Review key policy priorities in summary on Overview chapter.
Overweight and obesity, physical inactivity and poor diet are responsible for a significant proportion of the cancer burden in Australia. In 2017, the Obesity Policy Coalition and the Global Obesity Centre (GLOBE) published Tipping the Scales, a consensus statement drawing upon national and international evidence to address obesity in Australia. This consensus statement is endorsed by Cancer Council Australia and over 30 other community, public health, medical and academic groups.(1) The evidence-based actions addressed junk food marketing to children, food reformulation, the Health Star Rating food labelling scheme, active transport, a sugary drinks health levy and public education campaigns.
Both the National Obesity Strategy and the National Preventive Health Strategy provide frameworks to identify actions to address poor diet and weight gain.
The key evidence-based policy priorities that need greater attention and government support for implementation are outlined below.
Create environments that support healthy eating
National Nutrition Policy
In 2022 the Australian government allocated $0.7million over 4 years to develop a National Nutrition Policy Framework. The framework will take a multi-sector, ‘whole-of government’ approach to identify, prioritise, drive and monitor healthy eating in Australia. Cancer Council recommends the development of this policy is guided by the World Health Organisation recommendations for national nutrition policies. The Nutrition Policy should be a comprehensive, multi-strategy approach including a focus on improving the sustainable supply of healthy foods; promote healthy foods; and decrease the supply and promotion of discretionary choices.(2-4)
Regulations to protect children from the marketing of unhealthy food and drinks
There is strong evidence that food and beverage marketing influences the types of food and beverages children demand, desire and consume.(5-7) In Australia, voluntary industry codes aimed at restricting the marketing of unhealthy food and beverages to children have proved ineffective. (8-11) This is an area where Australia is significantly lagging global best practice. To reduce children’s exposure to food advertising that promotes unhealthy foods, Cancer Council recommends developing a comprehensive food marketing policy framework and embedding the framework in statutory regulation.
Cancer Council supports the four action areas in the Brands Off our Kids! Report (12):
- Ensuring TV, radio and cinemas are free from unhealthy food marketing from 6am to 9.30pm
- Preventing processed food companies from targeting children
- Ensuring public spaces and events are free from unhealthy food marketing
- Protecting children from digital marketing of unhealthy food
Cancer Council also supports the implementation of independent and consistent nutrition criterion to determine which foods and drinks are classified as unhealthy and therefore unsuitable to be promoted to children. The Council of Australian Government Health Council developed a guide to define food and drink categories that are not recommended for promotion(13) which was demonstrated to be simple and easy to use criteria that aligns with the Australian Dietary Guidelines.(14)
Health Star Rating
The Health Star Rating (HSR), an interpretive front-of-pack labelling scheme, supports consumers to select healthier food products and encourages industry to produce healthier foods. (15) To improve the availability of healthier food options, Cancer Council recommends the Health Star Rating (HSR) system:
- be mandatory,
- is regularly reviewed to allow for improvement to align with emerging evidence and changes to the food market,
- incorporates transparent processes, underpinned by transparent governance structures, which are free from commercial conflict
- aligns with best practice dietary advice.
The HSR system is currently voluntary, but under the recent 5 year review industry uptake targets were established. If the final uptake target of 70% uptake across intended products by November 2025 is not met, Cancer Council recommends the system be made mandatory as was recommended in the 5 year review report. In the response to the five-year review, Food Ministers stated that consumer trust in the system could be undermined by inconsistent uptake and the effectiveness of the system is affected if there are not enough products displaying
Health Stars for consumers to compare foods(16). The National Obesity Strategy identified consideration of mandating the Health Star Rating system if targets are not met.
Nutrition content and health claims
Nutrition content and health claims on food labels can influence consumer purchasing decisions.(17) There are no restrictions preventing the use of nutrition content claims on foods that are less healthy, so these nutrient content claims (such as ‘source of calcium’ or ‘reduced fat’) frequently appear on unhealthy foods.(18) Products carrying general level health claims e.g. claims about health benefits such as ‘contains calcium for strong bones’ and ‘high in fibre for health gut bacteria’) must meet the Nutrient Profiling Scoring Criteria. The Nutrition Profiling Scoring Criteria is a score given to food to determine if it is eligible to make a health claim. The score incorporates the amount of energy, saturated fat, total sugar and sodium as well as the amount of protein, fibre, fruit, vegetables and nuts.(19) To support consumers in making informed decisions on the nutritional content of food purchases, it is recommended all products meet the Nutrition Profiling Scoring Criteria to carry a nutrition content claim or a health claim.
Food manufacturers can base general level health claims on either a pre-approved general health claim or a new claim by conducting a systematic review and notifying Food Standards Australia New Zealand.(20) This process has limited monitoring and relies on external complaints. Introducing a pre-approval process would contribute to ensuring all health claims are backed by sufficient, high-quality evidence and independently verified before claims are used in market.
Eating food high in added sugars, including sugars and syrups added to food or beverages during preparation, increases overall energy intake while reducing opportunities to eat more nutritious foods and can lead to weight gain. The Australian Dietary Guidelines advise Australians to limit their intake of foods and drinks containing added sugars.(21) The World Health Organization recommends that free sugars for adults and children should be at most 10% of their daily energy intake.(22) However, World Health Organization recommends that a further reduction to below 5% per day would provide additional health benefits. World Health Organization defines the term “free sugars” as “monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.(22) Added sugars are not adequately identified under current Australian labelling requirements.(23)
A review of the nutrition labelling to incorporate added sugar was conducted by Food Standards Australia New Zealand in 2019.(24) The review included three policy options for added sugar: i) on the nutrition information panel, ii) applying a pictorial representation of the sugar content (e.g. teaspoons of sugar) to sugary beverages/sugar-sweetened beverages, and iii) changing the statement of ingredients to identify sugars-based ingredients. It is expected that the Food Standards Australia New Zealand will provide a proposal for amending the code with regards to incorporating added sugar in the nutrition information panel in 2022.
Providing kilojoule information on fast food menus increase consumers’ knowledge on the amount of energy they are consuming to support healthier food options which can improve the health and wellbeing of millions of Australians.(25)
Kilojoule labelling on menu boards has been implemented by government in New South Wales, Victoria, Queensland, South Australia and the Australian Capital Territory,(26) however they have all used different approaches. Cancer Council recommends that a nationally consistent standard for kilojoule labelling on menu boards be developed, including for outlets such as cinemas, service stations, other takeaway food providers. Including further information on added sugars, saturated fat and sodium contents in fast foods, as well as nutrition standards for children’s meals are also recommended.
Increasing the nutritional quality of packaged and processed foods through product reformulation can improve population nutrition by reducing the whole population’s intake of nutrients of public health concern e.g. added sugars, sodium and saturated fats. To ensure that food manufacturers comply with reformulation goals, any activities must establish clear reformulation targets for the relevant nutrients in specific food categories, with accompanying time frames, and strict penalties for manufacturers who fail to meet these targets.
To date, reformulation has been left to voluntary industry initiatives such as the Healthy Food Partnership. Given the lack of any demonstrable efficacy, Cancer Council does not support this voluntary industry-focussed initiative. Six years after it was created, there is little evidence the Healthy Food Partnership is operating in accordance with best-practice recommendations.(27) Reformulation targets took more than five years to agree, apply to a narrow range of product categories, and are so weak that even if met by all manufacturers would not make a significant impact on population health.(28)
Food taxation and pricing
Price is a key driver of consumer decision making when purchasing foods and drinks, and therefore making adjustments to food taxation has the potential to affect population diets. The use of fiscal levers such as taxation incentives, grants, pricing and subsidies could be used to encourage physical activity and healthy diets.
Fresh fruit and vegetables are not subject to the goods and services tax (GST) in Australia, and this has been identified as an area where Australia is meeting global best practice benchmarks. It is important that this exemption is maintained. There are opportunities for government to further subsidise healthy food options, increasing their affordability, particularly in remote communities where fresh produce can cost up to 30% more than in urban areas.(29) Incorporating subsidies into a tax design to support those on low incomes may help to combat the impact of a tax on unhealthy foods and may result in higher consumption of healthier foods, such as fruit and vegetables.(30)
The introduction of higher taxes on energy dense and nutrient poor food products, such as sugar-sweetened beverages, to reduce consumption, has been identified as an area where Australia is significantly lagging behind other countries, and is a priority area for action. Cancer Council Australia recommends that the Federal Government implement a sugar-sweetened beverage health levy to effect a price increase of at least 20%, aimed at changing purchasing habits, achieving healthier diets and raising revenue for initiatives aimed at promoting healthy behaviours.(22)
Temporary price discounts have been identified as contributing to unhealthy diets, resulting in impulse purchases and stockpiling. In Australian supermarkets 40% of products are sold on price promotion.(31) Unhealthy foods are more frequently promoted and with larger discounts when compared to healthier foods in Australian supermarkets.(32)
Cancer Council recommends regulation of price promotions (including both temporary price reduction and multibuy offers) of unhealthy food products.
Create environments that support increased physical activity
An individual’s physical environment can influence their physical activity levels. Policies and planning regulations relating to housing, urban design and development and transport infrastructure that promote active living are critical to support increased physical activity levels. All levels of government together with urban planners, developers and Infrastructure Australia need to work together to ensure built environments encourage and support people to be more physically active. This will involve upgrading existing environments as well as ensuring new developments support active living.
Active transport interventions that promote walking and cycling, as well as the provision of safe travel environments, provide a practical and sustainable means of increasing physical activity levels in the population. (33)
The National Preventive Health Strategy identifies that ‘physical activity action should be guided by a specific national policy document’. The National Obesity Strategy identifies building more connected spaces to encourage regular physical activity; and minimising cost and access barriers to physical activity, active transport and sport as two sub-strategies to achieve the ambition for all Australians to live, learn, work, play and age in supportive, sustainable and healthy environments. Cancer Council Australia supports these actions to increase the proportion of Australians that are achieving physical activity guidelines and prevent cancer, including obesity-related cancers as well as cancers directly associated with insufficient physical activity.
Encourage increased physical activity and healthy eating through social marketing
Public awareness of the link between excess body weight, poor diet and physical inactivity and cancer is low. (34) Social marketing campaigns to raise community awareness and educate the community have been shown to be essential to support behaviour change. There is an urgent need for the Federal Government to implement a sustained, effective, and adequately funded social marketing campaign that encourages the population to adopt healthier eating and physical activity behaviours. While education campaigns are an important component of a comprehensive approach to obesity prevention, they cannot stand alone. It’s important that social marketing campaigns are introduced alongside environmental level approaches such as placing restrictions on the advertising of unhealthy food and beverages.
- Obesity Policy Coalition and Global Obesity Centre. Tipping the Scales - Australian Obesity Prevention Consenus. Melbourne, Australia: Obesity Policy Coalition 2017.
- Public Health Association Australia. National Nutrition Strategy Background Paper. Deakin, ACT: PHAA.
- Dietitians Australia. National Nutrition Strategy Position Paper. Deakin, ACT: Dietitians Association of Australia; 2021.
- Dietitians Australia. National Nutrition Strategy Evidence Brief. Deakin, ACT: Dietitians Association of Australia; 2021.
- Norman J, Kelly B, McMahon A-T, Boyland E, Baur LA, Chapman K, et al. Sustained impact of energy-dense TV and online food advertising on children’s dietary intake: a within-subject, randomised, crossover, counter-balanced trial. International Journal of Behavioral Nutrition and Physical Activity. 2018;15(1).
- Halford JC, Boyland EJ, Hughes GM, Stacey L, McKean S, Dovey TM. Beyond-brand effect of television food advertisements on food choice in children: the effects of weight status. Public Health Nutrition. 2008;11(9):897-904.
- Harris JL, Bargh JA, Brownell KD. Priming effects of television food advertising on eating behavior. Health Psychology. 2009;28(4):404-13.
- Watson WL, Lau V, Wellard L, Hughes C, Chapman K. Advertising to children initiatives have not reduced unhealthy food advertising on Australian television. Journal of Public Health. 2017;39(4):787-92.
- King L, Hebden L, Grunseit A, Kelly B, Chapman K. Building the case for independent monitoring of food advertising on Australian television. Public Health Nutrition. 2013;16(12):2249-54.
- Lumley J, Martin J, Antonopoulos N. Exposing the Charade - The failure to protect children from unhealthy food advertising. Melbourne: Obesity Policy Coalition; 2012.
- Smithers L, Lynch J, Merlin T. Television marketing of unhealthy food and beverags to children in Australia: A review of published evidence. Canbera: Australian National Preventative Health Agency; 2012.
- Hickey K, Schmidtke A, Martin J. Brands off our kids! Four actions for a childhood free from unhealthy food marketing. Melbourne: Obesity Policy Coalition; 2021.
- COAG Health Council. National interim guide to reduce children's exposure to unhealthy food and drink promotion. COAG Health Council; 2018.
- Watson WL, Khor P, Hughes C. Defining unhealthy food for regulating marketing to children - What are Australia's options. Nutrition & Dietetics. 2021;78(4):406-14.
- Mhurchu C, Eyles H, Choi Y-H. Effects of a Voluntary Front-of-Pack Nutrition Labelling System on Packaged Food Reformulation: The Health Star Rating System in New Zealand. Nutrients. 2017;9(8):918.
- Australia and New Zealand Ministerial Forum on Food Regulation. 2020.
- Mayhew AJ, Lock K, Kelishadi R, Swaminathan S, Marcilio CS, Iqbal R, et al. Nutrition labelling, marketing techniques, nutrition claims and health claims on chip and biscuit packages from sixteen countries. Public Health Nutrition. 2016;19(6):998-1007.
- Hughes C, Wellard L, Lin J, Suen KL, Chapman K. Regulating health claims on food labels using nutrient profiling: what will the proposed standard mean in the Australian supermarket? Public Health Nutrition. 2013;16(12):2154-61.
- Food Standards Australia New Zealand. Overview of the Nutrient Profiling Scoring Criterion: FSANZ; 2016.
- Wellard-Cole L, Watson WL, Hughes C, Chapman K. How effective is food industry self-substantiation of food–health relationships underpinning health claims on food labels in Australia? Public Health Nutrition. 2019;22(09):1686-95.
- National Health and Medical Research Council. Australian Dietary Guidelines Canberra: NHMRC; 2013.
- World Health Organisation. Guideline - Sugars intake for adults and children. Geneva: WHO; 2015.
- Day K, Clemons, R. Added Sugar in Food,2019..
- Food Standards Australia New Zealand. Review of nutrition labelling for added sugars. 2021.
- Food Regulation. Review of fast food menu labelling schemes 2018.NSW Food Authority; 2013.
- 26. Food Regulation. Review of fast food menu labelling schemes 2018.
- Jones A, Magnusson R, Swinburn B, Webster J, Wood A, Sacks G, et al. Designing a Healthy Food Partnership: lessons from the Australian Food and Health Dialogue. BMC Public Health. 2016;16(1).
- Rosewarne E, Huang L, Farrand C, Coyle D, Pettigrew S, Jones A, et al. Assessing the Healthy Food Partnership’s Proposed Nutrient Reformulation Targets for Foods and Beverages in Australia. Nutrients. 2020;12(5):1346.
- Harrison MS, Coyne T, Lee AJ, Leonard D, Lowson S, Groos A, et al. The increasing cost of the basic foods required to promote health in Queensland. Medical Journal of Australia. 2007;186(1):9-14.
- Lal A, Mantilla-Herrera AM, Veerman L, Backholer K, Sacks G, Moodie M, et al. Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis. PLOS Medicine. 2017;14(6):e1002326.
- Inside FMCG. Retailers and suppliers wasting over A$11bn on discounting 2018.
- Riesenberg D, Backholer K, Zorbas C, Sacks G, Paix A, Marshall J, et al. Price Promotions by Food Category and Product Healthiness in an Australian Supermarket Chain, 2017–2018. American Journal of Public Health. 2019;109(10):1434-9.
- Mahmood S, Macinnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. International Journal of Epidemiology. 2017;46(6):1797-813.
- Kippen R, James E, Ward B, Buykx P, Shamsullah A, Watson W, et al. Identification of cancer risk and associated behaviour: implications for social marketing campaigns for cancer prevention. BMC Cancer. 2017;17(1).