    5. 5. 1. Background
    6. 6. USA : 2 out of 3 overweight, 1 out of 3 obese “ among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese” Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847-50. 2004
    7. 7. Variation by ethnic group (US) Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847-50. 2004
    8. 8. Projections - England Klim McPherson Martin Brown & Tim Marsh Quantitative Modelling, Source: Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    9. 9. Projections - England Klim McPherson Martin Brown & Tim Marsh Quantitative Modelling, Source: Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    10. 10. Emerging global epidemic The cover of &quot;The Economist&quot;, Dec. 13-19, 2003.
    11. 11. WHO (2005) Preventing Chronic Diseases: a vital investment. Overview. Geneva: WHO p.4
    12. 12. Diet and Risk of NCDs <ul><li>Population-based prevention is the most cost-effective and the only affordable option for major public health improvement in NCD rates </li></ul><ul><li>Up to 80 % of coronary heart disease and up to 90 % of type 2 diabetes could be avoided through changing life habits. </li></ul><ul><li>About one third of cancers could be prevented by eating healthily, maintaining normal weight and being physically active throughout the life span. </li></ul>
    13. 13. CHD mortality in all Finland and in North Karelia 35-64 year old men -75% -82% 100 200 300 400 500 600 700 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 2000 2001 2002 Year North Karelia All Finland start of the North Karelia Project extension of the Project nationally Source: Pekka Pushka, National Public Health Institute, Finland
    14. 14. 2 Science and policy
    15. 15. Foresight obesity map: a picture of complexity! Source: Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    16. 16. What theoretical models are used to explain obesity? Adapted from: Tim Lang, Geof Rayner, Obesity: a growing issue for European policy? Journal of European Social Policy, Nov 01, 2005; 15: 301-327.
    17. 17. What historical/societal factors can help explain ‘passive obesity’*? <ul><li>DIET TRANSITION: </li></ul><ul><ul><li>Shift from simple to processed foods </li></ul></ul><ul><ul><li>Rise of fat production and consumption </li></ul></ul><ul><ul><li>Rise of soft drinks </li></ul></ul><ul><li>PHYSICAL ACTIVITY TRANSITION: </li></ul><ul><ul><li>Rise of cars </li></ul></ul><ul><ul><li>Decline in walking – and everyday work/nonwork ‘activity’ </li></ul></ul><ul><li>CULTURAL TRANSITION: </li></ul><ul><ul><li>Supermarkets, new food culture </li></ul></ul><ul><ul><li>‘ Sport by proxy’ - screen based culture </li></ul></ul><ul><ul><li>Commodity consumerism as way of life </li></ul></ul>* Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    18. 18. Source: Pepsico Example of dietary transition: soft drinks – following USA?
    19. 19. Example of dietary transition: fat overproduced and consumed WHO/FAO (2003) Diet, Nutrition and the Prevention of Chronic Diseases. WHO TR 916 p.18
    20. 20. Example of dietary transition: packaged food Source: Euromonitor, 2003 http://www.euromonitor.com 
    21. 21. Physical activity transition: motorised transport 1930-2000 Michael P Walsh, Motor Vehicle Pollution Control, Paper to China Fuel Economy Workshop, Hong Kong, December 13, 2004, http://www.walshcarlines.com/china/Applying%20The%20Lessons%20To%20China%20-%20MOVE%20.pdf
    22. 22. Drivers of diet and culture: ‘supermarketisation’
    23. 23. New supermarket culture: Tesco (Bangkok)
    24. 24. Yum! Brands: World's largest restaurant company: 34,000 restaurants, 100 countries New food culture: KFC (Bangkok)
    25. 25. 3. Rethinking public health and consumerism
    26. 26. There are world-wide actions underway to counter child obesity Source: Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    27. 27. Auditing national policies to counter obesity (Europe) Policies to reduce and prevent excess body weight and obesity in children and adolescents, WHO Europe, Factsheet 2.7, May 2007
    28. 28. Common national responses <ul><li>Countries vary in responses but most stress </li></ul><ul><ul><li>‘ The informed consumer in marketplace’ </li></ul></ul><ul><ul><li>National cultural traditions (e.g. Mediterranean diet) </li></ul></ul><ul><li>Reliance on ‘soft’ or partial responses </li></ul><ul><ul><li>Social marketing – eat less, do more </li></ul></ul><ul><ul><li>Labelling, information </li></ul></ul><ul><ul><li>Transfat bans </li></ul></ul><ul><ul><li>School soft drink bans </li></ul></ul><ul><ul><li>Community projects in healthy living </li></ul></ul><ul><ul><li>The WHO Global Strategy on Diet, Physical Activity and Health is the beginning of the global response - but as yet no society has developed a ‘whole society (‘North Karelia’)response to obesity </li></ul></ul>
    29. 29. Noting that short term initiatives have limited results Foresight says obesity represents the ‘Climate Change of Public Health’ * <ul><li>Failure to act at an early stage leads to immense and undesirable consequences. </li></ul><ul><li>Awareness not matched by requisite change by governments, markets and society. </li></ul><ul><li>Obesity ‘normalised’, even as the trends accelerate and the evidence grows. </li></ul><ul><li>Environmental determinants misunderstood and under-researched, while policy drifts towards individualised responsibility and treatment. </li></ul><ul><li>Danger that the political moment to act will be missed and historical point of reversal lost </li></ul>* Foresight, Tackling Obesities: Future Choices – Project Report UK Government Office for Science 2007
    30. 30. Simplifying complexity: The Ecological Public Health perspective suggests filtering policy reviews through ‘four domains’ * <ul><li>The physical world (the built environment, the nature of urbanisation, the extractive relationship with nature) </li></ul><ul><li>The physiological world (the body) – with obesity focus on energy use (thermodynamic) components </li></ul><ul><li>The social world (societal institutions, power - multi-layered and complex) </li></ul><ul><li>The cognitive world (the life world - interpretive structures which are individual yet based on shared meanings) </li></ul>Lang, T. and G. Rayner, Overcoming Policy Cacophany on Obesity: an Ecological Public Health Framework for Politicians. Obesity Reviews, 2007 8(1): p. 165-181.
    31. 31. Obesity and the consumer movement: developing a fresh approach <ul><li>There are no easy ‘consumer’ solutions; no (as yet) magic pill for obesity – and what would be the result? </li></ul><ul><li>Dealing with obesity means about asking questions about the society in which we all wish to live and inserting health into the framework of commerce and every life </li></ul><ul><li>Maintaining civil society pressure on politicians & companies, using parenting as a ‘pressure focus’ </li></ul>
    32. 32. Obesity and the consumer movement: developing a fresh approach <ul><li>Engage criticism of ‘choice’ ideology and food industry view that healthy products are a ‘niche market’ </li></ul><ul><li>Consumer NGOs can adapt their experience for health audits (e.g.UK National Consumer Council yearly health audits of top 10 retailers) - not just of food and supermarkets - but of public and private policy and action (food, transport, town planning, employment policies, etc.) </li></ul><ul><li>Build new alliances between public health movement, consumer movement and environmental movement. </li></ul>
    33. 33. Thank you! <ul><li>[email_address] </li></ul>

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