It Takes Guts to Fight Obesity
Smoking rates in Ontario dropped from 25 per cent to 19 per cent between 2001 and 2009, according to Health Quality Ontario’s 2011 report on the provincial health system. Over that same time period, several municipalities, the province and the federal government introduced a series of laws that restricted advertising and event sponsorship, sales to minors and smoking in the workplace. The Smoke Free Ontario Act extended smoking bans to all enclosed public places, including restaurants and bars.
Not surprisingly, the municipality with the longest experience with anti-smoking bylaws — Toronto, which banned smoking in restaurants in 1999 — now has the lowest smoking rate in the province, at 13 per cent.
The decline in smoking rates is a tremendous public policy achievement. But smoking is not the only health challenge Ontario and provinces across Canada face. Obesity rates are climbing. In Ontario, 18 per cent of people have a body mass index of 30 or more. One in two is physically inactive. And more than one in two don’t eat the recommended five servings of fruits or vegetables every day.
Obesity, physical inactivity and poor nutrition increase the risk of heart disease, several kinds of cancer and many other health problems that adversely affect quality of life. These challenges are also tremendously costly to Ontario’s health system. Every year, the province spends nearly $1.6 billion on costs related to obesity and $1.8 billion on costs related to physical inactivity. In an environment in which the health system is struggling to absorb the increased expenses associated with an aging population, potentially preventable costs like these are not sustainable.
Good public policy reduced smoking rates by 25 per cent in just eight years — why not aim for similar results with obesity?
Several steps have already been taken. These include Ontario’s Action Plan for Healthy Eating and Active Living, launched in 2006, that aimed to champion health promotion in the province, provide programs, services and incentives to enhance health and well-being and make healthy choices easier, among other objectives. However, between 2006 and 2009, obesity rates did not improve and, in fact, got slightly worse.
A provincial initiative that takes effect on Sept. 1, 2011, will impose nutrition standards on food and beverages sold in schools. We’ll be watching closely to see the effects — but much more needs to be done.
Other countries, including Sweden, Norway, Italy, the Netherlands and France, have achieved significantly lower obesity rates than Ontario’s, ranging between 10 per cent and 11 per cent. How have they done this? Here’s just a taste of their initiatives.
Sweden’s Public Health Bill, enacted in 2003, shifted the focus of that country’s public health strategy toward determinants of health rather than individual diseases. Two years later, central, local and regional governments started to implement 79 clearly defined measures with quantifiable targets that included changes in a broad range of areas — from the work environment and housing to transportation and education.
Norway used 11 different ministries in developing a strategy document called “A healthy diet for good health” in 2005, which included changes in grocery stores (lower prices for healthy foods), schools (ensuring health literacy and cooking skills), health-care facilities (starting with prenatal services), research organizations (closely studying disease indicators) and the media (communicating knowledge about food, diet and health).
Italy’s National Plan of Prevention 2005-2007 tackled everything from guaranteeing access to healthy food choices to creating urban environments that support physical activity. The health ministry worked with the ministry of agriculture to promote consumption of fruits and vegetables. And a nationwide initiative encouraged “children walking to school” to promote physical activity and reduce traffic and pollution near schools.
In the Netherlands, the ministry of health, welfare and sport committed to implement a “Covenant on Overweight and Obesity” in 2005. It brought together governmental and non-governmental organizations on initiatives such as cooking lessons in primary schools that required cooperation from the hospitality industry, supermarkets, the food industry and dietitians. As part of the covenant, the Dutch Food Industry Federation added an energy value logo to packaged foods.
France adopted a multi-sector approach with its National Nutrition Health Program for 2001-2005, which concentrated on food and physical activity. One of nine very specific objectives was to boost fruit and vegetable consumption among low consumers by 25 per cent. Another was to shrink the country’s average body mass index using a mix of health-care and education-based strategies.
What all of these countries share is an approach that looks beyond the health sector to engage other parts of society, and an emphasis on addressing the root causes of obesity rather than on treating the results. Both principles are worth considering if we are to make the significant strides toward reducing obesity — and improving related health outcomes — that we’ve already achieved by targeting smoking rates with effective public policy.
Dr. Ben Chan is president and CEO of Health Quality Ontario.