World Food Day 2020

Celebrating World Food Day

World Food Day is celebrated around the globe on October 16. Food is one of our basic needs as a society. But while diet-related health problems are placing an increasing burden on already stretched health systems, the COVID-19 pandemic has also highlighted just how important access to safe nutritious food is. The George Institute’s food policy team work in Australia and overseas to reduce death and disease caused by diets high in salt, harmful fats, added sugars and excess energy.  The team does multi-disciplinary research with a focus on outputs that will help governments and industries deliver a healthier food environment for all.

To celebrate World Food Day, we asked some of our food policy researchers to tell us about their work, to highlight how this work will help millions of people change their diets and the way they think about food.

Changing the focus from individual to society

Professor Simone Pettigrew is the Program Head of Food Policy at The George Institute for Global Health. Her work aims to move the focus away from the current emphasis on ‘personal responsibility’, which requires individuals to overcome the highly obesogenic environments in which they work and live. “Our research highlights the important role of factors that are often beyond individuals’ control and emphasises the need to create healthy food environments that encourage and facilitate healthy diets,” she said.

Accurate, user-friendly information about the healthiness of the products we eat and drink is a fundamental consumer right, and Simone’s work highlights the importance of legislative requirements to supply this information as an important element of health policy. The World Health Organization lists the provision of such information as central to efforts to improve human health.

The George Institute’s research shows very high levels of consumer support for the provision of such information, and for a broad range of other initiatives that would make information about food and beverage products more readily available while reducing exposure to prolific junk food and alcohol advertising.

“We are continuing to build the evidence on consumer demand for information about food and beverage products and the most effective methods of conveying this information to provide policy makers with the impetus and justification they need to mandate appropriate forms of labelling.”

Law is a powerful tool to improve population diet

Dr Alexandra Jones is a Research Fellow in Food Policy and Law at The George Institute for Global Health. Her work is multi-disciplinary, fusing quantitative analysis of the food supply with legal, policy and communications expertise to strategically influence policy.

Alexandra believes law is a critical tool to improve public health. “Most of us try to eat healthy as much as possible but being surrounded by unhealthy products and marketing undermines people’s efforts to maintain a healthy diet. One effective way we can shift population diets is to set higher standards for how the food industry makes, markets and sells the foods we eat.”

Alexandra conducts research and provides technical advice to governments in Australia and internationally on legal measures such as food labelling reforms, restrictions on unhealthy marketing, taxation of unhealthy foods, and standards for food provided in public settings such as schools and hospitals.  

“Research alone is rarely sufficient to drive policy change. The impact of our work is amplified through regular engagement with government through policy submissions, advocating in coalition with consumer and public health groups, and strategic use of media to hold industry accountable for putting profits before health.”

In 2021, Alexandra will start a five-year National Health and Medical Research Council Fellowship exploring components of effective policies to target excess sugar consumption. “Australians are eating too much sugar. Better food labels and taxes on sugary drinks are a lever for the food industry to improve their products as well as a tool to support consumers to make healthier choices.”

Let food be thy medicine

Dr Jason Wu is an Associate Professor at The George Institute for Global Health. He believes food is a fundamental determinant of health.

“If we use evidence-based policies and practices to change our society so that making the healthy choice becomes the easy choice I believe this will unlock the tremendous potential of healthy food to improve our all-round wellbeing,” he says.

An exciting project Jason has started working on is the ‘Produce Prescription’ pilot program. In this study researchers are working with clinicians to identify patients with poorly controlled type 2 diabetes who are also food insecure, and ‘prescribe’ them healthy foods provided by a local food supplier. The goal of this novel intervention is to both improve their diet and better control their diabetes.

“The Produce Prescription program exemplifies the concept of ‘Food is Medicine’ – by bringing our medical system and food system closer together, we are trying to make the well-known adage ‘let food be thy medicine’, into a reality.”

Having access to nourishing food is a human right, therefore connecting patients who are food insecure with improved food access is a key element of this program. As Jason explains, “this is particularly important right now, given the economic shock of COVID-19 and the resulting hardship for many Australian families.”

Not all food environments are created equal

Professor Jacqui Webster is the Head of Advocacy and Policy Impact at The George Institute for Global Health and Director of World Health Organization Collaborating Centre on Salt Reduction.

Jacqui leads one of The Institute’s food policy teams with a focus on interventions that can deliver real-world impact on people’s diets.

The team is working in collaboration with the National Institute of Nutrition in Vietnam to examine the feasibility of introducing low sodium salts onto the market. Funded by Resolve to Save Lives, this intervention has the potential to save thousands of lives a year through reducing blood pressure.

“Lack of available, affordable nutritious food and increasing consumption of cheap highly processed foods and meals are the main factors underpinning the increase in diet-related diseases globally,” says Jacqui.

Another of her projects in Australia is working through the Yuwaya Ngarra-li partnership between the University of New South Wales and the Dharriwaa Elders group in Walgett, to support Aboriginal communities to improve food and water security.

“Both of these projects are identifying innovative culturally context-specific interventions to improve diets and bring health benefits to communities worldwide.”

Going digital on the food supply

The Institute’s Food Policy Division is focused not just on robust science and research but also translating it in innovative ways to make a material impact on people’s diets.

Fraser Taylor is the Managing Director of FoodSwitch - a data-technology system that combines food attribute data with nutrient profiling algorithms to influence government policy, industry practice and consumer behaviour. The FoodSwitch mobile app empowers consumers to make better food choices by providing simple health information on a scanned product and suggesting healthier alternatives to 'switch' to.

“Our FoodSwitch data has underpinned over 60 research papers and has been used to benchmark the healthiness of products from the world’s biggest food companies, to influence the global investment community. We are now incorporating planetary health indicators into FoodSwitch to help address the impact of the world’s most pressing problem of climate change,” he said.

New funding to evaluate local health care alliances in NSW

New funding to evaluate local health care alliances in NSW

Professor David Peiris from The George Institute for Global Health and UNSW has received $956,000 in NHMRC Partnership funding for a project that aims to strengthen health system performance in NSW.

“Widening inequities, large variations in the quality of care, and uncontrolled growth in health care spending - which now represents more than ten percent of GDP – are threatening the sustainability of Australia’s healthcare system and ultimately the nation’s prosperity” Professor Peiris said. 

“This project involves an exciting NSW policy reform program, Collaborative Commissioning, which will support formation of local alliances between Local Hospital Districts and Primary Health Networks.  These alliances, Patient Centred Co-commissioning Groups (PCCGs), will be tasked with developing new ways of working to achieve better patient outcomes more efficiently,” he added.

Several PCCGs are in the process of being established with a goal of having state-wide coverage in all ten NSW Primary Health Network regions. Populations to be serviced are diverse. For example, Western Sydney is focusing on community-based services for people with urgent care needs who would otherwise use the emergency department alongside providing services for cardiology patients in the community. Western NSW is focussing on improving quality and access to care for people with diabetes at high risk of complications. North Sydney is focussing a strategy to support elderly people with complex urgent health needs.

The project is a partnership between the New South Wales Ministry of Health (NSW Health), Local Hospital Districts (LHDs), Primary Health Networks (PHNs), the Consumers Health Forum (CHF) and health service researchers from The George Institute, UNSW’s Centre for Big Data Research in Health and the Menzies Centre for Health Policy at the University of Sydney.

Stepped Wedge Trials

Economic evaluations alongside Stepped Wedge Trials: the need for appropriate statistical methods

A new study by The George Institute for Global Health has reviewed statistical methods used when conducting economic evaluation alongside stepped wedge trials (SWTs). We asked lead author and Head of the Statistics Division in Australia, Gian Luca Di Tanna, to tell us about the significance of this study for future clinical trials.

What is a stepped wedge trial?

An SWT is a multi-arm cluster randomised design, with a unidirectional cross-over: clusters switch from the control or routine care condition to the active intervention. In the most common design, all clusters begin in the control condition before crossing over at regular intervals to receive the intervention in a randomised order. This process continues until all clusters are exposed to the intervention. Due to their pragmatic design, SWTs have been used to assess the effect of new interventions in real-world settings where its not possible to apply the intervention across all clusters at the same time for logistical, financial or ethical reasons.

Why is this review important?

Stepped wedge trial design has become increasingly popular in health services research.  Many health services studies also include a health economic evaluation to assess the economic benefit of the intervention being investigated.  However, adequate documentation of appropriate methods of economic evaluation in an SWT is generally lacking in the literature.

What did you do?

We conducted a methodological systematic review of studies (protocols, trials results, cost effectiveness/utility analyses) that described an economic evaluation alongside an SWT.  We assessed their eligibility, findings, reporting of statistical methods and quality of reporting.

What did you find?

We looked at 69 studies that were eligible for our review. In around half of these, the reporting of statistical methods associated with the economic evaluation was incomplete.  Around half the remaining studies did not use appropriate statistical methods, failing to consider critical elements of an SWT such as correlation between costs and outcomes, clustering and time patterns.

What are the implications of this study?

This is the first attempt to review the statistical methodology of planned and conducted economic evaluation of SWTs to date. We intend to propose appropriate methods and perform a simulation study to assess the performance of SWTs to better inform methodologists and applied researchers interested in cost-effectiveness analyses of trials that are based on this design.