Community-based multi-strategy interventions
10.1
Submitters stressed the importance of multi-strategy prevention and
intervention programs and identified a number of promising approaches to
deliver effective programs at a community level.[1]
10.2
Ms Alexandra Jones from The George Institute is of the view that some
state governments have developed more initiatives and shown greater leadership
in addressing obesity compared to the Australian Government.[2]
10.3
Submitters reported that there have been a number of effective programs
at state and territory levels, including the OPAL and Healthy Together programs, which are aimed at preventing childhood obesity.[3]
10.4
Most of these programs were locally specific and are not ongoing, making
it difficult to fully evaluate their effectiveness and potential application
more broadly.
10.5
Inquiry participants also provided some examples of successful
international prevention programs driven by governments, which demonstrate that
initiatives that work have both a whole-of-government approach, as well as a
whole-of-community approach. This includes EPODE in France, which the South
Australian Government used as a model for the development of the OPAL program
and the Amsterdam Healthy Weight Program in the Netherlands.[4]
OPAL program
10.6
Between 2008 and 2015, the South Australian Government ran the OPAL
program in 20 communities.[5]
10.7
OPAL was an adaptation of the French program EPODE, a multi-strategy,
community-based obesity prevention initiative that brings together healthy
eating and physical activity programs available through schools, local
government, health services and community organisations.[6]
10.8
The program was coordinated through local governments, which engaged
with communities to tailor interventions.[7]
10.9
Professor Megan Warin from the University of Adelaide commented
positively on the program because of its whole-of-community approach:
The terrific thing about the OPAL program was that it did
attempt to take a socio-ecological approach, a whole-of-community approach...It
did have a large social marketing platform, but it has good community political
buy-in through leadership of local councils and community organisations.[8]
10.10
Flinders University of South Australia reported that as a result of the
OPAL program there were significant changes in the environments in which
children spent most of their time, namely home and school. At the community
level, changes included:
- more parents receiving nutrition and physical activity
information;
- reductions in discretionary food intake;
- greater use of physical activity items in the home;
- greater use of community gardens;
- more rules at home resulting in children spending less time
watching TV;
- primary caregivers being more active; and
- more children rating their teachers as good role models for
activity.[9]
10.11
However, due to budget cuts to the program, the full evaluation of the
program could not be completed.[10]
10.12
The National Rural Health Alliance expressed support for the program and
described it as an effective prevention program model that should be reinstated
and implemented across Australia.[11]
Healthy Together
10.13
The Victorian Government invested in the Healthy Together initiative
with the allocation of significant resources for 14 councils across Victoria
between 2011 and 2015, as part of the National Partnership on Preventive
Health.[12]
10.14
Similar to the OPAL program, Healthy Together was based on a
whole‑of‑community approach with council and community health
partners working with early childhood services, school and workplaces, and in
parks and leisure facilities.[13]
10.15
In 2015, the program was terminated prematurely due to the abolition of
the National Partnership Agreement on Preventive Health in 2014.[14]
10.16
Submitters are of the view that this program was effective and based on
the best evidence of what works as a whole-of-community approach.[15]
Amsterdam Healthy Weight Program
10.17
In 2012, Amsterdam City Council in conjunction with the Dutch Health
Department developed the Amsterdam Healthy Weight Program.
10.18
The program is based on the view that a healthy social and physical
environment for children is not just the responsibility of the parents, but a
responsibility shared by everyone including the food industry, schools and
government.[16]
10.19
The program seeks to address structural causes of obesity, such as
lifestyle, calorie dense food and the social and physical environment that makes
it difficult for parents to ensure their children eat healthily and exercise
adequately.[17]
10.20
The program focuses on both prevention and treatment interventions.
It includes:
- community based interventions such as cooking classes;
- school based programs;
- working with the food industry, including supermarket chains and
local snack bars to provide healthier food options;
- banning marketing of unhealthy food products to children at
sports events; and
- working with paediatric nurses and other health care
professionals.[18]
10.21
So far, the program has been very successful with a 12 per cent reduction
in overweight or obese children. The City of Amsterdam continues to build and
develop on this program.[19]
10.22
Miss Karen Den Hertog, Program Manager of the Amsterdam Healthy Weight
Program, told the committee that key elements in its success have been
political leadership and leadership at a program management level.[20]
10.23
The Boden Institute at the University of Sydney commended this program
for achieving significant drop in childhood obesity, especially in children
from low and very low socio-economic backgrounds.[21]
Programs in Aboriginal and Torres
Strait Islander communities
10.24
The committee heard that Aboriginal Community Controlled Health Organisations
(ACCHOs) run effective programs aimed at preventing and addressing the high
prevalence of obesity in Aboriginal and Torres Strait Islander communities.[22]
10.25
Ms Pat Turner, Chief Executive Officer of National Aboriginal Community
Controlled Health Organisation (NACCHO), gave the example of the Deadly
Choices program, which is about organised sports and activities for young
people. She explained that to participate in the program, prospective
participants need to have a health check covered by Medicare, which is an
opportunity to assess their current state of health and map out a treatment
plan if necessary.[23]
10.26
However, NACCHO is of the view that ACCHOs need to be better resourced
to promote healthy nutrition and physical activity.[24]
Access to healthy and fresh foods
in remote Australia
10.27
Ms Turner also pointed out that 'the supply of fresh foods to remote
communities and regional communities is a constant problem'.[25]
10.28
Similarly, Ms Salli Cohen, Executive Director, Strategic Policy and
Planning at the Northern Territory Department of Health, told the committee
that food insecurity is a significant problem for Territorians, particularly
for those living in remote and regional areas.[26]
10.29
Given that healthy food is more expensive in remote Australia, the National
Rural Health Alliance believes that incentives to provide fresh foods to remote
communities should be provided to grocers and transport operators servicing
these areas.[27]
10.30
Ms Cohen noted that the Australian Government's community store
licencing initiative has increased access to a healthier food range in remote
communities and called for the continuation and expansion of this program:
We would really welcome an ongoing commitment from the
Commonwealth government to the outback stores through the community store
licencing. We would welcome an ability for those stores to be able to purchase
foods at the same wholesale rates that the big retail stores have.[28]
10.31
NACCHO is of the view that the government should be proactive in working
with community stores to increase the consumption of healthy food choices.[29]
Committee view
Multi-strategy prevention programs
10.32
The committee noted the success of multi-strategy, community-based and
led prevention programs. This includes the OPAL and Healthy Together programs initiated by state and territory governments. Importantly, submitters
identified that a whole-of-government approach combined with a
whole-of-community approach is required for prevention programs to be
successful. The Amsterdam Healthy Weight Program demonstrates that a
multi-pronged approach involving all sectors of the community work well to
address the structural causes of obesity and is an effective driver to achieve
systemic changes. Developing pilot programs based on this approach should be
considered.
10.33
The committee noted the importance of promoting physical activity within
multi-strategy programs, including encouraging the use of active transport such
as walking and cycling. The committee is aware that one in six adults and eight
in ten children do not meet national physical activity requirements. A national
strategy to encourage regular physical activity should be considered to support
a culture and environment that promotes active travel, encourage physical
activity and sport participation and influence sporting environments to be more
inclusive.
Recommendation 18
10.34
The committee recommends the proposed National Obesity Taskforce
commission evaluations informed by multiple methods of past and current
multi-strategy prevention programs with the view of designing future programs.
Recommendation 19
10.35
The committee recommends the proposed National Obesity Taskforce is
funded to develop and oversee the implementation of multi-strategy, community
based prevention programs in partnership with communities.
Recommendation 20
10.36
The committee recommends the proposed National Obesity Taskforce develop
a National Physical Activity Strategy.
Aboriginal and Torres Strait
Islander communities
10.37
As discussed in Chapter 1, there is an increased prevalence of obesity
in the Aboriginal and Torres Strait Islander population and in regional and
remote Australia. The committee was told that, after tobacco, obesity
contributes most heavily to the disease burden affecting Aboriginal and Torres
Strait Islander Australians.[30] The committee is also cognisant that access to fresh foods in remote
communities is an ongoing challenge due to high costs of freight and
distribution. Therefore, developing and resourcing targeted culturally appropriate
prevention and intervention programs is a key priority. Importantly,
initiatives such as the Department of Prime Minister and Cabinet's Community
Stores Licensing Scheme, which requires community stores to stock a minimum
range of health foods must continue and be strengthened.
Recommendation 21
10.38
The committee recommends the proposed National Obesity Taskforce is
funded to develop and oversee culturally appropriate prevention and
intervention programs for Aboriginal and Torres Strait Islander communities.
Recommendation 22
10.39
The committee recommends the Commonwealth develop additional initiatives
and incentives aimed at increasing access, affordability and consumption of
fresh foods in remote Aboriginal and Torres Strait Islander communities.
Senator Richard Di
Natale
Chair
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