ANPHA: LOST IN AN EARTHQUAKE

So. The seismic monitor suggests that ANPHA, the Australian National Preventive Health Agency, established in 2011, is likely to slip into Hades through a crack in the ground as the tectonic plates of the Commission of Audit and the Hockey budget shift and grind.  What a pity.  ANPHA began in 2011.  Let’s be clear why it was a good idea, so that when it’s gone (assuming it goes) we can mourn its passing properly.

The major afflictions of our community are conditions such as heart disease. stroke, cancer, depression, and problems of bones and joints.  None of these things are as preventable as whooping cough or polio, but the decline in heart disease in Australia in the past half century is deeply encouraging.  Through a combination of better treatment, less smoking and dietary change we’ve more than halved – considerably more in the case of the under 65s – death rates.  These disorders have a major preventive element in them.

The risks for heart disease are fully described.  They relate closely to what we eat, how much we drink, our physical activity and more.  Yes, these behaviours are ultimately matters of choice: we are, as GW Bush would say, are the deciders. 

But we’re not really.  The shopping environment influences what we choose to buy.  The advertising environment powerfully influences our purchases of alcohol.  The economic environment determines where we can afford to live.  Get real. These are shapers, the causes behind the causes.  And we must attend to these things if prevention is to work. 

Without legislation, kiss goodbye to tobacco control.  Other countries label foods so that people – not just robots – can work out which are the healthiest.  New York has eliminated trans fats – by legislation from all prepared food.  More broadly in the US, man-made trans fat consumption fell by 600 million tonnes between 2005 and 2012 as Dow and other vegetable oil producers acceded to the expectations and legislative urging of American citizens and govenrnments that they would produce stuff that was health promoting and not damaging.

Set yourself a preventive agenda that seeks to achieve these lifestyle opportunity-promoters and you need strength including at a national level.  Individuals struggle to win these battles.  Groups such as the National Heart Foundation, cancer societies and others have been zealous.  But the thought behind ANPHA was that it could become a counterweight to the big-time, burly avarice that drives health-destroying profiteering.  No wonder the alcohol industry will declare drinks all rounds in celebration when the bulldozers demolish ANPHA!  Bewdy mate, drink up!

The politics of prevention are what made ANPHA so important to our health future and so hated by those who, like the tobacco barons of yore, want free rein to push their wares no matter the health costs.  Get rid of food labelling, they beseech the government!  It infringes our liberty as manufacturers to sell whatever we want.  Think of our civil liberties!  Make health a matter of choice but diminish the capacity of the consumer to choose intelligently! Please, Mr Government, DO it! 

Yes, ANPHA could support more research in prevention.  From the perspective of big business research is pretty innocent stuff and usually has little commercial impact.  It’s safe.  But when research is translated into advocacy, that’s when trouble starts. That’s when those driven fundamentally by profit start worrying, and when the political tectonic plates start grinding in response. And advocacy is what a national agency with muscle could do.

So. When ANPHA goes that is what goes with it - the ability for an agency, with clout, to argue for changes that will help ensure a future in which it would be easier to choose to be healthy.  Shame.