In June the IEPCP attended the 2019 Public Health Association of Australia Public Health Prevention Conference. Subtitled ‘Smashing the Silos’, this year’s Public Health Conference was a bumper three day event held at the Melbourne Convention & Exhibition Centre. The program and presentations can be accessed here
IEPCP highlights were:
• Lucie Rychetnik, Australian Prevention Partnership Centre The Lancet Commission on Obesity reports the urgency to address under-nutrition, obesity, and climate change – a global syndemic (A syndemic is the aggregation of co-occuring and mutually reinforcing epidemics in a population which exacerbates the prognosis and burden of disease). The drivers of those three epidemics are policy inertia (ie a reluctance to create effective policies against powerful external commercial influences).
Ms Rychetnik explained that we need to think about how to link all three epidemics and improve all. An example she gave is: to reduce red meat consumption (healthier diets [Obesity/NCDs], more land for sustainable agriculture [under-nutrition], lower emissions [climate]) – a neat illustration of systems thinking to support health and environments!
• Oliver Huse, Global Obesity Centre, on the cost-effectiveness of regulation restricting sugar sweetened beverage price promotions in Australia. In Australia 48% of price promotions of beverages are on SSBs (including soft drinks and cordials). In NZ, 63% of beverage purchases are made based on price promotions. The UK government already have a plan to ban price promotion of unhealthy food/drinks. Costs savings are associated with the estimated 66 227 disease cases (mainly diabetes) which would be avoided. Cost increases for the government would lie in creating public health legislation, supporting supermarkets, marketing policy and auditing supermarkets. Mr Huse recommends that significant savings will be made by banning price promotion on SSBs.
• Dr Maureen Murphy, University of Melbourne, on local food environments in Melbourne, Victoria and translating evidence into policy and practice. In the food environment, supermarket access has been associated with lower bmi in highly disadvantaged areas. Urban planning policy also states that 80-90% of dwellings need to have access to supermarkets. However the Planning Act needs health and wellbeing to be integrated and to reverse the onus of proof of harm (ie alcohol outlets need to have to prove that they will not have harmful effects).
• Alison McAleese, Livelighter, on attitudes and awareness to alcohol labelling in Australia. Alcohol is energy dense and is estimated to be a 6% contribution to energy intake and is Australia’s larges source of discretionary consumption. In her research she found: 31% had seen pregnancy image to not drink, 21% had seen ‘safest to not drink while pregnant’ label.
64% of respondents said that alcohol should have KJ labelling, 70% said alcohol products should have ingredients label, and 64% said alcohol should have health warning label. Ms McAleese concluded that there is a high level of public support for labels on alcohol with health and nutrition information, but that there is low current awareness of pregnancy advisory labelling.
Economics of Prevention
In a session on the economics of prevention we learned from Todd Harper, Cancer Council Victoria, that we are excellent at building the case that there is a problem, but less good at building the case of how to fix it. We need to synthesise existing evidence of what works and what is ‘good value for money’, and need to develop new evidence. Prevention doesn’t need to ‘save’ money to be a good value investment.
How can we make the most of our work?
– forums with government
– identify returns on investment
Teresa Fels, Department of Treasury and Finance, Victoria, told us that the majority of health expenditure goes to hospitals or primary care. Prevention spend is low and hasn’t grown. There is no framework that helps set out how to assess prevention interventions (eg what elements should be captured). Why is this? Evidence for interventions is patchy; defining and reaching the target cohort is not always simple; timeframe for measurable outcomes is generally lengthy; attribution of outcomes to interventions can be difficult.
Using an economic lens can help to lend rigor to the work. Look at the NZ investment approach. They look at intergenerational wellbeing through the Living Standards Framework
The Framework is embedded into treasury and budget. On the website there are a set of indicators to inform investment decisions: current and future wellbeing.
Communication and Health Promotion
Toby Roderick, Customedia
Reach and campaigning in health promotion communications:
– Potential for reach in 18-39 age group is digital video (ie Youtube), display, payTV, social
– Potential for reach in 25-49 age group is digital video, payTV, social, display
– potential for reach in 50-74 age group is digital video, social, display
There is strong growth in watching catch up on TV (usually more viewers collected around a smart tv to watch catch-up than regular tv programming), live radio is still a good medium.
So, what are we up against from industry?
– Soft drink advertising $33 million
– Fast food advertising $180 million
People can use their mobile phones to search food and drink delivery now.
– media mix
– diverse target audiences
– campaigns need to be relevant to outside the core target
– be careful about the rush towards explicit targets (keep it broad)
– Mass media still gives good cost efficiencies to reach health promotion audiences
Mark Chenery, Common Cause Australia on framing health promotion messaging. (firstname.lastname@example.org)
-Mr Chenery worked on a project for VicHealth asking ‘how do we counter opposition to health promotion messages?’ Opposition to messaging is described as a nanny state argument and an individual focus – ‘not the role of government to intervene in my lifestyle choices…’)
His research asked: who thinks this about the nanny state and why and how do we respond? Most people can perceive the same issue from different points of view. So don’t ask where people are at, but ask how far can they go? Ie how far can their opinion be swayed?
Methodology: public discourse analysis, advocate interviews, frames analysis, online survey and dial testing
• 13.7% opposition (impossible to change their minds);
• 17.7% supporters;
• 68.6% persuadable.
– the problem (but less)
– the role of government
– but support for solutions more variable.
All persuadables supported the concept of choice ie individualism (so use the term ‘healthy options’ rather than ‘healthy choices’.) Advocate interviews found that persuadables care about equity, social justice. Persuadable people responded to social justice arguments. It resonates.
– Don’t mention ‘junk food’ – use ‘unhealthy’
– Don’t mention ‘sugar tax’ – use ‘health levy’
-don’t waste time on nanny state debates. They are small group and cannot be persuaded. Their argument doesn’t work on majority anyway
– don’t tap into choice and responsibility frames (eg healthy options NOT choices)
– Do highlight the external barriers people face
– Do frame health promotion as a social justice issue