The mere proposal in a regional Australian town to ban smoking in its CBD is a sign the decades-long public policy assault on tobacco has succeeded. The Rudd Government introduced a Great Big New Tax on Cigarettes weeks ago to barely a feather of resistance. Attitudes have changed. The war on smoking has been won.
But smokers have been replaced by another group who present a similar public health challenge. They, too, risk dying early. They could be harming their children, are a drag on the economy because of frequent illness, and impose multi-million-dollar healthcare costs on the rest of the healthy community.
They are the overweight and the obese.
As a long-term threat to public health, obesity is now potentially as damaging and costly as smoking, if not more so. The case for dramatic policy intervention is mounting with every survey of the nation’s weight profile.
A landmark report in the early 1990s put the cost of smoking to the national economy – when smoking rates were higher – at $12.7 billion a year. A more recent estimate pegged it at over $30 billion.
In 2008, Access Economics put the cost of obesity to the national economy at a mining-tax-consuming $58 billion a year.
Is it time to apply some of the harsh public health policy measures used to cut smoking rates to obesity?
Imagine Leonard Cohen singing “Everybody Knows” as a soundtrack to a TV ad showing a big fat person getting open heart surgery, and you’re on the right track.
“Our forefathers were not obese,” says Simon Stewart, head of Preventative Cardiology at the Baker IDI Heart Research Institute in Melbourne. “We certainly know there are genetic predispositions to being overweight… but there’s many things we can do to counteract inherited predilections to obesity.”
Everyone acknowledges some people can’t control their weight. It’s not quite like smoking, in that being overweight isn’t always entirely a matter of personal choice.
But anyone who is overweight can also do some things to keep their weight down.
By many measures over half of Australians are overweight or obese. Not only is there a direct risk to overweight or obese people themselves, but the increasing prevalence of obesity means that as big waistlines become more common it becomes more acceptable to be unhealthily fat.
Many people my age will remember “the fat kid” in school. Go down to the local soccer league on a Saturday morning and you’ll see there are now, literally, football teams full of them.
In 20 to 30 years these kids will have more health problems, which will start to develop in middle age, right when should be at the height of their earning power and tax contribution.
For these kids being big is normal. Who is going to pay for the health problems that come with obesity?
Contrast this to smoking which is now a marginal social choice. Yet thanks to the new tobacco tax, Australian smokers will pay an extra $5 billion to the Treasury bottom line over the next four years.
As with other problems, weight issues tend to be intergenerational and affect the less well-off. But research has shown that it’s not just a problem in families: there is a social phenomenon of being bigger becoming more normal.
The trouble is while being big might become more acceptable, the health problems don’t change. And they are strikingly similar to those caused by smoking.
Obesity carries a higher risk of heart disease, stroke, and certain types of cancer. It can cause complications in pregnancy and force workers into early retirement or extended absence from work due to illness. Obese people may also pay less tax over their lifetimes because they die early and so contribute less to society. They also impose a financial burden on others who lead healthier lifestyles.
All of these problems are cited by governments as justification for the draconian, increasingly brutal financial and social interventions against smokers.
In looking at how to deal with obesity, some lessons from the campaign against smoking are instructive. It started with health warnings, creeping advertising bans and public education campaigns. Smokers were socially marginalised through bans – first in workplaces, then in restaurants and pubs, and now in public places, and warnings about the dangers of passive smoking
Lately the methods have been financial penalties in the form of dramatic direct tax increases, sold with a political message that smokers are enemies of the state because they are a public health burden.
Then there are the distressing advertising campaigns.
Now punishing people for being fat just as smokers have been punished for smoking is a ludicrous proposition. Individuals have varying underlying causes of their weight problems.
But there are lessons to take from the broad thrust of the anti-smoking movement. It has been successful through a combination of marketing restrictions, public awareness campaigns, financial incentives to manage the problem, and a gradual shift in social attitudes.
So what would a comprehensive anti-obesity campaign look like? Prof Stewart of the Baker IDI Heart Research Institute has outlined some of the radical ideas – and successes they have had with them - here.
Some other thoughts: financial incentives such as tax breaks or increased family payments for commitments to physical activity – say sending the kids to sport training twice a week - could be a start.
A barrage of health ads, as confronting and dramatic as those used against smokers, could help too. Have an obese person talk mournfully to camera about how they had to quit their job because they couldn’t do it any more.
You can’t tax fatty food – why shouldn’t healthy people be able to enjoy a Big Mac, a triple cream Brie or Mississippi mudcake? – but what about subsidies for healthy food?
And I’m no fan of tighter advertising restrictions but it’s probably worth reviewing which products can justifiably claim to be healthy. Perhaps certain foods could be forced to carry messages about the importance of a healthy lifestyle and balanced diet.
That is, after all, the eventual goal of an obesity policy: people doing exercise and having a healthy diet.
But after the war on smoking has practically been won, do we have the stomach for a similar war on obesity?
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