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IN 2012 all nations, including Australia, agreed to a set of voluntary goals and targets to reduce the mortality associated with global epidemics of non-communicable diseases, specifically cancer, diabetes, cardiovascular disease and lung disease.
The overarching goal is one colloquially known as 25 x 25, meaning a reduction of premature mortality due to non-communicable diseases (NCD) by 25% by the year 2025, compared to the baseline year of 2010.
There are eight other voluntary targets Australia has signed onto, including a 30% reduction in tobacco use, 10% reduction in the harmful use of alcohol, 30% reduction in salt intake, and no increase in obesity and diabetes. And we are also aiming for a 25% reduction in high blood pressure.
What is unusual is that these goals are for all countries — not just low- or middle-income countries, as was the case for the Millennium Development Goals (MDGs).
How is Australia tracking on its NCD goals? Are we likely to get there? And are we helping other countries get there?
If we start with tobacco then it looks good, with new data showing that daily smoking has dropped from 15.1% in 2010 to 12.8% in 2013. And the future looks even healthier with the federal and state governments (with the support of all the major political parties) continuing support for increasing the cost of tobacco through taxation, along with other measures such as plain packaging, effective mass media campaigns and a healthy competition between the states and jurisdictions for the most effective smoke free laws.
The Intergovernmental Committee on Drugs has a National Tobacco Strategy to reduce smoking levels to less than 10% by 2018.
The recent National Drugs Strategy Household Survey also showed some encouraging trends as daily drinking declined significantly between 2010 and 2013 (from 7.2% to 6.5%) to the lowest level seen since 1991 for both males and females. Fewer 12–17-year olds are drinking alcohol and the proportion abstaining from alcohol increased significantly between 2010 and 2013 (from 64% to 72%).
This welcome news is in light of the recent Burden of Disease study by Turning Point researchers showing we have had much higher deaths and disability due to alcohol than previously thought. We may be able to reach the global 10% reduction in harm associated with alcohol, but given the level of harm we should be aiming for a much more substantial reduction.
It seems we are making little or no progress in salt consumption. The salt reduction target of 20% by 2025 does look like a real challenge for Australia. Yet, if we could reach it, according to Professor Bruce Neal at the George Institute we would substantially reduce our huge national spend on antihypertensive drugs, let alone improve the health of hundreds of thousands of Australians.
However, the most challenging target facing Australia is on the overweight–obesity–diabetes front. One reason is that even by reaching the global target (no increase on 2010 rates) we would still have levels of obesity and diabetes at Everestian heights. And it is highly unlikely on current trends that we will be able to keep diabetes at 2010 levels
The NCD action group, led by Robert Beaglehole and Ruth Bonita, along with The Lancet, have developed Countdown 2025 — a very neat approach to measuring progress towards 25 x 25, including a template to track each country’s progress.
Australia should be signing on to this. Then we would really know how we are tracking. A great project for the MJA perhaps?
How much are we helping our neighbours? This can be done in many ways — the most effective are by setting great examples, documenting them and sharing them. This is where our experience in tobacco control is a great case in point.
However, our lack of willingness to tackle the power of the alcohol, junk food and soft drink industries means we don’t control obesity, diabetes and alcohol related harms and it sets bad examples for other countries, as does our reduction in development assistance in health.
We are on the right track in achieving some of the NCD targets. But as a wealthy, and hopefully smart, country it will be a great shame if we fall off track in helping ourselves and our neighbours.
Rob Moodie is professor of public health at the Melbourne School of Population and Global Health, and was the inaugural chair of global health at the Nossal Institute.
We continue to be entrely beholden to the food industry and the industry’s desire for us to cosume more. They are entirely unconcerned with the health outcomes of our current eating habits and provide only the appearance of change in improving our food choices. It’s not meaningful to really talk about the junk food industry; almost all food is highly processed and most processed food has too much salt and is too calorie-dense.
It won’t be enough to get voluntary agreements because behviour change needs a shove and not a tickle. That means proper carrots and sticks, or what’s known as an ‘enabling environment’. It’s a great pity that the Danish fat tax wasn’t around long enough to be evaluated. We probably need a ‘calorie-density’ tax to make sufficient change. A fat tax might shift industry further in the direction of high sugar content. But new taxes are a hard sell and the ‘nanny state’ moniker will be pushed by industry, conveniently forgetting that the enormous cost of health issues is at taxpayer expense.
We need a lobby to match the food industry, much like tackling big tobacco in the 90s.
In my opinion obesity is totally under rated. Health costs created by obesity probably surpass the costs caused by smoking. Yet it is still viewed as being ok to be fat. In stark contrast to smokers who are today almost treated like criminals. Equal efforts and campaigns to target obesity are long overdue. Australians have become one of the fatest specimens of home sapiens walking this planet.