The role of high body weight, physical inactivity, and poor diet in the development of cancer and other chronic diseases has led to the development of policy frameworks aimed at reducing their impact.
The World Health Organization (WHO) published a Global Action Plan for the Prevention and Control of Non-communicable Diseases in 2013, aimed at reducing the burden of non-communicable diseases by 2025 through action on nine targets (including halting the rise in obesity) measured by 25 indicators of performance.(1) The recommended interventions were updated in 2017 to take into consideration new cost-effectiveness evidence.(2) The WHO has stated that all signatory countries need to
- set national non-communicable disease targets
- develop and implement policies to attain them
- establish a monitoring framework to track progress.
The World Cancer Research Fund (WCRF) International has developed a food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases, known as the NOURISHING framework.(3) The NOURISHING Framework brings together 10 policy areas across three domains of food environments, food systems and behaviour change communications. The framework is based on the principle that food policies to prevent obesity and improve food intake should aim to improve dietary behaviours by improving the availability, affordability, and acceptability of healthy diets, while decreasing the availability, affordability and acceptability of unhealthy diets. Importantly, NOURISHING provides global level recommendations, within which policy-makers have the flexibility to select specific policy options that are appropriate for their national/local contexts and target populations.(3)
The WCRF has more recently created the MOVING Framework(4) a policy framework to promote physical activity. The framework highlights policy actions needed within four domains: Active Societies, Active Environments, Active People and Active Systems. The aim of the framework is to promote physical activity across the lifespan through providing opportunities for physical activity in schools and workplaces, improving infrastructure (e.g. public transport, and walking and cycling paths) and education. The aim of the framework is to promote physical activity across the lifespan through providing opportunities for physical activity in schools and workplaces, improving infrastructure (e.g. public transport, and walking and cycling paths) and education.
Current policy environment in Australia
With a vision of improving the health and wellbeing of all Australians at all stages of life, the National Preventive Health Strategy was released in December 2021 by the Australian government. The National Preventive Health Strategy highlights the importance of keeping Australians well by treating people before they become unwell. The Strategy focuses on ensuring Australians have a good start in life and live in good health as long as possible, with an emphasis on the need for health equity in priority populations.
The strategy highlights the top three risk factors with the greatest impact on the burden of disease: tobacco use, overweight and obesity and dietary risk factors. To reduce the burden these risk factors pose to the Australian population, accelerated action areas were highlighted in the strategy, including improving access to, and the consumption of, a healthy diet and increasing physical activity. Specific targets including reducing the prevalence of inactivity by 2030 and increasing the consumption of vegetables have been set.
In March 2022 the Australian government released the National Obesity Strategy 2022-2032. Aligning with the National Preventive Health Strategy, this strategy is a 10-year roadmap to prevent, reduce and treat overweight and obesity in Australia. It acknowledges the importance of addressing the wider determinants of health such as inequities, creating healthy environments, empowering individuals to stay healthy and ensuring access to early intervention and supportive health care.
The overall purpose of the strategy is to increase the consumption of healthy foods whilst decreasing consumption of unhealthy foods, as well as increasing physical activity and decreasing sedentary behaviour. There is also a focus on reducing stigma and ensuring equity and health for all. The strategy highlights areas for government to focus on with specific exemplar actions. These include reducing exposure to unhealthy food and drink marketing, promotion and sponsorship, improving food labelling and exploring fiscal policies such as a sugar-sweetened beverage tax.
Both the National Obesity Strategy and National Preventive Health Strategy aim to reduce rates of overweight and obesity, improve dietary intake and increase physical activity. They therefore share the following common targets, goals and objectives:
- Halt the rise and reverse the trend in the prevalence of obesity in adults by 2030*
- Reduce overweight and obesity in children and adolescents aged 2-17 years by at least 5% by 2030*
- Adults and children (≥9 years) maintain or increase their fruit consumption to an average 2 serves per day by 2030**
- Adults and children (≥9 years) increase their vegetable consumption to an average 5 serves per day by 2030**
- Reduce the proportion of children and adults’ total energy intake from discretionary foods from >30% to <20% by 2030**
- Increase the proportion of adults and children who are not exceeding the recommended intake of free sugars by 2030**
- At least 50% of babies are exclusively breastfed until around 6 months of age by 2025
- Reduce the prevalence of insufficient physical activity amongst children, adolescents and adults by at least 15% by 2030**
- Reduce the prevalence of Australians (≥15 years) undertaking no physical activity by at least 15% by 2030**
* Referred to as a target in the NPHS and a goal in the NOS
** Referred to as a target in the NPHS and an objective in the NOS
The success of the National Obesity Strategy is reliant on a clear governance framework, as the National Obesity Strategy is not solely a Commonwealth government strategy but was led by the Queensland government on behalf of all State, Territory and Commonwealth governments. An implementation plan must clearly articulate priority actions for all governments, as well as agreed targets, timeframes and reporting processes to ensure coordinated action and collective accountability to ensure the National Obesity Strategy is implemented effectively.
The Australian Government has identified programs, including the Healthy Food Partnership(7) and the Health Star Rating system(8), as part of a broader national nutrition framework. However, there is currently no National Food and Nutrition Plan. The Australian Prevention Partnership Centre’s report on tackling obesity identified this as an area where Australia is significantly lagging behind other countries and is a priority area for action.(9) The 2022 Australian budget(10) allocated funds to develop a National Nutrition Policy Framework to identify, prioritise, drive and monitor healthy eating in Australia.
In 2015, the Government launched the Healthy Food Partnership (7) focusing on improving the dietary habits of Australians by making healthier food options more accessible and increasing consumer knowledge on healthier options and portion sizes.(7) The program aims to provide a non-regulatory platform for collective, voluntary action between Government, the public health sector and the food industry, and includes three main goals, (i) encourage healthy eating, (ii) appropriate portion sizes, and (iii) reformulation.(7)
Clear food labelling can assist consumers to be aware of healthier food options(11-14) which in turn can assist with eating a healthy diet and avoiding additional weight gain, thereby reducing their cancer risk.
Health Star Rating
In 2014, the Health Star Rating system was implemented on a voluntary basis by the Australian food industry.(8) The Health Star Rating is a front-of-pack labelling system that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars; more stars indicate a healthier option within a given food category. The system was developed and funded by the Australian state and territory Governments in collaboration with the food industry, public health and consumer groups. The system aims to provide consumers with a quick, easy, standardised way to compare similar packaged foods. Front-of-pack labelling has been identified as an area where Australia is meeting global best practice benchmarks.(9) A five-year review finalised in 2020 resulted in modifications to improve the Health Star Rating System including specific industry uptake targets, and greater penalties applied to total sugars and sodium, however the system remains voluntary.
If the uptake rate from 2014-2019 is maintained the uptake target of 70% of products displaying a health star rating is theoretically feasible. However, that rate is likely difficult to maintain as it is driven by inconsistent uptake across the food supply; retailers have applied the rating to most of their products, and healthier products (those with a health star rating on 4.5) had the highest proportional uptake.(15) Less healthy products were more likely not displaying health stars.
A 2020 policy guideline was developed by the Australia and New Zealand Ministerial Forum on food regulation to provide strategic guidance to food regulators and aims to ensure food labels provide the population with information to make informed food decisions to support a diet that aligns with the Australian Dietary Guidelines. (16) This policy guideline acknowledges the role that food labels and hence food labelling regulation plays in supporting people to identify healthier options.
Nutrition content and health claims on food labels
Nutrition content and health claims are used by the food industry to market the addition of nutrients to foods or highlight certain health benefits or other nutritional characteristics of foods. (17) In Australia, the use of these claims is regulated in the Australia New Zealand Food Standards Code. (18) Nutrition content claims are claims about the presence or absence of a nutrient, e.g. ‘contains calcium’. Health claims refer to a relationship between a food and health rather than a statement of content. There are two types of health claims: general level health claims, e.g. ‘contains calcium for strong bones’; and, high level health claims refer to a serious disease or biomarker, e.g. ‘contains calcium to prevent osteoporosis’. (18)
Food marketing to children
The Australian Communications and Media Authority is responsible for the Broadcasting Services (Australian Content and Children's Television) Standards 2020. (19) These standards include limited protection of children from advertising in specific programs that are labelled ‘C’ or ‘P’.
The Advertising Standards Bureau administers the industry codes of practice, developed by the Australian Association of National Advertisers. These are very general in scope and limited in application.
The Australian Prevention Partnership Centre’s report on comparing Australia’s progress in halting and reducing obesity with global best practice has identified regulations to reduce exposure of children to marketing of unhealthy food as an area where Australia is significantly lagging behind, and flagging this as a priority area for action. (9)
The UK has acknowledged the role advertising has on overweight and obesity rates and has recently set a higher standard around unhealthy food marketing to children. The proposed law will only allow advertisements of food high in sugar, saturated fat and salt between 9pm and 5:30am on TV, online and UK on demand programs. (20)
It is well recognised that many of the factors influencing physical activity do not typically sit within the scope of the health sector. Any effective strategy for increasing population physical activity levels will require a national plan focused on promoting physical activity through a variety of areas, including active transport, urban planning, and sport and recreation.
As outlined above, both the National Preventive Health Strategy and National Obesity Strategy aim to improve physical activity levels in the Australian community by increasing green and open spaces, mass media campaigns to create healthier social norms and supporting early childhood centres and other places of work and education to promote physical activity.
The National Sport Plan, Sport 2030, was released in 2018, is the first national sport plan and focuses on using sport to reduce the burden of chronic diseases in Australia with a clear aim of making Australians the world’s most active and healthy sporting nation. Targets within the plan include to improve the physical and mental health of Australians through the benefits of sport, physical activity participation and social connectedness. (21)
Other Federal Government policy initiatives have focused primarily on encouraging increased participation of children and young people in sports and other physical activities (22) (23). For example, the ‘Girls make your move’ campaign launched in 2016 which supports girls aged 12-19 to be more active (22) and the ‘Sporting Schools Program’ which provides funding to schools to deliver sporting activities for students. (23)
State and territory initiatives
A range of strategies have been undertaken by state and territory governments to reduce rates of overweight and obesity, physical inactivity, and poor diet.
Examples include the ‘Get Healthy Coaching and Information Service’ in NSW and healthy food provision guidelines in school canteens and hospital/health care settings. (24) South Australia and Queensland also offer free personal health coaching services.(25)(26) In Western Australia, the ‘LiveLighter’ campaign began in 2012 to help address rising rates of overweight and obesity in adults.(27) In 2014, this successful campaign was extended to Victoria, the Northern Territory and the Australian Capital Territory.(27) Tasmania commenced LiveLighter in 2017.
The Food Policy Index assesses the extent to which Australian Commonwealth, State and Territory governments are implementing globally recommended policies for improving population nutrition and creating healthier food environments. (9) The 2019 report showed states and territories varied in their level of implementation of recommended policies, however, some were recognised as meeting global best practice benchmarks. These included(9):
- menu labelling regulations in fast food outlets in the Australian Capital Territory, Victoria, New South Wales, Queensland and South Australia
- support and training systems to help schools and organisations to provide healthy foods in Victoria
- independent statutory health promotion agencies in Victoria and Western Australia
- mechanisms to incorporate population health considerations into all policy development processes in South Australia.
- removal of unhealthy food and drink advertising on government owned buses in ACT
- removal of alcohol advertising on public transport in WA.
- World Health Organisation. Global Action Plan for the Prevention and Control of NCDs 2013-2020. Geneva: WHO; 2013.
- World Health Organisation. 'Best Buys' and Other Recommended Interventions for the Prevention and Control of Noncommunicable Diseases -Updated (2017) appendix 3 of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020. Geneva: WHO; 2017.
- Hawkes C, Jewell J, Allen K. A food policy package for healthy diets and the prevention of obesity and diet-related non-communicable diseases: the NOURISHING framework. Obesity Reviews. 2013;14:159-68.
- World Cancer Research Fund International. MOVING framework
- Department of Health. National Preventive Health Strategy 2021-2030. Canberra, Australia; 2021.
- Commonwealth of Australia. The National Obesity Strategy 2022-2032. Canberra, Australia; 2022.
- Department of Health. Healthy Food Partnership Canberra, Australia: Department of Health; 2016.
- Australian Government. Health Star Rating Canberra, Australia: Australian Government; 2014.
- The Australian Prevention Partnership Centre. Policies for tackling obesity and creating healthier food environments: 2019 progress update. Deakin University 2019.
- Department of Health. Preventive Health - National Preventive Health Strategy. Canberra, Australia: Department of Health; 2022.
- Campos S, Doxey J, Hammond D. Nutrition labels on pre-packaged foods: a systematic review. Public Health Nutrition. 2011;14(8):1496-506.
- Hawley KL, Roberto CA, Bragg MA, Liu PJ, Schwartz MB, Brownell KD. The science on front-of-package food labels. Public Health Nutrition. 2013;16(3):430-9.
- Magnusson RS. Obesity prevention and personal responsibility: the case of front-of-pack food labelling in Australia. BMC Public Health. 2010;10(1):662.
- Roberto CA, Bragg MA, Seamans MJ, Mechulan RL, Novak N, Brownell KD. Evaluation of Consumer Understanding of Different Front-of-Package Nutrition Labels, 2010–2011. Preventing Chronic Disease. 2012;9.
- Shahid M, Neal B, Jones A. Uptake of Australia’s Health Star Rating System 2014–2019. Nutrients. 2020;12(6):1791.
- Australia and New Zealand Ministerial Forum on Food Regulation. Policy Guideline on Food Labelling to Support Consumers to Make Informed Healthy Food Choices 2020.
- Food Standards Australia New Zealand. Nutrition content claims and health claims Food Standards Australia & New Zealand; 2021.
- Australia New Zealand Food Standards Code - Standard 1.2.7 - Nutrition, health and related claims (2016).
- Broadcasting Services (Australian Content and Children's Television) Standards 2020 (2020).
- Department of Health and Social Care. New advertising rules to help tackle childhood obesity UK Government 2021.
- Department of Health. Sport 2030 - Participation, Performance, Integrity Canberra, Australia: Department of Health 2018.
- Department of Health. Girls Make Your Move Canberra, Australia Department of Health; 2016.
- Australian Sports Commission. Sporting Schools Canberra, Australia: Australian Sports Commission; 2016.
- NSW Health. NSW Healthy Eating and Active Living Strategy: Preventing overweight and obesity in New South Wales 2013-2018. Sydney, Australia NSW Ministry of Health 2013.
- Queensland Health. Obesity Prevention Programs Queensland, Australia: Queensland Health; 2022.
- SA Health. Get Healthy Information and Coaching Service South Australia, Australia: SA Health; 2022
- LiveLighter. Background: LiveLighter; 2022