Obesity could be taken off the national health agenda if we follow the example set by the town of Wellington and the city of Penrith. They have both undertaken community action in response to the problem of overweight and obesity that demands our attention.
In February 2003, 450 of the Wellington’s 9000 residents weighed in for a program of exercise and changed diet. They called it the WellingTONNE Challenge (link here). The program, supported by the Federal and NSW health departments, promoted healthy cooking classes, negotiated with local sport and recreation providers to offer special deals at gyms, golf courses and line dancing venues. Shops were pressed to offer healthy food at competitive prices. Hotels offered counter meals of grills with salad instead of schnitzel and chips. Collectively, participants in the WellingTONNE Challenge shed 770 kg by May 2003, and a tonne by June 2004. Importantly, this loss was sustained and they enjoyed it.
The Penrith Food Project (link here) was started in 1991 by academics at Sydney’s Westmead Hospital in conjunction with the Penrith City Council and the Wentworth Area Health Service. It continues in modified form in 2006, aided by great interest from the council in health-supportive urban development. The Project brought food retailers, farmers, citizens, urban planners, schools, childcare centres and bus companies together with local government to improve access to healthy foods and healthy diets. Retailers bought more fresh produce from local farmers. The same retailers agreed to deliver food to home-bound residents. A bus company altered its routes to improve shopping access. Local fruit and vegetable purveyors set up a regular fruit stand on the train platform during commuter hours.
The Council conducted a rural lands study, and began to value its agricultural industry. Applicants for new public buildings and spaces were asked to provide rooms and facilities for mothers to breastfeed. A school started and maintained a lucrative veggie garden. Twelve council-run day care centres developed and implemented their own nutrition policy with support from the project. These small changes all moved in the right direction — they created an environment that favoured healthy weight.
Both these projects show that it is possible to make great community health gains when small changes are made by many people.
Because many public health problems — obesity and overweight among them — originate in the deeper strata of society, they are complex to solve. Simple one-line solutions have little chance of success. True, occasionally simple interventions are highly effective in public health, like draining a malarious swamp in an African village, or lying babies on their back to avoid SIDS. More commonly, public health problems are far more difficult to solve. This is true of smoking and road traffic crashes, problems that demanded multiple strategies for success. Cigarette smoking has reduced by 20% in Australia over the last 2 decades because of changes in taxation, cessation of advertising, anti-passive smoking laws and health education. The road toll has been cut by a 50% in the past 40 years because of regulations on seat belts, the use of RBT units and radars, and road and vehicle redesign.
Thanks to Sean Leahy
Taking a community-based approach to tackling overweight and obesity is clearly the direction to move in. It is an approach advocated by the Federal Department of Health and Aging in their recently published action plan on overweight and obesity, Health Weight for Adults and Older Australians: A national action agenda to address overweight and obesity in adults and older Australians 2006-2010 (link here). This report recognises that a combination of behavioural and environmental changes are needed if we are to successfully tackle the problem and highlights the ‘themes’ (resulting from extensive consultation and literature review) that underpin its action plan. These themes, or recommendations, ought to be taken seriously. They include:
1. Community action and community development to engage people in local actions and build the capacity of local communities to make changes conducive to preventing weight gain
2. Cross-sector partnerships to produce environmental and policy changes that support the prevention of weight gain at the population level
3. Public-private partnerships in a range of initiatives, including food production and promotion, services related to weight management and physical activity
A community-based approach to the problem is far more constructive because it is inclusive. It welcomes participation from people and groups who usually are denied the chance — like the food production and advertising industry, who have shown they are willing and able to play their part in a way that is both profitable and health-sustaining. Parents, otherwise hammered for moral turpitude because they do not ban TV, feed fruit or whip their children into after school sport, feel lighter and more efficacious supporting school and recreational strategies that change the environment in which children live, learn, socialize, eat and exercise. Winning their support is bound to make a difference.
In the words of the rocket scientist, this is not rocket science. We need to be careful not to see it as a single cause-single remedy public health problem. We can take comfort that the social, structural and commercial forces that inadvertently lead to it are morally neutral. They are not malignantly disposed to health. Food company boards do not meet to ask, How can we kill another 1000 people tomorrow with excess consumption of our product? Urban developers do not furrow their brows thinking up civic designs to render the foot obsolete. They don’t need to because healthy food and exercise-friendly urban design can be highly profitable. By finding ways of working with the commercial sector, urban developers and other groups traditionally seen as ‘outside’ public health, we can be confident that the problem of obesity will be solved in the next decade.