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from the College of Nurses Aotearoa (NZ) Inc.
Who we are and What we do
This submission is on behalf of the College of Nurses , Aotearoa (NZ) Inc. The College is a professional association for registered nurses which aims to support excellence in clinical practice, research and education and to work with consumers to influence health policy. The College aims to address obesity and related issues through the provision of appropriate health services, the development of constructive health policy and through effective nursing practice.
Nurses work across the entire spectrum of health services and are critically aware of both the socio-political determinants of health and the personal and social consequences of poor health. Above all, nurses are aware that prevention, early intervention and patient self management of a range of chronic disorders, including type 2 diabetes and obesity, are critical if New Zealand is to continue delivering effective health services. Added to this nurses are trained to view each person holistically - that is, that labelling a person as overweight or diabetic does not assist any person to make healthy lifestyle choices and that personal behavioural practices frequently interlink with each other and are closely linked to the social and political milieu for families and individuals.
The submission arises from a consultative process amongst members and is presented by the Executive Director, Professor Jenny Carryer.
We argue that:
The majority of front line health professionals (doctors and nurses) subscribe to the overly simplistic notion that obesity results from a simple imbalance between energy in and energy out and is therefore the result of lifestyle negligence on the part of the individual. As such, responses are often punitive rather than constructive. Even though 85% of the general public present annually to general practice settings the majority of people prefer not to discuss behavioural practices such as unhealthy eating patterns or the harmful behaviour frequently associated with diabetes such as lack of physical activity or being overweight, for fear of being judged and then being told how to ‘fix' the problem as perceived by the practitioner.
We argue that:
Addressing obesity and type two diabetes demands an integrated “whole of society approach” which needs to be ambitious and far reaching. Some of these approaches will be costly in the short term but essential to avoid crippling costs in the long term.
We will not repeat the many alarming statistics and research available as we know most submissions will provide that information. We are, however, aware of and support the assertions of other key groups in:
Recognising that:
- Urgent action to tackle obesity and overweight is required.
- Current actions to tackle obesity and overweight are insufficient, largely unco-ordinated and grossly under-resourced.
Prevention of obesity needs to occur at a societal level, as well as at an individual level.
- The burden of disease from obesity affects everyone, but is disproportionately greater for low socio-economic, Maori and Pacific peoples. More than 6 out of 10 Pacific adults and children and Maori adults are overweight and obese. It is also essential to acknowledge the issues in diabetes and cardiovascular disease for Asian people living in NZ.
- The causes of obesity are many. While genetic and individual lifestyle choices are clearly important, the population of New Zealand has not suddenly and collectively lost their willpower to exercise and eat a healthy diet. However, as in other countries where obesity is also a problem, there have been dramatic societal and environmental shifts in many factors, such as urbanisation, marketing and quality of foods, time pressures and food availability, which have changed food consumption and energy expenditure patterns. These are some of the underlying causes of obesity.
- Many of the causes of obesity lie outside the control of the parent and individual, particularly people of low socio-economic status since their choices are heavily constrained by cost, availability and location.
- Robust training of health professionals in interventions for harmful behaviour (prevention and early intervention) is essential to reduce and turn around the current obesity and diabetes type II escalation. Moving some funding presently utilised for obesity and diabetes interventions to utilise existing and well-recognised training approaches for health practitioners to assist people to make healthy choices.
- Along with the World Health Organisation and other major groups, we endorse the following recommendations. We endorse these recommendations as they are based on consistent evidence.
1) Re-orient the health sector
- HEHA is a strategy but there has been a failure to develop a coherent national direction or strategic implementation of the plan. HEHA implementation is presently fragmented, under resourced and haphazard at best. Only with visionary leadership and legislative changes will the obesogenic, environmental and health determinant issues that are currently ill-directed within HEHA be tackled.
- An expert and independent taskforce on obesity is required. This should advocate for strategic direction on policy, training of health professionals in appropriate responses to individuals and research and promotion of food and nutrition issues in the health and non-health sectors. This taskforce should include health professionals and provide advice on urgent means to improve the skills of clinicians in responding to the problem.
- Government must lead and encourage, enable and, if necessary, require every sector to carry out interventions or establish policies, which tackle the factors underpinning obesity. This requires cross government leadership, commitment from the highest level of government, commitment from multiple government sectors, and impact assessment of how government policies affect obesity. To prevent obesity there must be societal environmental change, and this must be supported by a broad, whole-of-government response. Strong leadership and co-ordination are needed to get obesity onto non-health sector organisations' agendas and to make the breadth of measures required happen. Other models which have cross sector planning include, the SARS and bird flu pandemic planning.
- Increase practical support for physical activity. Issues such as perception of danger, lack of suitable space, poverty and provision of child care need to be vigorously addressed if access to pleasurable exercise is to be made equitable.
There is inadequate workforce capacity to undertake nutrition and physical activity work in the health and education sectors, and in the community.
2) Create healthy public policy
- Progress must be made on the Public Health Bill so there is provision in law for government to set in place population measures that will assist in the prevention of non-communicable diseases. This will require both individual and populations as a whole approach. The focus of the bill must adequately deal with social environments, assessment of health impacts and the wider determinants of health that influence all disease states, both non-communicable and communicable. To enable this, the meagre resources for preventing non-communicable diseases must be enhanced to reflect where the greatest burden of disease lies.
- Health impact assessment on all central and local government policy to ensure there are positive effects on population nutrition and physical activity from non-health sector policies, programmes and projects. This is particularly important in urban growth and infrastructure, and transport sectors.
3) Create supportive environments
- Legislation/regulation is needed to prohibit marketing, across all types of media, of energy dense, low nutrient foods - a known causal factor for obesity. Voluntary self-regulation of marketing does not protect population wellbeing (particularly of children) rather it serves industry interests.
- Simplify food labelling for consumers and focus on improving health rather than increasing food industry sales. This requires implementation of a traffic light food labelling system that is easy for consumers to use and a review of the Nutrition and Health Related Claims legislation to ensure it helps to prevent obesity rather than promote obesity.
- Investigate mechanisms for improving access to low cost nutritious foods and decreasing access to high energy density food at a neighbourhood level.
- It is critical that Government protect, promote and support breastfeeding by allocating sufficient resources to fully implement actions called for in the WHO-UNICEF Global Strategy for Infant and Young Child Feeding 2003 and the Innocenti Declaration 2005.
4) Strengthen community action
- Evidence shows that multi-component school based programmes are effective in changing what children eat and do address the obesity and type 2 diabetes issues although there is some uncertainty about long term sustainability. Mandating comprehensive and integrated food and nutrition programmes for all levels of education is required – from preschool up. Food and nutrition policies would exclude all foods (and promotion of them) that are not appropriate for “everyday” consumption from school environments. This would include tuck shops sales, soft drink sales, choc bar fundraising, fast food sponsorships deals, sponsored curriculum materials, etc. This needs to be set in legislation/ regulation and consider how it will build on existing school-setting programmes. Also, nutrition curricula and basic cooking skills need to be priority subjects in schools. Finally, school inspection criteria (from the Education Review Office) should include appraisals of school health programmes.
- The environment must also support individual action to maintain a healthy weight. It is vital to promote food and nutrition policies and active travel plans within workplaces and educational institutions. Policies would exclude all foods (and promotion of them) that are not appropriate for “everyday” consumption from these environments. These policies would promote the economic benefits for workplaces from healthier staff, and educational and behaviour benefits for students.
The College of Nurses Aotearoa (NZ) urges the Health Select Committee to adopt the above recommendations as a matter of urgency. We regard the formation of a national taskforce as critical to advising Government on initiating and co-ordinating its responses to this complex but urgent problem.
Healthy Eating Healthy Action ( Ministry of Health, 2003) |
