OBESITY
Obesity and climate change mitigation in Australia: overview and analysis of policies with co-benefits Melanie Lowe1
O
besity is one of Australia’s greatest public health challenges. Australia is one of the heaviest nations, with more than 60% of adults and 25% of children being classified as overweight or obese, and close to two-thirds of the population predicted to be overweight or obese within the next decade.1 As a major risk factor for many chronic conditions, particularly cardiovascular disease and Type 2 diabetes, high body mass is the second highest cause of the disease burden in Australia.2 Obesity is inequitably distributed across the population, being more prevalent among people of lower socioeconomic status, Indigenous Australians and some ethnic groups.3 In economic terms, it was estimated that obesity cost Australian society and governments $58.2 billion in 2008.4 Thus, reducing obesity rates would have significant health and economic benefits. Despite the urgency of the problem, government responses continue to be piecemeal and slow, being largely limited to social marketing campaigns and local behaviour-changing programs. Climate change caused by anthropogenic greenhouse gas (GHG) emissions is predicted to be another defining global health challenge of the 21st century.5 In Australia, potential health effects include: increased deaths and illness from more frequent extreme weather events; an increase in allergenic pollens and air pollutants that cause respiratory illness; an increase in the range and seasonality of mosquito-borne infections; and shortages of fresh water and food.6-8 Disadvantaged groups are likely to be at higher risk of these health effects, leading to increased health inequalities.7 Thus, there are immediate health and environmental
Abstract Objective: To provide an overview of the shared structural causes of obesity and climate change, and analyse policies that could be implemented in Australia to both equitably reduce obesity rates and contribute to mitigating climate change. Methods: Informed by the political economy of health theoretical framework, a review was conducted of the literature on the shared causes of, and solutions to, obesity and climate change. Policies with potential co-benefits for climate change and obesity were then analysed based upon their feasibility and capacity to reduce greenhouse gas emissions and equitably reduce obesity rates in Australia. Results: Policies with potential co-benefits fit within three broad categories: those to replace car use with low-emissions, active modes of transport; those to improve diets and reduce emissions from the food system; and macro-level economic policies to reduce the overconsumption of food and fossil fuel energy. Conclusion: Given the complex causes of both problems, it is argued that a full spectrum of complementary strategies across different sectors should be utilised. Implications: Such an approach would have significant public health, social and environmental benefits. Key words: obesity, climate change, political economy of health, policy analysis, co-benefits imperatives to reduce global GHG emissions. As one of the world’s highest per capita emitters, Australia’s contribution to this effort has been particularly inadequate.9 While the strong emissions reduction targets of some local and state governments, and the 2012 carbon price legislation, are steps in the right direction, the Federal Government has only committed to a 5% emissions reduction on 2000 levels by 2020.10 There is a growing recognition in the literature that obesity and climate change are closely related issues, having some shared causes and solutions.3,5,11-26 However, as yet, there has been no thorough overview and analysis of policies with co-benefits for these two critical problems, and particularly not for the Australian context.
This article outlines the three main structural shared causes of obesity and climate change. It then explores a range of policy options that could be used in Australia to equitably reduce both obesity rates and GHG emissions.
Methods A literature search was undertaken to identify the shared causes of, and shared policy solutions to, obesity and climate change. Applicable literature was identified by searching electronic databases, search engines and library catalogues using appropriate synonyms and combinations of the terms ‘obesity’, ‘climate change’ and ‘greenhouse gas emissions’. All Englishlanguage literature that discussed shared
1. McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Victoria Correspondence to: Ms Melanie Lowe, McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, Level 5, 207 Bouverie St, University of Melbourne, Victoria 3010; e-mail: [email protected] Submitted: July 2013 Revision requested: July 2013 Accepted: August 2013 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 2014; 38:19-24; doi: 10.1111/1753-6405.12150
2014 vol. 38 no. 1
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
19
Lowe Article
causes and/or shared solutions was included as long as it was peer reviewed or reputable grey literature from research institutions, governments or non-government organisations. Searching continued until few new resources were being uncovered. Potential shared policy solutions were then analysed based on their feasibility and capacity to both reduce GHG emissions and equitably reduce obesity rates in Australia. This involved drawing on the broader literature on obesity and climate change mitigation that does not specifically discuss the links between the two problems. This paper is informed by the political economy of health perspective. Political economy of health is “a macroanalytic, critical, and historical perspective for analysing disease distribution… with particular emphasis on the effects of stratified social, political, and economic relations within the world economic system” (p.132).27 From this perspective, obesity and climate change are understood as inherently structural issues. It is emphasised that individuals’ unhealthy and GHG-emitting behaviours are not necessarily freely chosen, being instead shaped by the social, economic and political environment.28,29 In adopting this framework, this article focuses on policies that could alter social and economic structures in ways that make healthy and low GHG-emitting behaviour more possible, rather than strategies such as public education, which aim to change behaviour by improving awareness and attitudes.
Results Shared causes of obesity and climate change Car dependence Daily tasks involve a host of emissionsintensive, effort-saving devices that contribute to climate change, obesity and obesity-related diseases. Technologies such as computers, domestic labour-saving devices and television have become commonplace, and these replace human energy expenditure with fossil fuel energy, and/or take up time that could be spent more actively. The motor car is arguably the most obesogenic and polluting of these technologies.12,30 Australia is one of the most car-dependent nations in the world, with cars accounting for at least 70% of all trips to work and school.31-33 In contrast, only 5% of people in capital cities usually commute by bicycle or on foot and only 13% of Australians
20
use public transport as their main mode of transport.31 Car use contributes to obesity by reducing human energy expenditure.19,34,35 Driving is sedentary and displaces active transport modes such as walking, cycling or public transport (which usually involves physical activity to get to and from stations or stops).11,23,33,36,37 Because of this, each additional hour spent driving per day carries a 6% increased risk of becoming obese.38 Car traffic also contributes to obesity by generating parental concern about children’s safety, thus reducing children’s independent mobility and play outdoors.33 Simultaneously, GHG emissions from cars’ exhausts have been growing rapidly, and accounted for 8% of Australian emissions in 2008.39 Significant emissions are also generated by the fuel industry, vehicle manufacturing and road construction.40 Car dependence in Australia has been fostered by urban planning, transport and fiscal policies. Urban planning has allowed huge growth in low-density outer suburban sprawl, which promotes car dependence by making public transport less effective and placing distances between residences, shops, services and workplaces that are too far to walk or cycle easily.11,41,42 Car-centric infrastructure has also been prioritised over all other forms of transport infrastructure since the second half of last century.1,40 Despite a recent revival of government interest in improving public transport, governments continue to spend at least four times more on roads than rail.43 Indeed, a lack of public transport services at a convenient time, and long journey times are common reasons why people do not commute by public transport.31 Meanwhile, cycling and walking are discouraged by a lack of safe and convenient pedestrian and cycling routes, particularly in sprawling suburbs and rural areas.40 Driving is further encouraged by fiscal policies such as subsidies and tariff assistance to the automotive industry, providing fringe benefits tax for car use and having a low fuel excise, which makes petrol in Australia cheaper than in most developed countries.1,33
Australia’s food system Australia’s globalised food system is another major contributor to obesity and climate change. Increased national wealth has been accompanied by a shift over the past few decades from traditional diets high in grains, legumes and other sources of dietary fibre, to more energy-dense diets high in fats and sugars.21 This has raised overall energy intake,
contributing to population weight gain.44 Australian diets are among the unhealthiest in the world,45 with over-consumption of energy-dense and highly processed beverages and snack and fast foods.46 Increased consumption of animal products rich in saturated fat has also contributed to greater energy-density of diets.21,22,47 Dietary variation between different subgroups of the population helps to explain inequities in obesity distribution. For example, low-income Australians are more likely to consume energy-dense foods and eat smaller amounts of fruit and vegetables than people on higher incomes.1 Simultaneously, food is responsible for 26% of Australia’s GHG emissions.48 While all foods produced by the industrial food system entail some GHG emissions, the most fattening foods, such as highly processed foods and animal products, are among the most emissions-intensive.3 The agricultural sector accounts for 16% of net emissions in Australia, with livestock production generating 80% of agricultural emissions.21 Of animal products, red meat and dairy are the most GHG-intensive.18,49 Similarly, highly processed pre-prepared snack and fast foods require large amounts of fossil fuel energy during processing and packaging.12 Transportation is also a major contributor to the embodied emissions of many foods, particularly if they are air-freighted.49 The food environment is a key determinant of diets. The three largest supermarket chains now dominate Australia’s food system, accounting for 80% of fresh food and grocery sales.50 In addition, the proliferation of food service outlets has been matched by increases in eating out. While supermarkets and some restaurants are important sources of healthy food, a high percentage of the food in both sectors is highly processed and energy-dense.47 The location of food outlets is associated with the poorer diets of lower socioeconomic Australians. For instance, studies in Melbourne found that disadvantaged neighbourhoods have closer access to fast food, and poorer access to healthy food than higher income areas.50,51 Food prices may also make unhealthy, emissions-intensive foods more accessible, particularly for lower income households. Developments in food technology have made foods containing sugar, fats, refined grains and potatoes cheap sources of dietary energy compared to fruit and vegetables.52,53 Exposure to fast and ‘junk’ food advertising is also associated with increased consumption
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
Obesity
Obesity and climate change
of these foods.1,44,54 Australia largely relies on industry self-regulation of food marketing, resulting in high exposure to advertising of energy-dense foods, particularly on television.1 Many of these advertisements target children, who are more impressionable than adults.55
The global economic system Since World War II, economic growth has been pursued as the most important policy goal across the world.47,56 The rise of neoliberalism and free-market ideology since the 1980s has further intensified the emphasis on growth. Instead of the state ensuring social welfare through government provision of services, in deregulated markets, continuous growth is touted as the solution to all social problems through its ability to create employment and goods and services.57 Thus, economic growth measured in terms of gross domestic product (GDP) has become virtually synonymous with progress.58 However, GDP is a poor indicator of progress if progress is understood to mean an improvement in human wellbeing.14,58 While economic development is important for wellbeing in poor countries, continued economic growth in rich countries does not advance – and may even reduce – wellbeing.56,59 This is partly because GDP counts the economic value of all goods and services exchanged on the market, even if those items indicate the presence of problems, such as increased healthcare expenditure due to obesity.14,58 Moreover, equating economic growth with wellbeing ignores the fact that infinite growth is impossible on a planet with finite biophysical resources.56,58 Continued economic growth necessitates progressive increases in production and consumption, with new ways of promoting spending continuously being devised.14,57 Growth also contributes to consumer culture indirectly through increasing income inequality within society.56,59 In Australia and most other countries, growth has delivered its benefits asymmetrically, with the income gap between rich and poor widening since the 1980s.56,60 Australia is now one of the most stratified developed societies.61 High income inequality is thought to enhance social status competition, which increases the pressure to consume in order to prevent appearing inferior to others.59 As Figure 1 shows, the economic system primarily contributes to obesity and climate change by driving the ever-rising consumption of emissions-intensive, unhealthy food and technology.13,57
2014 vol. 38 no. 1
Furthermore, the imperative to increase industrial productivity by using labour-saving technologies displaces manual jobs resulting in reduced physical activity, heightened GHG emissions and increased unemployment, which contributes to income inequality.57,62 Economic growth thus becomes an even greater imperative to curb unemployment by creating new jobs for displaced workers.62 At the same time, in response to demands for increased productivity and consumption, Australians work some of the longest hours in the developed world.61,63 This contributes to consumption of unhealthy pre-prepared food and effort-saving technology as people attempt to compensate for time scarcity.63,64 The impact of economic growth on climate change also extends well beyond these factors, as the production and consumption of most goods and services produces some GHG emissions.
Shared policy solutions By targeting these shared causes, obesity, obesity-related chronic diseases and climate change can be tackled simultaneously.
Policies for replacing car use with active transport Widespread substitution of car use with active travel would significantly reduce GHG emissions, and rates of obesity and obesity diseases.11,22,25,34 For example, a US related study calculated that replacing short car trips with walking or cycling could almost eliminate obesity in the absence of dietary change and significantly reduce US GHG emissions.34 Making cars a less attractive transport option would stimulate a shift towards active
transport. One option is to increase the cost of car use.22,35,65,66 Ways to do this include raising the fuel excise,66 increasing parking and car registration fees, and introducing congestion charges such as those levied in London and Stockholm, which have substantially reduced car traffic and increased cycling.22,35,67 However, as transport can be fairly price insensitive, pricing policies should not be relied on as the sole mechanism for deterring people from driving.68 Other possibilities include reducing car parking spaces, lowering speed limits and closing some roads to cars.22,25,35,65 However, making driving more difficult without providing transport alternatives would exacerbate inequities in accessing jobs and essential services.69 Therefore, it is imperative that car use deterrents are accompanied by policies that make active transport more convenient.37,69 Efficient, accessible and affordable public transport can encourage active travel, thereby reducing obesity and GHG emissions. For example, six to eight months after the introduction of a light rail service in Charlotte, North Carolina, people using the service to commute to work had an 18% reduction in their BMI and significantly reduced odds of becoming obese.70 Another study found that having public transport nearby increases walking energy expenditure and decreases motorised energy expenditure.15 Wellpatronised public transport uses only a small fraction of the fossil-fuel energy required to move people in cars.71 As there is great diversity in Australian settlement patterns, the most appropriate types of public transport (bus, train, tram or ferry) should be assessed on a local basis. Larger government subsidies for public transport would also promote
Figure 1: Schematic representation of the global economy’s contribution to obesity and climate change. Economic growth (↑ GDP)
Neo‐liberalism and free‐market ideology
↑ income inequality
↑ social status competition/ chronic stress
↑ production and consumption of material goods ↑ availability and over‐ consumption of energy‐dense emissions‐ intensive foods
↑ unemployment
Manual labour replaced by labour‐saving technologies
GHG emissions
CLIMATE CHANGE ↑ working hours
High consumption of emissions‐ intensive labour‐ saving technology for personal use
Inequitable distribution of risk factors
↓ physical activity
OBESITY
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
21
Lowe Article
increased patronage of services, and improve equity of access.65 Strategies that would make public transport journeys faster and more convenient include increasing the speed and frequency of services, and integrating different services to create a seamless network.30,72 Effective public transport should be accompanied by policies that improve bicycle and pedestrian infrastructure. Through significant investment in cycling, countries such as Denmark and the Netherlands have achieved cycling rates more than 10 times higher than Australia.73 Along with traffic calming measures, cities in these countries have extensive networks of bike lanes and paths, widespread intersection modifications and priority signals, abundant bike parking, and co-ordination of cycling routes with public transport.73 Tax incentives and showering facilities in workplaces could also encourage cycling to work.12,67 Infrastructure that encourages walking for transport includes well-designed, continuous networks of pavements and walking trails, with safe and convenient pedestrian crossings.67,68 Land-use planning is integral to promoting active transport. In particular, higher residential density and greater land use mix increases cycling and walking for transport, by creating shorter distances between residences, workplaces and services.11,15,74-76 There is also evidence that compact cities encourage public transport use.11,26,41 Certainly, density and mixed land use play a significant role in the higher rates of active transport in the inner-city compared with the outer suburbs of Australian cities.75 Land-use planning in existing and proposed outer suburban developments needs to be radically rethought in order to make them more conducive to healthy and environmentally sustainable transport.
Policies for improving diets and reducing emissions from the food system Reducing exposure to marketing of unhealthy, highly processed foods and beverages could reduce consumption of these foods, thus lowering GHG emissions and rates of obesity and obesity-related diseases.14 Most of the policy proposals in this area aim to reduce children’s exposure to television marketing. For example, it has been recommended that advertising of highly processed energy-dense foods be banned during children’s viewing times.1 While the effect of such bans in countries like Sweden and Norway remains unclear,77 a
22
range of other research supports prohibition. For instance, an Australian study found that removing such advertising from children’s viewing times would significantly reduce unhealthy food consumption, lower childhood obesity rates and save public money.44 Despite strong public support, a bill to restrict junk food advertising to children was recently voted down in the Australian Senate.78 Alternatives that may face less opposition include taxing advertising at a high rate, restricting the number of television advertisements targeting children, or regulating against certain persuasive marketing techniques such as the use of cartoon characters.1,77 However, these approaches are unlikely to be as effective as full prohibition. Food taxes and/or subsidies could also have co-benefits.1 As consumers are responsive to food prices, introducing subsidies on healthy, low-emissions foods may encourage people to eat more of these foods and less unhealthy food.12,79 The alternative is to raise the price of energy-dense, emissions-intensive foods by placing new taxes on them.12 International examples include taxes on soft drinks in some US states, and on pre-packaged foods high in fat and sugar in Hungary.1,80 An important strength of such taxation is the potential to raise substantial revenue that could be used for other obesity and climate change prevention programs.12,22 However, as taxation could increase food insecurity for lower income Australians, it should be used in combination with subsidies and/or other policies to improve access to healthy food.1 Increasing urban agriculture could yield cobenefits for obesity and climate change.14,81 Community gardens can increase fruit and vegetable consumption among gardeners and create opportunities for physical activity.81 Assuming that consumption of energy-dense emissions-intensive foods is reduced as a result, making community gardens a standard urban feature could reduce obesity and GHG emissions. Furthermore, local food production in community gardens could reduce GHG emissions from food transport, retailing and packaging. Preferentially implementing these policies in disadvantaged areas with poorer access to healthy foods could contribute to reducing obesity inequities.50 Agricultural reserves should be created to halt the encroachment of suburbia into prime agricultural land close to urban areas. The food retail environment could also be improved. Policy options include restricting the density of fast food outlets and using
land-use policies and incentives to attract healthy food businesses to low-income areas.47 Locational access to food markets could be improved, as this can increase fruit and vegetable intake.82 In the US, farmers’ market voucher programs have also increased fruit and vegetable consumption among low-income recipients.82 Buying direct from producers at local farmers’ markets has the additional benefit of reducing emissions from food transport. A new food labelling system could be introduced. In Australia, there is growing interest in implementing a star-rating system on the front of packaging to facilitate healthy food choices.83 It has also been suggested that labelling food products based on their embodied GHG emissions could assist consumers to make environmentally friendly food choices.84,85 Labelling food with both health and environmental impacts would enable consumers to consider both of these factors when making purchasing decisions. However, as labelling largely relies on selfmotivated behaviour change, it should be used in conjunction with more structural changes to reduce consumption of unhealthy, high-emissions foods.3 Reducing the production and consumption of meat and dairy products would greatly reduce GHG emissions and rates of obesity and associated diseases.3,21,49 Vegetarian or vegan diets may have the greatest potential to produce co-benefits, but aiming for everyone to embrace these is unrealistic. Even reducing adults’ daily average meat consumption from 250 grams to 90 grams would have significant co-benefits.21 Although ways to achieve this dietary change remain largely untested, potential options include taxing and labelling meat and dairy foods as described above, or increasing the cost of animal products by including agricultural emissions in a GHG tax or emissions trading scheme. As discussed in the next section, agricultural emissions are excluded from Australia’s current carbon price.10 Legislation and policies to encourage breastfeeding of infants would also have co-benefits, as exclusive breastfeeding for the first six months can protect against childhood obesity, while reducing consumption of dairy in infant formula.12
Macro-level economic policies to reduce emissions and obesity rates There are a number of ways to slow the treadmill of production and consumption that contributes to obesity and climate change. A positive first step would be for
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
Obesity
Obesity and climate change
governments in Australia to de-emphasise economic growth as a policy objective. Alternatives to GDP as a measure of progress should be considered, such as a wellbeing index or gross domestic happiness.13 Reducing income inequality could ease the social status competition that contributes to unhealthy and environmentally destructive consumerism.59 While narrowing the gap between rich and poor would lower obesity rates across all social strata, it could also reduce the social gradient of obesity distribution, and lower discrepancies in the ability to adapt to climate change.59 Income inequality could be reduced before and/or after taxation. In order to tackle the soaring pay rates of the highest income earners,61 governments could legislate a ceiling on pay rates, or limit pay to a maximum of some multiple of the average or lowest paid workers in a particular company. Another before-tax approach would be to increase the minimum wage. Japan is an example of a country that has achieved high income equality through these types of measures.59 Options to reduce income inequality through taxation and benefits include plugging tax loopholes and collecting inheritance taxes from the very wealthy, introducing more progressive taxation rates, and increasing welfare payments and benefits. Sweden is an example of a country that has a high degree of equality because of redistributive taxes and benefits.59 As Australia has historically relied upon taxation and benefits for redistribution of wealth, these types of policies may be the most feasible. However, using taxation in combination with before-tax policies is likely to be most effective. Labour market reforms could also lower obesity rates and GHG emissions. One option is to shift employment towards sectors that are less resource- and emissions-intensive, and more labour-intensive.86 Examples include non-industrial agriculture, recycling and renewable energy, running public transport services instead of cars, and selling ‘energy services’ rather than energy supplies.56 With more labour inputs required, increased investment in these sectors could raise employment levels, thereby reducing income inequality. In addition, some of these jobs (such as gardening and installing solar panels) involve more physically active labour, with benefits for reducing obesity rates. A second potential labour market reform is to reduce working hours. This could reduce unemployment and under-employment by sharing the available work more equally, thus
2014 vol. 38 no. 1
decreasing income inequality.56,62 Reducing working hours is also the most cited way of reducing the pressure for growth as a means of job creation.56,57,86 Furthermore, having more free time would allow people to engage in more healthy and environmentally friendly activities, such as growing fresh food, and cycling instead of driving.63,64 Australia could aim for a return to the 40-hour week, or follow the example of countries like France that have a 35-hour working week.64 While enforcing these shorter hours may be problematic, strategies such as increasing the minimum wage and providing more opportunities for job-sharing would enable people to work shorter hours. Pricing or trading GHG emissions could also yield co-benefits for obesity and climate change. Options include taxing GHG emissions at the site of production,18,61 or corporate emissions trading schemes.68 Theoretically, a tax or trading scheme could have co-benefits by increasing the price of unhealthy and emissions-intensive foods and technologies, and providing incentives for renewable energy use and more energy-efficient production.13,14 In 2012, the Federal Government introduced a fixed carbon price (initially set at $23 per tonne),10 with recent plans to transition to a carbon trading scheme linked to the European Union scheme in 2014.87 With more than 50% of the revenue being redistributed to compensate low income earners, the carbon tax may help to reduce income inequalities in Australia. However, while Australia’s carbon price will reduce emissions from the wider economy to some degree, it is unlikely to have much impact on obesity rates. This is because emissions from household transport, agriculture and food are excluded from Australia’s carbon price.10 Personal emissions trading could also have co-benefits. This involves allocating a number of tradeable emissions units to all individuals, who then use these when purchasing emissions-intensive products.13,14 Any leftover units can be sold to people who require more. This provides a financial incentive for people to increase their energy expenditure and decrease consumption, and may redistribute wealth from rich high-consumers, to poorer low-consumers.13,14 The world’s first personal emissions trading scheme is being trialled on Norfolk Island in Australia.88
Conclusion Based on the literature, this paper has explored how car dependence, the food system and the global economy contribute
to both obesity and GHG emissions in Australia. It also considered possibilities for affecting transformative structural changes to address these issues simultaneously. Given the complex causes of both problems, implementing any single policy, or tackling just one shared cause, is unlikely to deliver sufficient change. Instead, a full spectrum of complementary policies across multiple sectors is required to achieve widespread and equitable improvements across the transport, food and economic systems. In particular, macro-level economic policies and more sector-specific transport and food policies could support and complement each other. Such an approach would have benefits for the environment, as well as the two greatest health threats facing Australia.
Acknowledgements The author thanks her supervisor, Hans Baer, for providing direction on this manuscript, and is grateful to Billie Giles-Corti, Peter Ferguson and Lorna Atkinson for their comments on drafts of this article.
References 1. National Preventative Health Taskforce. Australia: The Healthiest Country by 2020, National Preventative Health Strategy – A Roadmap for Action. Canberra (AUST): Commonwealth Department of Health and Ageing, Population Health Strategy Unit; 2009. 2. Institute for Health Metrics and Evaluation. GBD Profile: Australia. Seattle (WA): IHME; 2013. 3. Friel S, Dangour A, Garnett T, Lock K, Chalabi Z, Roberts I, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: Food and agriculture. Lancet. 2009;374(9706):2016-25. 4. Access Economics. The Growing Cost of Obesity in 2008: Three Years On. Canberra (AUST): Diabetes Australia; 2008. 5. Costello A, Abbas M, Allen A, Ball S, Bellamy R, et al. Managing the health effects of climate change. Lancet. 2009;373:1693-733. 6. Hennessy K, Fitzharris B, Bates B, Havey N, Howden S, Hughes L, et al. Australia and New Zealand. In: Parry M, Canziani O, Palutikof J, van der Linden P, Hanson C, editors. Climate Change 2007: Impacts, Adaptation and Vulnerability Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge (UK): Cambridge University Press; 2007. 7. McMichael A, Woodruff R, Whetton P, Hennessy K, Nicholls N, Hales S, et al. Human Health and Climate Change in Oceania: A Risk Assessment 2002. Canberra (AUST): Commonwealth Department of Health; 2003. 8. Woodruff R, Hales S, Butler C, McMichael A. Climate Change Health Impacts on Australia: Effects of Dramatic CO2 Emission Reductions. Canberra (AUST): Australian Conservation Foundation and the Australian Medical Association; 2005. 9. Styles J. Climate Change: The Case for Action. Canberra (AUST): Commonwealth Parliamentary Library; 2009 [cited 2010 Nov 25]. Available from: http://www.aph.gov. au/About_Parliament/Parliamentary_Departments/ Parliamentary_Library/pubs/rp/rp0809/09rp28 10. Wiseman J, Edwards T. Post-carbon Pathways: Reviewing Post Carbon Economy Transition Strategies. CPD Occasional Paper No.: 17. Sydney (AUST): Centre for Policy and Development; 2012. 11. Bloomberg M, Aggarwala R. Think local, act global: How curbing global warming emissions can improve local public health. Am J Prev Med. 2008;35(5):414-23.
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
23
Lowe Article
12. Delpeuch F, Maire B, Monnier E, Holdsworth M. Globesity: A planet out of control? London (UK): Earthscan; 2009. 13. Egger G. Health,“illth”, and economic growth: Medicine, environment, and economics at the crossroads. Am J Prev Med. 2009;39(1):78-83. 14. Egger G, Swinburn B. Planet Obesity: How We’re Eating Ourselves and the Planet to Death. Crows Nest (AUST): Allen and Unwin; 2010. 15. Frank L, Greenwald M, Winkelman S, Chapman J, Kavage S. Carbonless footprints: Promoting health and climate stabilization through active transportation. Prev Med. 2010;50:S99-S105. 16. Friel S, Bowen K, Campbell-Lendrum D, Frumkin H, McMichael A, Rasanathan K. Climate change, noncommunicable diseases, and development: The relationships and common policy opportunities. Annu Rev Public Health. 2011;32:133-47. 17. Haines A, Dora C. How the low carbon economy can improve health. Br Med J. 2012;344:e1018. 18. Haines A, Smith K, Anderson D, Epstein P, McMichael A, Roberts I, et al. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change. Lancet. 2007;370:1264-81. 19. Higgins P, Higgins M. A healthy reduction in oil consumption and carbon emissions. Energy Policy. 2005;33:1-4. 20. Macdiarmid J, Kyle J, Horgan G, Loe J, Fyfe C, Johnstone A, et al. Sustaining diets for the future: Can we contribute to reducing greenhouse gas emissions by eating a healthy diet? Am J Clin Nutr. 2012;96:632-9. 21. McMichael A, Powles J, Butler C, Uauy B. Food, livestock production, energy, climate change, and health. Lancet. 2007;370:1253-63. 22. Michaelowa A, Dransfeld B. Greenhouse gas benefits of fighting obesity. Ecol Econ. 2008;66:298-308. 23. Morabia A, Costanza M. It takes a train to knock down global warming and obesity. Prev Med. 2010;51:449-50. 24. Roberts I, Edwards P. The Energy Glut: Climate Change and the Politics of Fatness. London (UK): Zed Books; 2010. 25. Woodcock J, Edwards P, Tonne C, Armstrong B, Ashiru O, Banister D, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: Urban land transport. Lancet. 2009;374:1930-43. 26. Younger A, Morrow-Almeida H, Vindigni S, Dannenberg A. The built environment, climate change, and health: Opportunities for co-benefits. Am J Prev Med. 2008;35(5):517-26. 27. Morgan L. Dependency theory in the political economy of health: An anthropological critique. Med Anthropol Q. 1987;1(2):131-54. 28. McDonnell O, Lohan M, Hyde A, Porter S. Political economy theory, health and healthcare. In: Social Theory, Health and Healthcare. Basingstoke (UK): Palgrave Macmillan; 2009. p. 36-62. 29. Minkler M, Wallace S, McDonald M. The political economy of health: A useful theoretical tool for health education practice. Int Q Community Health Educ. 1995;15(2):111-25. 30. Mees P. Public transport policy in Australia: A density delusion? Dissent. 2010;32:45-9. 31. Australian Bureau of Statistics. 4102.0 - Australian Social Trends, 2008: Public Transport Use for Work and Study. Canberra (AUST): ABS; 2008. 32. Davison G. Car Wars: How the Car Won Our Hearts and Conquered Our Cities. Crows Nest (AUST): Allen and Unwin; 2004. 33. Hinde S, Dixon J. Changing the obesogenic environment: Insights from a cultural economy of car reliance. Transp Res Part D Transp Environ. 2005;10:31-53. 34. Higgins P. Exercise-based transportation reduces oil dependence, carbon emissions and obesity. Environ Conserv. 2005;32(3):197-202. 35. Maibach E, Steg L, Anable J. Promoting physical activity and reducing climate change: Opportunities to replace short car trips with active transport. Prev Med. 2009;49:326-7. 36. Davis A, Valsecchi C, Fergusson M. Unfit for Purpose: How Car Use Fuels Climate Change and Obesity. London (UK): Institute for European Environmental Policy; 2007. 37. Woodcock J, Banister D, Edwards P, Prentice A, Roberts I. Energy and transport. Lancet. 2007;370:1078-88. 38. Frank L, Andresen M, Schmid T. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 2004;27(2):87-96.
24
39. Department of Climate Change and Energy Efficiency. National Greenhouse Gas Inventory: Accounting for the Kyoto Target May 2010. Canberra (AUST): Commonwealth of Australia; 2010. 40. Paterson M. Car culture and global environmental politics. Rev Int Stud. 2000;26:253-70. 41. Giles-Cort B, Ryan K, Foster S. Increasing Density in Australia: Maximising the Benefits and Minimising the Harm. Melbourne (AUST): National Heart Foundation of Australia; 2012. 42. Luk J. Reducing car travel in Australian cities: Review report. J Urban Plan Dev. 2003;129(2):84-96. 43. Australian Conservation Foundation. Australia’s Public Transport: Investment for a Clean Transport Future. Carlton (AUST): ACF; 2011. 44. Magnus A, Haby M, Carter R, Swinburn B. The costeffectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children. Int J Obes. 2009;33:1094-102. 45. Bradbury K. Australian diet ‘worse than American'. ABC News. 2010 March 22 46. Rangan A, Kwan J, Flood V, Louie J, Gill T. Changes in ‘extra’ food intake among Australian children between 1995 and 2007. Obes Res Clin Pract. 2011;5:e55-e63. 47. Friel S, Marmot M, McMichael A, Kjellstrom T, Vagero D. Global health equity and climate stabilization: A common agenda. Lancet. 2008;372:1677-83. 48. Australian Conservation Foundation. Consumption Atlas. Carlton (AUST): ACF; 2013 [cited 2013 May 18]. Available from: http://www.acfonline.org.au/ consumptionatlas/ 49. Carlsson-Kanyama A, Gonzalez A. Potential contributions of food consumption patterns to climate change. Am J Clin Nutr. 2009;889:1704S-9S. 50. Burns C, Inglis A. Measuring food access in Melbourne: Access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne. Health Place. 2007;13:877-85. 51. Reidpath D, Burns C, Garrard J, Mahoney M, Townsend M. An ecological study of the relationship between social and environmental determinants of obesity. Health Place. 2002;8:141-5. 52. Burns C. A Review of the Literature Describing the Link between Poverty, Food Insecurity and Obesity with Specific Reference to Australia. Melbourne (AUST): VicHealth Physical Activity Unit; 2004. 53. Drewnowski A, Darmon N. The economics of obesity: Dietary energy density and energy cost. Am J Clin Nutr. 2005;82:265S-273S. 54. Lobstein T, Dibb S. Evidence of a possible link between obesogenic food advertising and child overweight. Obes Rev. 2005;6:203-8. 55. Strasburger V. Children, adolescents and the media. Curr Probl Pediatr Adolesc Health Care. 2004;34:54-113. 56. Jackson T. Prosperity without Growth: Economics for a Finite Planet. London (UK): Earthscan; 2009. 57. Homer-Dixon T. The Upside of Down: Catastrophe, Creativity, and the Renewal of Civilization. Washington (DC): Island Press; 2006. 58. Victor P. Managing without Growth: Slower by Design, Not Disaster. Cheltenham (UK): Edward Elgar Publishing; 2008. 59. Wilkinson R, Pickett K. The Spirit Level: Why More Equal Societies Almost Always Do Better. London (UK): Penguin Books; 2009. 60. Saunders P. Examining Recent Changes in Income Distribution in Australia. Sydney (AUST): University of New South Wales Social Policy Research Centre; 2003. 61. Baer H. Towards democratic eco-socialism in Australia as part of a global climate change mitigation strategy: A utopian vision. Proceedings of the Fourth Australian Conference on Utopia, Dystopia and Science Fiction; 2010 Oct 29; Monash University, Melbourne, Australia. 62. Schor J. Plentitude: The New Economics of True Wealth. Carlton North (AUST): Scribe Publications; 2010. 63. Hayden A, Shandra J. Hours of work and the ecological footprint of nations: An exploratory analysis. Local Environ. 2009;14(6):575-600. 64. Martin R. The role of law in the control of obesity in England: Looking at the contribution of law to a healthy food culture. Aust N Z Health Policy. 2008;5:21. 65. Buehler R. Determinants of automobile use: Comparison of Germany and the United States. Transportation Res Rec. 2009;2139:161-71.
66. Hensher D. The imbalance between car and public transport use in urban Australia: Why does it exist? Transp Policy. 1998;5:193-204. 67. National Public Health Partnership. Promoting Active Transport: An Intervention Portfolio to Increase Physical Activity as a Means of Transport. Melbourne (AUST): National Public Health Partnership; 2001. 68. Carter N. The Politics of the Environment: Ideas, Activism, Policy. Cambridge (UK): Cambridge University Press; 2001. 69. Rissel C. Active travel: A climate change mitigation strategy with co-benefits for health. NSW Public Health Bull. 2009;20(1-2):10-3. 70. MacDonald J, Stokes R, Cohen D, Kofner A, Ridgeway G. The effect of light rail transit on body mass index and physical activity. Am J Prev Med. 2010;39(2):105-12. 71. Public Transport Users Association. Common Urban Myths about Transport - Myth: Public Transport doesn’t Really Save Energy. Melbourne (AUST): PTUA; 2009 [cited 2011 May 29]. Available from: http://www.ptua. org.au/myths/energy.shtml 72. Public Transport Users Association. What Makes Public Transport Work? Melbourne (AUST): PTUA; 2010 [cited 2011 May 12]. Available from: http://www.ptthatworks. org.au/pillars.html 73. Pucher J, Buehler R. Making cycling irresistible: Lessons from The Netherlands, Denmark and Germany. Transport Rev. 2008;28(4):495-528. 74. McCormack G, Giles-Corti B, Balsara M. The relationship between destination proximity, destination mix and physical activity behaviors. Prev Med. 2008;46(1):33-40. 75. Pucher J, Garrard J, Greaves S. Cycling down under: A comparative analysis of bicycling trends and policies in Sydney and Melbourne. J Transp Geogr. 2011;19:332-45. 76. Saelens B, Handy S. Built environment correlates of walking: A review. Med Sci Sports Exerc. 2008;40 Suppl 7:S550-66. 77. Caraher M, Landon J, Dalmeny K. Television advertising and children: Lessons from policy development. Public Health Nutr. 2006;9(5):596-605. 78. Public Health Association of Australia. Restrictions on Junk Food Advertising to Kiddies – Senate Wrong [Media Release]. Canberra (AUST): PHAA; 2011 March 4. 79. Powell L, Chaloupka F. Food prices and obesity: Evidence and policy implications for taxation and subsidies. Millbank Q. 2009;87(1):229-57. 80. Holt E. Hungary to introduce broad range of fat taxes. Lancet. 2011;378(9793):755. 81. Dixon J, Donati K, Pike L, Hattersley L. Functional foods and urban agriculture: Two responses to climate change-related food security. NSW Public Health Bull. 2009;20(1-2):14-8. 82. Pearson A, Wilson N. Optimising locational access of deprived populations to farmers’ markets at a national scale: One route to improved fruit and vegetable consumption? PeerJ. 2013;1(e94). 83. Plibersek T, Neumann S. Star Rating System for Packaged Foods [Joint Media Release]. Canberra (AUST): Commonwealth Department of Health; 2013 June 14. 84. Olofsdotter M, Juul J, editors. Climate Change and the Food Industry. Climate Labelling for Food Products: Potential and Limitations: Oersund (SWE): Oresund Food Network and Oresund Environment Academy; 2008. 85. Shwom R, Lorenzen J. Changing household consumption to address climate change: Social scientific insights and challenges. WIREs Clim Change. 2012;3:379-95. 86. Jackson T, Victor P. Productivity and work in the ‘green economy’: Some theoretical reflections and empirical tests. Environ Innov Soc Transit. 2011;1:101-8. 87. Clean Energy Regulator. Starting Emissions Trading on 1 July 2014: Policy Summary. Canberra (AUST): Commonwealth of Australia; 2013. 88. Norfolk Island Carbon/Health Evaluation. The Norfolk Island Carbon/Health Evaluation Study. Norfolk Island (AUST); NICHE; 2011 [cited 2013 Aug 19]. Available from: http://www.norfolkislandcarbonhealthevaluation.com/
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
Obesity and climate change mitigation in Australia: overview and analysis of policies with co-benefits Melanie Lowe1
O
besity is one of Australia’s greatest public health challenges. Australia is one of the heaviest nations, with more than 60% of adults and 25% of children being classified as overweight or obese, and close to two-thirds of the population predicted to be overweight or obese within the next decade.1 As a major risk factor for many chronic conditions, particularly cardiovascular disease and Type 2 diabetes, high body mass is the second highest cause of the disease burden in Australia.2 Obesity is inequitably distributed across the population, being more prevalent among people of lower socioeconomic status, Indigenous Australians and some ethnic groups.3 In economic terms, it was estimated that obesity cost Australian society and governments $58.2 billion in 2008.4 Thus, reducing obesity rates would have significant health and economic benefits. Despite the urgency of the problem, government responses continue to be piecemeal and slow, being largely limited to social marketing campaigns and local behaviour-changing programs. Climate change caused by anthropogenic greenhouse gas (GHG) emissions is predicted to be another defining global health challenge of the 21st century.5 In Australia, potential health effects include: increased deaths and illness from more frequent extreme weather events; an increase in allergenic pollens and air pollutants that cause respiratory illness; an increase in the range and seasonality of mosquito-borne infections; and shortages of fresh water and food.6-8 Disadvantaged groups are likely to be at higher risk of these health effects, leading to increased health inequalities.7 Thus, there are immediate health and environmental
Abstract Objective: To provide an overview of the shared structural causes of obesity and climate change, and analyse policies that could be implemented in Australia to both equitably reduce obesity rates and contribute to mitigating climate change. Methods: Informed by the political economy of health theoretical framework, a review was conducted of the literature on the shared causes of, and solutions to, obesity and climate change. Policies with potential co-benefits for climate change and obesity were then analysed based upon their feasibility and capacity to reduce greenhouse gas emissions and equitably reduce obesity rates in Australia. Results: Policies with potential co-benefits fit within three broad categories: those to replace car use with low-emissions, active modes of transport; those to improve diets and reduce emissions from the food system; and macro-level economic policies to reduce the overconsumption of food and fossil fuel energy. Conclusion: Given the complex causes of both problems, it is argued that a full spectrum of complementary strategies across different sectors should be utilised. Implications: Such an approach would have significant public health, social and environmental benefits. Key words: obesity, climate change, political economy of health, policy analysis, co-benefits imperatives to reduce global GHG emissions. As one of the world’s highest per capita emitters, Australia’s contribution to this effort has been particularly inadequate.9 While the strong emissions reduction targets of some local and state governments, and the 2012 carbon price legislation, are steps in the right direction, the Federal Government has only committed to a 5% emissions reduction on 2000 levels by 2020.10 There is a growing recognition in the literature that obesity and climate change are closely related issues, having some shared causes and solutions.3,5,11-26 However, as yet, there has been no thorough overview and analysis of policies with co-benefits for these two critical problems, and particularly not for the Australian context.
This article outlines the three main structural shared causes of obesity and climate change. It then explores a range of policy options that could be used in Australia to equitably reduce both obesity rates and GHG emissions.
Methods A literature search was undertaken to identify the shared causes of, and shared policy solutions to, obesity and climate change. Applicable literature was identified by searching electronic databases, search engines and library catalogues using appropriate synonyms and combinations of the terms ‘obesity’, ‘climate change’ and ‘greenhouse gas emissions’. All Englishlanguage literature that discussed shared
1. McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, University of Melbourne, Victoria Correspondence to: Ms Melanie Lowe, McCaughey VicHealth Centre for Community Wellbeing, School of Population and Global Health, Level 5, 207 Bouverie St, University of Melbourne, Victoria 3010; e-mail: [email protected] Submitted: July 2013 Revision requested: July 2013 Accepted: August 2013 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 2014; 38:19-24; doi: 10.1111/1753-6405.12150
2014 vol. 38 no. 1
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
19
Lowe Article
causes and/or shared solutions was included as long as it was peer reviewed or reputable grey literature from research institutions, governments or non-government organisations. Searching continued until few new resources were being uncovered. Potential shared policy solutions were then analysed based on their feasibility and capacity to both reduce GHG emissions and equitably reduce obesity rates in Australia. This involved drawing on the broader literature on obesity and climate change mitigation that does not specifically discuss the links between the two problems. This paper is informed by the political economy of health perspective. Political economy of health is “a macroanalytic, critical, and historical perspective for analysing disease distribution… with particular emphasis on the effects of stratified social, political, and economic relations within the world economic system” (p.132).27 From this perspective, obesity and climate change are understood as inherently structural issues. It is emphasised that individuals’ unhealthy and GHG-emitting behaviours are not necessarily freely chosen, being instead shaped by the social, economic and political environment.28,29 In adopting this framework, this article focuses on policies that could alter social and economic structures in ways that make healthy and low GHG-emitting behaviour more possible, rather than strategies such as public education, which aim to change behaviour by improving awareness and attitudes.
Results Shared causes of obesity and climate change Car dependence Daily tasks involve a host of emissionsintensive, effort-saving devices that contribute to climate change, obesity and obesity-related diseases. Technologies such as computers, domestic labour-saving devices and television have become commonplace, and these replace human energy expenditure with fossil fuel energy, and/or take up time that could be spent more actively. The motor car is arguably the most obesogenic and polluting of these technologies.12,30 Australia is one of the most car-dependent nations in the world, with cars accounting for at least 70% of all trips to work and school.31-33 In contrast, only 5% of people in capital cities usually commute by bicycle or on foot and only 13% of Australians
20
use public transport as their main mode of transport.31 Car use contributes to obesity by reducing human energy expenditure.19,34,35 Driving is sedentary and displaces active transport modes such as walking, cycling or public transport (which usually involves physical activity to get to and from stations or stops).11,23,33,36,37 Because of this, each additional hour spent driving per day carries a 6% increased risk of becoming obese.38 Car traffic also contributes to obesity by generating parental concern about children’s safety, thus reducing children’s independent mobility and play outdoors.33 Simultaneously, GHG emissions from cars’ exhausts have been growing rapidly, and accounted for 8% of Australian emissions in 2008.39 Significant emissions are also generated by the fuel industry, vehicle manufacturing and road construction.40 Car dependence in Australia has been fostered by urban planning, transport and fiscal policies. Urban planning has allowed huge growth in low-density outer suburban sprawl, which promotes car dependence by making public transport less effective and placing distances between residences, shops, services and workplaces that are too far to walk or cycle easily.11,41,42 Car-centric infrastructure has also been prioritised over all other forms of transport infrastructure since the second half of last century.1,40 Despite a recent revival of government interest in improving public transport, governments continue to spend at least four times more on roads than rail.43 Indeed, a lack of public transport services at a convenient time, and long journey times are common reasons why people do not commute by public transport.31 Meanwhile, cycling and walking are discouraged by a lack of safe and convenient pedestrian and cycling routes, particularly in sprawling suburbs and rural areas.40 Driving is further encouraged by fiscal policies such as subsidies and tariff assistance to the automotive industry, providing fringe benefits tax for car use and having a low fuel excise, which makes petrol in Australia cheaper than in most developed countries.1,33
Australia’s food system Australia’s globalised food system is another major contributor to obesity and climate change. Increased national wealth has been accompanied by a shift over the past few decades from traditional diets high in grains, legumes and other sources of dietary fibre, to more energy-dense diets high in fats and sugars.21 This has raised overall energy intake,
contributing to population weight gain.44 Australian diets are among the unhealthiest in the world,45 with over-consumption of energy-dense and highly processed beverages and snack and fast foods.46 Increased consumption of animal products rich in saturated fat has also contributed to greater energy-density of diets.21,22,47 Dietary variation between different subgroups of the population helps to explain inequities in obesity distribution. For example, low-income Australians are more likely to consume energy-dense foods and eat smaller amounts of fruit and vegetables than people on higher incomes.1 Simultaneously, food is responsible for 26% of Australia’s GHG emissions.48 While all foods produced by the industrial food system entail some GHG emissions, the most fattening foods, such as highly processed foods and animal products, are among the most emissions-intensive.3 The agricultural sector accounts for 16% of net emissions in Australia, with livestock production generating 80% of agricultural emissions.21 Of animal products, red meat and dairy are the most GHG-intensive.18,49 Similarly, highly processed pre-prepared snack and fast foods require large amounts of fossil fuel energy during processing and packaging.12 Transportation is also a major contributor to the embodied emissions of many foods, particularly if they are air-freighted.49 The food environment is a key determinant of diets. The three largest supermarket chains now dominate Australia’s food system, accounting for 80% of fresh food and grocery sales.50 In addition, the proliferation of food service outlets has been matched by increases in eating out. While supermarkets and some restaurants are important sources of healthy food, a high percentage of the food in both sectors is highly processed and energy-dense.47 The location of food outlets is associated with the poorer diets of lower socioeconomic Australians. For instance, studies in Melbourne found that disadvantaged neighbourhoods have closer access to fast food, and poorer access to healthy food than higher income areas.50,51 Food prices may also make unhealthy, emissions-intensive foods more accessible, particularly for lower income households. Developments in food technology have made foods containing sugar, fats, refined grains and potatoes cheap sources of dietary energy compared to fruit and vegetables.52,53 Exposure to fast and ‘junk’ food advertising is also associated with increased consumption
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
Obesity
Obesity and climate change
of these foods.1,44,54 Australia largely relies on industry self-regulation of food marketing, resulting in high exposure to advertising of energy-dense foods, particularly on television.1 Many of these advertisements target children, who are more impressionable than adults.55
The global economic system Since World War II, economic growth has been pursued as the most important policy goal across the world.47,56 The rise of neoliberalism and free-market ideology since the 1980s has further intensified the emphasis on growth. Instead of the state ensuring social welfare through government provision of services, in deregulated markets, continuous growth is touted as the solution to all social problems through its ability to create employment and goods and services.57 Thus, economic growth measured in terms of gross domestic product (GDP) has become virtually synonymous with progress.58 However, GDP is a poor indicator of progress if progress is understood to mean an improvement in human wellbeing.14,58 While economic development is important for wellbeing in poor countries, continued economic growth in rich countries does not advance – and may even reduce – wellbeing.56,59 This is partly because GDP counts the economic value of all goods and services exchanged on the market, even if those items indicate the presence of problems, such as increased healthcare expenditure due to obesity.14,58 Moreover, equating economic growth with wellbeing ignores the fact that infinite growth is impossible on a planet with finite biophysical resources.56,58 Continued economic growth necessitates progressive increases in production and consumption, with new ways of promoting spending continuously being devised.14,57 Growth also contributes to consumer culture indirectly through increasing income inequality within society.56,59 In Australia and most other countries, growth has delivered its benefits asymmetrically, with the income gap between rich and poor widening since the 1980s.56,60 Australia is now one of the most stratified developed societies.61 High income inequality is thought to enhance social status competition, which increases the pressure to consume in order to prevent appearing inferior to others.59 As Figure 1 shows, the economic system primarily contributes to obesity and climate change by driving the ever-rising consumption of emissions-intensive, unhealthy food and technology.13,57
2014 vol. 38 no. 1
Furthermore, the imperative to increase industrial productivity by using labour-saving technologies displaces manual jobs resulting in reduced physical activity, heightened GHG emissions and increased unemployment, which contributes to income inequality.57,62 Economic growth thus becomes an even greater imperative to curb unemployment by creating new jobs for displaced workers.62 At the same time, in response to demands for increased productivity and consumption, Australians work some of the longest hours in the developed world.61,63 This contributes to consumption of unhealthy pre-prepared food and effort-saving technology as people attempt to compensate for time scarcity.63,64 The impact of economic growth on climate change also extends well beyond these factors, as the production and consumption of most goods and services produces some GHG emissions.
Shared policy solutions By targeting these shared causes, obesity, obesity-related chronic diseases and climate change can be tackled simultaneously.
Policies for replacing car use with active transport Widespread substitution of car use with active travel would significantly reduce GHG emissions, and rates of obesity and obesity diseases.11,22,25,34 For example, a US related study calculated that replacing short car trips with walking or cycling could almost eliminate obesity in the absence of dietary change and significantly reduce US GHG emissions.34 Making cars a less attractive transport option would stimulate a shift towards active
transport. One option is to increase the cost of car use.22,35,65,66 Ways to do this include raising the fuel excise,66 increasing parking and car registration fees, and introducing congestion charges such as those levied in London and Stockholm, which have substantially reduced car traffic and increased cycling.22,35,67 However, as transport can be fairly price insensitive, pricing policies should not be relied on as the sole mechanism for deterring people from driving.68 Other possibilities include reducing car parking spaces, lowering speed limits and closing some roads to cars.22,25,35,65 However, making driving more difficult without providing transport alternatives would exacerbate inequities in accessing jobs and essential services.69 Therefore, it is imperative that car use deterrents are accompanied by policies that make active transport more convenient.37,69 Efficient, accessible and affordable public transport can encourage active travel, thereby reducing obesity and GHG emissions. For example, six to eight months after the introduction of a light rail service in Charlotte, North Carolina, people using the service to commute to work had an 18% reduction in their BMI and significantly reduced odds of becoming obese.70 Another study found that having public transport nearby increases walking energy expenditure and decreases motorised energy expenditure.15 Wellpatronised public transport uses only a small fraction of the fossil-fuel energy required to move people in cars.71 As there is great diversity in Australian settlement patterns, the most appropriate types of public transport (bus, train, tram or ferry) should be assessed on a local basis. Larger government subsidies for public transport would also promote
Figure 1: Schematic representation of the global economy’s contribution to obesity and climate change. Economic growth (↑ GDP)
Neo‐liberalism and free‐market ideology
↑ income inequality
↑ social status competition/ chronic stress
↑ production and consumption of material goods ↑ availability and over‐ consumption of energy‐dense emissions‐ intensive foods
↑ unemployment
Manual labour replaced by labour‐saving technologies
GHG emissions
CLIMATE CHANGE ↑ working hours
High consumption of emissions‐ intensive labour‐ saving technology for personal use
Inequitable distribution of risk factors
↓ physical activity
OBESITY
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
21
Lowe Article
increased patronage of services, and improve equity of access.65 Strategies that would make public transport journeys faster and more convenient include increasing the speed and frequency of services, and integrating different services to create a seamless network.30,72 Effective public transport should be accompanied by policies that improve bicycle and pedestrian infrastructure. Through significant investment in cycling, countries such as Denmark and the Netherlands have achieved cycling rates more than 10 times higher than Australia.73 Along with traffic calming measures, cities in these countries have extensive networks of bike lanes and paths, widespread intersection modifications and priority signals, abundant bike parking, and co-ordination of cycling routes with public transport.73 Tax incentives and showering facilities in workplaces could also encourage cycling to work.12,67 Infrastructure that encourages walking for transport includes well-designed, continuous networks of pavements and walking trails, with safe and convenient pedestrian crossings.67,68 Land-use planning is integral to promoting active transport. In particular, higher residential density and greater land use mix increases cycling and walking for transport, by creating shorter distances between residences, workplaces and services.11,15,74-76 There is also evidence that compact cities encourage public transport use.11,26,41 Certainly, density and mixed land use play a significant role in the higher rates of active transport in the inner-city compared with the outer suburbs of Australian cities.75 Land-use planning in existing and proposed outer suburban developments needs to be radically rethought in order to make them more conducive to healthy and environmentally sustainable transport.
Policies for improving diets and reducing emissions from the food system Reducing exposure to marketing of unhealthy, highly processed foods and beverages could reduce consumption of these foods, thus lowering GHG emissions and rates of obesity and obesity-related diseases.14 Most of the policy proposals in this area aim to reduce children’s exposure to television marketing. For example, it has been recommended that advertising of highly processed energy-dense foods be banned during children’s viewing times.1 While the effect of such bans in countries like Sweden and Norway remains unclear,77 a
22
range of other research supports prohibition. For instance, an Australian study found that removing such advertising from children’s viewing times would significantly reduce unhealthy food consumption, lower childhood obesity rates and save public money.44 Despite strong public support, a bill to restrict junk food advertising to children was recently voted down in the Australian Senate.78 Alternatives that may face less opposition include taxing advertising at a high rate, restricting the number of television advertisements targeting children, or regulating against certain persuasive marketing techniques such as the use of cartoon characters.1,77 However, these approaches are unlikely to be as effective as full prohibition. Food taxes and/or subsidies could also have co-benefits.1 As consumers are responsive to food prices, introducing subsidies on healthy, low-emissions foods may encourage people to eat more of these foods and less unhealthy food.12,79 The alternative is to raise the price of energy-dense, emissions-intensive foods by placing new taxes on them.12 International examples include taxes on soft drinks in some US states, and on pre-packaged foods high in fat and sugar in Hungary.1,80 An important strength of such taxation is the potential to raise substantial revenue that could be used for other obesity and climate change prevention programs.12,22 However, as taxation could increase food insecurity for lower income Australians, it should be used in combination with subsidies and/or other policies to improve access to healthy food.1 Increasing urban agriculture could yield cobenefits for obesity and climate change.14,81 Community gardens can increase fruit and vegetable consumption among gardeners and create opportunities for physical activity.81 Assuming that consumption of energy-dense emissions-intensive foods is reduced as a result, making community gardens a standard urban feature could reduce obesity and GHG emissions. Furthermore, local food production in community gardens could reduce GHG emissions from food transport, retailing and packaging. Preferentially implementing these policies in disadvantaged areas with poorer access to healthy foods could contribute to reducing obesity inequities.50 Agricultural reserves should be created to halt the encroachment of suburbia into prime agricultural land close to urban areas. The food retail environment could also be improved. Policy options include restricting the density of fast food outlets and using
land-use policies and incentives to attract healthy food businesses to low-income areas.47 Locational access to food markets could be improved, as this can increase fruit and vegetable intake.82 In the US, farmers’ market voucher programs have also increased fruit and vegetable consumption among low-income recipients.82 Buying direct from producers at local farmers’ markets has the additional benefit of reducing emissions from food transport. A new food labelling system could be introduced. In Australia, there is growing interest in implementing a star-rating system on the front of packaging to facilitate healthy food choices.83 It has also been suggested that labelling food products based on their embodied GHG emissions could assist consumers to make environmentally friendly food choices.84,85 Labelling food with both health and environmental impacts would enable consumers to consider both of these factors when making purchasing decisions. However, as labelling largely relies on selfmotivated behaviour change, it should be used in conjunction with more structural changes to reduce consumption of unhealthy, high-emissions foods.3 Reducing the production and consumption of meat and dairy products would greatly reduce GHG emissions and rates of obesity and associated diseases.3,21,49 Vegetarian or vegan diets may have the greatest potential to produce co-benefits, but aiming for everyone to embrace these is unrealistic. Even reducing adults’ daily average meat consumption from 250 grams to 90 grams would have significant co-benefits.21 Although ways to achieve this dietary change remain largely untested, potential options include taxing and labelling meat and dairy foods as described above, or increasing the cost of animal products by including agricultural emissions in a GHG tax or emissions trading scheme. As discussed in the next section, agricultural emissions are excluded from Australia’s current carbon price.10 Legislation and policies to encourage breastfeeding of infants would also have co-benefits, as exclusive breastfeeding for the first six months can protect against childhood obesity, while reducing consumption of dairy in infant formula.12
Macro-level economic policies to reduce emissions and obesity rates There are a number of ways to slow the treadmill of production and consumption that contributes to obesity and climate change. A positive first step would be for
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
Obesity
Obesity and climate change
governments in Australia to de-emphasise economic growth as a policy objective. Alternatives to GDP as a measure of progress should be considered, such as a wellbeing index or gross domestic happiness.13 Reducing income inequality could ease the social status competition that contributes to unhealthy and environmentally destructive consumerism.59 While narrowing the gap between rich and poor would lower obesity rates across all social strata, it could also reduce the social gradient of obesity distribution, and lower discrepancies in the ability to adapt to climate change.59 Income inequality could be reduced before and/or after taxation. In order to tackle the soaring pay rates of the highest income earners,61 governments could legislate a ceiling on pay rates, or limit pay to a maximum of some multiple of the average or lowest paid workers in a particular company. Another before-tax approach would be to increase the minimum wage. Japan is an example of a country that has achieved high income equality through these types of measures.59 Options to reduce income inequality through taxation and benefits include plugging tax loopholes and collecting inheritance taxes from the very wealthy, introducing more progressive taxation rates, and increasing welfare payments and benefits. Sweden is an example of a country that has a high degree of equality because of redistributive taxes and benefits.59 As Australia has historically relied upon taxation and benefits for redistribution of wealth, these types of policies may be the most feasible. However, using taxation in combination with before-tax policies is likely to be most effective. Labour market reforms could also lower obesity rates and GHG emissions. One option is to shift employment towards sectors that are less resource- and emissions-intensive, and more labour-intensive.86 Examples include non-industrial agriculture, recycling and renewable energy, running public transport services instead of cars, and selling ‘energy services’ rather than energy supplies.56 With more labour inputs required, increased investment in these sectors could raise employment levels, thereby reducing income inequality. In addition, some of these jobs (such as gardening and installing solar panels) involve more physically active labour, with benefits for reducing obesity rates. A second potential labour market reform is to reduce working hours. This could reduce unemployment and under-employment by sharing the available work more equally, thus
2014 vol. 38 no. 1
decreasing income inequality.56,62 Reducing working hours is also the most cited way of reducing the pressure for growth as a means of job creation.56,57,86 Furthermore, having more free time would allow people to engage in more healthy and environmentally friendly activities, such as growing fresh food, and cycling instead of driving.63,64 Australia could aim for a return to the 40-hour week, or follow the example of countries like France that have a 35-hour working week.64 While enforcing these shorter hours may be problematic, strategies such as increasing the minimum wage and providing more opportunities for job-sharing would enable people to work shorter hours. Pricing or trading GHG emissions could also yield co-benefits for obesity and climate change. Options include taxing GHG emissions at the site of production,18,61 or corporate emissions trading schemes.68 Theoretically, a tax or trading scheme could have co-benefits by increasing the price of unhealthy and emissions-intensive foods and technologies, and providing incentives for renewable energy use and more energy-efficient production.13,14 In 2012, the Federal Government introduced a fixed carbon price (initially set at $23 per tonne),10 with recent plans to transition to a carbon trading scheme linked to the European Union scheme in 2014.87 With more than 50% of the revenue being redistributed to compensate low income earners, the carbon tax may help to reduce income inequalities in Australia. However, while Australia’s carbon price will reduce emissions from the wider economy to some degree, it is unlikely to have much impact on obesity rates. This is because emissions from household transport, agriculture and food are excluded from Australia’s carbon price.10 Personal emissions trading could also have co-benefits. This involves allocating a number of tradeable emissions units to all individuals, who then use these when purchasing emissions-intensive products.13,14 Any leftover units can be sold to people who require more. This provides a financial incentive for people to increase their energy expenditure and decrease consumption, and may redistribute wealth from rich high-consumers, to poorer low-consumers.13,14 The world’s first personal emissions trading scheme is being trialled on Norfolk Island in Australia.88
Conclusion Based on the literature, this paper has explored how car dependence, the food system and the global economy contribute
to both obesity and GHG emissions in Australia. It also considered possibilities for affecting transformative structural changes to address these issues simultaneously. Given the complex causes of both problems, implementing any single policy, or tackling just one shared cause, is unlikely to deliver sufficient change. Instead, a full spectrum of complementary policies across multiple sectors is required to achieve widespread and equitable improvements across the transport, food and economic systems. In particular, macro-level economic policies and more sector-specific transport and food policies could support and complement each other. Such an approach would have benefits for the environment, as well as the two greatest health threats facing Australia.
Acknowledgements The author thanks her supervisor, Hans Baer, for providing direction on this manuscript, and is grateful to Billie Giles-Corti, Peter Ferguson and Lorna Atkinson for their comments on drafts of this article.
References 1. National Preventative Health Taskforce. Australia: The Healthiest Country by 2020, National Preventative Health Strategy – A Roadmap for Action. Canberra (AUST): Commonwealth Department of Health and Ageing, Population Health Strategy Unit; 2009. 2. Institute for Health Metrics and Evaluation. GBD Profile: Australia. Seattle (WA): IHME; 2013. 3. Friel S, Dangour A, Garnett T, Lock K, Chalabi Z, Roberts I, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: Food and agriculture. Lancet. 2009;374(9706):2016-25. 4. Access Economics. The Growing Cost of Obesity in 2008: Three Years On. Canberra (AUST): Diabetes Australia; 2008. 5. Costello A, Abbas M, Allen A, Ball S, Bellamy R, et al. Managing the health effects of climate change. Lancet. 2009;373:1693-733. 6. Hennessy K, Fitzharris B, Bates B, Havey N, Howden S, Hughes L, et al. Australia and New Zealand. In: Parry M, Canziani O, Palutikof J, van der Linden P, Hanson C, editors. Climate Change 2007: Impacts, Adaptation and Vulnerability Contribution of Working Group II to the Fourth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge (UK): Cambridge University Press; 2007. 7. McMichael A, Woodruff R, Whetton P, Hennessy K, Nicholls N, Hales S, et al. Human Health and Climate Change in Oceania: A Risk Assessment 2002. Canberra (AUST): Commonwealth Department of Health; 2003. 8. Woodruff R, Hales S, Butler C, McMichael A. Climate Change Health Impacts on Australia: Effects of Dramatic CO2 Emission Reductions. Canberra (AUST): Australian Conservation Foundation and the Australian Medical Association; 2005. 9. Styles J. Climate Change: The Case for Action. Canberra (AUST): Commonwealth Parliamentary Library; 2009 [cited 2010 Nov 25]. Available from: http://www.aph.gov. au/About_Parliament/Parliamentary_Departments/ Parliamentary_Library/pubs/rp/rp0809/09rp28 10. Wiseman J, Edwards T. Post-carbon Pathways: Reviewing Post Carbon Economy Transition Strategies. CPD Occasional Paper No.: 17. Sydney (AUST): Centre for Policy and Development; 2012. 11. Bloomberg M, Aggarwala R. Think local, act global: How curbing global warming emissions can improve local public health. Am J Prev Med. 2008;35(5):414-23.
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
23
Lowe Article
12. Delpeuch F, Maire B, Monnier E, Holdsworth M. Globesity: A planet out of control? London (UK): Earthscan; 2009. 13. Egger G. Health,“illth”, and economic growth: Medicine, environment, and economics at the crossroads. Am J Prev Med. 2009;39(1):78-83. 14. Egger G, Swinburn B. Planet Obesity: How We’re Eating Ourselves and the Planet to Death. Crows Nest (AUST): Allen and Unwin; 2010. 15. Frank L, Greenwald M, Winkelman S, Chapman J, Kavage S. Carbonless footprints: Promoting health and climate stabilization through active transportation. Prev Med. 2010;50:S99-S105. 16. Friel S, Bowen K, Campbell-Lendrum D, Frumkin H, McMichael A, Rasanathan K. Climate change, noncommunicable diseases, and development: The relationships and common policy opportunities. Annu Rev Public Health. 2011;32:133-47. 17. Haines A, Dora C. How the low carbon economy can improve health. Br Med J. 2012;344:e1018. 18. Haines A, Smith K, Anderson D, Epstein P, McMichael A, Roberts I, et al. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change. Lancet. 2007;370:1264-81. 19. Higgins P, Higgins M. A healthy reduction in oil consumption and carbon emissions. Energy Policy. 2005;33:1-4. 20. Macdiarmid J, Kyle J, Horgan G, Loe J, Fyfe C, Johnstone A, et al. Sustaining diets for the future: Can we contribute to reducing greenhouse gas emissions by eating a healthy diet? Am J Clin Nutr. 2012;96:632-9. 21. McMichael A, Powles J, Butler C, Uauy B. Food, livestock production, energy, climate change, and health. Lancet. 2007;370:1253-63. 22. Michaelowa A, Dransfeld B. Greenhouse gas benefits of fighting obesity. Ecol Econ. 2008;66:298-308. 23. Morabia A, Costanza M. It takes a train to knock down global warming and obesity. Prev Med. 2010;51:449-50. 24. Roberts I, Edwards P. The Energy Glut: Climate Change and the Politics of Fatness. London (UK): Zed Books; 2010. 25. Woodcock J, Edwards P, Tonne C, Armstrong B, Ashiru O, Banister D, et al. Public health benefits of strategies to reduce greenhouse-gas emissions: Urban land transport. Lancet. 2009;374:1930-43. 26. Younger A, Morrow-Almeida H, Vindigni S, Dannenberg A. The built environment, climate change, and health: Opportunities for co-benefits. Am J Prev Med. 2008;35(5):517-26. 27. Morgan L. Dependency theory in the political economy of health: An anthropological critique. Med Anthropol Q. 1987;1(2):131-54. 28. McDonnell O, Lohan M, Hyde A, Porter S. Political economy theory, health and healthcare. In: Social Theory, Health and Healthcare. Basingstoke (UK): Palgrave Macmillan; 2009. p. 36-62. 29. Minkler M, Wallace S, McDonald M. The political economy of health: A useful theoretical tool for health education practice. Int Q Community Health Educ. 1995;15(2):111-25. 30. Mees P. Public transport policy in Australia: A density delusion? Dissent. 2010;32:45-9. 31. Australian Bureau of Statistics. 4102.0 - Australian Social Trends, 2008: Public Transport Use for Work and Study. Canberra (AUST): ABS; 2008. 32. Davison G. Car Wars: How the Car Won Our Hearts and Conquered Our Cities. Crows Nest (AUST): Allen and Unwin; 2004. 33. Hinde S, Dixon J. Changing the obesogenic environment: Insights from a cultural economy of car reliance. Transp Res Part D Transp Environ. 2005;10:31-53. 34. Higgins P. Exercise-based transportation reduces oil dependence, carbon emissions and obesity. Environ Conserv. 2005;32(3):197-202. 35. Maibach E, Steg L, Anable J. Promoting physical activity and reducing climate change: Opportunities to replace short car trips with active transport. Prev Med. 2009;49:326-7. 36. Davis A, Valsecchi C, Fergusson M. Unfit for Purpose: How Car Use Fuels Climate Change and Obesity. London (UK): Institute for European Environmental Policy; 2007. 37. Woodcock J, Banister D, Edwards P, Prentice A, Roberts I. Energy and transport. Lancet. 2007;370:1078-88. 38. Frank L, Andresen M, Schmid T. Obesity relationships with community design, physical activity, and time spent in cars. Am J Prev Med. 2004;27(2):87-96.
24
39. Department of Climate Change and Energy Efficiency. National Greenhouse Gas Inventory: Accounting for the Kyoto Target May 2010. Canberra (AUST): Commonwealth of Australia; 2010. 40. Paterson M. Car culture and global environmental politics. Rev Int Stud. 2000;26:253-70. 41. Giles-Cort B, Ryan K, Foster S. Increasing Density in Australia: Maximising the Benefits and Minimising the Harm. Melbourne (AUST): National Heart Foundation of Australia; 2012. 42. Luk J. Reducing car travel in Australian cities: Review report. J Urban Plan Dev. 2003;129(2):84-96. 43. Australian Conservation Foundation. Australia’s Public Transport: Investment for a Clean Transport Future. Carlton (AUST): ACF; 2011. 44. Magnus A, Haby M, Carter R, Swinburn B. The costeffectiveness of removing television advertising of high-fat and/or high-sugar food and beverages to Australian children. Int J Obes. 2009;33:1094-102. 45. Bradbury K. Australian diet ‘worse than American'. ABC News. 2010 March 22 46. Rangan A, Kwan J, Flood V, Louie J, Gill T. Changes in ‘extra’ food intake among Australian children between 1995 and 2007. Obes Res Clin Pract. 2011;5:e55-e63. 47. Friel S, Marmot M, McMichael A, Kjellstrom T, Vagero D. Global health equity and climate stabilization: A common agenda. Lancet. 2008;372:1677-83. 48. Australian Conservation Foundation. Consumption Atlas. Carlton (AUST): ACF; 2013 [cited 2013 May 18]. Available from: http://www.acfonline.org.au/ consumptionatlas/ 49. Carlsson-Kanyama A, Gonzalez A. Potential contributions of food consumption patterns to climate change. Am J Clin Nutr. 2009;889:1704S-9S. 50. Burns C, Inglis A. Measuring food access in Melbourne: Access to healthy and fast foods by car, bus and foot in an urban municipality in Melbourne. Health Place. 2007;13:877-85. 51. Reidpath D, Burns C, Garrard J, Mahoney M, Townsend M. An ecological study of the relationship between social and environmental determinants of obesity. Health Place. 2002;8:141-5. 52. Burns C. A Review of the Literature Describing the Link between Poverty, Food Insecurity and Obesity with Specific Reference to Australia. Melbourne (AUST): VicHealth Physical Activity Unit; 2004. 53. Drewnowski A, Darmon N. The economics of obesity: Dietary energy density and energy cost. Am J Clin Nutr. 2005;82:265S-273S. 54. Lobstein T, Dibb S. Evidence of a possible link between obesogenic food advertising and child overweight. Obes Rev. 2005;6:203-8. 55. Strasburger V. Children, adolescents and the media. Curr Probl Pediatr Adolesc Health Care. 2004;34:54-113. 56. Jackson T. Prosperity without Growth: Economics for a Finite Planet. London (UK): Earthscan; 2009. 57. Homer-Dixon T. The Upside of Down: Catastrophe, Creativity, and the Renewal of Civilization. Washington (DC): Island Press; 2006. 58. Victor P. Managing without Growth: Slower by Design, Not Disaster. Cheltenham (UK): Edward Elgar Publishing; 2008. 59. Wilkinson R, Pickett K. The Spirit Level: Why More Equal Societies Almost Always Do Better. London (UK): Penguin Books; 2009. 60. Saunders P. Examining Recent Changes in Income Distribution in Australia. Sydney (AUST): University of New South Wales Social Policy Research Centre; 2003. 61. Baer H. Towards democratic eco-socialism in Australia as part of a global climate change mitigation strategy: A utopian vision. Proceedings of the Fourth Australian Conference on Utopia, Dystopia and Science Fiction; 2010 Oct 29; Monash University, Melbourne, Australia. 62. Schor J. Plentitude: The New Economics of True Wealth. Carlton North (AUST): Scribe Publications; 2010. 63. Hayden A, Shandra J. Hours of work and the ecological footprint of nations: An exploratory analysis. Local Environ. 2009;14(6):575-600. 64. Martin R. The role of law in the control of obesity in England: Looking at the contribution of law to a healthy food culture. Aust N Z Health Policy. 2008;5:21. 65. Buehler R. Determinants of automobile use: Comparison of Germany and the United States. Transportation Res Rec. 2009;2139:161-71.
66. Hensher D. The imbalance between car and public transport use in urban Australia: Why does it exist? Transp Policy. 1998;5:193-204. 67. National Public Health Partnership. Promoting Active Transport: An Intervention Portfolio to Increase Physical Activity as a Means of Transport. Melbourne (AUST): National Public Health Partnership; 2001. 68. Carter N. The Politics of the Environment: Ideas, Activism, Policy. Cambridge (UK): Cambridge University Press; 2001. 69. Rissel C. Active travel: A climate change mitigation strategy with co-benefits for health. NSW Public Health Bull. 2009;20(1-2):10-3. 70. MacDonald J, Stokes R, Cohen D, Kofner A, Ridgeway G. The effect of light rail transit on body mass index and physical activity. Am J Prev Med. 2010;39(2):105-12. 71. Public Transport Users Association. Common Urban Myths about Transport - Myth: Public Transport doesn’t Really Save Energy. Melbourne (AUST): PTUA; 2009 [cited 2011 May 29]. Available from: http://www.ptua. org.au/myths/energy.shtml 72. Public Transport Users Association. What Makes Public Transport Work? Melbourne (AUST): PTUA; 2010 [cited 2011 May 12]. Available from: http://www.ptthatworks. org.au/pillars.html 73. Pucher J, Buehler R. Making cycling irresistible: Lessons from The Netherlands, Denmark and Germany. Transport Rev. 2008;28(4):495-528. 74. McCormack G, Giles-Corti B, Balsara M. The relationship between destination proximity, destination mix and physical activity behaviors. Prev Med. 2008;46(1):33-40. 75. Pucher J, Garrard J, Greaves S. Cycling down under: A comparative analysis of bicycling trends and policies in Sydney and Melbourne. J Transp Geogr. 2011;19:332-45. 76. Saelens B, Handy S. Built environment correlates of walking: A review. Med Sci Sports Exerc. 2008;40 Suppl 7:S550-66. 77. Caraher M, Landon J, Dalmeny K. Television advertising and children: Lessons from policy development. Public Health Nutr. 2006;9(5):596-605. 78. Public Health Association of Australia. Restrictions on Junk Food Advertising to Kiddies – Senate Wrong [Media Release]. Canberra (AUST): PHAA; 2011 March 4. 79. Powell L, Chaloupka F. Food prices and obesity: Evidence and policy implications for taxation and subsidies. Millbank Q. 2009;87(1):229-57. 80. Holt E. Hungary to introduce broad range of fat taxes. Lancet. 2011;378(9793):755. 81. Dixon J, Donati K, Pike L, Hattersley L. Functional foods and urban agriculture: Two responses to climate change-related food security. NSW Public Health Bull. 2009;20(1-2):14-8. 82. Pearson A, Wilson N. Optimising locational access of deprived populations to farmers’ markets at a national scale: One route to improved fruit and vegetable consumption? PeerJ. 2013;1(e94). 83. Plibersek T, Neumann S. Star Rating System for Packaged Foods [Joint Media Release]. Canberra (AUST): Commonwealth Department of Health; 2013 June 14. 84. Olofsdotter M, Juul J, editors. Climate Change and the Food Industry. Climate Labelling for Food Products: Potential and Limitations: Oersund (SWE): Oresund Food Network and Oresund Environment Academy; 2008. 85. Shwom R, Lorenzen J. Changing household consumption to address climate change: Social scientific insights and challenges. WIREs Clim Change. 2012;3:379-95. 86. Jackson T, Victor P. Productivity and work in the ‘green economy’: Some theoretical reflections and empirical tests. Environ Innov Soc Transit. 2011;1:101-8. 87. Clean Energy Regulator. Starting Emissions Trading on 1 July 2014: Policy Summary. Canberra (AUST): Commonwealth of Australia; 2013. 88. Norfolk Island Carbon/Health Evaluation. The Norfolk Island Carbon/Health Evaluation Study. Norfolk Island (AUST); NICHE; 2011 [cited 2013 Aug 19]. Available from: http://www.norfolkislandcarbonhealthevaluation.com/
Australian and New Zealand Journal of Public Health © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia
2014 vol. 38 no. 1
