Sugar tax might be the sweetener to change behaviour

The sugar tax concept has divided opinion in Australia, and both major political parties have rejected the idea of introducing the tax.

However, sales of soft drinks within a Melbourne hospital dropped by more than a quarter during an Australian-first trial of a sugar tax, monitored by researchers at Deakin University’s Global Obesity Centre.

The trial, carried out at a convenience store in The Alfred over 17 weeks, increased the cost of sugary drinks by 20 per cent.

The results, recently published in the Journal of the Academy of Nutrition and Dietetics, showed sales of the sugary drinks dropped by 27.6 per cent by the final week of the trial, while sales of water increased by almost the same amount.

The team behind the research believe there had, up until their trial, been limited real-world evidence of how an increase to the price of sugar sweetened beverages would change purchasing behaviour in Australia.

Lead researcher Miranda Blake, Associate Research Fellow at the Global Obesity Centre in Deakin’s School of Health and Social Development, said that the trial shows that an increase to the cost of sugary drinks can have a significant impact on lowering consumption.

“Sugary drinks are considered a good target for price manipulation because of their association with increased risk of health issues like obesity and dental decay, their minimal nutritional benefits and the apparent responsiveness of purchases to price changes,” Ms Blake said.

“Voluntary changes by retailers, which make healthy choices relatively more attractive and affordable, may be particularly appealing to retail outlets in community health promotion settings like hospitals, healthcare centres and sports and recreation facilities.”

Project supervisor Dr Kathryn Backholer, a Senior Research Fellow at the Deakin centre, said researchers interviewed customers and staff to get their perspective on the price increase, as part of the trial.

“About a third of the customers surveyed said the price difference had changed their purchasing decision, or would have changed it. Nearly two thirds of those surveyed said they agreed with intervention,” Dr Backholer said.

The World Health Organization (WHO) last year said that a tax of 20 per cent or more results in the drop of soft drink sales, which they say would also cut healthcare costs if it succeeded in improving health outcomes.

The Grattan Institute has suggested a tax of 40 cents per 100 grams of sugar, and calculated that obesity costs Australians $5.3 billion a year. The savings they have projected would mean an extra $500 million for the Budget.

And a study led by researchers from the Australian National University, performed in Thailand, suggested that thousands of cases of type 2 diabetes could be prevented every year by cutting out sugary drinks.

The AMA believes a sugar tax sends a message to parents of children and other consumers that there is a problem with these drinks. While acknowledging a sugar tax is not a magic bullet, it is time start sending the message that highly sugared carbonated drinks are a part of the problem with a growing obesity epidemic.

MEREDITH HORNE

Sugar tax might be the sweetener to change behavior

The sugar tax concept has divided opinion in Australia, and both major political parties have rejected the idea of introducing the tax.

The trial, carried out at a convenience store in The Alfred over 17 weeks, increased the cost of sugary drinks by 20 per cent.

MEREDITH HORNE

China increases commitment to world health

The People’s Republic of China has agreed to an enhanced relationship with the World Health Organization (WHO), collaborating to reduce the impact of health emergencies around the globe.

WHO Director-General Dr Tedros Adhanom Ghebreyesus recently completed a three-day official visit to China and said the meetings held there had paved the way for more strategic alliances on delivering universal health coverage.

While in Beijing, Dr Tedros met privately with Premier Li Keqiang for high-level discussions on how China can expand its international health security cooperation. Dr Tedros also met with Vice Premier Liu Yandong, Vice Chairman Han Qide of the Chinese People’s Political Consultative Conference (CPPCC), and National Health and Family Planning Commission Minister Li Bin.

During the meeting with Minister Li Bin, China signed a memorandum of understanding with WHO for an additional voluntary contribution of US$20 million in support of WHO’s global work. WHO and China agreed to enhanced collaboration to reduce the impact of health emergencies; build stronger health systems to deliver universal health coverage; and focus on the well-being of women, children and adolescents at the centre of global health efforts.

“China’s health reforms show it’s possible to implement far-reaching, quality transformations in a short time,” Dr Tedros said.

“Its success in providing 95 per cent of its population with access to health insurance is a model for other countries in how to make our world fairer, healthier and safer. We can all learn something from China.”

In addition to official government meetings, Dr Tedros met China’s next generation at an event in Beijing with more than 200 young health leaders. He encouraged the young leaders to inspire their peers and loved ones to make healthy choices, telling them: “You are the future, it is true. But you are also the present. Your ideas and actions matter now, and I believe in you.”

CHRIS JOHNSON

Minister to co-chair Indigenous Suicide Prevention Committee

Indigenous Health Minister Ken Wyatt will co-chair a new steering committee working directly with Aboriginal communities to address Indigenous suicide prevention.

Mr Wyatt made the announcement as the Kimberley Suicide Prevention Trial begins detailed planning and delivery of potentially lifesaving initiatives across the region.

“This is where the rubber hits the road, working very closely at the community level, involving young people, families and elders,” the Minister said when attending a recent suicide prevention roundtable in Broome.

Mr Wyatt said he believed it was important in establishing a strong working partnership between local Aboriginal communities and the Commonwealth, especially through younger people.

“We now have a strong operational plan based around the communities, to bring promising and proven strategies together in liaison with local people, to make a difference on the ground,” he said.

The Minister praised a presentation by Kimberley Aboriginal Youth Suicide Prevention Forum members Jacob Corpus (aged 20) from Broome and Montana Ahwon (19) from Kununurra, and said young people must be supported to play key roles in reducing suicide.

“Both Montana and Jacob are incredible and inspiring young leaders who have helped identify key factors that impact on Kimberley youth, which the steering committee will now consider,” Mr Wyatt said.

He also recognised the importance of including young Aboriginal people on advisory groups, to help empower them to take up future leadership roles.

Youth forum recommendations included: support for emerging young leaders, positive role models and mentoring; teaching in school of local culture and country traditions; the dangers of drugs and alcohol, and the importance of resilience; and strong youth engagement and networking through sports, arts and local cultural activities.

The steering committee will be co-chaired by Kimberley Aboriginal Medical Service Deputy CEO Rob McPhee and will report to the Kimberley Suicide Prevention Working Group.

The Government has committed funding of up to $1 million per year over three years to June 2019 to the Kimberley Suicide Prevention Trial, to support suicide prevention activities developed by the working group.

The Minister for Indigenous Affairs, Senator Nigel Scullion, has also announced the Government will commit $10 million to expand nationally the suicide prevention trials conducted in WA over the past year.

The Critical Response Team (CRT) model involves trained crisis team visits to families affected by suicide and other traumatic events to co-ordinate support services to help them deal with loss and to build resilience by communities for communities.

Suicide rates among Indigenous people in the Kimberley region of Western Australia are among the highest in the world, according to the World Health Organization. During the period 2001–2010, age-adjusted suicide rates among Indigenous and non-Indigenous Australians were respectively 21.4 and 10.3 per 100 000 population per year.

The AMA remains committed to working in partnership with Aboriginal and Torres Strait Islander groups to advocate for government investment and cohesive and coordinated strategies to improve health outcomes for Indigenous people. The AMA recognises Aboriginal and Torres Strait Islander peoples are among the most disadvantaged groups in Australia, and experience high levels of mental ill health and low levels of social and emotional wellbeing.

To read more on the AMA’s position go to position-statement/aboriginal-and-torres-strait-islan….

MEREDITH HORNE

Fast food plans to slow down antibiotic use

Fast food giant McDonald’s has recently announced that it aims to serve up more antibiotic-free meat at its restaurants around the world.

McDonald’s has said that from 2018 it will begin implementing a new chicken antibiotics policy in markets around the world, which will require the elimination of antibiotics defined by the WHO as Highest Priority Critically Important (“HPCIA”) to human medicine.

This plan includes Australia. McDonald’s estimate that each year it purchases 21.4 million kilos of Australian chicken.

The world’s largest burger chain will also work toward limiting the use in cattle and pigs of antibiotics important to human medicine, a significant move because McDonald’s is such a significant purchaser of beef and pork.

Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses and parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it.

As a result, standard medical treatments become ineffective, infections persist and may spread to others. Resistance to current antimicrobials is increasing faster than the development of new drugs, and so effective treatments cannot keep pace. The World Health Organization (WHO) describes AMR as a looming crisis in which common and treatable infections will become life threatening.

More than 1,000 cases of almost-untreatable superbugs were reported in Australia in the 12 months to March this year.

For the first time, the Australian Commission on Safety and Quality in Health Care has tracked dangerous bacteria resistant to the last line of antibiotics.

Speaking to SKY News earlier this year, AMA Vice President Dr Tony Bartone said: “The over-prescription of antibiotics is a problem because, world-wide, we’ve seen the emergence of what we call anti-microbial resistance – that is, resistance by bacteria to antibiotics, life-saving antibiotics in the past.

“Now with this emerging resistance, it’s becoming more and more difficult to treat these resistant bacteria, and we’ve all got a role to play in trying to reduce that incidence and that spread.”

In April 2014, WHO released its new global report, Antimicrobial resistance: global report on surveillance, which states ‘… this serious threat is no longer a prediction for the future, it is happening right now in every region of the world and has the potential to affect everyone.’

The Australian Government and other international governments have already identified antimicrobial resistance (AMR) as a high-priority issue.

MEREDITH HORNE

[Correspondence] Intertwining migration, ethnicity, racism, and health

Johanna Hanefeld and colleagues’ Comment (June 17, p 2358)1 on research into migration, mobility, and health, and Richard Horton’s Offline Comment (July 1, p 14)2 on racism need integrating. Racism is not in Hanefeld and colleagues’ research agenda;1 their agenda is researcher orientated, which is similar to those agendas proposed for ethnicity,3 but distant from the grave threats and challenges in Horton’s piece2 on racism. Hanefeld and colleagues1 contend, correctly in my view, that the resolutions of the 2008 World Health Assembly and the WHO global consultation of Migrant Health4 in 2010 have had little effect.

Processed meats need a closer look

OPINION
By Dr Alphonse Roex and Dr Heleen Roex-Haitjema

In October 2015, the authoritative International Agency for Research on Cancer (IARC) confirmed that processed meat causes cancer and red meat is a probable carcinogen (Table 1.^1,2).

IARC Carcinogenic Classification Groups

Likelihood to cause cancer in humans

Type of meat

Examples

Causes cancer

Processed meats

Bacon, ham, sausages, hot dogs, hamburgers, ground beef, mince, corned beef, beef jerky, canned meat, offal and blood

Probably causes cancer

Red meats

Meat from mammals: pork, veal, beef, bull meat, sheep, lamb, horse meat and,

Meat from hunting: wild boars, deer, pigeons, partridges, quail and pheasants

Table 1. Based on the IARC’s data on the carcinogenicity of processed meat and red meat.^1,2

The IARC assessed more than 700 epidemiological studies regarding red meat and more than 400 provided data on processed meat. The IARC estimates that worldwide the consumption of diets high in processed meat results in approximately 34,000 deaths annually and diets high in red meat in 50,000 avoidable cancer deaths per year. Eating an extra portion of 50 grams of processed meat daily increases the relative risk of colorectal cancer by 18 per cent.

The strength of evidence that processed meat is a carcinogen is comparable with tobacco smoking and asbestos.^3,4

Diets high in animal protein show a 75 per cent increase in total mortality, a 500 per cent increase in diabetes, a 400 per cent increase in cancer risk, and produce significantly higher levels of IGF1, a potent cancer-promoting hormone.⁵

Chronic diseases are responsible for considerable human suffering and contribute heavily to the burden of disease nationally. Australia’s ever increasing total healthcare expenditure has in 2016 for the first time surpassed 10 per cent of its Gross Domestic Product. It is estimated that 55-60 per cent of this total is spent on chronic disease management.

Nearly two years have passed since the World Health Organisation’s report on the categorisation of processed animal products as carcinogenic. The time has come that we doctors take the initiative to inform our citizens and create systems, processes and policies to protect our patients and communities from further harm from such known carcinogens. We were finally moved to show united leadership 60 years ago in regards to smoking. Ultimately, after roughly 7000 scientific publications showing the relationship between smoking and lung cancer, healthcare providers became advocates for the best available medical evidence trumping the lures of a treasured habit for many of their patients (and indeed, fellow colleagues).

The American Medical Association in the USA has led the way by calling on hospitals there to improve the health of patients, staff and visitors by (1) providing a variety of healthful food, including plant-based meals that are low in fat, sodium and added sugars, (2) eliminating processed meats from menus and (3) providing and promoting healthful beverages.^6,7^,8

Springmann et al. estimated the effects of consuming less – or no – animal products on global population health should a transition to a more plant-based diet be made leading up to 2050. Conclusions reached were a reduction in premature deaths, abundant economic benefits and reduced greenhouse gas emissions. Table 2.⁹

Healthier diets compared to present omnivorous diet	Characteristics diets	Human health benefits: millions of premature deaths avoided	Economic valuation: value-of-statistical life approach. Trillion of AUD saved per year
Healthy Global Diet (WHO)	Less meat and sugar; More vegetables and fruit	5.1	27.6
Vegetarian	Minimal animal products: dairy and eggs only	7.3	36.8
Vegan	No animal products: plant-based only	8.1	39.4

Table 2. Human lives and money saved in 2050 if the world population would adapt more healthful diets. Based on publication M Springmann et al.⁹

We understand that our AMA is aware of the issue and we are engaging with its Public Health team.

The time for compassionate action and leadership on this important issue by the Australian medical profession has arrived. All medical administrators, procurement officers, caterers and doctors (in association with registered dietitians) should then feel encouraged, empowered and supported to play a role in implementing the elimination of processed meats in medical institutions.

Views expressed in the above Opinion piece are those of the authors and do not reflect official policy of the AMA.

The authors’ credentials are listed below:

Dr Alphonse Roex MD PhD, FRANZCOG

Senior Consultant Obstetrics and Gynaecology The Lyell McEwin Hospital South Australia
Senior Lecturer, The University of Adelaide
Medical degree: Utrecht University, the Netherlands
Specialist degree and PhD: Free University Amsterdam, The Netherlands
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health

Dr Heleen Roex-Haitjema, Paediatrician (not practising)
Certificate in Plant-Based Nutrition, Cornell University, New York
Certified Food for Life Instructor, The Physicians Committee for Responsible Medicine, Washington DC
Medical degree: Utrecht University, The Netherlands
Specialist degree: Free University Amsterdam, The Netherlands.
Member PCRM (Physicians Committee for Responsible Medicine (Washington DC USA)
International presenter on Nutrition and Health.

References

Bouvard V, Loomis D, Guyton KZ et al. on behalf of the IARC Monograph Working Group. Carcinogenicity of consumption of red and processed meat. Lancet Oncology 2015.
http://publications.iarc.fr/Book-And-Report-Series/Iarc-Monographs-On-The-Evaluation-Of-Carcinogenic-Risks-To-Humans. Volume 114 (2015).
IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 83 (2004) Tobacco Smoke and Involuntary Smoking.
IARC Monographs on the Evaluation of Carcinogenic Risks to humans. Volume 100C. (2012) Asbestos.
Levine ME et al. Low Protein Intake is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population. Cell Metabolism 2014;19:407-17.
https://janeunchained.com/2017/06/23/ama-comes-out-against-serving-processed-meats-in-hospitals/
http://www.pcrm.org/nbBlog/american-medical-association-passes-healthy-food-resolutions
https://wire.ama-assn.org/ama-news/ama-backs-comprehensive-approach-targ…
Springmann M. et al. Analysis and valuation of the health and climate change co-benefits of dietary change PNAS doi:10.1073/pnas. 2016; 1523119113.

Tracking the impact of climate change on health

The World Health Organisation (WHO) has launched the second round of its Climate and Health Country profiles – providing updated national level evidence on health risks and opportunities, and tracking progress.

The WHO UNFCCC Climate and Health Country Profile Project aims to provide country-specific, evidence-based snapshots of the climate hazards and health risks facing countries.

The project has strengthened the linkages between climate and health communities; promoted innovative research on national climate hazard and health impact modelling; and engaged an inter-ministerial network of climate and health focal points to develop, advance and disseminate the findings.

Climate change undermines access to safe water, adequate food, and clean air, exacerbating the approximately 12.6 million deaths each year that are caused by avoidable environmental risk factors.

Between 2030 and 2050, climate change is expected to cause approximately 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress, and billions of dollars in direct damage costs to health.

WHO works with countries across the world to protect the most vulnerable populations from the health effects of extreme weather events, and to increase their resilience to long-term climate change.

At the same time, the policy decisions and polluting energy sources that are causing climate change are also causing direct health impacts, most notably contributing to the 6.5 million deaths each year from air pollution.

Through the 2015 Paris Agreement on climate change, countries have made commitments to cut carbon pollution, for example through promoting cleaner energy sources, and more sustainable urban transport systems, that will also protect and improve the health of their own populations. WHO is supporting countries to assess the expected health gains from their Paris commitments, and to promote policy choices that bring the greatest benefits both to health, and the environment.

The Lancet has called climate change: “The biggest global health threat of the 21st century.”

The Lancet’s report Managing the Health Effects of Climate Change, states that the effects of climate change on health will affect most populations in the next decades and put the lives and wellbeing of billions of people at increased risk.

The next series of WHO’s climate and health country profiles will be released in 2019.

The just released list can be found at: http://www.who.int/globalchange/resources/countries/en/

The AMA’s Position Statement on Climate Change and Human Health can be viewed at: position-statement/ama-position-statement-climate-change-and-human-health-2004-revised-2015

MEREDITH HORNE

[Viewpoint] A developmental approach to the prevention of hypertension and kidney disease: a report from the Low Birth Weight and Nephron Number Working Group

In 2008, the World Health Assembly endorsed WHO’s Global Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) 2013–2020,1 based on the realisation that NCDs cause more deaths worldwide than do communicable diseases. This plan strongly advocates prevention as the most effective strategy to curb NCDs. Furthermore, the life-course approach, which was highlighted in the Minsk Declaration,2 reflects increasing recognition that early development affects later-life health and disease.

Treating depression with antibiotics

Researchers at Deakin University have undertaken a trial using an antibiotic to treat depression.

The trial added a daily dose of minocycline – a broad-spectrum antibiotic that has been prescribed since 1971 – to the usual treatment of 71 people experiencing major depression.

The research team, led by Deakin’s Centre for Innovation in Mental and Physical Health and Clinical Treatment within the School of Medicine, then compared the effects to a control group taking a placebo.

The results have been published in the Australian & New Zealand Journal of Psychiatry and show that those taking minocycline reported improved functioning and quality of life.

Lead researcher Dr Olivia Dean said the minocycline trial was small, but had some significant results.

“We found that those on minocycline reported significant improvements in functioning, quality of life, global impression of their illness, and there was also a trend towards improvements in anxiety symptoms,” Dr Dean said.

The trial was based upon evidence that suggests people with a major depressive disorder have increased levels of inflammation in their body.

Dr Dean said that: “Specifically, minocycline reduces brain inflammation in cell models, and thus we wanted to see if it was useful for people.”

There is a huge need for improved treatment options for people with major depression. Beyond Blue estimates that In Australia, 45 per cent of people will experience a mental health condition in their lifetime. In any one year, around one million Australian adults have depression.

The World Health Organisation released data this year that shows more than 300 million people around the globe are now living with depression.

“Current antidepressants are useful, but many people find a gap between their experience before becoming unwell and their recovery following treatment,” Dr Dean said.

Dr Dean said her team was now in the process of applying for funding to expand the trial to a larger group.

This research was supported by Deakin University, the Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Barwon Health, Chulalongkorn University, the Brain and Behavior Foundation (USA), and an Australasian Society for Bipolar and Depressive Disorders/Servier grant.

MEREDITH HORNE