Unconventional Practice, "Innovative" Interventions and the National Law.

This column explores a recent health profession disciplinary case which throws light on the problems of unconventional interventions by medical practitioners under the Health Practitioner Regulation National Law Act 2009 (Qld). The case involved "innovative" practices which were later found to have been scientifically unsupported, dangerous to patients and grounds for cancelling the health practitioner's registration. This column looks at common features of these kinds of cases in Australia and then examines recent attempts by the Medical Board of Australia to draft policy guidance around the use of unconventional practice in medicine. This column concludes with a number of changes to improve the effectiveness of the proposed policy.

Using regulation to limit salt intake and prevent non-communicable diseases: lessons from South Africa's experience.

OBJECTIVE: To analyse the policy process for the South African regulation setting upper limits for salt in thirteen commonly consumed food categories, to inform future policy action for prevention of non-communicable diseases. DESIGN: Semi-structured interviews (n 10) were conducted with key stakeholders from government, academia, non-governmental organisations and the food industry. Interviewees were asked about the content, context, process and actors involved in developing the regulation. Data were analysed according to Walt and Gilson's health policy analysis triangle. SETTING: South Africa. PARTICIPANTS: Key actors and stakeholders in the policy process to develop the salt regulation. RESULTS: The regulation was a response to research establishing the effectiveness of food supply interventions and to a shared perception that government regulation was the quickest way to address the problem of salt overconsumption. While the regulations were developed through a consultative process, food industry stakeholders perceived the consultation as inadequate. Implementation is currently underway, supported by a health promotion programme. Monitoring and enforcement were identified as the most likely challenges due to capacity constraints. CONCLUSIONS: Comprehensive mandatory salt limits are an innovative approach to food reformulation. Factors that enabled regulation included robust scientific evidence, strong political and bureaucratic leadership, and the pragmatic use of existing regulatory instruments. The main challenges identified were disagreement over the appropriate nature and extent of food industry participation, and monitoring and enforcement challenges due to capacity constraints.

Government action on diabetes prevention: time to try something new.

Type 2 diabetes mellitus, driven by overweight and obesity linked to unhealthy diets, is the fastest-growing non-communicable disease in Australia. Halting the rise of diabetes will require a paradigm shift from personal to shared responsibility, with greater accountability from Australian governments and the food industry. It will also require governments to try something different to the prevailing approaches emphasising education and the provision of information. We propose four priority areas where government regulation could strengthen Australia's response. Those areas relate to mandatory front-of-pack food labelling, regulating junk food advertising, better oversight of food reformulation and taxing sugar-sweetened beverages.

'Sustainability does not quite get the attention it deserves': synergies and tensions in the sustainability frames of Australian food policy actors.

OBJECTIVE: The development of food policy is strongly influenced by the understanding and position actors adopt in their 'framing' of sustainability. The Australian Government developed a National Food Plan (2010-2013). In public consultations on the National Food Plan Green Paper, the government sought stakeholders' views on sustainability. The present study examined the way in which the food industry and civil society organizations framed sustainability in their submissions to the Green Paper. DESIGN: Submissions by food industry actors and civil society organizations were analysed using a framing matrix that examined positioning, drivers, underlying principles and policy solutions related to sustainability. Submissions were open coded and subsequently organized based on themes within the framing matrix. SETTING: Australia. SUBJECTS: One hundred and twenty-four written submissions (1420 pages). RESULTS: While submissions from industry and civil society organizations often framed sustainability similarly, there were also major differences. Civil society organizations were more likely to make the link between the food supply and population health, while industry was more likely to focus on economic sustainability. Both viewed consumer demand as a driver of sustainability, welcomed the idea of a whole-of-government approach and stressed the need for investment in research and development to improve productivity and sustainable farming practices. CONCLUSIONS: The meaning of sustainability shifted throughout the policy process. There are opportunities for creating shared value in food policy, where the health, environment and economic dimensions of sustainability can be compatible. However, despite pockets of optimism there is a need for a shared vision of sustainability if Australia is to have a food policy integrating these dimensions.