Saturday, 11 March 2017

This Australian Paradox

This post discusses potential pitfalls in our translation of "research" to policy and practice.  We can give simple messages, but they need to reflect the context within which the analysis is framed.  Simple messages CAN accurately reflect context.  This post is specifically in response to:  ABC Lateline April 2016: Analysing the Australian Paradox: experts speak out about the role of sugar in our diets.  Available to view online at : http://www.abc.net.au/lateline/content/2015/s4442720.htm

The content of this post is in some way a warning, a friendly "heads up", that our profession, dietetics, does not want to enter a "post-truth" era, and how we can all contribute to keeping it real.  The other end of :post-truth" would naturally be "truth", however, we know there is no absolute truth in "what to eat to achieve health".  So in avoiding "post-truth" this does not imply we must achieve "truth".  What we can aspire to is maybe a "fluid-truth"...we should probably workshop that.  Look up post-truth for yourself too, from a number of sources, because I don't think it means what you think it means.  Inconceivable?  

The case of the "Australian Paradox" has polarised many, and I guess I leverage here what I have learnt from analysing the case, to repackage the learnings into what could be termed: a reminder of our individual and collective responsibility in how we present our research.   

Here, you should watch the ABC program.  Then come back over here.  No CPD points will be allotted.  Soz.
....At its most basic, based on the available evidence, one cannot claim Australia’s high rate of food-related disease IS because of soft drinks, but nor can one claim it IS NOT because of soft drinks.    

The more correct “conclusion” to be stated here is:

“Based on the available evidence on total sugar consumption, and sales of all sugar-sweetened beverages (SSB), it is reasonable to suggest processed foods with added sugar, including SSBs, are likely one of the highest contributors to discretionary intake in Australia.”….this last part itself has not been unequivocally established, and it is unclear across all work on the alleged “Australian Paradox” how far or how close this statement may be “true”.  As a simple message: we do not know which food is the sole cause of food-related disease.  We can say drinking soft drinks is not healthy.  

 Analysis using 2012 “household spending on food” (ABS 2012) reported Australian’s spend 7% of their total food-budget on “drinks” (trolley at-right).  

If we use the Australian Dietary Guidelines (ADG) as the benchmark of “what to eat to be healthy”, which is the purpose of the ADG, the recommended percentage of the food budget to “drinks” should be 0% (trolley at-left).  Note this analysis was completed too in 2012 before the 2013 ADG release (which had been scheduled for 2012). However, the 2013 release did not alter the “scientific evidence” illustrated.

The data presented here in these trolleys is “spend on food” which is different from “contribution of the food to actual intake”.  Given SSBs, and processed foods with added sugar, have the marketing power of price elasticity (which means, are able to “go on special” to “price drop” more frequently, and far more competitively compared with say, vegetables), the 7% spend on drinks could in fact translate to the highest single food-type to total sugar intake per family. 

On alcohol, Australians choose to spend 15% of their food budget on alcohol and the ADG would like to see 0% on alcohol.  As an aside, this statistics is not to be used as a “see alcohol is worse” because alcohol requires its own analyses and public health strategy, a different “public health menace” so-to-speak.

There are many ways to look at “the problem” of what is greatest contributor to food-related disease in the Australian food-supply.  Investigating “one genre of data” (eg total consumption of sugar) is one-part of understanding what is happening.  To draw conclusions based on the “single genre” data source is reasonable, but must be framed in the context of that “single input”.  Or, use a number of sources (triangulation) to build a more robust narrative of what is happening, why, and with what consequences.  Either way, to say with such compulsion “It is NOT soft drinks” and/or “sugar is NOT a problem in Australia” feeds directly into a parallel market (commercial enterprise) at the expense of “healthy people healthy nations”.  To give substance to “see there’s no problem” build a legacy that is very difficult to claw back, as we are currently experiencing in the Australian Paradox case. 

To make statements of what IS and what IS NOT a problem would require a level of evidence we simply do not have, at least retrospectively, that such statement as is/is not can be “unequivocally established”.  When we zoom-out, when we put on our public health lens, and think about the food-supply we want to create that IS compatible with health, it is fair to say, a food-supply with less dominance of SSBs and high-sugar packaged foods on our supermarket shelves, has got to be more compatible with achieving "healthy people, healthy nations".

This is where we can set an objective, and work backward from there.  For example, current spend on SSB is 7% we want to get that down to 2% by 2020?  How are we going to do that? 

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