Actions speak louder than words : accelerating national policies for obesity and related chronic illness

In 2006, over 60% of adult Australians are obese or overweight as measured by Body Mass Index (weight in kilograms divided by height in metres squared). Adult and childhood obesity is growing at about one percentage point per year. A central tenet of this thesis is that with such prevalence and growth rates of the human girth, obesity is a major public policy issue that has a large direct cost in the burden of related chronic conditions and an even larger hidden cost of lost productivity that is not being addressed by governments in Australia. With yet another report on obesity imminent from the National Obesity Task Force, I argue that Australia needs to replace its reliance on talk-fests about obesity by government policies that redefine obesity as a national health priority area requiring immediate collective action by households, the food, drink and advertising industries, health insurers and the federal and state governments. The obesity epidemic requires embedding into Medicare and private health insurance the types of economic incentives that are now reducing the risks of unhealthy lifestyles in other parts of the world, emphasizing the role of personal responsibility in changing unhealthy lifestyles. While all these initiatives are, given the current chasm between federal and statelterritory governments, rather difficult to implement, I argue that policies are required to prevent obesity in all age groups, and complacency is not an option. This thesis makes six substantive contributions to the policy debate on obesity in Australia. First, it identifies the types of direct treatment costs and the hidden costs of workloss (absenteeism) and lost productivity while at work (presenteeism) that are generated by highly prevalent chronic disorders that are poorly managed in Australia. Second, it provides new estimates of the costs of obesity, overweight and physical inactivity in 2004105, identifying both the direct and indirect costs of chronic conditions associated with these three risk factors. Third, it analyses data from a small pilot study of weightloss in Australia using a new behavioural model, concluding that policies that buttress self-efficacy and intrinsic motivations should be considered in government policy for obesity. Fourth, drawing on the new discipline of behavioural economics, it concludes that regulation of advertising of food and drinks to children is unlikely to be as effective as economic incentives that enhance the sense of personal responsibility. Fifth, it proposes changes in the economic incentives within the Medicare and private health insurance systems, and it identifies gaps in workplace health promotion that should be remedied by gradual changes in workers' compensation insurance and new tax incentives to employers. Sixth, it recommends the creation of a new National Council on Obesity and Chronic Disease headed by a Parliamentary Secretary responsible to the Cabinet for the development of cross-portfolio strategies and the creation of public-private partnerships against obesity and chronic conditions. The last recommendation emerges as a preferred alternative to leaving all major decisions on obesity and related chronic conditions in the hands of politically-charged bodies such as the Council of Australian Governments (COAG). The thesis concludes with a set of recommendations on macro-environments that need to be considered in devising new policies to attack the obesity epidemic on both the demand side (i.e., the population) and the supply side (i.e., all providers of care, all payers for such care and all suppliers of dietary intakes who can influence weightloss behaviour), all influenced by new economic and behavioural incentives for healthier diets and physical activity rather than by government regulatory zeal