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Health, a wider view
Health Coalition Aotearoa 2022 Conference Health: Taking in the wider picture
by Peter Barclay
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From the perspective of the whole food plant-based community, the wider picture of health is clear and simple. Don’t eat animal products, remove sugar, oil and salt from your diet wherever possible and stay away from ultraprocessed foods, sugary drinks, tobacco and alcohol. Oh, and don't eat dairy or fish.
Now, does that sound like an easy road to good health? Well, from the perspective of the super-convinced that summation might mean a collective thumbs up, but for the wider community, the answer is nowhere near that simple.
The problem, of course, is that so many actors are involved. And, more than anything, when we talk about achieving good health at a personal level, it always involves some seriously disruptive thinking. On a bigger scale, it's even more awkward because so many organisations have a lot of 'skin+ in the game'. Some have vested commercial interests, but others take such a diverse stand on what good health means that even a simple approach becomes crazily__+++ complicated.
You might think that ‘the evidence’ would sort this out but, take a subject like fluoridated water for example. Here the health debate is still strongly divided, and dare we attempt to discuss the vexed question of vaccination or the value (or otherwise) of wearing a mask?
These might be 'extreme' examples but if you ponder on the subject a bit, it’s easy to see why so many of us come up with such sage remarks when it comes to health, like; ‘health, oh it’s such a broad picture’ and “I know one thing; it’s not a one size fits all” or
‘a vegan diet? But that’s so restrictive.’
If this train of thinking has begun to paint a picture, you might now be in the right frame to consider what was presented at the
August conference of Health Coalition Aotearoa. The HCA is an amalgam of over 60 organisations interested in health. It is led by the renowned Professor Boyd Swinburn, head of Population
Nutrition and Global Health in the School of Population Health,
Evidence Based Eating New Zealand, of which I am an executive member, is one of them. Others include Doctors for Nutrition, the NZ Heart Foundation, He Waka Tapu, Dieticians NZ, ASH, Alcohol Healthwatch, Auckland Women’s Health Watch, Healthy Auckland Together, Child Poverty Action Group, PSA, Save the Children, Stroke Foundation, Garden to Table, Alcohol Action NZ, Consumer, Kidney Health New Zealand, to name but a few, along with a further 56 individually listed academics.
In various ways, all of these organisations exert pressure on the Government and the Department of Health to improve health outcomes for all New Zealanders.
The conference was notable by the fact that speakers ranged from Andrew Little, the Minister of Health, to Dr Ayesha Verrall, Boyd Swinburn Diana Sarfati Andrew Old
Associate Minister of Health, and the most senior executive members of New Zealand’s newly rearranged health system. It was pretty much ignored by the news media, and for average Joe's like me, it was quite a mind grind.
The challenge lies in understanding how all these various organisations and academics can ever channel a clear message to Government that will result in workable solutions on the ground. First public address
Dr Diana Sarfati, in her first public address as the new Director General of Health, offered some interesting thoughts..
“I have a particular interest in cancer prevention; that’s where I’ve come from most recently. One of the first things I did as Chief Executive of Te Aho o Te Kahu was to develop and organise a Cancer Prevention Report,” she said.
“The purpose of that report was to state the importance of prevention in terms of cancer, to look at where we are at in terms of prevention and, most importantly, to look at policy options that government might like to consider in strengthening that preventive action.
“That’s important because just in the cancer space, and of course, that’s only one part of the much more complex puzzle because, hypothetically, up to half of all cancers can be prevented if we could maximise preventive activity. That’s 14,000 fewer people being diagnosed with cancer every year and nearly 4500 fewer people dying from cancer every year.”
Wow, that sounds simple to me, just eat a whole food plantbased diet. But wait, there’s more. Lets take a look at that report. There are many elements in it that WFPB’rs will certainly salute but what about the following?
“Wholegrains, non-starchy fruits/vegetables, dietary fibre, and dairy products can reduce the risk of these cancers: bowel, breast, oesophagus, kidney, bladder, liver, oral cavity, pharynx, larynx.”
Oops, was there a dairy company on the horizon there? I jest, of course, but the milk bottle icon used in the report looks suspiciously like Fonterra's much-lauded opaque design - although it's now made of plant-based material and is kerbside recyclable, so that's a plus, I guess.
Dr Sarfati told the conference that focusing on prevention was “the best tool we have in our tool kit”, especially in terms of
addressing inequities.
“The cancers where there are the biggest inequities in terms of who develops cancer are also the cancers that are the most preventable. So, if we address those elements of prevention we are also addressing inequities, and we would likely address that huge statistic that Maori are twice as likely to die from cancer as non-Maori in this country.”
She said preventative strategies were the most cost-effective but, “a strong and sustainable approach to prevention requires a whole lot of elements. It requires commitment from successive governments. It requires strong Māori leadership and governance. It requires effective cross-sector collaboration. It requires good research and evaluation and data and monitoring and it requires support for communities to have more control over the environments in which they live.” The value of advocacy
A point worth noting for organisations like EBE NZ, Doctors for Nutrition and all other groups making up the Health Coalition was that for Dr Sarfati, “the role of advocacy groups and researchers is a really critical one. Collectively you are really good at identifying the key issues, the priorities, creating and collating evidence and providing a single minded focus so we never lose sight of those goals.
“So, when I’m thinking about how can we collectively create change, one thing is to think about how we can help government to make those changes. Part of that picture is providing them with evidence and focus and making them aware how important an issue is, but that’s not the only thing that needs to happen.
“There’s also the stuff that government has to worry about like what the people out there want and what the people out there think is reasonable. And if you’re not getting the message to the people out there it is very difficult for government to move.”
Now, here's the point where my eyes start to glass over.
Did we (i.e. all the members of the Health Coalition) seemingly have an ally on our hands, or did she just tell us that we have to change the public mind before Government will ever do anything?
If that’s the case, then it’s our job first to convince meat eaters that they’re on the wrong path. When that happens, we can all join hands with the Health Department and, together, skip merrily off to Government and happily write the beef, dairy and fishing industries out of existence.
It never worked that way with smoking. With smoking, the evidence carried the day. And, let’s not forget the fact that processed meats have been given class one classification as carcinogenic with red meat coming a close second. Health risk falls disproportionately
Doctor Andrew Old, Deputy Director-General, Public Health Agency, told the conference that “alcohol, smoking, physical inactivity and unhealthy diets account for something like a third of all health loss. And further, we know that the impact of those risks falls disproportionately on Maori and Pacific communities and on communities experiencing socio-economic deprivation.
“That disadvantage is further compounded by the fact that many of those communities live in areas where there are excessive numbers of fast food outlets, alcohol outlets and the like.”
He said there was a serious need to “address the commercial determinants of heath. There is a real, fundamental and irreconcilable conflict between the interests of some companies to make a profit for their shareholders and the aims of the New Zealand public health system to build towards pai ora (good health) for all New Zealanders.
“Things like lobbying which can rely on manipulating science in attributing harm to individual choices. Direct resistance to public health initiatives – industry-generated delays in introducing tobacco plain packaging would be an example of that.”
But wait, it gets better.
“There is significant commercial influence on policy and public opinion as well as on individual consumer practice. Developing and marketing products that appeal to particular groups, as we heard from Dr Christina McKerchar (another conference speaker) earlier; children exposed to junk food advertising on average 68 times per day, promoted and self-regulated industry codes over national legislation and finally, corporate responsibility washing that aims to paint business in a favourable light but may actually be covert marketing.
“Or, legal challenges that are mounted by supermarket chains against local alcohol policies. Developing and marketing products that appeal to particular groups as we heard from Dr Christina McKerchar (another conference speaker) earlier; children exposed to junk food advertising on average 68 times per day, promoted and selfregulated industry codes over national legislation and finally, corporate responsibility washing that aims to paint business in a favourable light but Picture, Grant Dixon may actually be covert marketing. "So, if we’re serious about improving health and health equity, then we need to not only understand but collectively address these issues.”
Well high five and a smiley face Dr Old! Overall, his address gave more than a hint that New Zealand’s new health administration has the power and the will to intervene where it counts. He continues:
“Although its most obvious when we are talking about food environments, these dynamics are at play across the spectrum of public and population health, including as we work towards sustainability and climate change.
“But there is hope. We have done this before, and we can do it again, and I think our experience with tobacco control is instructive. That experience has shown us that a comprehensive and integrated approach from strategy and policy, regulation, pricing and, again to come back to Dr Safarti’s call around community action, and taking the community with us on that journey, has had, and continues to have significant impact.”
Who knows what will happen here. Perhaps, if the regulators get a serious foot in the door, we could be in for a sea change and that 116 page Cancer Prevention Report might hold a clue. In a segment that looks at potential solutions, that word ‘mandate’ rears its head at least five times.
