Healthy Action Healthy Eating:Toward an Integrated Approach to Physical Activity, Nutrition and Healthy Weight for New Zealand

To the Ministry of Health:Draft Consultation Document

Introduction

Thank you for the opportunity to contribute to the development of strategic policy directions for Healthy Action – Healthy Eating for New Zealanders.

Alcohol Healthwatch is a charitable trust contracted to the Ministry of Health to undertake health promotion activities within the Auckland region and nationally, aimed at reducing and preventing alcohol-related harm and promoting safe and healthy drinking environments. Working under the terms of the Ottawa Charter and the Principles of the Treaty of Waitangi, Alcohol Healthwatch provides information, support and coordination for professional and community groups on alcohol-related issues. This also includes ensuring that alcohol-related harm is considered and addressed at a policy development level.

Alcohol Healthwatch applauds the way in which the Ministry of Health is aiming for a coordinated and integrated approach to address the public health problems of poor nutrition, obesity and activity levels. It is also heartening to see the way in which the principals of the Ottawa Charter are being utilised as a basis for action. However the coordinated integration has not extended to incorporate the critical role of alcohol - a role that has significance to nutrition, obesity and activity. This omission is concerning.

There are several specific aspects to alcohol and its relationship with physical activity and nutrition that form the basis for this concern that will be addressed below. Fundamentally alcohol-related harm is one of the Government’s top 13 health priorities and is significantly related to the public health issues under discussion. Yet it has somehow failed to rate even a passing mention in the strategy document.

We can only second guess the reasoning behind this omission and suffice to say there can only be a few possible explanations.
1. Alcohol has been forgotten
2. Alcohol has been considered and dismissed as unimportant for an integrated strategy
3. Alcohol is sufficiently covered by other policy documents such as the National Drug Policy and the National Alcohol Strategy.

Regardless of the reason behind the lack of discussion or inclusion of alcohol, we believe this oversight is a significant flaw in the document. There are specific issues relating to alcohol, nutrition and physical activity that must be considered and included in the strategic framework, particularly since the aim is to develop an integrated strategy.

1. Alcohol is a food as well as drug

While the National Drug Policy addresses the harms that result from the psychoactive properties of alcohol as a drug, it does not provide a strategic framework for addressing alcohol as a food and the consequences thereof.

Alcohol may provide little if any nutritional value but it is high in calories that are used by the body. This means that while alcohol is a drug it is also a food regulated by the National Food Standards of the Australia New Zealand Food Authority. This together with the fact that 90% of the population consume alcohol is sufficient in itself to warrant inclusion.

As a widely consumed food product with health and nutrition implications, it is appropriate and legitimate to include alcohol as an integral part of all proposed integrated strategic policy. Only in this way can the Healthy Action ¡V Healthy Eating strategies be considered truly comprehensive, coordinated and integrated.

Recommendation:

„h Incorporate alcohol into all food and nutrition policy documents and action strategies.

2. Alcohol is counterproductive to activity levels

Sport and recreation in New Zealand is increasingly becoming steeped in alcohol. Unlike the ban that has been placed on tobacco sponsorship, alcohol sponsorship has infiltrated sport to become deeply imbedded in the culture. Alcohol sport sponsorship has attained a “sacred cow” status politically, making efforts to create a supportive environment for reducing harm very difficult. The marriage between alcohol and sport is at best paradoxical. Alcohol is a depressant drug that works to counter good physical activity and performance. As such it has no value in the sporting and recreational context.

Recommendations:

 That the Sport and Recreation Agency takes steps to remove alcohol from sport. Establishing alternative alcohol-free sport or at the very least including strong consistent alcohol health and safety messages in association with sport and recreation is essential for good public health.
 Ensure that the proposed development of health impact assessment tools for activity, food, nutrition and weight (3.12, page 39) include the impact of alcohol.

3. Alcohol consumption contributes to obesity

Alcohol may contribute to obesity in a number of ways. The energy supplied by alcohol calories is substantial at 7 calories per gram. The body cannot store this supply so it must be ‘burned up’ first, causing carbohydrates and fats to be stored (Institute of Alcohol Studies Fact Sheet 2001).
Alcohol can also affect normal appetite. This can range from stimulating increased appetite and overeating through to the suppression of appetite and malnutrition. Consequently, alcohol interferes with healthy weight reduction and can significantly contribute to obesity.

Alcohol consumption can also go hand in hand with a sedentary lifestyle. As a depressant alcohol slows down the central nervous system which in turn can reduce the motivation to be active. It is linked to mental health disorders and depression which can indirectly lead to inactivity.

These factors combine to significantly increase the imbalance between physical activity and calorie absorption to compound the problem of obesity.

Recommendations:

 To be effective, strategies to reduce obesity and those aimed at getting people out and actively moving must include strategies to reduce alcohol intake.
 Awareness of the negative consequences of alcohol on weight reduction and activity levels needs to be increased.
 Ensure the DHB Toolkits on obesity, include the link with alcohol.
 Ensure that the development of health impact assessment tools for healthy weight, includes alcohol.

4. Alcohol undermines nutrition

Alcohol, being high in energy content, can displace essential nutrients such as folate, thiamin and other vitamins and calcium. This has serious repercussions for ensuring health and physical wellbeing. However there appears to be no linkages being made at a strategic level. For example the DHB toolkit on Nutrition (Ministry of Health 2001) is linked to 7 other strategies - non of which are alcohol-related.

Recommendations:

 Increase the level of public understanding that alcohol compromises adequate nutrition
 Incorporate health and safety messages on alcohol containers and all relevant advertising, promotion and merchandising
 Ensure the DHB Toolkit on nutrition, includes the link with alcohol strategies

5. Alcohol displaces folic acid

Of particular concern is the effect of alcohol-related nutrient loss on a developing fetus. It is noted that the Healthy Action – Healthy Eating document gives considerable weight to the subject of increasing folic acid intake before and during pregnancy to minimise the chances of birth defects such as megaloblastic anaemeia or neural tube defects.

Reference is made in the document to the fact that 49% of women have folate intakes lower than recommended for pregnancy (page 11). We would suggest that some of this deficiency is due to increasing levels of alcohol consumption by young women since the peak fertility years for women coincides with peak levels of socialising with alcohol.

Alcohol is a known antagonist to folate absorption and metabolism. Enclosed (appendix 1) is a paper from researchers from the Institute of Food Nutrition and Human Health (Massey University 2001) that indicates a reduction in folate level in New Zealand mothers, commensurate with alcohol intake before and during pregnancy.

The Ministry of Health and the Australia New Zealand Food Authority are leading efforts to increase folic acid intake for women of reproductive age. While the background paper on Food and Nutrition Guidelines for Healthy Pregnant Women mentioned alcohol displacing nutrients, this important information is not translating into strategic action targets and therefore not reaching the public. For example the Ministry’s pamphlet on folic acid makes no mention of the importance of reducing alcohol intake for ensuring improved folic acid uptake. When strategies are implemented in isolation of other key factors, their effectiveness is reduced.

Recommendations:

 Objective 2,46: in the document must include increased awareness of how alcohol counters folic acid uptake
 Support mandatory alcohol and pregnancy health and safety messages on alcohol containers and any continued alcohol advertising
 Undertake New Zealand research as to the effects of alcohol on nutrition during pregnancy

6. Alcohol compromises infant health during breastfeeding

Breastfeeding is vitally important for a healthy start from birth. However as the enclosed news item of a tragic scenario shows us (Appendix 2), establishing breast feeding without reinforcement of other critical factors such as alcohol use is simply insufficient.

While there has been folklore that alcohol improves lactation, studies now show that alcohol can actually reduce milk production (J Menella, Alcohol Research and Health, 2001. Vol.25; No.3; pp 230-234). Alcohol in breast milk is transferred to the baby. This can lead to the milk changing in taste and possibly being rejected by the infant. It has also been demonstrated that infants consume less milk when their mothers had drunk alcohol rather than non-alcoholic drinks however the difference was not noticed by the mothers.

Anecdotally, midwives report that one of the primary reasons why mothers quit breastfeeding early is to re-establish prior drinking patterns. While this indicates an awareness of the harm from drinking alcohol during breastfeeding, strategies for extending the period of breastfeeding for abstinent mothers must be explored alongside efforts to ensure abstinence during pregnancy and breastfeeding occurs in the first place.

In a combination of ways, alcohol is detrimental to breastfeeding and compromises early development.

Recommendations:

 Increase efforts to ensure knowledge of alcohol is reinforced when mothers are establishing breastfeeding
 Establish strategies to prolong breastfeeding for parents who drink alcohol

Conclusion

Given that 90% of the adult population drink alcohol and a large proportion do so hazardously on occasions, alcohol must form a key part of the Healthy Action – Healthy Eating strategic document. The document is positive in the way in which it takes a coordinated and integrated approach to addressing these public health issues. However, the Ministry of Health cannot claim a truly integrated approach while at the same time ignoring the counteractive effects of alcohol in relation to the other strategies.

Alcohol is an antagonist to nutrition in direct proportion to its consumption and is implicated in obesity and sedentary lifestyles. The good news is that people can be persuaded to change unhealthy habits if they are provided with biological evidence on how their own lifestyle behaviour is harming their bodies when the messages are consistently delivered (J McClure, American Journal of Medicine, 2002; 22:200-7). However as highlighted by this submission there is little indication that consistent messages are being delivered regarding alcohol and nutrition based health. That must change if the desired integrated strategy to achieve a healthy nation is to be achieved.

Alcohol Healthwatch looks forward to seeing extended alcohol health promotion integrated with future strategic activity and nutrition policy.

Prepared by Christine Rogan
Health Promotion Advisor
Alcohol Healthwatch