Brief to Government from Jury and Expert Panel

A South Australian Citizens’ Jury on Obesity Prevention

In April 2015, the School of Public Health, University of Adelaide held a citizens’ jury to ask a diverse group of South Australians their views on the use of regulation and law for obesity prevention in children. The HealthyLaws research findings, including the jury recommendations, were discussed with a roundtable of experts in May 2016 and specific solutions for South Australia were developed.

The Issue for South Australia

South Australia has the worst rates of overweight and obesity in Australia. Nearly one-quarter of South Australian children (23.9%) are overweight or obese. Socially disadvantaged children are more likely to be affected but high levels of obesity and overweight are seen across all population groups. Habits set down in childhood give rise to unhealthy lifestyles amongst adults and it is clear that poor nutrition is a significant contributor to chronic disease in South Australia.

Jury Highlights

The HealthyLaws citizens’ jury supported targeted legislative and fiscal approaches for prevention of overweight and obesity, particularly in the case of children. The Jury advocated a multi-faceted approach but were mindful of potential impact on business.

The jury was motivated by a range of beliefs and shared values including:

• Perceived lack of knowledge and skills in the community to choose and prepare nutritious food
• Poor access in the community to information to guide healthy food choices
• Concern about the socio-economic gradient in obesity prevalence
• A desire to preserve individual choice while recognising that food industry marketing influences which foods people choose to buy and consume.

Jury Recommendations

The jury made ten recommendations in the following priority order:

1. Extended school-based education to improve children’s understanding of the benefits of healthy nutrition and physical activity and their skills in sport and in growing and cooking food.
2. Mandatory food labelling to clearly indicate sugar and fat content
3. Imposition of taxes on food products with high fat/high sugar content. The jury indicated their support for this action would be even stronger if the taxes are used to subsidise healthy food
4. Improved general public education about nutrition
5. Mandatory physical education, mandatory food standards in school canteens and zoning regulations to control future food outlets near schools
6. Bans on television advertising of high fat high sugar items during childrens’ viewing times
7. A Senate inquiry to establish clear guidelines for defining unhealthy food
8. Education for new parents on nutrition particularly in the toddler and pre-school period
9. Bans on unhealthy-food company sponsorship in sport and schools
10. Farm subsidies to promote consumption of healthy Australian-grown food

Solutions for South Australia from the Expert Round Table

A round table of experts (May 2016) considered the HealthyLaws research findings and recommended the following five short to medium-term cost-effective solutions, which align with the recommendations of the Jury, for the first phase of a renewed focus on obesity prevention in South Australia:

• Audit and enforce existing nutritional guidelines in food outlets in public institutions including schools and hospitals and, in particular, strictly enforce soft drink bans in schools.
• Develop and enforce strategies to steer consumers towards healthy choices e.g. require water rather than soft drinks be advertised on all drink vending machines on public property.
• Ban unhealthy food advertising on public property including bus shelters and public institutions.
• In the new planning act, health should be a consideration for all new planning applications. In particular, there should be zoning regulations to prevent new food outlets close to schools.
• Support councils to implement their public health plans around healthy food access.

There is potential in Part 8, SA Public Health Act, 2011 to issue state-wide Codes of Practice relating to specified industries or activities implicated in any non-communicable condition of significance to public health: for example, this might include in the areas of advertising and sale of goods and for labelling of food. In addition, the expert round-table recommended that South Australia raise the issue of a sugar tax on all food products or specific food products at the Australian Health Ministers’ Advisory Council.

South Australia has often shown national and global leadership on social and environmental issues, including the use of citizens’ juries and engagement to include community voices in policy decisions. Other aspects of our research, examining obesity prevention in New York City, indicate that a state-wide public discussion of issues associated with obesogenic environments, supported by Government, would increase health literacy, change behaviours and improve nutritional intake.

Our Citizens’ Jury Process

We recruited twenty South Australians (16 from Adelaide and 4 from rural areas) through the state-wide Health Omnibus survey using random stratified selection. The selected individuals participated in a citizens’ jury over 2.5 days. The process was guided by an independent facilitator.

The jury was conducted under direction from a multidisciplinary research team. An Advisory Group, provided oversight: the Group was drawn from State Government (health, education), NGOs, allied disciplines and a consumer advocacy organisation.

Jurors were provided with verbal evidence from experts and in written summaries. Evidence included: current understanding of harms and causes of obesity; review of legal responses in Australia and elsewhere; effectiveness of legal interventions; public and industry views on the use of law for obesity prevention; and information about legal, economic and ethical issues.