Commercial determinants in the spotlight

The Annual Conference of Health Coalition Aotearoa tackled the impacts on alcohol, tobacco and junk food on our collective health.

Addressing the commercial determinants of health will do more for health equity in New Zealand than even the very best health care reforms, says National Director of the National Public Health Service Nick Chamberlain.

His words came at the ASMS-sponsored Health Coalition Aotearoa annual conference at Parliament in August, as part of a panel discussion alongside Director General of Health Dr Di Sarfati and Deputy Director of the Public Health Agency Dr Andrew Old.

Chamberlain says industrial food producers have had an inappropriate relationship with New Zealand, and seeing the effects of commercial determinants of health first hand in his hometown led him to apply for the position of National Director.

“As you enter Whangārei from the Auckland side you have our second poorest suburb,” he says.

“At the entrance of this suburb a McDonald’s was built and then a KFC opened on the other side of the street. There is a hospital up the road and a multitude of liquor stores. Don’t get me started on the vape stores.” Chamberlain says he quoted Hugh Grant from the movie Love Actually during his interview for the National Director role – the scene where Hugh Grant as the British Prime Minister stands up to the American President who had taken what he wanted without compromise and bullied his staff.

Chamberlain says New Zealand has a bad relationship with some large-scale producers of harmful products and the companies act as “bullies”.

“A friend who bullies us is no longer a friend and, since bullies only respond to strength, from now onward we must be prepared to be much stronger.”

Taking a stronger stance on commercial determinants of health could have large health impacts on the wider population and, in particular, Māori communities.

“There is a two to four times benefit in Māori and Pasifika communities,” says Chamberlain.

He urges people to give Health NZ a chance.

“As one entity we can implement policy across New Zealand and get greater support from sectors.

There are many opportunities in the new [health] system.”

At the conference, Minister of Health Andrew Little said Government is committed to tackling alcohol, nutrition and tobacco harm as the three major commercial determinants of health, but there are gaps in their data in some areas.

“We’re committed to improving lives and tackling issues,” he said, “[but] the data to inform our work is dated; most would say outdated. Our most recent adult nutrition survey was taken in 2008/2009 and, for children, the so-called current data goes back to 1992. As such, the Ministry of Health commenced work to scope a nutrition survey.”

Keynote speaker Dr Sandro Demaio from VicHealth in Australia, talked about the global impact of noncommunicable diseases (NCDs) in Australia.

“It is a pandemic on a pandemic,” he said.

“Over the last half-century, we have seen these diseases move from what used to be a rounding error in statistics to dominating the world.

“In Australia, 89% of all deaths are due to NCDs and 71% globally.”

Demaio says reducing commercial determinants is not about tearing down the economic system but about realising where the realities of our modern economic system come at a cost to the health of others.

“The reality is the majority of the planet is fed by smallholder farmers,” he said. “It’s easy to forget that. There are, though, some groups that carry a significant cost to the public health for the privilege and benefit of just a few.”

Demaio says strong political will, public awareness and accountability are key to removing the harms caused by products. Other countries are starting to act with bans or restrictions of advertisements for sugary products – like recommendations made in ASMS’ Tooth be told report – as well as restrictions on alcohol and tobacco marketing.

Health Coalition Aotearoa chair Boyd Swinburn says the conference provided an opportunity for those within the public health space to hear from policymakers and hold them to account where possible.

He said this is particularly important when some bills set to make a difference to New Zealander’s health may be wavering in the Parliament chambers.

“We congratulate them when they are doing well but must be mindful of how bills can change,” Swinburn said.

“Two areas we are concerned about are any wavering in the review of the Sale and Supply of Alcohol Act and the proposed regulations protecting children from junk food marketing where they seem to be taking a weaker option.”

Swinburn thanked ASMS for their sponsorship of the event and assisting, as senior doctors and dentists are at the coal face of treating the effects of NCDs caused by commercial imperatives.

By Matt Shand | Journalist