Public Health Expert

Professor Tony Blakely is an epidemiologist at the University of Otago, Wellington. He has an extensive portfolio of research. Tony initiated and implemented the New Zealand Census-Mortality Study (NZCMS) in the late 1990s, a pioneering study linking the national censuses with mortality data to allow monitoring and research on ethnic and socio-economic inequalities and the contribution of smoking to mortality (the NZ census periodically includes smoking). He has also led the parallel study, CancerTrends, that links census and cancer registration data to allow cancer incidence and survival studies.

Analysis of a new NZ Treasury Report on soft drink tax - Public Health Expert

Feb 28, 2017

By Professors Tony Blakely, Nick Wilson, Boyd Swinburn and Cliona Ni Mhurchu The Government has an action plan to tackle childhood obesity, but it lacks a tax on sugary drinks – a strategy for which there is good evidence.  A new Treasury Report on soft drink tax price elasticities has just emerged. It has the look of a strategically published document that if and when – during election year – certain politicians need to defend non-action on taxing sugary drinks, they can point to this Report and obfuscate.  Indeed, this New Zealand Treasury Report has already been used for this purpose in Australia. We critique this Report in this blog, with a view to preventing its misrepresentation and to encourage a more informed discussion on taxing sugary drinks. There are no magic bullets to reduce obesity. Therefore a comprehensive plan … Read More

Front-of-pack nutrition labels improve understanding but not healthy food choices - Public Health Expert

Feb 03, 2017

Prof Tony Blakely, Prof Cliona Ni Mhurchu The three labels study participants were randomised to: traffic light labels, health star rating and nutrition information. Health Star Rating and Traffic Light nutrition labels have a minor impact on New Zealand consumer healthy food choices, according to the Starlight trial –  a randomised trial just published from our HRC-funded DIET Programme based at the University of Auckland. The study involved 1357 New Zealand shoppers split into three groups of about 450 each and randomly allocated to one of three labels: Traffic Light labels, Health Star Rating labels, or Nutrition Information Panels. Participants used their smartphones to scan food products in supermarkets to ‘see’ the allocated nutrition labels. The study concluded that labels which interpret healthiness such as Traffic Light labels (TLL) and Health Star Rating (HSR) labels, had little impact on … Read More

Improving New Zealand’s preparations for the next pandemic - Public Health Expert

Feb 01, 2017

By Dr Julia Scott, Prof Nick Wilson, Prof Michael Baker.  In a globalised world an infectious disease outbreak anywhere is a potential threat to New Zealand. Recent such threats have included severe acute respiratory syndrome (SARS), pandemic influenza (2009), Ebola and Zika. In the context of an upcoming University of Otago, Wellington Public Health Summer School symposium on the topic of emerging infectious diseases, this blog discusses how NZ could ensure it is better prepared in this public health domain. What are the threats? Emerging infectious diseases (EIDs) are those which have appeared for the first time in a population, increased rapidly in incidence or range or developed antimicrobial resistance (1). EID outbreaks have increased since 1940, due in part to changes in the human-animal-environment interface, and between 1940 and 2004, 60% of EID outbreaks were caused … Read More

The Brits are doing it: likely health benefits from a levy on soft drinks - Public Health Expert

Dec 16, 2016

By Prof Tony Blakely, Prof Nick Wilson, Dr Cristina Cleghorn, Dr Linda Cobiac A study published today finds that the UK soft drink levy being introduced in 2017 is likely to benefit health (reduced obesity, diabetes and dental caries) – when considering a range of different Drinks Industry responses. In this Blog we comment on these results and the possible implications for countries like New Zealand. Before Brexit, the Cameron Government in the UK announced it was taking obesity seriously – well, they at least decided to introduce a levy on sugar-sweetened beverages (SSBs).  Post-Brexit, the Brits are pushing ahead with the levy, and it is now out for public consultation. So what is the policy?  Basically, it is a three-tier levy of (current estimates from the UK Office for Budget Responsibility) of 18 pence per litre on ‘mid-sugar’ drinks (5 to 8g per 100 ml) and 24 pence per litre on ‘high-sugar drinks’ (>8g sugar per 100 ml).  If the tax were to be completely passed on to consumers that would equate to an increase in price of: 75% for high-sugar drinks such as regular Coca-Cola, Red Bull and orange juice 31% for mid-sugar drinks sugar such as Coca-Cola life (stevia supplemented) 0% for low sugar drinks such as Diet Coke. Varying levels of sugary Coca Cola drinks But here’s the thing.  It is up to the Drinks Industry how they ‘manage’ this levy.  They might: Pass it on to the consumer as price increases, as we illustrated above (this effectively turns it into a tax to the consumer who may then choose to buy less or buy cheaper lower-sugar products) Reformulate their products to reduce sugar levels to get them down to a lower levy category Use marketing strategies to change the market share by category of drinks (e.g. changing product size, introduction of new mid-sugar and low-sugar products) Or some combination of a, b and c – possibly, the most likely strategy. So what impact might this levy actually have on public health?  A paper published today in the journal Lancet Public Health (including one of us [TB] as a co-author; press release here) addresses just this question by modelling how the levy may play out through the three options (a, b and c). There are many uncertainties in doing this type of modelling, but, in our view, it is necessary to provide planners and policy-makers with best estimates of the likely health impacts.  And it allows us to consider uncertainty – which is always large when consider a new policy (though there is huge international experience with other types of taxes). What did the study find?  Interestingly, product reformulation (“b” above, assuming a best-case scenario of 30% reduction in sugar concentration in high-sugar drinks and 15% for mid-sugar drinks) shows the greatest impact. That is in terms of reduction in obesity, diabetes and decayed missing or filled teeth rates.  For example, a 0.9% reduction in obesity rates (95% uncertainty interval 0.03% to 1.9%) across all ages, but an approximately 10% reduction in obesity rates for 4 to 10 year old children. The price increase (“a” above; assuming 100% tax-pass-through to prices by category, the expected consumer change in demand and consumption, but no supply side response like reformulation above) generates about half the health gains for reformulation above. And the change in market share (“c” above; 12 percentage point reduction in high-sugar market share, and 6 percentage point increase in both mid- and low-sugar market share, where 12/6 percentage points would be required for the Industry to achieve its pledge to reduce energy intake from by 20% from 2015 to 2020) generates about the same gains as the price increase mechanism (“a”). Rankings of these three mechanisms was the same for the other health outcomes of diabetes and decayed missing or filled teeth rates. Unsurprisingly, if the Drinks Industry just bundled up the levy and passed it on evenly across all levels of sugary drinks, the health benefits would be less. Perhaps also unsurprisingly, the full health gains of the policy are likely to be greater than just the short-run impacts on obesity, diabetes and oral health. So the actual health benefits would probably be greater than modelled in this study and include long-run benefits on reducing cardiovascular disease, some cancers and arthritis. There might also be benefits to child mental health given how obesity can impact on psychologically. What might these results mean for other countries like New Zealand? Governments could consider this new study, the information collected during the UK’s consultation process on the levy, and on the early responses by the UK Drinks Industry (as the article details – some companies have already announced reformulation plans). But they also need to keep an eye on the evidence emerging from other approaches to SSB taxes in Mexico, various US cities, and Pacific Island nations. A straight excise tax on SSBs will almost certainly generate good health gains, but this paper suggests that the UK levy approach is an alternative that may open up more opportunity for product reformulation (although reformulation would still – presumably – occur with a ‘straight excise tax’). In summary, this new study adds to the growing body of evidence that fiscal policy tools applied to SSBs may benefit health, particularly child health, and may save costs for health systems. Governments have a range of fiscal policy options to choose from.  And there is high certainty that taxes or levies on SSBs will generate heath gain, albeit uncertainty about the actual magnitude of health gain. Read More

Casting a long shadow: Infection drives stomach cancer inequalities in Māori and Pacific peoples - Public Health Expert

Nov 28, 2016

By Dr Andrea Teng, Prof Tony Blakely, Prof Michael Baker, Prof Diana Sarfati In this Blog we discuss our recently published study that shows that infection from the bacteria Helicobacter pylori is the major driver of stomach cancer inequalities borne by Māori and Pacific peoples in NZ. We also discuss a possible next step which could be for one DHB to pilot a ‘test and treat’ screening programme that seems likely to help reduce such inequalities. Māori and Pacific people have 3 to 6 times the rates of stomach cancer as NZ Europeans. These are some of the starkest relative inequalities between ethnic groups in New Zealand (1). This disparity is particularly concerning given poor stomach cancer survival. In 2013 the Ministry of Health reported that 80 Māori and 35 Pacific people died from stomach cancer, out of … Read More

Health benefits from eradicating rats, stoats and possums - Public Health Expert

Nov 07, 2016

Prof Nick Wilson, Dr Mary McIntyre, Dr Osman D Mansoor, Dr Paul Blaschke, Prof Michael Baker The eradication of some introduced pests such as rats, stoats and possums in New Zealand, seems increasingly feasible with a new national 2050 goal and action at the city level eg, Wellington. The primary benefits will be to native birds and enhanced biodiversity, as well as for agriculture (if bovine tuberculosis is eradicated nationally). But what about the spin-offs for public health? This blog starts to explore this issue and provisionally concludes that there are many potential health benefits from the eradication or near-complete control of these pest species. The recently announced plans for a “predator-free” Wellington City (1) are part of a long-term trend that has seen successful pest eradication on many of NZ’s offshore islands and in “mainland islands” … Read More

Why are some preventable cancer deaths in Māori and Pacific peoples increasing? - Public Health Expert

Oct 31, 2016

Dr Andrea Teng, June Atkinson, Dr George Disney, Prof Nick Wilson, Prof Diana Sarfati, Dr Melissa McLeod, Prof Tony Blakely Work we just published shows some adverse trends in cancer deaths by ethnic group, as well as some favourable trends. In this blog we discuss some of the key findings of this research and what the options are for NZ society to address the harmful trends for obesity-related cancers, tobacco-related cancers and infection-related cancers. We have just published an update on cancer mortality inequalities, from the New Zealand Census Mortality Study (NZCMS) and CancerTrends, in the journal BMC Cancer. The results show a changing pattern of ethnic inequalities in cancer in New Zealand.1 For every 100,000 people who identified as Māori, from 2006-11 there were more than 100 ‘excess’ cancer deaths each year that did not occur among the … Read More

Cost-effective personalised medicine: Herceptin as a case study - Public Health Expert

Oct 25, 2016

Prof Tony Blakely, Dr Nisha Nair This blog is, and isn’t, about the breast cancer drug Herceptin. It is about Herceptin in that we report on a study we just published in the journal PLoS Medicine about the health gains, costs, and cost-effectiveness of Herceptin. It isn’t about Herceptin in that the key point is far more general: in the age of personalised and precision medicine, our country’s funding decisions are often blunt and imprecise, some may even say wasteful. We raise some hard and contentious issues – but talking about money and health in the same breath always is. Most of you will recognise Herceptin (trastuzumab) for the controversy that surrounded it, rather than for the breast cancer treatment drug itself. Breast cancer which is human epidermal growth factor receptor-2 positive (HER2+ for short) is more aggressive than other … Read More

Smokefree Aotearoa 2025 – how might tobacco retail restrictions contribute? - Public Health Expert

Oct 19, 2016

By Dr Amber Pearson, Frederieke Sanne van der Deen, Dr Cristina Cleghorn, Dr Nhung Nghiem, Prof Tony Blakely, Prof Nick Wilson We have just published research on the health gains and cost-savings from various legally mandated restrictions on tobacco retail outlets. In this blog, we briefly consider the results and put the findings in a wider context of how New Zealand might reach its Smokefree 2025 goal. There is increasing policy and research interest in restrictions on tobacco retail outlet locations and density – including for achieving tobacco endgame goals. Many studies in the ‘neighbourhoods and health’ research stream have estimated the health effects of access to features of the built environment, including access to: alcohol outlets and harmful drinking (1), parks and obesity (2), gambling outlets and behaviours (3), etc. Easy access to tobacco retail outlets … Read More

Should Smokefree Indoor Areas = Vapefree Areas? - Public Health Expert

Oct 03, 2016

Prof Nick Wilson, Prof Janet Hoek, A/Prof George Thomson, Prof Richard Edwards The NZ Ministry of Health is currently reviewing public submissions on options that would allow nicotine-containing e-cigarettes to be sold legally in NZ. This consultation raises questions about how the wider uptake of e-cigarette use (known as “vaping”) will be managed. In this blog, we consider arguments about the indoor public settings where vaping should be allowed or prohibited. We conclude that there seems an overall strong rationale for “Smokefree = Vapefree” in all circumstances for the indoor areas covered by current smokefree laws and policies. It is timely that the Ministry of Health is considering whether and how to allow access to nicotine-containing e-cigarettes in NZ. These products could potentially increase quit rates (though scientific evidence on this point remains unclear) or move nicotine-users to where … Read More