Regulation and the prevention agenda

Australians face crippling rates of chronic disease. The main culprits are behavioural risk factors that reflect unhealthy lifestyles: record levels of obesity, misuse of alcohol, tobacco use and too much salt, fat and sugar in our diets. Healthier and longer lives are possible, but new ways of influencing consumer choices are required. While educational strategies are important for individuals, they rarely succeed as population-wide interventions. Often, the problem is not lack of knowledge but difficulty in translating knowledge into action in unhealthy environments. Regulation and legislation play an important role in shaping healthier choices, but every gain for public health runs up against reflexive beliefs about individual responsibility and the “nanny state”.

Unhealthy lifestyles earn vast revenues for Big Tobacco, Big Alcohol and Big Food. The latter two industries have cleverly populated the policy space with weak, self-regulatory initiatives that are surprisingly complex yet designed for easy compliance. By failing to cover the placement of alcohol advertisements, for example, the Alcohol Beverages Advertising (and Packaging) Code permitted a website that targets children to advertise alcoholic drinks.1 The food industry’s initiatives on responsible advertising contain so many escape clauses that they surely represent a new kind of Swiss cheese.2 Australian parents have learned that they only deserve to have healthy children if they can withstand the pervasive influence of junk-food advertising. But unhealthy industries have not had it all their own way. Big Tobacco was decisively beaten over plain tobacco packaging; and the federal Minister for Health recently announced a front-of-pack food-labelling system that facilitates healthier choices by evaluating the nutritional quality of food.3

Where to from here, in the grand, intergenerational challenge of disease prevention? The report of the National Preventative Health Taskforce offers a goldmine of policy options, many of which are yet to be acted on.4 Prescriptive “command and control”-style laws remain necessary in some areas.5 Government leadership is needed in restricting the sale of tobacco over the internet, abolishing all duty-free allowances for tobacco and requiring health warnings and energy labelling on alcoholic beverages. The alcohol control agenda could be pushed along further by setting a minimum price per standard drink to discourage discounting.

In other areas, we need new solutions in the battle between business-as-usual and statutory controls. Governments can make progress through more subtle and incremental changes, including “legislative scaffolds” to strengthen the performance and credibility of industry-led initiatives. These include:

• Setting official goals, targets and indicators for progress. Governments need to commit to bold goals and to clearly communicate the contributions that business is expected to make. For example, food industry self-regulation needs to significantly reduce children’s exposure to unhealthy food advertising. This is not happening at present.6

• Closing off significant gaps in self-regulatory schemes. The principal vehicle for improving diet through food reformulation, the Food and Health Dialogue, currently covers only eight food categories compared with the 80 found in the United Kingdom equivalent.7,8 Regulation needs to restrict the placement of alcohol advertising in media with large youth audiences and to reduce alcohol industry sports sponsorship.

• Improving the accountability of self-regulatory regimes. Industry codes should be administered independently and closely monitored by government, with public disclosure of industry performance. The credibility of food advertising codes is seriously damaged by letting a trade association administer the schemes, and by letting food companies devise their own nutrition standards as the basis for deciding what products can be advertised to children.

In many areas, including food and alcohol, self-regulatory codes are de-facto regulations intended to forestall more intrusive government action. Where independent monitoring indicates that voluntary initiatives are failing, industry must be left in no doubt that the government will escalate its involvement by introducing regulatory interventions that truly serve public health objectives.