Western Sydney Leadership Dialogue Discussion Paper

Western Sydney’s Heavy Issue

July 2019 Contents Director’s Foreword

The Obesity Epidemic 03 Working with our network of supporters and partners, the Dialogue is always looking at how we can advance the Obesity in Australia 04 conversation on the issues that matter to our region. We’re Obesity in Greater Western Sydney 05 building bigger and better hospitals across Western Sydney, Recommendations 08 which is great, but the health of our growing population is Sugar Tax 09 facing some challenging headwinds. Health Star Ratings 14 Obesity and diabetes across the region are on the rise. This Junk Food Advertising 18 is a national and global problem, but the risk factors and LGA Ownership & Urban Planning 22 apparent higher rates of obesity in Sydney’s West compel us, Current Government Initiatives 32 as an advocate for the region, to speak up. References 34 Government is bearing the bulk of the costs of this epidemic and, we propose, all levels of government need to do more to address it. Price signals, clearer consumer information, restrictions on advertising, stronger leadership and health- focused planning all need to be on the table.

In this paper, we examine the costs, causes and potential answers to Western Sydney’s “obesogenity” – the built-in environmental factors that exacerbate the diabetes risk factors and make healthy living in the region such an uphill struggle for so many.

The problem is well-known, and the solutions are not revolutionary. It’s now time for some leadership on Western Sydney’s “heavy issue”.

Adam Leto Executive Director, Western Sydney Leadership Dialogue [email protected]

2 The Obesity Epidemic

Global obesity numbers have nearly tripled since 1975. By 2016 more than 1.9 billion of the world’s adults (39 per cent) were overweight. Of these, over 650 million (13 per cent) were obese. In the same period, the number of children aged 5-19 who were overweight or obese had increased from 4 per cent to 18 per cent of all children (340 million)1. Body Mass Index (BMI) More of the world’s population is now overweight BMI = weight (kg) / height2 (m) than underweight, and most human beings live in countries where eating too much kills more Overweight: 25 - 30 people than eating too little2. Obese: 30 and above

Being obese or overweight is a major risk factor for multiple noncommunicable diseases, including the leading global cause of death in 2012, cardiovascular failure (heart diseases and stroke). It is a causal factor in diabetes, musculoskeletal disorders and various cancers. Childhood obesity is associated with a higher chance of premature death and disability in adulthood, along with chronic respiratory difficulties, increased risk of fractures, hypertension and debilitating psychological effects3.

The Heavy Issue | westernsydney.org.au | July 2019 Obesity in Australia

Currently 63 per cent of adult Australians and 28 In 2011-12, obesity cost Australia an estimated $8.6 per cent of Australians aged 5 – 17 are overweight billion; $3.8 billion of it direct, and $4.8 billion indirect9. or obese. This places us in the worst third of OECD The cumulative cost of obesity by 2025 has been nations for obesity among people aged 15 and over4, projected as high as $87.7 billion10. The latest AIHW and ranks us as the fifth most overweight OECD nation Burden of Disease modelling suggests that if every overall5. Between 1995 and 2015 the number of obese Australian instead maintained a normal BMI this cost adults increased from 18.7 per cent to 27.9 per cent would fall dramatically alongside the prevalence of and the trend is accelerating6. Between 2014 and 2017 obesity’s comorbidities: as diabetes would drop by 53 the number of Australians living with obesity rose by per cent, for example, chronic kidney disease by 38 per 900,0007. cent, heart disease by 25 per cent and stroke by 22 per cent11. As an individual’s weight climbs, so does their cost to the health system. Our Government spends 51 The Australian government has recognised the extent per cent more on those with a BMI of 35 and over of the crisis. In May 2018, the Federal Senate convened (severely obese) than on those with a healthy BMI8. the Select Committee into the Obesity Epidemic The costs of being obese and overweight* include in- in Australia12. The Committee presented its Final patient, emergency, outpatient, pharmaceutical and Report13, including 18 Recommendations and two continuing allied health care associated with common Dissenting Reports, in December 2018. diseases and conditions, but also the higher costs and longer recovery times associated with treating a range of other health issues experienced by people who are obese.

*For simplicity, this paper will henceforth generally refer to these two clinical categories as ‘obesity’.

4 Obesity in Greater Western Sydney

Research consistently identifies higher rates of obesity in Local Government Areas (LGAs) in GWS than in Sydney as a whole, and markedly so in comparison to inner, eastern and northern LGAs14.

Figure : Overweight & obese adults & children 2014-15 (ASR per 100 population)15

40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 -

Camden Fairfield Liverpool Penrith Blacktown Cumberland Hawkesbury Parramatta Wollondilly Blue Mountains Campbelltown The Hills Shire Canterbury-Bankstown

Adult overweight Adult obese 2-17 years overweight 2-17 years obese but not obese but not obese Rest of Sydney Rest of Sydney Rest of Sydney Rest of Sydney

• Sydneysiders living in the Western Sydney or Nepean Blue Mountains Primary Health Areas (PHA) are on average 12.5 per cent more likely to be overweight or obese than those living in the Central and Eastern Sydney or Northern Sydney PHA16. • GWS is home to the Sydney Local School Areas with the five highest rates of obesity among Sydney schoolchildren17. • In 2012–13, Aboriginal and Torres Strait Islander adults, who are disproportionately represented in parts of GWS, were 1.6 times more likely to be obese18.

The Heavy Issue | westernsydney.org.au | July 2019 Data limitations & obesity risk factors in GWS

Notwithstanding strong general indicators like Reduced access to health information and lower those on the previous page, data fragmentation levels of health literacy and a lack of detail adds to the difficulty of tackling Parts of GWS are characterised by comparatively obesity effectively in GWS, since crude statistical lower levels of heath literacy and availability of generalisations can all too easily mutate into counter- health information generally, reducing the reach and productive stereotyping and stigma. The Dialogue impact of information campaigns about obesity, and notes the complex causal role in this issue of cultural especially the role of a nutritional diet and physical or socioeconomic background, household and family activity in preventing it. This is exacerbated for structure, employment patterns and technology use, residents of lower Socio-Economic Status (SES) and as well as genetic and epigenetic factors. Improving Non-English Speaking (NES) and Indigenous cultural our collection and understanding of data at a granular backgrounds who are over-represented in parts of level will be fundamental to tackling obesity in GWS, GWS. as will the disciplined and sensitive eschewing of any suggestion that a higher comparative incidence of obesity in GWS is a result of any failures of Lower levels of ‘spare’ time character, attitude, work ethic, intelligence or parental Everything is spread out more in GWS. Add in relatively responsibility. Far more constructive is to unmask the scarce public transport and more traffic, and the result common risk factors that stakeholders are increasingly is less of the ‘spare’ time needed to live the healthy recognising as contributing to higher rates of obesity lifestyle fundamental to preventing obesity. Less time in similar urban environments all over the world. This for daily physical activity, whether it is organised sport, paper addresses GWS as an inherently ‘obesogenic’ individual exercise or just walking the dog. Less time environment in more detail later, but principle among for maintaining a balanced, nutritional diet – for meal these increased risk factors are: planning, provisioning and preparation. This relative time deficit is magnified when raising a family; in GWS, parents invariably have further to go to get their children where they need to be, leaving even less of their ‘less time’ to ensure they eat well and keep active.

6 Fewer accessible ‘active travel’ options More obstacles to daily physical activity The longer average daily commutes imposed by It’s bad enough lacking the time to exercise each GWS’s geographical sprawl are rendered an even day, and it’s worse if you can’t even be active on higher obesity risk factor by an accompanying the way to and from work. But those living in relative deficit of ‘active transport’ options. GWS who do manage to free up some time for physical activity generally also have a harder Most people in GWS who must travel long time finding somewhere to do it. Relative to the distances to and from work each day have little rest of Sydney, much of GWS is short on readily choice but to use their cars for at least part of their accessible beaches, green leafy parks, recreation journey. Even those who’d much prefer to walk, areas, footpaths, tracks and cycleways. Sports ride a bike, or at least flex their core muscles on facilities are usually more dispersed and traffic a moving bus or train, rather than inch along in far less conducive to getting about on foot. GWS sedentary captivity on a gridlocked tollway, often is also often hotter and less amenable to outside simply lack any viable option. activity. The result is that staying physically active can take much more effort than elsewhere in Sydney. A relatively unhealthy food environment In recent years, the arrival of budget supermarket competition has improved the diversity and availability of nutritional whole and fresh foods in GWS. Unfortunately, also increasing, and more rapidly, has been the availability of food that’s anything but ‘whole’ and ‘fresh’. Vending machines and 24-7 convenience and fast food shops, including expanding home delivery services, are making GWS, in relative terms, an unhealthy food environment. In combination with the time risk factors, it is becoming easier every day for those in GWS to eat poorly, and harder to eat well.

The Heavy Issue | westernsydney.org.au | July 2019 Recommendations

With these higher obesity risk factors in mind, the Dialogue is putting forward a five-point plan for tackling obesity

8 A ‘sugar tax’ on sugar-sweetened beverages

Sugar Sweetened Beverages (SSB) and Obesity The over-consumption of a high-energy, low nutrient diet, particularly in the form of added sugar, is a well-established causal factor in the obesity epidemic.

Research shows that SSB such as soft drinks, processed fruit juices, flavoured milks and energy drinks contribute disproportionately to this sugar over-consumption. In the US, analysis suggests that SSBs accounted for at least one-fifth of the weight gained between 1977 and 200719. The Dialogue joins other public health advocates in their call for the Federal 1Government to impose a 20 per cent tax on sugar sweetened beverages20. I am not prepared to look back at my time here in this parliament doing this job and say“ to my children’s generation, ‘I’m sorry, we knew there was a problem with sugary drinks, we knew it caused disease, but we ducked the difficult decisions and we did nothing’”. British Chancellor George Osborne 16 March 201621

The Heavy Issue | westernsydney.org.au | July 2019 SSB and GWS Beyond the piecemeal approach Global sales data indicates that Australia is ranked Policy makers have long acknowledged the impact about 15th in the world in the consumption of all of SSB on health outcomes and costs, and in NSW combined SSB22 and 10th of soft drinks alone23, with there are many individual strategies and programs in the Australian Health Survey indicating that up to 52 place to reduce their consumption. State government per cent of the added sugar in Australian diets is now initiatives like Finish With The Right Stuff30, which helps consumed in this form24. Australians in lower SES children choose water over fizz after organised sport, cohorts, over-represented in parts of GWS, are more and the Healthy School Canteens revamped drink likely to consume SSBs than higher SES cohorts25, criteria31, are two well-targeted examples. Leadership as are their children26. Indigenous Australians, who is also being shown at more localised policy levels, are also over-represented in some key areas of GWS, such as in the banning by the Western Sydney Local consumed on average 16 per cent more added sugar Health District of the sale of SSB at the Westmead in the form of SSB than non-Indigenous Australians27. Hospital Precinct32. Meanwhile, the latest NSW Schoolchildren Physical Activity and Nutrition Survey (SPANS) suggests that The campaign to reduce the amount of excess added those from particular diverse cultural backgrounds, sugar Australians guzzle remains piecemeal, however, again over-represented in parts of GWS, may also and sometimes contradictory. Advocates increasingly consume more SSBs in comparison to the Sydney agree that the time is right to pull the hefty policy lever average28. of a Federal sugar tax, to send a clear price signal on SSB consumption and give strategic focus to its health The causal correlation of such overlapping increased risks. risk factors with a higher than average consumption of SSB and subsequently higher rates of obesity is starkly We know that replacing one can illustrated in the diabetes ‘hotspot’ of Western Sydney, of soft drink per day with water will where Diabetes Australia has estimated that as many make a huge difference to a person’s as 50 per cent of residents either have or are ‘at risk’ “health. Consuming one can of soft of the disease. Type 2 Diabetes has been particularly drink (375ml) a day is estimated to lead linked with the over-consumption of SSB29, and the to a 6.75kg weight gain in a year…” Dialogue suggests that reducing SSB consumption Christine Newman, Manager Health Promotion & generally will have a particularly beneficial impact on Deputy Director Centre for Population Health health outcomes in GWS. Western Sydney Local Health District33

10 The global results are in So-called ‘sin taxes’ work. They are also an In the last year, five more countries, including unremarkable feature of all modern market Ireland, the UK and South Africa, joined the 26 economies. Imposing a negative price signal nations and several US states already imposing a to encourage a voluntary reduction in the SSB tax - with great results35: consumption of a discretionary product which, • In the two years from its introduction in 2014, while legal, is well known to have harmful Mexico’s 10 per cent levy reduced SSB sales and expensive health outcomes when over- by an average 7.6 per cent per year, and consumed, isn’t ‘nanny state meddling’, increased water consumption by an average government ‘bullying’ or ruinous market 2.1 per cent per year 36; ‘distortion’. It’s sound public health policy. • even before the UK’s sliding levy kicked off in 2018, manufacturers had responded We can now be increasingly confident that sugar by reducing the added-sugar content of their taxes on SSB work. While many in the local food SSB to mitigate its sales impact37; and beverage industry and its supply chains • in Hungary, a 2011 sugar tax similarly dismiss the idea and our legislators go on doing motivated 40 per cent of manufacturers their best to avoid the discussion altogether, to reduce SSB sugar content, while also Australia is quickly being left behind34. reducing consumer sales by 7.5 per cent within a year38; • meanwhile, 2014’s world champion consumer of SSB, Chile, where three out of four adults are overweight, has seen consumption plunge by 21.6 per cent since imposing a tax in that year39; and • an added benefit of applying a sugar tax to SSBs tends to be significantly increase public awareness of their health risks, and those of obesity generally.

The Heavy Issue | westernsydney.org.au | July 2019 The global evidence is well and truly in: sugar taxes work Figure : The tax process & response

Reaping the health rewards Research indicates that a 20 per cent price rise on SSB could result in a reduction of consumption of about 12.6 per cent, potentially driving a subsequent ‘contributory’ decline in obesity rates of up to 2.7 per cent for men and 1.2 percent for women. Proportionally projected flow-on reductions in diabetes, cardiovascular disease and some cancers could equate to thousands of healthy life years gained. One estimate suggests that in 25 years, 1,606 Australians who would otherwise have died could still be alive. In that period there would be 4,400 fewer heart disease cases, 16,000 fewer diabetes sufferers and 1,100 fewer strokes40. These are real and measurable human impacts, cascading across generations.

12 Counting the economic gains There will be economic benefits, too. Even calculations incorporating the anticipated reduction in consumption have estimated that a 20 per cent tax on SSB will raise about $400 million annually41. In direct healthcare costs, the behavioural changes and subsequent reduction in obesity flowing from the tax could save Australians around $425 million over the lifetime of the 2010 population. The reduced healthcare expenditure would pay back the cost of legislating and monitoring the levy 14 times over42.

There would also be enormous indirect economic gains due to increased productivity. According to one estimate, the lifetime productivity gain per person whose obesity is prevented or mitigated as a flow-on impact of the tax, will be equivalent to $5,375 per person, translating into $751 million worth of productivity gains for the paid working sector, and $1,172 million for unpaid work43.

The Heavy Issue | westernsydney.org.au | July 2019 A mandatory and consistent Health Star Rating (HSR) System

Obesity and diet A balanced, nutritional diet is critical to preventing obesity. To assist people in maintaining one, health organisations give dietary advice of varying detail and complexity. The World Health Organisation’s (WHO) authoritative guidelines tend to be technical and quantitative: ‘total fat intake should not exceed 30 per cent of total energy intake’, ‘saturated fats less than 10 per cent of total energy intake’, ‘free sugar intake less than 10 per cent of total energy intake’, and so on44. While such nutritional detail is important, it can be difficult to translate into day-to-day shopping decisions. On the other hand other sources offering advice about a ‘wide variety of nutritious foods’ from The Dialogue joins other public health five key food groups, such as those in the Australian advocates in expressing concern Dietary Guidelines (ADG)45, can be too general to help 2about aspects of the national Health out in the supermarket aisle. Star Rating System, and takes the opportunity offered by the current It’s for these reasons that more simplified systems of review to call for the following food labelling have evolved. improvements: 1. Make the system mandatory 2. Replace ‘total sugars’ with ‘added sugars’ in the algorithm and HSR nutrient icon 3. Ensure greater consumer awareness and understanding

14 Food labelling and shopping in GWS The increased obesity risk factors in GWS make the This HSR is based on a calculation derived from system adopted to label any product’s nutritional a product’s contained combination of so-called value particularly important. Being able to make ‘positive’ nutrients and ‘risk’ nutrients, key metrics quick, confident decisions about what to take of which are also listed. The label is intended to from the shelf is vital to any Australian who wants provide an at-a-glance comparison of similar to eat well, but especially those who have: shopping trolley options: in theory, the more • further to travel and thus less time to spend stars, the healthier the choice. in the aisles; • fewer sources of unpackaged food and so a The Dialogue is a strong supporter of the higher dependence on product labelling; HSR concept and acknowledges the many • tighter budgets and thus less ‘mobility of positive aspects of its performance to date choice’; The HSR system does work. Although product • generally lower levels of health literacy and participation remains modest, the information nutritional awareness. where it is displayed generally represents a good alignment of nutritional value with the When you’re limited in spending money and ADG48. Recent surveys indicate that 77 per cent time-poor, deciding which food will best provide of consumers regard the HSR system as easy your family with a balanced, nutritional diet to understand and 70 per cent as easy to use49. demands a labelling system that is simple, clear, Some confusion persists, however; while 70 per consistent and universal. cent of participants in one survey found the HSR made it easier to compare similar products as Australia’s Health Star Rating System was intended, 50 per cent in the same survey also conceived to fill that role mistakenly thought it was useful for comparing Phased in from 2014 and currently under a products from separate categories50. Currently, 58 scheduled Five-Year Review46, the Health Star per cent of Australian consumers say they ‘trust’ Rating (HSR) system47 system is a voluntary- the HSR system and 67 per cent have ‘confidence’ only, front-of-pack labelling system that assigns in it - figures that could certainly be improved51. a product a nutritional rating from ½ a star to 5 stars.

The Heavy Issue | westernsydney.org.au | July 2019 Shortcomings persist but they are correctable Core food groups: necessary to provide The Dialogue echoes those who have drawn attention the nutrients the body needs, as per to shortcomings in the HSR system and who are using ADG the review process to advocate for their correction. Among the reforms suggested in submissions to date Discretionary food choices: not the Dialogue specifically supports: necessary to provide the body’s nutrients; may add variety58 1. That the HSR System become mandatory Currently placing HSRS information on packaging is voluntary and the uptake from industry has been It’s a change the public supports, with 65 per cent of limited. According to the current review’s draft report, survey respondents wanting to see the HSR on many in 2017-18 the HSR appeared on approximately 31 per more products56. With almost three in five shoppers 52 cent of eligible products (5,448 products) in Australia . who do buy HSR-labelled products reporting that the Data accumulated by The George Institute for Global number of stars influences their decision to buy57, the Health between 2013 and 2017, however, indicated system must become universal. that the HSR were displayed on only 3,524 products – 53 or just 7.5 per cent of their supermarket sample . Even 2. That ‘total sugar’ be replaced with ‘added in their more recent audit of ‘major supermarkets’ in sugar’ in the HSR algorithm and HSR nutrient 2017, found only 28 per cent of eligible items were icon 54 HSR-labelled . The HSR System algorithm and associated labelling currently doesn’t differentiate between naturally More pertinently, the predominant rating among occurring sugars and sugar added in a manufacturing 55 those that do opt in is a high four stars , confirming process. The former is found in many core foods the intuitively obvious: that food companies will likely which are part of a recommended ADG diet, while only volunteer a product’s HSR when it’s a healthy one. added sugar is often found in discretionary choices Clearly this degrades the system’s integrity. Unless of dubious nutritional value. The HSR system’s failure displaying the HSR – good, bad, or indifferent – of every to separate the two can give rise to misleading, and at selection across a category becomes compulsory, any times absurd, dietary advice. For example, while plain nutritional comparison will remain incomplete. milk – containing only natural sugar – receives four stars, one brand of flavored milk (with ‘added sugar’) scores an even ‘healthier’ 4.559.

16 Excess consumption of added sugar is a key driver 3. That consumer awareness and of obesity, but as the HSR calculator currently understanding of the HSR system be more functions high levels of it can be compensated actively promoted by positive nutrient components, such as protein The HSR Five-Year Review has received many or fibre. This distorts the integrity of the system60. submissions and a common theme has been One 2015 analysis found that 14 per cent of the need to increase consumer awareness and ‘discretionary’ foods and beverages displaying understanding of the system64. Surveys indicate a HSR received 3.5 stars or more61, despite in that some Australians remain confused about many cases having high levels of added sugar. what the HSR stars represent and how they can Meanwhile, one consumer study suggested that help them shop for a balanced, nutritional diet. products with 3 HSR stars or more have come to be regarded as ‘healthier options’, while those Some key shortcomings would be rectified by the with 2 or less are generally viewed as unhealthy62. changes supported above, but more accessible Clearly the potential for misleading nutritional nutritional information is especially vital for advice needs to be addressed. healthier shopping in GWS, and the Dialogue recommends increasing HSR understanding and Recent modelling has found that substituting awareness to ensure that shoppers: ‘added sugar’ into the HSR algorithm greatly • understand the relationship between the improves discrimination between ‘core foods’ HSR and the ADG, especially the former’s role and ‘discretionary choices’63. The researchers as a tool for following the latter; concluded that the improved alignment of the • understand potentially misleading nuances HSR and the ADG represented by their data of the system and have enough detail behind ‘argue for inclusion of added sugar in an updated the HSR calculations to make informed HSRS algorithm and declaration of added sugar decisions about what the ratings truly as part of mandatory nutrient declarations’. represent; and • fully understand what like-to-like category comparison means.

An improved HSR system and a better functional understanding of how it works, and what the labeling actually indicates, will increase GWS consumer confidence in its nutritional authority, improving their shopping and overall dietary habits.

The Heavy Issue | westernsydney.org.au | July 2019 A reduction in ‘junk food’ advertising on public transport and other government property Research has proven that food advertising influences children’s preferences, purchase requests and consumption. The growing expert consensus is that the specific marketing of ‘discretionary’ food choices to the young is contributing significantly to poor diets, weight gain and obesity65,66,67. From the age of three, ‘junk’ food brands are more recognisable to our children than healthy ones68, unsurprising given their exposure to the former s twice the rate69. With Australian children now consuming up to 41 per cent of their calories from ‘non-core’ food choices, one of the most efficient means to reduce their risk of becoming overweight or obese is to restrict its marketing to them70. While junk food ads also influence adults, as a public health issue, it’s most relevant with regards The Dialogue joins other public health to children since lifelong eating habits are usually advocates in expressing concern at established early, meaning that overweight children 3the marketing of discretionary (‘junk’) are likely to remain so into adulthood71. Health foods using public transport assets, advocates have estimated that banning junk food ads particularly the targeting of children. during children’s television viewing hours in Australia While not limiting future scope, the alone has the potential to save $300 million in long Dialogue specifically recommends the term health care costs72. State government take immediate steps to: • ban such advertising on the Sydney Metropolitan train network; • ban, or at least reduce, such advertising on buses designated to public school routes.

18 The Dialogue takes no position on the wider issue The Dialogue recognises and encourages further of broadcast and print advertising, while noting the discretionary food industry’s voluntary that voluntary industry codes like the Australian restriction of broadcast advertising to our Food and Grocery Council’s ‘Responsible children…but wonders where the ads are going? Children’s Marketing Initiative’, which urges its One answer is becoming clearer; onto our public members to advertise ‘only healthier choices trains and buses. to children’ that encourage ‘a healthy lifestyle through good diet and physical activity’73, shows Junk food advertising on the Sydney that even their source recognises how harmful Metropolitan train network junk food ads really are to young minds. Growing revenue figures illustrate how food industry marketing is expanding into non-broadcast channels like out-of-home Turning over a new leaf? advertising77. In Australia, such advertising As the health sector advocates for a TV ban in now reaches millions daily, and Sydney’s vast particular, and parental support builds for one, network of train carriage and station billboards, junk food advertisers are growing cannier in their signs, e-scrolls and e-screens is particularly branding strategies. McDonald’s, for example, fertile territory for targeting our young. About 15 makes much of having ‘voluntarily reduced our per cent of the one million commuter journeys advertising during children’s television programs’74 each day are taken by children and adolescents, over the last decade. Stabled franchises KFC and close to 45 per cent by young adults (18– and Pizza Hut similarly trumpet their 2008 34)78. Railway marketing tends to ‘stick’, too: one commitment to cease advertising ‘directly to 2013 study revealed that 67 per cent of people children’ or ‘during children’s programming’ – a noticed ads at train stations more than at other decision which parent company Yum! Australia public places, thanks to longer linger times - of humbly laments ‘came at significant cost to which an average 21 per cent is spent staring idly our business’75. Meanwhile Coca-Cola Amatil’s at cross-track ads79. Responsible Marketing Policy makes a loud public commitment to not direct any ads, from any source, at any children under the age of 1276.

The Heavy Issue | westernsydney.org.au | July 2019 No surprise then that a close audit of food and beverage Clearly, while nominally embracing responsible self- advertising at all of Sydney’s 178 train stations over the regulation in the higher-profile broadcast media, summer and winter of 2016 revealed some unsettling junk food producers continue to bombard our train- figures80: travelling children ‘under the radar’ with harmful • of the 6,931 advertisements recorded, 1,915 (27.6 dietary messaging. It’s for this reason that the Dialogue per cent) were for food or beverage; advocates for a ban. • 84.3 per cent of these were for discretionary products and only 8.0 per cent for core foods; • junk snacks and SSB were the most commonly The financial impact advertised, regardless of season; and Currently, Sydney Trains nets about $100 million • Coca-Cola was the largest single advertiser on dollars annually in total revenue from its outdoor Sydney trains (10.9 per cent of all ads). advertising platforms84, and clearly a significant chunk comes from junk food advertising. The net impact on State coffers of a ban, however, is uncertain. Other GWS obesity risk factor advertisers will certainly occupy what is clearly prime The Dialogue notes that the while the study found influencing space, but regardless of this, the longer- no notable variation in the total number of food and term savings in reduced public healthcare costs must beverage ads across stations servicing different SES also be factored in. It makes no financial sense for cohorts, junk food ads represented a significantly Transport for NSW to accept a few million dollars to higher percentage at lower SES stations. Added to show junk food ads to our children on trains, when longer exposure times of commuting school children health advocates are arguing that removing ads for from GWS, this further increases the obesity risk of an junk food on our childrens’ TVs might save NSW Health already vulnerable cohort81. up to $300 million.

Such findings are far from isolated. Another Banning food producers from advertising their investigation of outdoor advertising that focused on discretionary food products may also increase their areas near NSW primary schools also identified train marketing of healthier products in the same spaces, stations as junk food ‘hot zones’, host to a staggeringly retaining the existing revenue but promoting a less high 90 per cent of all such ads in the defined areas82. harmful dietary message. Meanwhile a 2018 Cancer Council NSW environmental scan of food advertising in train stations and on trains (and buses) found that 82 per cent were for non-core food, with a third for SSB and one in five for fast foods like burgers or fried chicken83.

20 This is proving to be the case in the UK, where a As such scrutiny intensifies, health advocacy and carefully negotiated ban on junk food advertising public opinion is inclining towards a blanket ban has just kicked in on Transport for London (TfL) akin to the London policy, or as imposed on ACT assets – not only its train and tube networks, buses in 201587. but buses, riverboats, and even some taxis and roads85. Total food and drink ads earned TfL The Dialogue acknowledges this but notes that about twenty million pounds in 2016-17, but the complexity of Sydney bus contracts makes rather than pull their historical portion of that such a ban problematic. GWS is serviced almost spend, companies like Coke and McDonalds have entirely by private bus companies, each with negotiated contracts that allow them to promote individual advertising arrangements and using no-sugar and salt-free items and salads. bus shelters controlled by many different LGAs. A more realistic policy position is that any bus While the Dialogue does acknowledge the designated to service the school run of any NSW argument that any junk food advertising can public school should not serve as a platform for be potentially harmful to our children’s dietary junk food advertising. The Dialogue recommends habits, in such a complex policy area ‘the perfect that the NSW Government take the necessary should never become the enemy of the good’. contractual steps to ensure this going forward, and urges other agencies with any means to do so to similarly reduce commuting schoolchildren’s Junk food advertising on Sydney’s buses exposure to poor dietary messaging. It’s for this reason that the Dialogue recommends a more modest approach to junk food advertising The NSW Government could also consider on Sydney buses, which is replicating our immediately initiating a phase-out of junk food train network’s ‘under the radar’ targeting of advertising on all government-operated bus commuting children. One recent study tracking services. The Dialogue would strongly support school runs found that 75 per cent of the food such an initiative. ads Sydney’s school children see while en route were for junk foods. Alarmingly, 72 per cent of the food ads platformed on designated school buses were also for junk food86.

The Heavy Issue | westernsydney.org.au | July 2019 Mayors taking ownership & leading the way to more healthy local lifestyles The Dialogue has long recognised the impact on those who live in GWS of certain characteristics common to the region, noted earlier as increased obesity risk factors but increasingly described collectively, as obesogenic, or tending to cause obesity88. This more sophisticated discussion of GWS’s built and lived environments is welcome. The Dialogue recommends that Mayors make a concerted effort to highlight the obesogenity of their LGA and its impact on individual health, and take a personal leadership role in remaking it to inspire and enable more nutritious, physically active local lifestyles, while avoiding any stigmatisation of obesity.

Outing GWS’s obesogenic environments: No blame, no shame & Raising awareness of the crippling impact of 1. GWS Mayors! Take ownership of remaking your ‘obesogenic LGAs’ an obesogenic environment is fundamental to 4 5 avoiding the social stigma and negative stereotyping surrounding obesity issues90. This is critical to the 2. Lead the way to more nutritious, success of any reduction strategy. A clear sense of physically active local lifestyles personal responsibility and behavioural agency plays a big part in maintaining a healthy diet and a physically active lifestyle, but intimations of blame – or worse, shame – can easily overwhelm those tackling their Living in Sydney’s West makes weight issues with an air of passive futility91. it much easier to put on weight than elsewhere” “AMA NSW President, Dr Kean-Seng Lim89

22 It’s here that Mayors can play a powerful leadership role in upending the local discussion. They should point out loudly and often, the simple – and in the Dialogue’s view, disgraceful – truth that people in GWS are more likely to be overweight than the rest of Sydney (RoS) only because GWS’s obesogenic environments conspire against maintaining a normal, healthy BMI. GWS’s living environment often makes it harder to eat well, and easier to be inactive.

Figure : The uphill battle against obesogenity

Nutritional Obesogenity: eating ourselves to death in a food desert A ‘food desert’ is an urban environment that’s scarce on the fresh food that can efficiently satisfy our body’s daily nutritional needs, and abundant in the junk food that can’t, and makes us unhealthy in the attempt92. This over-consumption of high energy, low nutrient (‘discretionary choice’) food at the expense of the healthy (‘core’) food groups is a key causal driver of obesity. Our most recent National Health Survey Nutrition First figures indicate that the average Australian now supplies 35 per cent of their daily energy from the former (of which WHO recommends only ‘limited’ amounts), while from the latter, fewer than 4 per cent of us consume (for example) enough vegetables, and only one-in-10, enough dairy 93.

The Heavy Issue | westernsydney.org.au | July 2019 In comparison to the RoS, food deserts in GWS are On the other hand, cars can exacerbate food desert more prevalent, and, where they do exist, are more effects too, as can commuting in general97. Work day bleak94. While the arrival of discount supermarkets travel patterns typically overlap with morning and and new suburban shopping centres have made it evening mealtimes, and long, slow drives on roads potentially easier to source cheap, fresh food, the over-serviced by convenient, garishly-alluring food true measure of a food desert lies not in the isolated options can prove irresistible. It’s no mistake that but in the relative ease of access to ‘good’ and ‘bad’ around 60 per cent of franchise take-away sales are nutrition. Here, recent analysis shows that compared via their drive-throughs98. Even the more active travel to eastern, inner and northern suburbs, take-away options can divert us into a food desert: one UK study food in the west tends to be relatively more abundant of train commuters reported a 32.8 per cent increase and accessible than fresh food, with many more areas in opportunity ‘snacking’ enroute, adding an average home to more fast food outlets than supermarkets95. 767 intake calories a week. The study concluded: “The For example, around 28 per cent of neighborhoods unhealthy foodscape created in many stations by the in the Parramatta-Blacktown-Mount Druitt corridor growing prevalence of fast food outlets…creates a have at least a three-to-one ratio of takeaway outlets potential health pitfall…’99 to supermarkets and green grocers, while only 20 per cent of Sydney’s Lower North Shore hosts this ratio96. This city is going on a diet!” Less obvious factors beyond comparative availability Oklahoma City Mayor, Mick Cornett100 can add to a food desert too, including food costs and cultural appropriateness, consumer mobility, storage “ and preparation options, advertising and accessibility, Leading the way out of a food desert: The city and even the changing nature of farming. Such factors that lost a million pounds combine to make maintaining a healthy, balanced and In 2007 Oklahoma City was named America’s fast food nutritional diet a greater challenge than elsewhere. capital and one of its fattest cities. Mayor Mick Cornett For many residents in GWS, the economy-of-scale took it personally. Acknowledging his own need to lose victory of the isolated shopping centre over the local a few pounds, he used a televised press conference grocers, butchers, bakers and fruit & vegetable sellers to challenge his city to shed some with him, setting who once provisioned a good daily diet within walking a collective goal of one million101. He then set about distance of their homes, has made food shopping a leading his tribe out of Oklahoma City’s food desert. weekly bulk-buying exercise. This can be extremely difficult without a car.

24 Key aspects in the remaking of the city’s Let’s make it easier for nutritional landscape included: parents to choose healthy foods!” • A website where citizens could track Nutrition Program Manager, Cancer Council individual and collective dietary progress, “NSW, Wendy Watson104 get nutritional advice, and find options for healthier food stores, recipes and restaurants; Making core foods easier and discretionary • an integrated media and commercial food choices harder sector publicity campaign; Local councils and Mayors in GWS have an • powerful incentives for local food businesses important role to play in making it easier for their and outlets to lift their nutritional game; residents to eat well and harder to eat badly. • community produce gardens and urban markets; and State governments and urban planning experts • zoning changes skewed towards promoting have recognised the food desert problem ‘core’ food outlets over ‘discretionary’ foods. for some time and there are many excellent resources to draw on. NSW Health’s Healthy Above all, the mayor’s vigorously visible Urban Development Checklist105 includes a whole personal leadership started a stigma-free public chapter outlining how councils can prioritise conversation about Oklahoma City’s dietary ‘Healthy Foods’. Nutrition-improving planning habits: ‘Mothers and fathers were talking about tools include land use and zoning designations, it with their kids. Churches were starting their dietary education and marketing initiatives, own running groups, their own support groups positive management of LGA assets such as bus for people dealing with obesity102’. The impact of shelters, food outlets and vending machines in charismatic local leadership is one of the most public spaces, ‘food oasis’ initiatives like water salutary lessons from Oklahoma City. As a direct bubblers, community gardens and breastfeeding result of Mayor Cornett’s commitment and vision, locations, and public meal services such as America’s ‘fast food capital’ lost its million pounds Meals on Wheels, or Victoria’s local government within five years, and by 2015 had reduced its enterprise, Community Chef106. There is potential obesity rate by over 2 per cent103. for far-sighted nutritional thinking in GWS’s expanding greenfield environment, where Voluntary Planning Agreements (VPA) with commercial developers can play a strategic role in avoiding future food deserts. The new megamarket centerpiece of Oran Park Town is one example that has elevated ‘accessible healthy food’ to its rightful place as an urban planning metric107.

The Heavy Issue | westernsydney.org.au | July 2019 The proposed Western Sydney Fresh Food Precinct108 What has proven effective in tempering the relative is its expression on a grand scale, as well as a dominance of take-away outlets in some parts revitalization of GWS’s market garden history. of NSW, at least, are grassroots campaigns by energised community groups using existing planning Equally important is the local government’s role in mechanisms. Most notable among these has been making it harder – or ‘less easy’ - for their residents in the Blue Mountains LGA, where determined locals to eat badly. The Dialogue acknowledges the calls have held McDonald’s (and other franchises) at bay for from some health advocates that Councils be granted two decades with LEP zoning ‘local clauses’ which just planning power over ‘discretionary choice’ food happen to prohibit drive-through approvals on every outlets on direct health grounds109. Such bans have commercially viable site along the Great Western been tentatively tried overseas, for example near some Highway112. Other protest groups and Councils have schools in the UK, and in the low SES area of South similarly leveraged floor area limitations113, insufficient LA in 2008, but both their enforceability and efficacy parking and land use incompatibility114. Still others remain uncertain110. The Dialogue also recognises that have made deals with individual franchise operators: viable local governance demands the transparent and for example, not to sell fast food to children wearing fair reconciliation of the competing interests of all LGA school uniforms, or in school hours115. stakeholders, including commercial ones. In playing a role in safeguarding their constituency’s nutritional The common thread is local community activation and welfare, Councils must navigate a democratically leadership. Here, the Dialogue notes that many GWS mandated path between over-regulation of individual residents who are no less concerned about ‘junk food’ choice, and regulatory negligence. than others elsewhere in Sydney may lack the time and ability to engage in complex planning disputes, and again urges Mayors to step up when appropriate, to help remake their nutritional landscape.

Every GWS LGA except Cumberland, What can governments do to Canterbury-Bankstown and make it harder for parents to give their Parramatta has a higher percentage of kids terrible food?” three-or-more vehicle household, than “MP for Londonderry & Shadow Minister for Western 118 one-or-no vehicle households Sydney, Prue Car111

26 Built Obesogenity: Driving ourselves into an Active travel: Walking, riding, early grave running, skating, scootering, GWS is long on distance and short on public catching trains, buses, ferries... any transport116. As a result, the region is addicted to mode that makes you physically cars117. active! It contains all eight Sydney LGAs with the lowest Inactive travel: Sitting in your car use of public transport for commuting119. Over feeling frustrated half of GWS households own two or more 120 vehicles (39 per cent for the rest of Sydney ). Increasing walkability and encouraging the use This dependence manifests in constant traffic of active and public transport requires reducing 121 gridlocks and long commutes , meaning more GWS’s dependence on private vehicles129. The of each day spent not being physically active. The way Australia has done urban sprawl to date, results are predictable: people who drive to work with cul-de-sacs, car-friendly streets and lack of are 13 per cent more likely to be overweight or trees near footpaths, is counterproductive to the 122 obese than ‘active travel’ commuters , people increased use of active130 and public transport131 who live in less walkable areas are 60 per cent - an explicit objective of all levels of government. more likely to be overweight123, as well as more prone to Type 2 Diabetes124 and cardio-vascular 125 disease . GWS and physical inactivity Australian Guidelines on Physical Activity132 reflect Conversely, neighbourhoods with good those of the World Health Organisation133 and walkability have a protective association from essentially recommend at least an hour a day 126 obesity and Type 2 Diabetes . Studies suggest for children and a bare minimum of 2.5 hours a that, regardless of SES, health or behaviour, week for adults, along with strength activity and adults who switch from driving to work to public sedentary screen time advice. transport or active transport, lose a small amount of weight due to the regular incidental exercise Australia’s numbers aren’t great. The most recent 127 involved . Increased walking has been flagged Physical Activity Across the Life Cycle data134 as an economical approach to reducing health indicate that overall, only 30 per cent of children inequalities including cardiovascular disease, aged 2–17, and 44 per cent of adults aged 18 and 128 diabetes, and some cancers . over, are meeting the guidelines.

The Heavy Issue | westernsydney.org.au | July 2019 Physical activity decreases with age for all cohorts, SPANS also revealed ‘active travel’ as the least and children aged 13–17 are the least likely to meet prevalent form of school transport for children and the guideline (7.9 per cent). Among Indigenous adults, adolescents, at only 15 per cent and 14 per cent, and significantly over-represented in parts of GWS, only 38 predictably, the car as the most prevalent (43 per cent per cent met the guidelines compared to 46 per cent and 37 per cent)139. of non-Indigenous adults. Similarly, Health Tracker surveys recorded markedly more adults per 100 in Low levels of physical inactivity are a problem for GWS than in Greater Sydney who reported doing ‘low all Australians, but the aforementioned in-built exercise or no exercise’, with the most inactive suburbs obesogenity of GWS makes targeted improvements in all falling within GWS LGAs135. the region a high priority. This is particularly important for the wellbeing of children, who are highly vulnerable to environmental factors but relatively powerless to If more Australians were shape their environment. Unlike their parents’ and physically active for just 30 minutes a grandparents’ generations, policy-makers must grasp day, the Australian healthcare system the opportunity to encourage and teach healthy “ 136 lifestyles for today’s children to lock in substantial could save $1.5 billion a year” long terms gains for the health system. For GWS, we need to give our children the best fighting chance of As for children, while the most recent NSW School overcoming the region’s obesongenic environment. Physical Activity and Nutrition Survey (SPANS)137 reveals no disparity in activity rates across Sydney children, it does imply reasonable correlating risk Putting the brakes on the car: How Geelong got factors for GWS. For example, schoolchildren of healthy together Middle Eastern background, notably over-represented There are good templates for how local governments in parts of GWS, were significantly less likely than all can go about getting its younger residents moving. others to meet recommended daily physical activity levels (19 per cent of all children, but only 13 per cent One illustrating case study is the City of Greater of Middle Eastern children). A 2009 ABS survey similarly Geelong’s Healthy Together experience140 of 2011-15. suggested that children who were born overseas As part of the National Partnership Agreement on were 9 per cent less likely to participate in ‘physical Preventative Health, this local government played activities’ (sport or dancing) than children born in a flagship role in Victoria’s LGA-focussed ‘complex Australia, while the children of parents who were both adaptive systems’ experiment, applying a wide array of born overseas were 24 per cent less likely138. anti-obesity programs at scale and on multiple levels to improve nutrition and increase physical activity.

28 The focus was strongly on childhood obesity with The results were striking. Between 2011 and 2014 the project extending into 95 per cent of the LGAs when Healthy Together was running at full steam, early learning centres and kindergartens, over 80 adult obesity rates in the LGA reduced by 6.9 per per cent of its primary schools, and 70 per cent cent, against a state-wide rising trend142. of its secondary schools. Both the Barwon Health and Bellarine Community Health networks were ‘Designing out’ built obesogenity involved, as were many sports organizations The Geelong experience shows how state strategic and workplaces. At its peak, Healthy Together planners, local governments and community involved 33,000 students and 34,000 employees, groups can take a coordinated approach to with one in four Geelong residents reached by its increasing local levels of daily physical activity. programs, which included: • Leading state-wide initiatives like Premier’s Active April and Walk to School, increasing Our cities and towns must be active travel at Geelong schools from 4,326km places where it is easy for us to be to 78,000km (a participation increase of 3 to active every day... the only way this 28 schools, and 119 to 7,475 students); “ can happen is if health and built • developing Active Travel Routes for 11 environment professionals work schools in partnership with City of Geelong together” engineers; Active Living NSW 143 • partnering with the AFL Geelong Cats and QUIT to launch Cats Don’t Smoke campaign, In its 2017 submission to the Greater Sydney including footballer Joel Selwood as its Council draft District Plans, the Healthy Planning nutritional and physical activity Health Expert Working Group (HPEWG) identified six Champion; planning priorities to help remake an obesogenic • numerous programs to change behaviors built environment144. These included making in various cohorts; for example, a ‘parents green space available, creating widespread with infants’ initiative involving over 200, and opportunities for physical activity, and making Geelong: Active City, which helped over 90 per walking, wheeling and cycling the obvious, easy cent of participants move from ‘insufficiently movement options. Translating these priorities active’ to ‘sufficiently active’ according to IAW into reactivated living environments is well within Australian guidelines; and the control of GWS’s local governments. Day-to- • development and adoption of the Greater day decisions over land allocation, street network Geelong Physical Activity Strategy 2014- design, residential density, open space and 2017141. individual developments can gradually ‘design out’ the built obesogenity that is proving so catastrophic to its residents’ health. In particular:

The Heavy Issue | westernsydney.org.au | July 2019 Walkability: Traffic management plans can Building design: At the individual project level, progressively relinquish the car’s hegemony over urban there’s an almost limitless number of ways that local centres. This should be not just via evolving street governments can influence the remaking of their ergonomics, but also driver behavioural mechanisms obesogenic built environments, especially using like parking costs, congestion penalties and vehicle Voluntary Planning Agreements (VPAs) as powerful restrictions. Compact, mixed use developments, grid collaborative tools. From incentivising workplaces street networks, paved footpaths with plentiful seating, to include bike storage and employee changing lighting and foliage cover, lower vehicle speeds in facilities, to encouraging public water fountains and residential areas and increased public transport will green ‘physical activity’ spaces, the only limits are on also gradually plan in walkability. a Mayor’s vision, imagination and planning ambition.

Cyclability: The process will be accelerated by NSW Active Living: This planning evolution to expanded cycle networks and designated bike lanes, move us away from Sydney’s obesogenic past more public bike parking and workday storage options. is well underway. Active Living NSW has already Here, a focus on GWS’s energetic younger residents is issued HPEWG-prepared Planning Action Resources likely to be especially effective. Rider safety, training on Green Infrastructure Cooling148 and Creating and education programs targeting school travel habits Walkable Neighbourhoods149, the first in an ongoing are a great way to inculcate a generational transition series of planning tools that will help empower local to active travel. Local governments also have the governments to reshape and reactivate their LGAs. scope to provide bike maps, maintenance resources and online information hubs. Cycleways Sydney145 is Western Sydney Diabetes Leaders Alliance This a great template. alliance of over 100 organisations from the public, private and NGO sector is providing an excellent Green open space: The creation of more green open platform for a coordinated approach to preventing space for GWS is not simply about giving all Sydney diabetes, a common comorbidity of obesity. Regular residents a fair go at an active daily lifestyle, although meetings and workshops seek to synergise the those with easy access to it exercise harder and more creativity and strategic vision of a range of stakeholders, frequently146. As climate change accelerates, ‘green combining it with the established expertise and data infrastructure’ will play another vital role; helping resources of the region’s health networks. By accessing to combat the ‘heat island’ phenomena already many different local community organisations, from disproportionately experienced in GWS. churches and schools to businesses and not-for-profit groups, the Alliance aims to foster inclusive, lateral Councils can enhance this further with the provision thinking about how urban planning and targeted local of green gyms, running tracks and especially an interventions can improve access to nutrition and abundance of imaginative, active playground encourage more physical activity, especially among equipment for our children. children. Many are included in their latest blueprint for action, Healthy Living Options for Western Sydney.

30 Making inactivity hard, and activity easy Whatever gets a GWS heart pumping The final component in a whole of community Everybody is motivated to get physically active by approach to increasing the levels of physical different things. activity is marshalling the best ways and means to get individuals moving. Running tracks, Some in GWS love the camaraderie and parklands, bike lanes and active travel options competitiveness that comes with team sport. can only help reduce obesity if people use them. Others prefer the solitude of individual exertion. It’s especially important that younger Australians Many families like to get active together. Some get feel encouraged and enabled to embrace an their heart rates pumping to pumping music, other active lifestyle, as childhood behaviour generally stretch their limbs in zen-like silence. Whether it’s evolves into lifetime habits. going hard in weekend frenzies or taking a stroll to work every day, each GWS resident has their It’s with this mind - incentivising physical activity, own idea of the ‘perfect way to exercise’. When especially in our young - that the Dialogue’s final encouraging an increase in activity, what really recommendation in its 5-Point Strategy looks to matters is that no-one’s preference gets neglected. the people of GWS themselves. Central to this is decentralisation. All levels of government and public service, along with local businesses, not-for-profits and individuals, can play a part in creating a rich and vibrant physical activity ecology, but for maximum inclusion, programs need to be diverse, dispersed, and designed and driven at the grass roots.

The Heavy Issue | westernsydney.org.au | July 2019 Current Government Initiatives

In a similar vein the Live Life Get Active156 partnerships We love active vouchers!” are free fitness camps, funded by local corporate Community Liaison Officer, Lebanese-Muslim sponsors and using existing LGA parks and open Association & Co-Founder Auburn Tigers AWFL, Amna spaces. Councils can also tailor initiatives to suit “Karra-Hassan150 local cultural particulars, as in Cumberland Council’s women-only swimming sessions at Auburn Aquatic It is important to note that there’s plenty going on Centre157. Campbelltown’s Bicycle Education and already, at different levels of government and in the Road Safety Centre158 offers regular free access to its private and non-government sector: facilities on Sundays and during school holidays. LGAs can also partner with external organisations in building State: Reducing childhood obesity is a Premier’s in more activity, such as in Liverpool City Council’s Priority, with the aim being a 5 per cent reduction Kelso Skate Park159 upgrade, which used a Community by 2025151. Leadership at this level has provided Building Partnerships grant and joined with NSW welcome public awareness and strategic focus and Health and Sydney Water to also install a water station is helping to galvanise action at local levels. State-run to keep busy young skaters well hydrated. Meanwhile programs like the Premier’s Sporting Challenge152 and Blacktown’s Adopt-a-Park160 initiative is a fine example the Active Kids vouchers153 scheme acknowledge the of a Council harnessing the volunteer energies of its importance of encouraging activity from an early age. residents to reduce obesogenic obstacles to activity One side benefit of the Active Kids scheme is proving that take the form of unamenable local parks. to be the unprecedented collection of granular data, crucial for tracking progress of the Premier’s Priority154. Schools: Schools are an excellent hub for promoting children’s physical activity. Current examples include Local Government: Good examples of creative Go4Fun161, Ride2School day162, Walk Safely To management of LGA physical activity assets abound. School Day163 and the early childhood Munch n Move For example, the re-opening of Lake Parramatta to programs164. The Dialogue applauds and encourages swimming activity in 2015155 is a particularly notable further the leadership shown by the NSW government result of GWS Councils thinking collectively and in using education networks to promote childhood strategically. physical activity.

32 Private: The private sector too is playing an increasing role in promoting physical activity, as an economic as well as a heath imperative. This can take the form of high-level corporate partnerships in major events like the NAB RunWest Festival165, local commercial initiatives like the free swimming lessons offered to children by Macarthur swim schools during Learn2Swim week166, and all points in between. To get everyone in Greater Western Sydney moving, everyone in Not-For-Profit: Finally, there is the NFP and Greater Western Sydney needs to charitable sector, which provides a rolling array get moving! of activity-based incentives for us all to get more active, and especially our children. Well-known campaigns include the Heart Foundation’s Jump Rope for Heart167, the Cerebral Palsy Alliance’s Steptember168, Cancer Council’s Relay for Life 169 and Oxfam’s Walk Against Want170.

Ultimately, there’s an infinite number of ways those living in GWS can increase physical activity. The only limitation is on the imagination and vision of the many diverse individuals who make up each local community. Once again, the Dialogue urges local Mayors in particular to take a strong, visible leadership role.

The Heavy Issue | westernsydney.org.au | July 2019 References

34 1. World Health Organisation 2018, Obesity and Overweight, https://www.who.int/news-room/fact-sheets/detail/ obesity-and-overweight 2. Ibid 3. Ibid 4. Australian Institute of Health and Welfare (AIHW) 2018, Australia’s Health 2018: in brief, https://www.aihw.gov.au/ reports/australias-health/australias-health-2018-in-brief/contents/how-do-we-compare-with-similar-countries 5. OECD 2017, Health at a Glance 2017: OECD Indicators How Does Australia Compare?, http://www.oecd.org/australia/ Health-at-a-Glance-2017-Key-Findings-AUSTRALIA.pdf 6. The Heart Foundation 2015, Overweight and obesity statistics, https://www.heartfoundation.org.au/about-us/what- we-do/heart-disease-in-australia/overweight-and-obesity-statistics 7. The Obesity Collective 2019, Weighing In: Australia’s growing obesity epidemic,https://static1.squarespace. com/static/57e9ebb16a4963ef7adfafdb/t/5c9a8961f4e1fc9deceb1ae4/1553631602322/Obesity+Collective_ Australias+Growing+Obesity+Epidemic+report+27+03+19.pdf 8. Buchmueller, T.C. & Johar, M 2015, ‘Obesity and health expenditures: evidence from Australia’, Economics & Human Biology, vol. 17, pp. 42-58, PubMed, DOI: 10.1016/j.ehb.2015.01.001 9. Price Waterhouse Cooper 2015, Weighing the cost of obesity: A case for action, https://www.pwc.com.au/pdf/ weighing-the-cost-of-obesity-final.pdf 10. Ibid 11. Australian Institute of Health and Welfare (AIHW) 2018, What can we improve?, https://www.aihw.gov.au/reports/ australias-health/australias-health-2018-in-brief/contents/what-can-we-improve 12. Select Committee into the Obesity Epidemic in Australia 2018, Select Committee into the Obesity Epidemic in Australia, https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Obesity_epidemic_in_Australia 13. Select Committee into the Obesity Epidemic in Australia 2018, Select Committee into the Obesity Epidemic in Australia, https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Obesity_epidemic_in_Australia/Obesity/ Final_Report 14. Australian Institute of Health and Welfare (AIHW) 2018, Overweight & Obesity, https://www. aihw.gov.au/reports-data/indicators/healthy-community-indicators/phn101/central-and- eastern-sydney-nsw/overweight/overweight-obesity?filter=IND0023|2|Age-standardised%20 percentage&filter=IND0023|4|2014%E2%80%9315&filter=IND0023|1|Adults%20who%20are%20overweight%20 or%20obese 15. Ibid 16. Australian Institute of Health and Welfare, Overweight & Obesity, Central & Eastern Sydney 2014-15 https://www.aihw.gov.au/reports-data/indicators/healthy-community-indicators/phn101/central- and-eastern-sydney-nsw/overweight/overweight-obesity?filter=IND0023|2|Age-standardised%20 percentage&filter=IND0023|4|2014%E2%80%9315&filter=IND0023|1|Adults%20who%20are%20overweight%20 or%20obese

The Heavy Issue | westernsydney.org.au | July 2019 17. Aubussen, K 2017, ‘Health tracker reveals suburbs with highest rates of obese children’, 2 May, Sydney Morning Herald, https:// www.smh.com.au/healthcare/health-tracker-reveals-sydney-suburbs-with-highest-rates-of-obese-children-inactive-adults- 20170427-gvtjys.html 18. Department of Prime Minister & Cabinet 2014, Aboriginal & Torres Strait Islander Health Performance Framework 2014 Report, https://www.pmc.gov.au/sites/default/files/publications/indigenous/Health-Performance-Framework-2014/tier-2-determinants- health/222-overweight-and-obesity.html 19. Woodward-Lopez, G, Kao, J & Ritchie, L 2011, ‘To what extent have sweetened beverages contributes to the obesity epidemic?’, Public Health Nutrition, vol. 14, no. 3, pp. 499-509, PubMed, DOI: 10.1017/S1368980010002375 https://www.foodpolitics.com/wp- content/uploads/Woodward-Impact-of-SSBs.PubHlthNutr-2011.pdf 20. Cancer Council Australia 2016, Position statement – sugar sweetened beverages, https://wiki.cancer.org.au/policy/Position_ statement_-_Sugar-sweetened_beverages 21. Rt Hon. George Osborne 2016, Budget speech UK House of Commons 16 Mar, https://www.gov.uk/government/speeches/budget- 2016-george-osbornes-speech 22. Popkin, B.M & Hawkes, C 2016, ‘Sweetening of the global diet, particularly beverages: patterns, trends and policy responses’, Lancet Diabetes & Endocrinology, vol. 4, no. 2, pp. 174-186, PubMed https://www.ncbi.nlm.nih.gov/pubmed/26654575 23. ABS 2006, cited in ABC 2016, Sugar Tax: Australia’s sugary drink consumption more substantial than UK’s, https://www.abc.net.au/ news/2016-03-17/sugary-drinks-tax-in-australia/7253896 24. Australian Bureau of Statistics 2012, Australian Health Survey: Consumption of Added Sugars 2011-12, https://www.abs.gov.au/ ausstats/[email protected]/Lookup/4364.0.55.011main+features12011-12 25. Australian Bureau of Statistics 2015, Australian Health Survey: nutrition first results – foods and nutrition 2011-12, http://www. abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Consumption%20of%20 Sweetened%20Beverages~710 26. NSW Schools Physical Activity and Nutrition Survey (SPANS) 2015, Summary Report, https://www.health.nsw.gov.au/heal/ Publications/spans-2015-summary-report.PDF 27. Lee, A & Ride, K 2018, Review of nutrition among Aboriginal and Torres Strait Islander People, https://healthinfonet.ecu.edu.au/ healthinfonet/getContent.php?linkid=572796&title=Review+of+nutrition+among+Aboriginal+and+Torres+Strait+Islander+people 28. SPANS 2015 op. cit. 29. Malik, S, Popkin, B, Bray, G, Despres, JP, Willet, W & Hu, F 2010, ‘Sugar-sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes’, American Diabetes Association Diabetes Care, vol. 33, no. 11, pp. 2477-2483, http://care.diabetesjournals.org/ content/33/11/2477 30. NSW Health n.d., Finish with the right stuff, http://www.rightstuff.health.nsw.gov.au/ 31. NSW Department of Education 2018, Healthy school canteens: The food and drink criteria, https://healthyschoolcanteens.nsw.gov. au/canteen-managers/the-food-and-drink-criteria 32. Western Sydney Local Health District 2017, Westmead hospital bans sale of sugary drinks, https://www.wslhd.health.nsw.gov.au/ News/2017/Westmead-Hospital-bans-sale-of-sugary-drinks 33. Ibid. 34. Han, E 2018, ‘Dozens of countries now tax sugary drinks but sweet-toothed Australia isn’t interested’, 8 January, Sydney Morning Herald, https://www.smh.com.au/healthcare/dozens-of-countries-now- tax-sugary-drinks-but-sweettoothed-australia-isnt- interested-20180103-h0cv21.html

36 35. Pym, H 2018, ‘Sugar tax is already producing results’, 12 March, BBC, https://www.bbc.com/news/health-43372295 36. Colchero, A, Popkin, B, Rivera, J, Shu Wen, N 2017, ‘Sustained consumer response evidence from two-years after implementing the sugar sweetened beverage tax in Mexico’, Health Affairs, vol. 36, no. 3, pp. 564-571, https://www. ncbi.nlm.nih.gov/pmc/articles/PMC5442881/ 37. Pym, H 2018op. cit. 38. Obesity Policy Coalition 2016, Australia should follow UK with 20% sugary drinks tax, http://www.opc.org.au/media/ media-releases/australia-should-follow-uk-with-sugary-drinks-tax.html 39. Majid, A 2018,‘Major new study shows Chile’s sugar tax has sharply reduced sales of sugary drinks’, 3 July, The Telegraph, https://www.telegraph.co.uk/news/2018/07/03/major-new-study-shows-chiles- sugar-tax-has-sharply- reduced-sales/ 40. Veerman J, Sacks G, Antonopoulos N, Martin J PLOS One The Impact of a Tax on Sugar-Sweetened Beverages on Health and Health Care Costs accessed 22 Mar 2019 https://journals.plos.org/plosone/article?id=10.1371/journal. pone.0151460 41. Ibid. 42. Nomaguchi, T, Cunich, M, Zapata-Diomedi, B, Veerman, JL 2017, The Impact on productivity of a Hypothetical Tax on Sugar-Sweetened Beverages, Health Policy, vol. 121, no. 6, pp. 715-725, https://www.ncbi.nlm.nih.gov/ pubmed/28420538 43. Ibid. 44. World Health Organisation 2018, Healthy diet, https://www.who.int/news-room/fact-sheets/detail/healthy-diet 45. Eat for Health 2015, Australian Dietary Guidelines, www.eatforhealth.gov.au/guidelines/australian-dietary- guidelines-1-5 46. mpconsulting 2019, Health Star Rating System Five year Review Draft Report, http://healthstarrating.gov.au/internet/ healthstarrating/publishing.nsfContent/0CAEF445C5D3783ACA2583AD007C1727/$File/Health-Star-Rating-System- Five-YearReview-Draft-Report.pdf 47. Health Star Rating System 2019, About, http://healthstarrating.gov.au/internet/healthstarrating/publishing.nsf/ Content/About-health-stars 48. Jones, Radholm, Neil NCBI/US Nat. Library of Health Apr 2018 Defining Unhealthy: a Systematic Analysis of the Alignment between the Australian Dietary Guidelines and the Health Star Rating System accessed 23 Mar 2019 https://www.ncbi.nlm.nih.gov/pubmed/29670024 49. mpconsulting op. cit. 50. Obesity Policy Coalition 2017, Submission to the 5 year review of the Health Star Rating system, http://www.opc.org. au/downloads/submissions/5-year-review-health-star-rating-system.pdf 51. mpconsulting op. cit. 52. Ibid. 53. The George Institute 2018, Health start ratings get it right and should be mandatory, say authors of new report, https:// www.georgeinstitute.org.au/media-releases/health-star-ratings-get-it-right-and-should-be-mandatory-say-authors- of-new-report 54. The George Institute 2018, Submission to the select committee into the obesity epidemic in Australia, https://www. georgeinstitute.org/sites/default/files/documents/tgi-submission-to-senate-enquiry-on-obesity.pdf

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The Heavy Issue | westernsydney.org.au | July 2019 Western Sydney Leadership Dialogue The Dialogue

Western Sydney Leadership Dialogue is a not-for-profit, community initiative leading a national conversation about Greater Western Sydney. The Dialogue facilitates interaction between key opinion leaders across industry, government, academia and the community, to inform public policy debate and to advance a Western Sydney regional agenda through research, analysis, advocacy and events.

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The Dialogue thanks the following people for their valued contribution to this paper: Jack Robertson Lauren Nicholls Luke Turner Adam Leto Sarah Campbell Faith Halliday