Tahna Pettman, Jillian Whelan, S. Allender, Tim Gill, Penny Love, Elizabeth Waters, Erin Smith, John Coveney, Anne Romanus, Kristy Bolton, Whelan, Jillian, Love, Penny, Romanus, Anne, Pettman, Tahna, Bolton, Kristy, Smith, Erin, Gill, Tim, Coveney, John, Waters, Elizabeth, and Allender, Steve
The prevalence of adult obesity continues to rise internationally.1 In 2011–12, 62.8% of Australian adults were classified as overweight (35.3%) or obese (27.5%); and 25.1% of children aged 2–17 were overweight (18.2%) or obese (6.9%).2 Data from the Global Burden of Disease study, released in 2014, indicates that poor diet, followed by overweight and obesity (high body mass index) are now the two leading risk factors contributing to burden of chronic disease in Australia.3 The prevention of obesity through population-level intervention holds great promise and the literature includes examples of community-based intervention trials.4–7 Recent systematic reviews indicate that community-based and community-wide approaches show potential to prevent obesity,8 particularly in school settings,9 and should encourage community engagement, participation and capacity building,4,10 policy, built environments and social marketing4,9 and whole of community change.11 Other core elements of successful community-based interventions have been identified as: a) implementation of multiple strategies; b) operation across multiple levels such as the socio-ecological model levels of individual, interpersonal, organisational, community and public policy; and c) development of community participation and ownership.10 Additional considerations might include: the ideal duration required for an initiative, methods to evaluate the impact on obesity prevalence long term, elements of best practice and identification of target populations.8,9,11,12 Community-based efforts to prevent obesity have been defined as “… a program of activities that occurred in the community, either at or through community settings or by engagement with existing community group(s), with objectives that could be expected to influence energy balance by promoting healthy eating and/or physical activity … excluding one-off events (e.g. a healthy eating fair), projects that focused solely on individual behaviour change (e.g. through educational counselling), higher level policy or ‘social marketing only’ programs and treatment or management oriented projects that worked solely with overweight or obese individuals.”13 For this discussion, community-based obesity prevention initiatives (CBI) include those with a focus on healthy eating and/or physical activity adopting a multi-strategy approach (policy, built environment, social marketing, partnership building), within multiple settings (e.g. health, education, community and commercial sectors such as community organisations, schools, workplaces or clinics) and across multiple (socio-ecological) levels, excluding one-off events and one-on-one educational sessions with individuals or small groups of individuals. In 2008, the Australian Federal Government launched a major investment of $932.7 million, through the National Partnership Agreement on Preventive Health (NPAPH), to address the rising prevalence of lifestyle-related chronic disease through communities, early childhood education and care environments, schools and workplaces, supported by national social marketing campaigns. Funding to the states/territories was provided through the Healthy Communities Initiative ($71.8 million; 2009–2014), Healthy Children's Initiative ($244.4 million; 2011–2018), and Healthy Workers' Initiative ($221.8 million; 2009–2018), with an agreed monitoring and reporting process to meet a set of population-level performance benchmarks. These benchmarks were to be assessed by the Council of Australian Governments (COAG) Reform Council at two time points: June 2016 and December 2017.14 The Federal Government budget of 2014 announced the NPAPH will cease as of 30 June 2014, forecast to generate savings to the Federal Government of $367.9 million over four years.15 The future health cost burden related to decreased investment in prevention remains unclear. Within states/territories this and other funding has provided opportunities to expand CBI through local and state governments and to direct funding grants to individual communities. Some states/territories have also shared strategies, such as social marketing campaigns and telephone counselling services to reduce duplication and costs.16,17 These layers of investment make it difficult to obtain a comprehensive picture of the current landscape of CBI in Australia. Recent research indicates that a common focus of these initiatives has been to increase healthy eating and physical activity through education and skill building;18 however, a more comprehensive understanding of CBI currently operating in Australia is needed. This overview aims to increase the awareness of the breadth of CBI activity, highlight the areas of commonality and scope, catalyse discussions and knowledge exchange between practitioners, communities, funders and researchers, and illustrate the national obesity funding investment within Australia.