Gabriela Mistral, a Chilean Poet who received the Nobel prize in literature in 1945, wrote:
“Many things we need can wait. The child cannot. Now is the time his bones are formed, his mind developed. To him we cannot say tomorrow, his name is today”
We cannot wait for more evidence, more money, more jobs and for the magic solution to do something about child obesity. We must look to the future and learn from the past. Farmers will tell you that unless you look after the soil, the plants and animals then the food that they produce is not good quality or quantity. They will also tell you that you get the most from domestic crops and stock if systematically they are nourished, bred and selected over many generations. They also know that as well as food, shelter and safety are required to enable most productivity. Yet we do not apply the same husbandry and care to our young. The number of children living in relative poverty is a blight on a country that once claimed to be a great place to bring up children. Food security and adequate housing are major issues for many families, so how can children reach their potential when third world diseases like rheumatic fever, rickets and glue ear prevent full participation in society.
The health of our nation and the world depends on the growth and development trajectory of children and then their children and so on. The past begets the future. What is not common knowledge is that what has gone before effects what comes after – in growth and ability to function – mentally and physically. In the first 40 weeks – from fertilised egg to birth 70% of all the cell divisions for growth occur. Chronic diseases of adulthood, such as cardiovascular disease, stroke, diabetes which kill three out of five people have their origins in early life. This was recognised for the first time as a global concern at the United Nations 2011 summit for prevention and control of non-communicable diseases:
“Improper nutrition during pregnancy is associated with stillbirths and pre-term births and increases the risk of gestational diabetes. There is also a significant relationship between maternal nutrition, foetal health and vulnerability to cardiovascular disease and diabetes later in life.”
The Pacific Islands Families Study is following over a 1000 children born in the year 2000 at Middlemore Hospital. The evidence gained from this study is a clarion call for action. At age 10 more than half were considered obese and according to our weight management guidelines should be followed up by their primary health provider. We also note from these “world leading statistics” that weight at 11 years can be tracked back to birth weight – those born heavy grow faster. Currently in Counties Manukau 3 out of ten adults aged 15 to 20 years are obese! These young adults and children will be, or are, parents soon and the cycle will be repeated. Parents have limited choices as children and adults are dependent on where they live and what opportunities are really available. Free choice, the clarion call of right wing economists, is a myth.
Two out of three women giving birth at Middlemore are overweight or obese. It is the norm not the exception. Furthermore it is not just Counties Manukau. One in ten pregnant women in New Zealand today has diagnosed gestational diabetes – this is the tip of an iceberg of the effects of malnourishment and lack of physical fitness which can occur at any body size but is more likely if overweight. All these factors are associated with poorer outcomes and future prospects for the baby. The good news is that earlier-in-life change can make a real difference for the child. For the population small changes, for example in the food supply, would make a big difference. Investment in public and population measures including health is required to do this.
It is common knowledge that a “balanced” diet is essential for health but an analysis of the food supply in New Zealand shows that we fall far short of this goal. Calories are not a problem – we are soaking in them. The challenge, for civil society, governments and industry is to put whole foods and the more than 50 essential nutrients back into the food supply in adequate quantities. White foods such as rice, flour, sugar and alcoholic drinks should be reduced because they are nutrient-poor – by contrast an emphasis on whole foods should become the norm. We do produce enough whole food in New Zealand to feed more than 20 million people yet somehow it is not getting to where we, as a nation, would get the best return for our investment. We need to talk about nutrient security not food security, focussing on the nutrient quality and quantity of the food not the calories to nurture a healthy, productive, intelligent workforce and society and future-proof New Zealand.
In policy terms there have been several positive initiatives over recent years. The National Heart Foundation, funded by the Ministry of Health and mentored by AUT University offers a 9 day course; the Certificate in Pacific Nutrition. This has seen over the last ten years almost 1000 graduates who have gone back into their communities and made a difference. But the barriers of poverty, location and history cannot be overcome without whole-of-society action. A whole of region and school approach is Project Energize, delivered by Sport Waikato through primary schools to improve the nutrition and physical activity environment and effectiveness of teachers. Funded in the Waikato by the Waikato District Health Board at $2m a year to reach 44000 children and 244 schools now, thanks to Counties Manukau Sport and Northland District Health board it is reaching a further 13000 children in Franklin, Mangere and Northland.
But these are limited gains from the past six years which in policy terms has been an unmitigated disaster in addressing policy issues such as obesity – a triumph for ideology over ‘public’ policy. Soon after it was elected in 2008 the National Government cut funding for the Obesity Action Coalition, scrapped the roles of District Health Board staff who were significant in implementing healthy food and drink guidelines for schools, removed the reporting requirement for healthy food in schools, cut funding for the Ministry of Health’s Healthy Eating Action Programme and removed the mandate that local councils should implement plans to ensure their communities health and social wellbeing. The policy vacuum created by Government sitting on its hands has been accompanied by a massive expansion in obesity and obesity related diseases estimated to cost us in dollar terms more than $700 million a year in public expenditure.
As the most recent New Zealand Health Survey illustrates 1.2 million New Zealanders are now obese – 3 in every 10 adults and one in nine children. The same numbers are overweight making only one third of New Zealanders not overweight or obese. Health researchers have done their best over recent years to highlight the crisis faced by the country in addressing obesity including the promotion of action plans requiring the commitment of families, communities and government. Government could begin by admitting that its hands-off approach has failed. The cost of doing nothing is failing current and future generations.
“Many things we need can wait. The child cannot.”