Four to five decades ago

When the Australian Nutrition Society was founded in 1975, the national school milk programme^{(Reference Thorley5)} had just come to an end and preventive health was not high on the Australian policy agenda. National and State Government health departments tended to be clinically focussed, with public debate centred around the launch and implementation of Medibank (the first version of Australia’s universal health care system, Medicare)^{(Reference Boxall and Gillespie6)}. Following discovery of vitamins in the early 20^th Century, nutrition practice had a strong focus on nutrient adequacy. In the community, this was particularly centred on maternal and child health, and, in hospitals and other institutions, on food service and clinical dietetics^{(Reference Wood7,8)} . From 1979, this evolved with the appointment of Ruth English as Chief Nutritionist in the Food and Nutrition Section of the Commonwealth Department of Health, building actively on the work of her predecessor, Margaret Corden, with emphasis on food and nutrition policy and policy tools, including assessment of nutritional status, food composition, dietary guidelines and national nutrition databases^{(Reference Wood7)}. Unfortunately, very little funding was made available for programme evaluation at this time, with some expectation that this would be taken up by states and territories^{(Reference Wood7,8)} .

Over the next decade, there was increasing interest in nutrition at a population level, championed by the many content experts of the Food and Nutrition Section of the Commonwealth Department of Health, including Karen Cashel, Nancy Hitchcok, Ian Lester and Nancy Palmer among others^{(Reference Wood7)}. Key activities included national dietary surveys of adults and children, the Report of the Nutrition Taskforce of the Better Health Commission and the high-profile ‘Life, Be in It Program^{(Reference Wood7)}’.

Importantly, leading and promoting related policy and food standards projects was the National Health and Medical Research Council’s (NHMRC) Nutrition Standing Committee, chaired by the Chief Medical Officer, with membership of medical scientists, such as Eben Hipsley, Roland Thorp, and Colin Binns, as well as prominent nutritionists including Katrine Baghurst, Janine Lewis and Beverley Wood^{(Reference Wood7–Reference Wood9)}. More information about the ground-breaking work of the Nutrition Standing Committee, until it was disbanded in 1990, and the Food and Nutrition Section of the Commonwealth Department of Health can be found in the National Archives of Australia^{(Reference Wood7–Reference Wood9)}. One high-profile public health intervention was the mandatory enrichment of bread making flour with thiamine to prevent and/or correct thiamine deficiency in at-risk groups who drank alcohol to excess and those with alcohol-related brain damage^{(Reference Wood10)}.

At state level, given Victoria’s specific investment in community health, it may not be surprising that Australia’s first Food and Nutrition Policy was developed in that state in March 1987^{(Reference Powles, Wahlqvist and Robbins11)}. This focused on improving population health through a co-ordinated approach involving health, agriculture, and education sectors, and was supported, including financially, by VicHealth the newly created, world first, visionary Victorian Health Promotion Foundation⁽¹²⁾.

It was also around this time there was increasing concern in First Nations’ communities and among health professionals about the high rates of Indigenous infant malnutrition, and the first cases of Type 2 diabetes in Indigenous adults^{(Reference Wood7,Reference Lee and Ride13,Reference Lee and Ride14)} . Progress in this area was aided by the establishment of Aboriginal community-controlled health services, following the first launch of such services in Redfern, Sydney in 1971⁽¹⁵⁾. Advocacy for nutrition action was assisted by high-profile scientific studies, such as the Kimberley study, which demonstrated the health value of traditional Indigenous diets involving the late Kerin O’Dea^{(Reference O’Dea16)}.

The Australian food and nutrition policy 1992

Momentum to develop the first (and only) National Australian food and nutrition policy came to a head in 1992, when the United Nations hosted the first World Nutrition Conference in Rome⁽¹⁷⁾. This policy did not suddenly materialise; it was the result of years of research, accumulating evidence, and advocacy. The full policy⁽¹⁸⁾ and many influential related documents are no longer readily available publicly⁽¹⁹⁾, but several are listed in the policy itself including the 1991 reform of Australia’s Food Standards Code, the Food Industry Strategy on food export and sustainability, several evidence statements produced by the Nutrition Standing Committee of the NHMRC in the late 1980s and early 1990s, and the 1992 national strategy for ecologically sustainable development^{(8,Reference Wood9)} . The development of the national food and nutrition policy was led by the nutrition staff in the Commonwealth Department of Health, Housing and Community Services^{(Reference Wood7,8)} and effected by a multi-sectoral oversight committee chaired by Paul Nestel, which included several members of the Nutrition Society of Australia^{(Reference Wood7,8,18)} . Several committee members are still practising today, including Colin Binns. Interestingly, at this time participating industry groups were credited with contributing, not only their own commercial perspectives, but also ‘food facts’ and ‘consumer perspectives’⁽¹⁸⁾.

Remarkably, the framework for the 1992 Australian Food and Nutrition Policy is not very different from the sort of approach that health advocates call for today^{(Reference Lee, Baker and Stanton4)}. Its key principles included social justice, a whole-of-system approach, and what was then called ‘ecologically sustainable’ development. The foreword noted the desire to ‘make healthy choices the easiest choices’. However, the four objectives (to improve knowledge and skills necessary for Australians to choose a healthy diet, to incorporate food and nutrition objectives into a broad range of policy areas and sectors, to support community based initiatives towards improving the diet of people with special needs, and to regularly monitor the food and nutrition system) were high level and quite broad. Parliamentary records incorrectly claim that the Food and Nutrition Policy was not reviewed after three years as planned;⁽¹⁹⁾ two evaluations were in fact completed.

An external evaluation conducted by ARTD in 1995 commented on the level of the objectives and found that the time frames for meaningful implementation were unrealistic^{(Reference Brooks, Milne and Paterson20)}. The evaluation made several recommendations, mainly related to governance, including the need for greater transparency around investment, and called for a strategic plan to guide implementation. The Commonwealth Department of Health and Family Services also produced its own review on the first three years of implementation of the policy⁽²¹⁾, outlining how $4.3 million had been spent on 17 projects, including national bread and lean meat promotion campaigns, and the first Northern Territory Aboriginal Food and Nutrition Policy⁽²¹⁾. Apart from implementation of the national nutrition education in schools programme which had a relatively high-profile, awareness of and involvement in these projects was not high⁽²¹⁾.

Eat well Australia: a national plan for co-ordinated nutrition policy action, 2000 to 2010

By the end of the 1990s, there was growing support for development of a formal, strategic implementation plan to implement the National Food and Nutrition Policy. This was aided by publication of several high-profile reports which added significantly to the evidence base for investment in implementation of the national nutrition policy. These included The Cost of Diet-related Disease in Australia in 1992 by Crowley et al ^{(Reference Crowley, Antioch and Carter22)}, Lester et al’s Australia’s Food and Nutrition in 1994^{(Reference Lestor23)}, Bear-Winfield et al’s Sharing Good Tucker Stories in 1996^{(Reference Bear-Winfield, Sharp and Dignan24)}, and the NHMRC’s Nutrition in Aboriginal and Torres Strait Islander Peoples in 2000⁽²⁵⁾ Nutrition policy action was also advocated by several not-for-profit organisations, including the National Heart Foundation, Cancer Councils, and professional associations including the then Dietitians Association of Australia, the Public Health Association of Australia, and Nutrition Australia, as well as the Nutrition Society of Australia.

Around this time the NHMRC’s trailblazing 1997 strategy, Acting on Australia’s Weight: a strategic plan for the prevention of overweight and obesity ⁽²⁶⁾, chaired by Public Health Nutritionist Cheryl Rae, recommended a comprehensive approach by tackling social and physical environments to support both healthy eating and physical activity. However, the plan remained largely unimplemented and is now referred to by some as ‘waiting on Australia to Act’^{(Reference Martin27)}.

Finally, against the groundswell call for nutrition action, the Council of Australian Government’s (COAG’s) National Public Health Partnership (NPHP) set up the Strategic Inter-Governmental Nutrition Alliance (SIGNAL) chaired by John Catford, to help develop and implement the 2000-2010 action plan – Eat Well Australia: an Agenda for Action for Public Health Nutrition, (EWA) ^{(28,Reference Catford29)} and the companion National Aboriginal and Torres Strait Islander Nutritional Strategy and Action Plan (NATSINSAP)⁽³⁰⁾. The EWA document outlined approach to governance as well as health gain initiatives, with the latter focussing on strategies to support vulnerable groups, promote healthy weight, increase consumption of vegetables and fruit, and improve maternal and child nutrition⁽²⁸⁾. Promotion of physical activity was also supported by the NPHP through the Strategic Intergovernmental Forum on Physical Activity and Health (SIGPAH). This was an exciting time, with a sense that real change was in the offing.

Unfortunately, Eat Well Australia was never evaluated. In late 2006, an internal NPHP review recommended winding down central governance, including SIGNAL, in favour of a more formalised, and, importantly, better funded preventive health agreement between states/territories and the Commonwealth government^{(Reference Wutzke, Morrice and Benton31)}. This agreement, the National Partnership Agreement on Preventive Health, shifted most responsibility for project delivery to the states/territories, with the opportunity for potentially significant financial rewards for achieving targets under the areas of ‘healthy children’, ‘healthy workers’ and ‘healthy communities’. It wasn’t until 2009 however, that the agreement was enacted^{(Reference Wutzke, Morrice and Benton31)}, By that time both SIGNAL and SIGPAH had been redesignated as ‘communication networks’ marking the end of their roles as relatively independent policy-driving bodies^{(Reference Wutzke, Morrice and Benton31)}.

NATSINSAP: a national plan for co-ordinated nutrition policy action with the aboriginal and Torres Strait Islander population, from 2000 to 2010

NATSINSAP had more lasting success nationally. Its seven co-designed priority areas were implemented under state and territory government and community leadership⁽³⁰⁾ and formally evaluated nationally in 2010⁽³²⁾. These included food supply in remote and rural areas, food security and socio-economic status, family-focussed nutrition promotion, nutrition issues in urban areas, the environment and household infrastructure, Aboriginal and Torres Strait Islander workforce, and national food and nutrition information systems⁽³⁰⁾. The development and implementation of NATSINSAP involved numerous Aboriginal and Torres Strait Islander organisations and drew on research evidence from successful community-led nutrition projects, such as the Minjilang Survival Tucker programme which also informed development of the first regional store nutrition policy of the Arnhem Land Progress Association (ALPA) in 1990^{(Reference Lee, Bailey and Yarmirr33)}.

The NATSINAP evaluation⁽³²⁾ was never officially released. However, it was finally made public in 2015 under a Freedom of Information process^{(Reference Locke34)}. Findings included that the action plan had achieved success in the training and employment of Indigenous Nutrition Workers particularly in the Northern Territory (especially on infant Growth Assessment and Action programmes) and in Queensland, and had improved food supply systems in remote community stores^(32,43) . The main barriers the evaluation identified were insufficient funding and resources, need for greater community-led control, and limited action in urban areas^{(32,Reference Locke34)} .

Despite these promising findings, nutrition was notably absent in early Closing the Gap strategies to reduce Indigenous disadvantage^{(Reference Browne, Hayes and Gleeson35)}, which in the preventive health area had a strong focus on reducing cigarette smoking^{(Reference Browne, Hayes and Gleeson35)}. From discussions at the time, it seemed Indigenous nutrition was, unjustifiably, all too often put in the ‘too-hard’ basket^{(Reference Browne, Hayes and Gleeson35)}.

Nutrition policy action in states and territories, 2000–2010

From 2000 and importantly following the formal demise of Eat Well Australia from 2007, most State and Territory Governments continued to push ahead with their own nutrition strategies. Only two of these were ever evaluated – in Queensland and Tasmania – and the Queensland data are available publicly^{(36,Reference Lee, Stubbs and Leonard37)} .

The Eat Well Queensland programme was overseen by a multi-sectoral forum supported by new state health funding of more than $11 million a year delivered over three budget cycles by the Labor government led by Peter Beattie. The main investment was for 105 new nutrition and health promotion positions across the state, responsible for more than 209 projects; nearly a third of these had a strong Indigenous focus^{(Reference Lee, Baker and Stanton4,36,Reference Lee, Stubbs and Leonard37)} . Evaluations of specific Eat Well Queensland projects were published in peer-reviewed journals^{(Reference Lee, Stubbs and Leonard37–Reference Miller, Lee and Obersky39)}, the biennial Queensland Chief Health Officer’s Reports from 2006⁽⁴⁰⁾ and in a special report at five years implementation, the half-way point^{(Reference Lee, Stubbs and Leonard37)}. Impacts were very promising. For example, the objective of the Queensland ‘Go for 2 and 5’ social marketing campaign was to increase the intake of fruit and vegetables across the state by one serve per person per day; according to the external evaluation consumption was increased by 1.1 serves from 2005 to 2007, with data supported objectively by increased produce sales of $9.4 million per month in Brisbane alone^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} . Other examples included that the Smart Choices Food Supply Policy ^{(Reference Dick, Lee and Bright38)} and the A Better Choice strategy^{(Reference Miller, Lee and Obersky39)} which improved food environments throughout the state respectively in more than 1,800 primary and secondary schools^{(Reference Dick, Lee and Bright38)} and in hospitals and health facilities^{(Reference Miller, Lee and Obersky39)}. Exclusive breastfeeding at six months of age increased from 3.1% to 13.3% from 2003 to 2007, and rates of healthy weight in children increased 2-3% more than comparable states by 2007, which equated to around 3000 less children becoming overweight and at least 1,200 fewer cases of Type 2 diabetes per year in Queensland from 2015^{(Reference Lee, Baker and Stanton4,36,Reference Lee, Stubbs and Leonard37)} . Recognition included the Queensland Eat Well Be Active campaign winning the national social marketing effectiveness award in 2007 and Queensland Health being presented with the gold award of the Australian and New Zealand Obesity Society in 2008, 2009 and 2011^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} . A characteristic of this period was close communication and collaboration between states and territories, with a tendency for states to implement and build on successful programme developed in other regions^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} .

However, in Queensland, this all came to an end with a change in state government in March 2012, when the National Liberal Party led by Cambell Newman was elected. Most of the nutrition and health promotion regional workforce (more than 160 staff) were made redundant overnight. Public outcry was muted, at best^{(Reference Lee, Stubbs and Leonard37)}.

Commonwealth-led nutrition policy initiatives, tools and resources, from the early 2000s

At the national level, from mid-way through the first decade of the 21st Century, nutrition-related activity tended to fall into one of two categories: specific policy initiatives, or development and/or implementation of policy-relevant tools and resources building on past initiatives.

Tackling nutrition as one risk factor in the prevention of obesity and chronic disease, from around 2010

The 21^st century saw increased global focus on overweight and obesity as risk factors for chronic disease including CVD, type 2 diabetes and some forms of cancer. A focus on obesity and chronic disease prevention more broadly meant collaborating with specialists across a range of risk factors including physical activity, cigarette smoking and alcohol intake, as well as nutrition. It also meant specific nutrition policy actions risked being subsumed under broader, higher-level programmes.

Consistent with this relatively new approach, the National Preventative Health Taskforce was established early in 2008 for a 3-year period^{(Reference Moodie58)}. In 2009 the taskforce produced the report: ‘Australia: The Healthiest Country by 2020’ which aimed to help transform Australia’s health system from treatment to prevention, through strategies such as increasing taxation on unhealthy products (such as cigarettes, alcohol and sugary drinks) and restricting advertising of unhealthy products. Once again, resources for implementation were limited, and in 2019, an analysis of progress of the preventive health report found that only one of its 27 recommendations had been completed^{(Reference Martin27)}.

In 2011, the Australian National Preventive Health Agency (ANPHA)⁽⁵⁹⁾ was established to strengthen investment in chronic disease prevention. In parallel with its fledgling ‘Shape Up Australia’ social marketing programme, ANPHA was set to champion the development of the new National Nutrition Policy for Australia^{(Reference Lee, Baker and Stanton4)}. However, the Agency was disbanded by the newly elected Liberal National Party Coalition under Tony Abbott in 2014⁽⁵⁹⁾.

Prior to this, our team won the Commonwealth tender to scope the new national nutrition policy for Australia^{(Reference Lee, Baker and Stanton4)}, as companion to the National Food Plan which had been released by DAFF earlier in 2013⁽⁴¹⁾. The brief was to review what was and was not working in nutrition both nationally and globally, and to develop a draft strategy suitable for public consultation in Australia. Overall, we found that a new comprehensive nutrition policy and action plan was required urgently in Australia as rates of diet-related chronic diseases were increasing rapidly. Several nutrition interventions were found to be effective; the most effective and cost-saving interventions were regulatory and legislative policy reforms, such as fiscal measures, advertising controls and mandatory warning labels on unhealthy foods and drinks^{(Reference Lee, Baker and Stanton4,Reference Lee, Cullerton and Herron60)} . The nutrition policies of most OECD countries, however, had a clear emphasis on traditional nutrition education strategies, with much less focus on strategies to reduce consumption of unhealthy foods and drinks^{(Reference Lee, Baker and Stanton4,Reference Lee, Cullerton and Herron60)} . Importantly, to address this, the reviewed policy evaluations recommended that, rather than being involved in policy formulation, conflicted stakeholders should be involved only in policy implementation^{(Reference Lee, Baker and Stanton4,Reference Lee, Cullerton and Herron60)} . Over all, few examples of quality, multi-strategy co-ordinated, inter-sectoral evidence-based nutrition policies were being implemented. So, it was not surprising that rates of obesity and diet-related chronic diseases were increasing in Australia and globally^{(Reference Lee, Baker and Stanton4,Reference Lee, Cullerton and Herron60)} .

Disappointingly, the final report was never released officially by the Abbott government, and the draft nutrition policy was never released for public consultation. Nevertheless, in 2016 the full report, including the consultation draft for a new nutrition policy for Australia, was made public under a Freedom of Information process^{(Reference Lee, Baker and Stanton4)}. The consultation draft nutrition policy contained in the document included four key principles – food, nutrition and health; social equity; environmental sustainability; and monitoring and surveillance, evaluation and review^{(Reference Lee, Baker and Stanton4)}.

One progressive approach to encourage nutrition policy action is the work of the International Network for Food and Obesity/non-communicable Diseases Research, Monitoring and Action Support (INFORMAS)⁽⁶¹⁾, a global, public-interest initiative dedicated to monitoring, benchmarking, and supporting actions to improve food environments and reduce the prevalence of obesity and diet-related chronic diseases. Launched in 2012 by a network of researchers and civil society organisations, including several members of the Nutrition Society of Australia, INFORMAS is auspiced by World Obesity⁽⁶¹⁾ and evaluates the healthiness of food environments across 10 domains (including food composition, labelling, promotion, and cost) and also assesses government and private sector policy actions. By comparing standardised data between countries and monitoring change over time, INFORMAS aims to increase accountability for the ‘upstream’ determinants of poor diet and obesity. The network’s goal is to generate actionable evidence that informs nutrition policy and promotes healthier food environments⁽⁶¹⁾. Relevant Australian data are available on the Food Environments Dashboard⁽⁶²⁾.

From around 2020, Australian governments have been progressing several nutrition-related policies working at different levels to target chronic disease prevention, overweight and obesity, and food and nutrition simultaneously. Like the first iteration of a national preventive health strategy, ‘Australia: The Healthiest Country by 2020’, the current National Preventive Health Strategy 2021-30 aims ‘to balance’ the health system ‘by enhancing the focus on prevention and by building systems-based change⁽⁶³⁾’. Developed by the Commonwealth of Department of Health, the broad strategy covers several risk factors of chronic disease, including smoking, obesity and physical activity as well as nutrition, and ‘aims to improve the health and wellbeing of all Australians at all stages of life, through a systems-based approach to prevention that addresses the wider determinants of health, reduces health inequities and decreases the overall burden of disease⁽⁶³⁾’.

Following two parliamentary enquiries into obesity, the National Obesity Strategy was launched by the Morrison government in 2022⁽⁶⁴⁾. The strategy is broadly aligned with, and shares several preventive health targets with, the National Preventative Health Strategy 2021-30 ⁽⁶³⁾. It also covers treatment and management of obesity, individual responsibility, and increased emphasis on addressing stigma amongst those living with obesity^{(Reference Martin27)}.

Funding of $700,000 was provided in the 2022 budget to specifically establish a new nutrition framework for Australia⁽⁶⁵⁾. However, there has been no action apparent in that area, and it is no longer mentioned on the Department of Health website⁽⁶⁵⁾.

Food security, defined as existing ‘when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs for an active and healthy life⁽⁶⁶⁾’ became an increasing concern during the COVID-19 pandemic. This has been exacerbated by the ongoing ‘cost-of-living’ and ‘housing affordability’ crises in Australia^{(Reference Lee, Herron and Fredericks67)} in turn underscored by rising inflation due to overseas conflicts^{(Reference Lee, Herron and Fredericks67)}. Once welfare payments increased under ‘Job Seeker’ payments during the COVID pandemic, it was reported that more than 80% of low socio-economic Australian families said they could afford a healthy diet for the first time^{(Reference Lewis, Herron and Chatfield68)}. Worryingly, recent results of the National Food and Nutrition Survey found that 13.2% (or 1.3 million) Australian households experienced food insecurity in 2023⁽⁶⁹⁾, with one in four low income households affected⁽⁶⁹⁾.

In order to meet international obligations, DAFF is now developing ‘Feeding Australia’, a National Food Security Strategy intended to apply across the whole food system⁽⁷⁰⁾. Regrettably, this has already attracted controversy. The body appointed to advise on this strategy, the National Food Council, has a membership with a marked bias towards corporate agriculture and food industry groups. Echoing challenges experienced during consultations that informed the development of the National Food Plan released in 2013, more than 200 health and civil society experts have signed open letters calling for clear steps to ensure the new strategy serves the public, not corporate, interests^{(Reference Carey71)}. Issues have also been brought to a head with wars in Ukraine^{(Reference Lee, Herron and Fredericks67)} and in the Middle East^{(Reference Rose72)}.

The National Food Security Strategy in Remote Aboriginal and Torres Strait Islander communities 2025-2035 has recently been launched by the National Indigenous Australian Agency (NIAA)⁽⁷³⁾. It aims to ensure access to affordable, nutritious food, with action items under seven key pillars: country and culture (supporting traditional food practices and land access), health and nutrition (building local nutrition workforces and health literacy), housing, infrastructure and environmental health (ensuring homes support safe food preparation and storage), families and communities (strengthening community-led, local solutions), remote retail (improving management and sustainability of community stores), supply chains (ensuring consistent, reliable food delivery), and healthy economies (fostering local economic development)⁽⁷³⁾.

Why such a checkered history of nutrition policy action in Australia?

Despite some success, public and political interest and action in nutrition in Australia over the last 50 years has been checkered at best. One challenge is a lack of continuity in approach, exemplified by focus along different components of the causal pathway at different times, such as diet and health being positioned under several broader issues such as obesity, chronic disease prevention, food insecurity, and/or, more recently, food system transformation. This is in marked contrast to the consistent approach adopted over the last 50 years in reducing smoking successfully under the ‘QUIT’ banner in Australia.

As outlined earlier, funding and support for several nutrition policy and infrastructure projects were formally ceased after change in federal or state governments. But such events were not the only times political decisions were taken to cease nutrition policy action in the last 50 years. So why does this happen? Why so many peaks and troughs when it comes to government support and funding of nutrition policy and programmes?

We had the opportunity to investigate this when reviewing Eat Well Queensland retrospectively^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} , applying Shiffman and Smith’s 2007 framework of determinants of political priority^{(Reference Shiffman and Smith74)} (with its four factors around actor power, ideas, political contents and issue characteristics) to nutrition issues over four decades. This clearly showed a coalescence of factors in the 1990s that contributed to nutrition being a political priority, with those same factors decreasing markedly in the early 2010s consistent with the ‘small government’, neo-liberal philosophy of the incoming state Liberal National Party Government in 2012.^{(Reference Lee, Stubbs and Leonard37)} That government then instigated a Commission of Audit, the final report of which re-enforced hospitals as the core health business of state governments, and preventive health as the role of primary health care and therefore the responsibility of the Commonwealth Government. This foreshadowed political battles around attempts to ‘cost shift’ jurisdictional responsibility for preventive health and left a ‘veritable vacuum’ in preventive health in Queensland^{(Reference Lee, Stubbs and Leonard37)}.

Key enablers of and barriers to successful, sustained nutrition policy and practice in Queensland were identified using Schell et al’s^{(Reference Schell, Luke and Schooley75)} framework of public health programme capacity for sustainability^{(Reference Lee, Stubbs and Leonard37)}. Among key enablers were the quality of governance and the influence of policy champions and advocates, adoption of whole-of-population approaches, commitment to evaluation and hence ability to demonstrate outcomes, and periods of political support and economic prosperity^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} Key barriers included change of government, leadership and ideology, lack of funding for evaluation and/or dissemination of results, and limited recognition of the importance of public support for nutrition promotion and chronic disease prevention^{(Reference Lee, Stubbs and Leonard37)}. Results suggested that a co-ordinated, well-funded, inter-sectoral approach to nutrition policy could deliver promising impacts and outcomes, but also that effective, ongoing effort is needed to improve sustainability of nutrition policy and programmes^{(Reference Lee, Baker and Stanton4,Reference Lee, Stubbs and Leonard37)} .

In 2016, a study of communication around nutrition provided further insight, with the network analysis of Cullerton et al.^{(Reference Cullerton, Donnet and Lee76)} identifying clear communication clusters, including the ‘nutrition professional’ cluster of academics and nutritionists talking mostly to themselves, the ‘activists’ such as key NGO figures and minor policy makers, and the ‘decision-maker’ cluster comprising senior policy makers, bureaucrats, and many food industry representatives. The results demonstrated that the food industry held the strategic high ground in advocating their interests to policy makers^{(Reference Cullerton, Donnet and Lee76,Reference Cullerton, Donnet and Lee77)} .

Public health objectives and the profits of the unhealthy food industries do not align. While the food Industry has a critical role to play in the implementation of nutrition policy and understands what is practically achievable, their involvement in policy formulation comes with a high risk of conflict of interest.

This point was highlighted by our team’s analyses of cost and affordability of typical and healthy diets in Australia^{(Reference Lee, Kane and Lewis78–Reference Lee, Patay, Herron and Parnell Harrison80)}. In these studies, the cost of habitual diets as reported in the 2013 National Nutrition Survey were compared with the cost of healthy diets, that incorporated minimal changes in order to meet the ADGs^{(Reference Lee, Kane and Lewis78)}. Disturbingly, healthy diets were unaffordable for many households, particularly those that were welfare dependent^{(Reference Lewis, Nash and Lee81)} and/or living in remote areas^{(Reference Lee, Patay, Herron and Parnell Harrison80)}, particularly Aboriginal and Torres Strait Islander groups^{(Reference Lee and Ride13,Reference Lee and Ride14,Reference Lee and Lewis82)} . More surprisingly, analysis also showed that healthy diets can be less expensive than unhealthy, habitual diets; yet due to the ubiquitous availability and promotion of unhealthy products, typical Australian families were spending around 58% of their food budget on unhealthy food and drinks, including discretionary take-away foods and alcoholic beverages^{(Reference Lee, Kane and Lewis78–Reference Lewis, Nash and Lee81)}. Therefore, it is unsurprising that the unhealthy food industries responsible are relatively happy with the status quo. In fact, several even go further, with frequent calls for broadening the GST base in Australia to apply to basic, fresh foods^{(Reference Davies, Veerman and Marklund83)}.

Current opportunities

Current opportunities to engage around nutrition policy include potential collaborative action under the United Nations (UN) decade of Action on Nutrition, which in early 2025 was extended to 2030, aligning with the Sustainable Development Goals (SDGs) to maintain political momentum for ending all forms of malnutrition, including obesity⁽⁸⁴⁾. This could include getting involved with global initiatives such as the WHO Food Systems Community of Practice⁽⁸⁵⁾ or INFORMAS⁽⁶¹⁾.

It is essential that advocacy around implementation of nutrition policy actions is co-ordinated. To this end, a broad blueprint for national nutrition action is outlined under the nutrition components of the National Preventive Health Strategy⁽⁶³⁾ and the National Obesity Strategy⁽⁶⁴⁾. More recent framing around food system transformation, including addressing food security and environmental sustainability, provides scope for new collaborations and approaches to nutrition policy and practice. This could be fostered by the development of a specific National Nutrition Framework using the funding provisioned in 2022.⁽⁶⁵⁾ Active membership of nutrition organisations such as the Nutrition Society of Australia and other relevant non-government and professional organisations can enhance advocacy efforts and increase capacity of the nutrition and health sector to influence policy and practice.

There are frequent opportunities to respond to single nutrition issues where they are a topic of national or state parliamentary enquiries, FSANZ proposals⁽⁴²⁾, or raised specifically by Government Departments and Agencies. One example of the latter is the current consultation on options to mandate infant formula marketing controls in Australia by the Australian Government Department of Health, Disability and Ageing⁽⁸⁶⁾. Another was the development and implementation of the National Strategy for Food Security in Remote Aboriginal and Torres Strait Islander Communities recently developed by NIAA after extensive consultation⁽⁷³⁾.

Technological developments have facilitated communication among like-minded individuals and organisations and streamlined co-ordinated calls for policy action, such as endorsing efforts to ‘raise the rate’ of welfare payments to improve economic access to healthy food in Australia⁽⁸⁷⁾.

Both informal networks, and formal professional societies, such as the Nutrition Society of Australia, can also share insights during broader policy development processes to help ensure consistent responses. One example is a large, informal email group for those interested in nutrition and health which has shared intelligence around the content of DAFF‘s closed co-design workshops on Feeding Australia to help inform the new National Food Security strategy^{(70,Reference Carey71,Reference Rose72)} .

This approach could also be useful in influencing the scope of practice of the recently launched Australian Centre for Disease Control (CDC)⁽⁸⁸⁾ which aims to ‘protect Australians from public health threats by strengthening prevention, preparedness and trusted public health advice’. Unlike its predecessor, ANPHA, that was disbanded in 2014, the CDC currently has a focus on communicable disease. However, it is understood that there is opportunity for the CDC to address prevention of chronic disease under future work plans.

At the state level, various nutrition policy initiatives are underway, often led by ‘wellbeing’ agencies that technically lie outside of government and therefore are more protected from political whim. An example is Health and Wellbeing Queensland, established in 2019 to replace nutrition and health promotion capacity lost in that state in 2012.⁽⁸⁹⁾ Disappointingly, VicHealth, the first such agency globally, is currently under notice of imminent absorption into the Victorian Health Department⁽⁹⁰⁾. A co-ordinated campaign of preventive health experts is actively seeking reversal of this decision⁽⁹¹⁾.