COMMENT:

The road to the bold gun reform we're now witnessing is littered with compelling
evidence and expert advice that was ignored. A new book exposes how vested
interests and political inertia have repeatedly cheated us of positive changes for
prevention that could save and improve thousands of lives every year. What will
it take to break through?

The usual political road to prevention looks like this: An independent report or
government inquiry makes strong recommendations for policies and actions on a
major issue such as guns, alcohol, or obesity; vested interests lobby hard against
the recommended prevention measures; politicians buckle under the pressure;
minor, ineffectual changes are
made; extensive damage from the problem
continues; and the cycle is repeated about every decade or so.

It took the slaughter of 50 people to give the politicians the steel to act in the
public interest against those vested interests – or "Ardern-up" as one Australian
commentator coined it. Our politicians, and especially the Prime Minister,
thoroughly deserve the huge praise they have received for their leadership in
responding to this crisis.

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What will it take for them to show similar leadership in public health? Tobacco,
alcohol and unhealthy foods contribute about one third of the ill-health and
premature death in New Zealand, yet we spend only 0.5 per cent of the health
budget on preventing harm from them. Hands up if you think this is a sensible
proportion, given the huge health gains and bang-for-buck that prevention
offers?

In his new book, The Health of the People, top public health expert and former
Vice-Chancellor of the University of Otago, Professor David Skegg, excoriates
successive governments and health ministers, especially Jenny Shipley, for
demolishing, neglecting and underfunding public health prevention.

Professor Skegg chaired the ill-fated crown entity the Public Health Commission (PHC)
when it was established in 1992. It very quickly became a major coherent force
for prevention, yet was cut down after only three years by a deadly combination
of inordinate industry power and a weak, short-sighted government.

The PHC made the apparent mistake of reviewing the international evidence on
how best to reduce the enormous harm that New Zealanders were suffering from
due to tobacco, alcohol and unhealthy food. The lobby groups for those legal but
harmful products were furious and pressured the then National government to
pull the commission down, which they obligingly did.

I was medical director of the Heart Foundation at the time and I remember how
the PHC injected such great energy and evidence-based leadership into
prevention in New Zealand during its brief existence and how devastated the
whole health community was when Shipley pulled its plug.

Over the subsequent decades, the public health infrastructure and capacity for
prevention has been almost continuously eroded and the policy actions to reduce
obesity and control alcohol and tobacco have been like the gun control story –
some minor gains, especially for tobacco, but very few substantive policies
implemented from all the various reports and inquiries.

No government has had the steel to introduce a sugary drinks tax, ban junk food
marketing to children, put the drinking age back to 20, or reduce the number of
outlets selling cigarettes. Even something as basic as ensuring healthy food in
schools and early childhood education centres was deliberately sent backwards
under Tony Ryall's watch as health minister.

While there were high expectations for this Government to be strong on
prevention, it has put virtually nothing on the table, apart from the welcome
regulatory moves by Associate Health Minister Jenny Salesa on smokefree cars
and vaping.

If the thousands of people who die prematurely and invisibly every year due to
unhealthy diets, obesity, tobacco, and alcohol suddenly and visibly died on a
single day, that might shock us into demanding urgent action. The serious
prevention tools of laws, regulations, taxes, and funding might be used for this
health crisis, just as they are currently being used for the gun crisis.

The Health Coalition Aotearoa is an alliance of health NGOs and researchers
which is calling for stronger action on prevention. It has plenty of effective
policies and actions sitting in the wings waiting for the one missing ingredient
that Skegg identifies in his book: the political will to implement them.

If the Ardern-up approach to leadership of showing compassion for people
suffering from preventable illnesses and early death, and the political resolve not
to buckle to vested interests can be applied to tobacco, alcohol and unhealthy
foods, that really will create the health of the people.

• Boyd Swinburn is a professor at University of Auckland and chair of the Health Coalition Aotearoa