Address to the Committee for Economic Development

Ladies and Gentlemen, I have been asked to talk about healthcare services for an ageing Australia. But in doing that I’m going to ask you to think about the total demand on our health system in the future, not just the demands of older people. Ageing of Australia’s population By 2051 Australia’s population is expected to reach 28 million – an increase of 37 per cent from today.
Over the same time the number of people over 55 is expected to increase by 113 per cent – from five million to around 10.7 million. The change will be even more marked among people aged 85 or over. At present they represent around 1.4 per cent of the population, by 2051 they will likely account for between 6 per cent and 9 per cent. Per capita, total health spending on people aged 65 to 69 in Australia in 2003 was almost four times greater than spending on those aged 25 to 29 years. For over 85 year olds, total health spending was six times greater! Clearly, as the proportion of our population in the old and “very old” age brackets increases rapidly over the next 20 to 30 years, we are facing much higher health costs. But while we are facing an inevitable “Demographic Destiny”, the impact of population ageing and whether we can manage it well are not simply matters of fate. We can change the way we do things, to reduce the impact. But grappling with this destiny is not just a matter for the Commonwealth. To succeed, we have to engage all levels of government – but more than that, we have to change attitudes and behaviours throughout our society. As a society, we need to put a lot less emphasis on cures – in the form of a pill or an ”op” – and a lot more emphasis, on prevention. We also need to teach younger people – even people in school now – the importance of having a life perspective on health and on ageing. The Australian Government is already working to engender this attitudinal shift – for example through new Medicare items for adult health checks, changes to private health insurance regulation, and assisting GPs in “prescribing” lifestyle changes rather than just medications. But I would like to broaden the parameters of this debate even further. The biggest single modifiable area of concern for our future health is not a disease. It is obesity.
Childhood obesity Already, as much as 80 per cent of Australia’s burden of disease can be attributed to chronic conditions – most of which can be linked to lifestyle factors such as obesity. With the population ageing, the burden of chronic disease arising from obesity presents a major challenge for our health system. We cannot afford – literally – to have this already high incidence of avoidable chronic disease rocket up even further, as a result of obesity. In this regard, the Babyboomer generation are only part of the bigger equation and the bigger problem. Our total health costs over the coming decades will also be heavily affected by the lifestyles and health or lack of it, of people who are now 20 something, or even less. But the outlook is bleak – scary even – when you consider that up to a quarter of Australian children, aged 7 to 15 years, are overweight or obese - and about one third of those who are overweight - or 1 in 12 overall - are now technically, obese. Yet while there is near-unanimous expert agreement about the severity of the problem, it has been far harder to reach a consensus on solutions to childhood obesity. The Australian Government is seeking to cast new light on the problem. The Government, in conjunction with the Australian Food and Grocery Council, is this year undertaking a National Diet and Physical Activity Survey of children aged 2-15 years.

But we are not just looking at the problem – we are trying to solve it.

On 29 June 2004, the Prime Minister announced a $116 million program, over four years, to tackle this growing problem. This program, Building a Healthy and Active Australia, includes the following initiatives:

• Active After-school Communities - $90 million to establish an after-school physical activity program in schools.

• Active School Curriculum – new funding conditions requiring education authorities to include in their curriculum at least two hours of physical activity per week for children in primary school and junior high school.

• Healthy School Communities - $15 million for grants to community organisations linked with schools, such as parents' and citizens' associations, to promote healthy eating.

• Information for Australian Families - $11 million to give Australian families practical help and information about how to make healthy eating and physical activity part of their everyday lives.

Despite the Australian Government’s efforts to encourage physical activity, the ideological stance adopted by federal and state Labor on the issue of childhood obesity threatens to undermine these initiatives.

The real problem

Almost every media story on childhood obesity has focussed on children’s diets.

There is no doubt that diet is important. But it is puzzling that attention has been skewed so heavily towards one side of the energy equation.

I suspect that part of the reason is that it is far easier to develop catchy and populist policies on diet.

This approach shot to prominence with Mark Latham’s calls for bans on junk food advertising, calls which have been taken up across the broad spectrum of the political Left ever since.

Opposition health spokesperson Julia Gillard recently renewed her calls for such a ban.

It's easy for Labor's social engineers to take cheap shots at Ronald McDonald, but where will it end?

Capital punishment for confectioners?

Public flogging for the Milky Bar kid?

And while beating up Ronald is popular, I haven't heard MsGillard telling the local fish and chip shop to take down its sign.

Nor have I heard MrBeazley insisting that the corner newsagent should hide the chocolate bars below the counter at the end of the school day.

he Labor Party’s cheap shots over junk food advertising are a typical example of Mr Beazley’s approach to policy – don’t fix the problem; just find a scapegoat to blame for it.

These attacks on food manufacturers have been a convenient way of avoiding, if I may be forgiven for borrowing a line, “an inconvenient truth”.

Let's stop kidding ourselves that fatty foods are a recent invention of the fast food industry; as if there was some recent golden age when children ate tofu and rocket salad for lunch at Australian schools.|

While the calorific intake of the average Aussie kid has risen slightly, the more radical lifestyle shift relates to how much time he or she spends in the park or the playground, not the tuckshop.

Parents have been struggling since time immemorial to get their kids to eat their greens. Suggesting that federal regulation of advertising will succeed where generations of parents have not is impractical and unrealistic.

Instead of taking cheap shots at the food industry, we should ask why children are getting less physical activity than ever before.

Factors behind declining physical activity

Three South Australian health experts last year published a research paper entitled: Evidence for secular trends in children’s physical activity behaviour.

They concluded:

…young people would like to be active but are often constrained by external factors such as school policy or curricula, parental rules in relation to safety and convenience, and physical environmental factors

I would like to address each of these three factors.

School sport

Perhaps the most obvious is the decline of school sport.

In part, this is a question of resources. After-hours sport is not seen as a core business of schools, and provision for such activities is often ad hoc and heavily reliant on volunteer work by teachers and parents.

Sport has even become an industrial issue because it’s considered wrong to “discriminate” against teachers who do not have the physical abilities needed for PE.

It’s also a legal issue, because some teachers are wary of mixing with young people of the opposite sex, and others are worried about law suits, despite assurances from their education departments.

There are still schools where individual teachers are very positive about sport and where all children have fun taking part in sport, whether or not they are competitive.

This is the spirit we need to promote, to encourage team behaviour, self discipline, and establish good lifestyle habits for life.

There is an argument – and many schools use it - that community sport will fill the void. Of course community sport is great, but it is not preventing the rising tide of obesity,

As I mentioned earlier, the Australian Government is providing funding to address the failure of State governments in this area.

But, in my view, there is a deeper cultural problem.

This problem stems from fashionable educational theories that have given rise to a growing hostility to compulsory school sport, particularly of the competitive kind.Our exaggerated fear of damaging the self-esteem of children has made us reluctant to force students into competitive sporting activity which might give rise to embarrassment.

Even the two hours of physical activity insisted upon by the Commonwealth has, in some cases, been watered down by schools to include “drama” and “human movement”.

It is interesting to observe that parents have, simultaneously with this trend, been voting with their feet.

Private school enrolments are soaring, and it is noteworthy that many private schools adopt a far less laissez-faire attitude to competitive sport.

Perhaps State governments should consider taking a leaf out of the book of such schools, and implement compulsory programs of sport along more traditional lines.

It is those children least likely to sign up to voluntary sporting activities who are likely to be in greatest need of them.

I am unconvinced that such programs would give rise to permanent emotional scarring.

But I am convinced that non-participation gives rise to the less speculative health problems associated with obesity.

Safe streets

Of course, children’s physical activity is not limited to the school oval.

Most of us remember games of cricket played in the street with neighbourhood kids, or heading down to the local park with a mate to kick the footy.

Sadly, this culture is also waning.

A primary reason for this is the increasing concern that parents feel over child safety.

While State governments like to wax lyrical about being “tough on crime”, responding to community concerns with populist rhetoric and longer prison sentences; the biggest problem is not sentencing but enforcement.

You have to catch a crim before you can sentence him. And that requires a police presence on our streets, with the power and the political support to maintain public order.

Crime statistics do not tell the whole story. In a climate of greater fear, people spend less time on the streets – which is good for the crime stats, but hardly good for the people.

This phenomenon has a disproportionate effect on children, whose parents are likely to stop them from wandering down to the neighbourhood park after school.

A great deal of this problem stems from an unwillingness of State governments to give police the direction and support they need to maintain order.

Recent events have thrown this problem into stark relief.

Take the aftermath of the recent riots in Cronulla, when police top brass were caught out issuing instructions not to “antagonise” vandals who had driven in convoy through suburban streets, leaving a trail of damaged property in their wake.

When the political focus turns to avoiding confrontation and provocation, instead of enforcing the law, the message to police on the streets is that they cannot expect support from their superiors when faced with possible allegations, false or otherwise of unnecessary force used by police officers.

If ’s children are to enjoy the same out-of-doors childhood as their parents did, we need to focus on making the streets safe for law-abiding citizens, including children.

This requires that we restore community respect for police, by giving them the legal tools and the political encouragement they need to crack down on loutish behaviour.

Urban planning

Another obstacle to getting our children active is the disappearance of much of urban and suburban ’s parklands.

The Australian Sports Commission engaged the University of South Australia in December 2003 to conduct research to provide an understanding of the factors influencing young peoples’ involvement in sport and physical activity.

One of the findings of this research was that the availability of play areas and equipment, such as basketball hoops, tennis courts, etc, impacts on the inclination of young people to engage in such activity.

With State government land restrictions driving up the price of real estate, new developments are frequently designed without adequate allowance for the sort of communal space in which children can play.

I’m talking about more than a token patch of grass with some play equipment.

Earlier generations of Australians grew up with trees to climb, creek beds to hide in and public pools to swim in.

The American academic dubbed by Time magazine as an “obesity warrior,” San Diego psychology Professor James Sallis, made exactly this point at the American College of Sports Medicine’s annual meeting recently.

He argued that built environments – our cities and suburbs – must take a large share of the blame for rising obesity.

In fact he says virtually everything American society has done for the past 100 years has made it easier for people to be fatter. New funding goes for highways, while new housing developments are built without bike paths or even footpaths.

For this reason, Sallis argues that education and “healthy living” campaigns – while beneficial – are not enough to get Americans’ weight back in balance.

Real change, he says, can only come when urban environments are adapted to allow people to go out without using a car – with more parks and paths.

I don’t think it’s drawing a long bow to say that all of this also applies to

As Sydney and other cities sprawl, new suburbs are built without any walker or biker facilities, or public transport, and people are forced to rely on their cars.

We know – and Sallis supports this – that people will walk more and exercise more, if they are given the facilities.

Our growing population makes some alteration of the suburban landscape inevitable.

But the lack of communal infrastructure in many new suburbs and the negligent land development policies of State governments are both undesirable and entirely avoidable.

Parental responsibility and government

I have pointed out a number of areas in which I believe State governments are failing our children.

Federal Labor would do well to quit the humbug on junk food advertising and instead encourage their State and Territory colleagues to address the problems I have outlined.

I note that I am not alone in my views. On 5 September, opinion pollster Mark Textor revealed in the Australian that only 13% of Australians believe that the principal answer to childhood obesity lies in encouraging children to eat less fatty foods.

By contrast, 73% believe that encouraging more physical activity is the answer.

The mums and dads of have not fallen for the red herring of junk food advertising bans. Their own practical experience tells them what the problem is.

It should not be forgotten that the ultimate responsibility lies with parents.

Parents need to encourage their kids into competitive sport.

They also need to ensure that, in setting the ground rules for where children can roam in the afternoons, they do not allow well-grounded concern to morph into paranoia.

We cannot wrap our children in cotton wool, as some educationalists would have us do. A more robust attitude to parenting is a prerequisite to solving the problem of childhood obesity.

But while government cannot replace parents, it can assist them – and it certainly should not be getting in their way.

Conclusion

I began this address by discussing the economic imperative to solve the problem of childhood obesity.

If nothing is done, our net spending on health will spiral out of control as our population ages and obesity-related diseases afflict the younger generations.

But ultimately, this is not just a question of economics.

It is about the quality of life that today’s young Australians can expect as they move into adulthood.

Maximising that quality of life is, at the end of the day, what all policy should aim to achieve.

The Australian Government will continue its efforts to assist parents in the fight against childhood obesity.

It is time for State governments – not to mention federal Labor – to demolish their ideological roadblocks and take practical steps to achieve a healthier