Att3 Fnms Final Report 0406

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fina l rep ort

a national food andnutrition monitoring a nd

surveillanc e system :a framework and abusiness c ase

Ap ril 2006


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final report: national food and nutrition monitoring and surveillance system April 2006

1 www.nexusmc.com.au

Nationa l food and nutrition m onitoring andsurveillanc e system: a framework a nd a

business c ase

Greg Maste rs, Ing rid Coles-Rutisha user, Ka ren Webb ,Ge off Marks & Jim Pea rse.

April 2006.

about NexusNexus Ma nag em ent Consulting solves c omp lex problems in p ublic and c omm unity

orga nisa tions. We he lp orga nisat ions deve lop p rac tica l strategies tha t c larify direc tion andma ke suc c essful imp lementa tion more likely.

With substa ntial public sec to r expertise a nd a responsive a pproa c h, Nexus wo rks with

c lients to a ssess ma nage me nt c ha lleng es and design p roc esses to solve them . Nexus sservices include:

strate gic a nd c orporate p lanning program evaluation

ma nage ment review and orga nisational development group fa c ilitat ion

strategic management training.

More de ta ils on our servic es c an b e found a t ww w.nexusmc .com .au and we c an b ec ontac ted a t g ma ste rs@nexusmc .co m.a u or on 02 9559 2468.


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ContentsExec utive summ ary 4

Glossary 10

Introduction 11

1. the need for a nationa l system 12

1.1 the c onte xt 13

1.2 c osts and risks a ssoc iated with no syste m 16

1.3 How to sell the c ase for an ong oing system 17

2. the fram ework for a national system 19

2.1 uses of a na tiona l system 213. propo sals for the c ore elem ents of a food and

nutrition mo nitoring system 23

3.1 the foo d supp ly 23

3.2 food purc hasing/ ac quisition 26

3.3 food and nutrient inta ke (& physic alactivity) 29

3.4 nut ritiona l sta tus 35

4. institutiona l & gove rnanc e arrangem ents 364.1 FNMS c oo rd ination c ent re 37

4.2 steering c om mitte e 38

4.3 tec hnica l advisory g roup s 39

4.4 c ontinuous survey p rog ram administrat ion 39

4.5 rela tionship with d a ta providers 39

5. op tions for structuring the die tary survey prog ram 40

5.1 nutrient inta ke da ta by age / sex sub-g roup 405.2 nutrient inta ke d at a by ma jor pop ula tion sub-

group s (adults) 41

5.3 estima tes of foo d intake 42

5.4 b iolog ica l me asures 43

5.5 da ta ava ilab ility and rep orting 44


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6. c osting the system 46

6.1 re-insta teme nt of the Ap pa rent Co nsump tion of Foo dstuffs 46

6.2 enhanc eme nt of the food c om po sitiondatabase 47

6.3 ad vice on survey questions on foo d andphysic al ac tivity b eha viours inc orpora tedinto hea lth surveys 49

6.4 c om prehensive d ieta ry a ssessment surveyprogram 49

6.5 na tional c oo rd ina tion c entre 59

6.6 summary 59

7. ad ditiona l c osts assoc iated with op tions formo difying the baseline comp rehensive dietaryassessment survey prog ram 61

8. implem enting the fram ework 64

appendices

ap pe ndix 1 projec t overview 66

append ix 2 list of sta keholders c onsulted 69append ix 3 summary of sub missions on disc ussion

paper 72

append ix 4 summ ary of internat iona l c onsultat ions 88

append ix 5 summ ary of expe rt panel c onsulta tions 106


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executive summary

An ad eq uate and varied diet is imp ortant for norma l

growth and de velop ment, ma intenance o f goodhea lth and the p revent ion of c hronic d isea se; as is theneed for up-to-da te, reliab le a nd timely da ta top rovide a basis for informe d d ec ision m aking andreg ula tion b y go vernment. Despite this, and c lea revide nc e for the c ontribution o f nutrition to thec onsid erab le b urden of p reve ntab le ill hea lth,Austra lia s polic y ma kers do not ha ve a deq uateinforma tion to de velop c ost-effec tive food and nutritionpo lic y a nd reg ulation.

The ne ed for a na tiona l food and nutrition m onitoringand surveillanc e system has long been rec og nised a ndit has bee n ide ntified a s a p riority in seve ra l pub lichea lth nutrition, obesity, physica l ac tivity and c hronicd isea se-related polic y d oc ume nts.

This rep ort p rovides a framew ork and c ost e stima tes forestablishing a national food and nutrition monitoringsurveillanc e system (FNMS). The dev elopment o f theframew ork follow s extensive c onsultation with a d iverse

rang e of sta keho lde rs: Australian, Sta te and TerritoryGovernments, non-government organisations,p rofessiona l assoc iat ions and industry b od ies. Theframe wo rk wa s a lso informe d by a review o f selec tedinternational ap p roa c hes to foo d a nd nutritionmonitoring.

Ove rwhe lming supp ort for an ongoing , sustainableFNMS em erge d from these c onsultat ions. Governmentagenc ies, po licy makers, reg ulato rs and ind ustry

rep resentatives state that they do not ha ve a de qua teinforma tion o n the follow ing: the nutritiona l ad eq uac y of the foo d supp ly; eq uity of food ac c ess; effec ts on hea lth of c hange s in the c om position of

foods in the food supp ly; use o f nutritiona l supp lem ents and their effe c t on

nutrient intake, nutritiona l sta tus and hea lth;


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differenc es in nutritiona l sta tus betwe en d ifferentpopulation sub-groups;

a lignm ent o f food and nutrient intakes in thepop ula tion with dieta ry ta rge ts and guide lines and

nutrient reference values developed for Australiaand New Zea la nd; trend s in ea ting p a tterns and their effec t on food

industry g row th a nd innova tion; imp lic a tions of tec hnologic a l and regulatory

c hang es on the c om po sition o f the foo d supp ly; and risks a ssoc ia ted with expo sure to b ioac tive

c om p ound s in foo ds a t c urrent leve ls ofconsumption.

The c onsulta tion p roc ess a lso ident ified a range o fsignific ant c osts and risks a ssoc ia ted with no t ha ving a nongoing system, inc lud ing: red uc ed ab ility to ap propriate ly dev elop , target a nd

mo nitor the outc om es of p ublic hea lth nutritioninterventions;

la te d ete c tion of new , or ac c elera ting , nutritionp rob lem s in the c om munity, and the lac k of trendinforma tion about t he p ossible c auses;

inc rea sing relia nc e on o utda ted da ta to unde rtakeeffective risk assessment for food additives,fortific a tion with vitam ins and minera ls, c hem ic a lresidues etc ; and

an inability to m onitor the o b jec tives of p ublic hea lthnutrition polic ies a nd p rog rams.

For the ma jority o f sta keho lde rs the c osts and risks of no thaving a system far outw eighed the c osts of

esta b lishing a n ongoing mo nitoring system.

THE FRAMEWORK

The frame work presented in this rep ort p rov ides a ba sisfor provid ing the informa tion id entified by sta keholdersa s nec essa ry for making informed d ec isions about fo odand nutrition polic y in Australia . The fram ew ork,d ep ic ted in figure 1, c onta ins four elem ents:


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food supp ly : informa tion on the ava ilab ility offoodstuffs and the composition of Australian foods;

food purc hasing/ ac quisition : informat ion onexpenditure o n food , type s of foo d purcha sed , pric e

and quantities boug ht; food sec urity; food and physica l ac tivity behav iours: 24-hour rec a ll

da ta , short questions about selec ted food ha bitsand me asures of physic a l ac tivity;

nutritiona l sta tus : informa tion on individua lsb iolog ic a l me asures.

Figure 1 framework for a national food & nutrition monitoring system

foodsupply

foodpurchasing

&acquisition

Food &physicalactivity

behavioursnutritionalstatus

During the c onsultat ions the re w as rem arkab lec onsistenc y a mo ng the d iverse rang e o f sta keholderson one point: a c om prehensive, na tional systemreq uires ong oing informa tion o n ea c h of the eleme nts.

The fram ew ork doe s not purport to a d d ress a ll of theinforma tion nee d s and suggested p riorities tha tem erged from c onsulta tions on a d ra ft fra me wo rk.Ra ther, a minima list or ba seline m od el that c ould b ebuilt up on over time is p roposed . This baselineframe wo rk c om prises seve n rec om me nda tions forimp roving d ata on foo d and nutrition, of whic h the keyprop osa l is the esta b lishment o f a n ong oing p rog ram ofc om prehe nsive d ieta ry surveys:

1. esta b lish a c ont inuous, c om prehe nsive d ieta rysurvey p rog ram which includes me asurem ent of

weight a nd height a s well a s a ssessme nt o f physica lactivity;

2. reinsta te the c om pila tion a nd repo rting o f theAp p arent Consump tion of Foo dstuffs time seriesda ta ;

3. strengthen the ong oing m aintenanc e a nd up da tingof food c omp osition da ta;

4. c ond uc t routine sec ond a ry a nalyses of ho useho ldexpenditure data;


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5. d evelop metho ds for monitoring c om munity fooda c c ess sec urity a nd food sec urity;

6. d evelop short survey questions on selec ted foo da nd physic a l ac tivity b eha viours; and

7. inc lude a pp rop ria te b iologic a l me asures ofnutritiona l sta tus in the o ngoing survey p rog ram.

To be susta inab le, the system req uires a perma nent ,de dic ate d c oordinating c entre c omp rising four to fivestaff with skills in food and nutrition monitoring, publichealth nutrition, data analysis and reporting, andep idemiolog y and b iosta tistics. The p rima ry purpo se ofthe c entre wo uld b e to ove rsee a nd c oo rdinate thec ore a c tivities. It is not p rop osed tha t the c entre would

unde rta ke the d ieta ry survey p rog ram b ut it wo uldp rod uc e nat iona l food a nd nutrition mo nitoring rep ortsbased on e xisting a nd new da ta sourc es, liaise w ith theorga nisa tion responsible for cond uc ting the surveyprog ram a nd with Foo d Sta nda rds Australia NewZea land in relation to their role in upd a ting the fo odc omp osition d ata , and p rovide tec hnic al ad vic e o nfood a nd nutrition m onitoring to othe r bod ies and

jurisd ic tions.

Figure 2 A model of governance and institutional arrangements for anational food and nutrition monitoring and surveillance system

STEERING COMMITTEE(funders, stakeholders)

NFNMScoordinating

centre(eg AIHW)

Technicaladvisorygroups

Surveymanagement& field work

Foodcomposition

data(FSANZ)

Existing datasources (egABS, states)

NPHIWG;CATI TRG

As shown in figure 2, a steering c om mittee c om prisingthe fund ers and sta keholders oversee the c ent re w ith


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tec hnic al and sc ientific ad vic e p rovid ed by releva ntexisting a nd new ly esta b lished expert g roup s.

COSTING THE SYSTEM

Seve ra l options for co nduc ting the c om prehensived ieta ry survey p rog ram a re c onsidered. The op tion thatha s bee n c osted is ba sed on surveying every yea r ana tiona lly rep resenta tive sa mp le of 2,000 ind ivid ua ls.Data on food intake wo uld be c ollec ted using a 24-hour rec a ll instrume nt (simila r to tha t used in the 1995NNS) with a sec ond 24-hour rec a ll c ond uc ted byte lephone interview on a ll resp ond ents. Physica l ac tivitywould b e a ssessed using a short set o f sta nd a rdisedquestions and height a nd we ight me asured for the fullsamp le. The b asic o p tion a lso a llow s for the c ollec tionof releva nt b iolog ica l me asures of nutritiona l sta tus(suc h a s iod ine, folate, iron, b loo d lipids, bloo d pressure)on 25% of the to ta l samp le in ea c h survey yea r. Thebasic o p tion is estima ted to c ost $1.2 million a nnua lly.

The c yc le o f survey a c tivities includes a p ilot of t hesurvey in yea r 1, da ta c ollec tion in yea r 2, ana lysis inyea r 3 and rep orting in yea r 4. The sec ond c yc le ofd ata c ollec tion w ould be gin in year 3, with a sam ple ofad ults. Tab le 1 show s the time seq uenc e of surveyactivities for the years 2006-2013.

Table 1 Comprehensive dietary survey program activities for theperiod 2006-2013 based on the baseline option .

Preparatorywork

Datacollection Analysis ReportingSurvey

groupYear

Children 2006 2007 2008 2009

Ad ults 2007 2008 2009 2010Children 2008 2009 2010 2011

Ad ults 2009 2010 2011 2012

Spec ialgroup eg0-2 yea rs

2010 2011 2012 2103

Note tha t the tab le include s prepa ra tory a nd planningwork a ssoc iate d with ea c h sta ge of c yc le. This doe s notnec essa rily me an a pilot stud y in ea c h yea r. Indeed , the


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who le purpose of a n ongo ing p rog ram is to minimise set -up c osts, includ ing p ilot survey c osts. For example,if child ren w ere surveye d in suc c essive ye a rs (i.e. 2007and 2008), there wo uld ob viously be no p ilot c osts in2007 for the 2008 survey. Ad d itiona l pilot c osts in 2008for a c hild ren s survey in 2009 will on ly be nec essa ry ifthere are changes to survey specifications.

Pilot costs in 2007 for the adult survey in 2008 would alsobe expec ted to b e m inima l given that themethod olog y will be e ssent ia lly the same a s tha t usedfor c hild ren. How eve r, there c ould b e signific ant p ilotc osts in 2010 for the spec ia l g roup to be surveyed in2010.

The p roposed annua l sample size o f 2,000 will enab lerep orting o f nationa l leve l da ta by NRV ag e/ sex groupfo r a ll survey me asures includ ing inta ke of food sc la ssified a t the ma jor foo d group level in the firstrep orting c yc le.

Mo re d eta iled rep orting of fo od intake will be possib leafter the sec ond c ycle for both c hildren and ad ults.Rep orting o f da ta by sta te w ill be p ossible for ad ults,without a ny over-samp ling, afte r the sec ond c yc le

exc ep t for Tasmania a nd the Territories.Seve ra l alternat ive op tions have a lso bee n c osted .These involve o ver-samp ling spec ific pop ula tion sub -group s or inc rea sing the num ber of rec a ll da ys from twoto four. This ad ds app roxima te ly $0.4-$0.6 million to thesurvey s annua l c osts. Om itting the b iolog ica l me asuresfrom 25% of t he samp le in a survey yea r red uc es thesurvey c ost b y a pp roxima te ly $0.2 million.

Othe r ma jor annual c osts inc lude app roxima tely $0.5million fo r the na tiona l co ordina tion c entre a nd $0.25million to e nhanc e the foo d c om po sition d ata ba se. Asma ller annua l am ount is a lso a lloc a ted to ma inta iningthe Ap parent Co nsump tion of Foo dstuffs data series.


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10www.nexusmc.com.au

glossary

ABS Austra lian Burea u o f Sta tistic s

AFNMU Australian Foo d a nd NutritionMonitoring Unit

AGPS Australian GovernmentPub lishing Service

AIHW Australian Institute of Health& Welfa re

ANDB Australian Nutrient DataBank

CATI Co mp ute r AssistedTelep hone Interviewing

CATI TRG Co mp ute r AssistedTelep hone InterviewingTec hnica l Referenc e Group

CSIRO Com mo nwea lth Scientificand Industrial ResearchOrganisation

DOHA Depa rtment o f Hea lth &Ageing

EWA Ea t Well Austra lia

FAO Foo d & Ag ricultureOrga nisat ion of t he UnitedNations

FNMS Foo d a nd NutritionMo nitoring an d Surveillanc eSystem

FSANZ Foo d Sta nd ards Austra liaNew Zealand

HES Household ExpenditureSurvey

NATSINSAP National Ab original andTorres Strait Islander NutritionStrate gy and Ac tion Plan

NHMRC National Health and Med ica lResearch Council

NHPC National Health PerformanceCommittee

NHS Nat iona l Hea lth Survey

NNS Nat iona l Nutrition Survey

NPHIWG Nationa l Public Hea lthInforma tion Working Group

NPHP Nationa l Public Hea lthPartnership

NRV Nutrient Refe renc e Va lues

NUTTAB Australia n nutrient referenc edatabase

OECD Orga nisa tion for Ec ono micCo-operation a ndDevelopment

SEIFA Soc io-Ec ono mic Ind exes forAreas

SIGNAL Strateg ic Inter-Gove rnme nta lNutrition Allianc e

SIGPAH Strate gic Intergovernmenta lForum for Physica l Ac tivity &Health

TGA Therape utic Good sAdministration

WHO World Hea lth Orga nizatio n


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introduction

In la te 2004, Nexus Ma nagem ent C onsulting wa s

enga ge d by the Australian G overnment Dep artment ofHea lth a nd Ageing, on b eha lf of the Stra teg ic Inter-Go vernme nta l Nutrition Allianc e (SIGNAL), to d evelop aframe wo rk and business c a se for an ong oing,susta inab le na tional food and nutrition mo nitoring andsurve illanc e system (see append ix 1 for an overview ofthe p rojec t a nd terms of referenc e).

This rep ort ha s bee n p rep a red follow ing e xtensivec onsulta tion with a range o f nat iona l sta keholders (seeapp end ix 2 for a list o f sta keholders c onsulted ,append ix 3 for a summa ry rep ort on the submissions ona d isc ussion p aper prep a red during the p rojec t,append ix 4 for a summ ary of the interna tiona lc onsulta tions and append ix 5 for a summ ary of theexpert panel consultations).

The rep ort is struc tured a s fo llows: sec tion 1 sta tes the need for a na tional food and

nutrition monitoring and surveillance system

sec tion 2 set s out a p rop osed frame wo rk for ana tiona l system sec tion 3 prov ides deta ils on p riorities for ea c h of the

eleme nts of the p rop osed frame wo rk:

food supp ly

food purchasing/acquisition

food a nd physic al ac tivity b eha viours

nutritional status

sec tion 4 p rop oses the gove rnanc e a rrange me ntsfor a na tiona l system;

section 5 suggests steps for implementing theframework;

sec tion 6 c osts the p rop osed frame work and system;and

section 7 provides indicative costs for a series ofop tional varia tions to the p rop osed fra me wo rk.


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1 the need for a national system

An ad eq uate and varied diet is imp ortant for norma l

growth and de velop ment, ma intenance o f goodhea lth and the p revent ion of c hronic d isea se; as is theneed for up-to-da te, reliab le a nd timely da ta top rovide a basis for informe d d ec ision m aking andreg ula tion b y go vernment. Despite this, and c lea revide nc e for the c ontribution o f nutrition to thec onsid erab le b urden of p reve ntab le ill hea lth,Austra lia s polic y ma kers do not ha ve a deq uateinforma tion to de velop c ost-effec tive food and nutritionpo lic y a nd reg ulation.

For examp le, p olic y ma kers, reg ula to rs and others donot have rea d y ac c ess to the informa tion need ed toanswer q uestions suc h a s: Is a nutritiona lly ad eq uate food supp ly ava ilab le a nd

ac c essible to a ll seg me nts of t he A ustralianpopulation?

Are there struc tura l ba rriers to eq uita b le food ac c esswithin Austra lia tha t nee d to b e a dd ressed ?

Is the c om position o f food s in the foo d supp lyc hang ing a nd a re the c hang es assoc iate d w ithinc rea sed or dec rea sed risk of nutrition rela ted illhealth?

What are the imp lic a tions of tec hnolog ic al a ndreg ulato ry c hang es on the c om po sition o f the foo dsupp ly, for population hea lth a nd fo r Australia s foo dindustry?

Are the risks of exposure to b ioac tive c om pounds infood ac c ep tab le, at c urrent levels of c onsump tion?

Is the c om position o f the overall d iet c hanging a nd isthis a ssoc ia ted with inc rea sed or dec rea sed risk ofmo rbidity, chronic d isea se a nd mo rta lity?

Are fo od hab its and nutrient intakes of thepop ula tion cha nging in line with dieta ry target s a ndguide lines and nutrient referenc e va lues deve lop edfor Australia a nd New Zea land ?

What a re the c urrent t rend s in ea ting p a tterns tha tma y affec t food industry growth a nd innovation?


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Is the nutritiona l sta tus of the pop ula tion c ha ngingand is this a ssoc iate d with inc rea sing or dec rea singrisk of m orbid ity, c hronic d isea se and mo rta lity?

Is nutritiona l sta tus d ifferent for d ifferent pop ulation

sub-g roup s and wha t e nvironm enta l, soc io-ec onomic a nd p ersona l fac tors a re a ssoc ia ted withthese d ifferenc es?

Is the use of nu tritiona l supp lem ent s c ha nging , andwha t a re the imp lic a tions for nutrient intake,nutritiona l sta tus and the he a lth of the pop ula tion?

1.1 THE CONTEXT

The ne ed for a na tiona l food and nutrition m onitoringand surve illanc e system ha s long bee n rec og nised .Reg ula r monitoring of the food and nutrition system wa sid ent ified a s one of four p riority ob jec tives of the Food a nd Nutrition Polic y fo r Austra lia adop ted in 1992. Anumb er of Austra lian G ove rnme nt-funde d initia tiveshave c ontributed tow ard s this ob jec tive sinc e 1992,including: Australias Food and Nutrition , AGPS, 1994 Plan for a Nat iona l Foo d and Nutrition Mo nitoring

Program , AIHW, 1995 Nationa l Nutrition Survey Austra lia 1995, ABS 1997-

1998 (4801.0 to 4805.0) Australian Foo d and Nutrition Mo nitoring and

Surveillanc e Projec t , AFNMU/ DOHA, 1999-2001.

The ne ed for a na tiona l food and nutrition m onitoringand surveillanc e system has a lso been a c knowledge din a numbe r of releva nt po lic y do c uments de veloped

sinc e 2001. Bluep rint fo r Nation-Wide Surveillanc e o f Chronic

Diseases and Associated Determinants.Prepared by National Public Health InformationWorking Group (NPHIWG) fo r the Nationa l Pub licHea lth Pa rtne rship in June 2005, this d oc ument set sout the essent ia l elem ent s of a na tiona l surve illanc esystem and highlights a s a high p riority thede velopme nt of integrated d ata on nutrition,


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physic al ac tivity and physic al and biome dica lmeasurements 1.

Hea lthy Weight 2008: The Na tiona l Ac tion Ag end a for Child ren and Young Peo p le and the ir Families.

This doc ument set a s a na tiona l ac tion in 2004 to'sc op e and d eve lop spec ific a tions for nat iona lnutrition and physic a l ac tivity m onitoring andsurveillanc e syste ms' 2.

Rura l, Reg iona l and Rem ote Hea lth. Informa tion Framework and Ind ic a to rs, Version 1, 2003 3.This doc ume nt outlined a frame work for desc ribingrura l hea lth informa tion a nd a set o f ind ic a torsaga inst whic h to repo rt on rura l hea lth, mod elled onthe Nationa l Hea lth Performa nc e Frame wo rk 4.

A p rop osa l for the Australian Hea lth Mea surem ent Survey Prog ram . This doc ument p rop osed a series ofc ross-sec tiona l hea lth mea surem ent surveys tha tinc lude p hysic a l and b ioc hem ic a l me asures ofhealth status and potentially modifiable risk factorsand dete rminants of hea lth including nutrition 5.

Ea t Well Australia A Stra teg ic Framew ork for Pub lic Hea lth Nut rition 2000/ 2010 (EWA): this d oc ument,deve lop ed by Stra teg ic Inter-Governmenta l Nutrition

Allianc e (SIGNAL) fo r the NPHP, desc ribes key a c tiona rea s for pub lic hea lth nutrition inc luding the ne edfor monitoring p rog ress in food and nutrition 6.

Nationa l Ab origina l and Torres Strait Island er Nutrition Stra te gy a nd Ac tion Plan2000/ 2010 (NATSINSAP),develop ed by SIGNAL for the NPHP as a c om pa niondoc ument to Eat Well Australia : this doc ume ntadd resses key a c tion a rea s for ATSI pop ulat ions

1 Blueprint for nation-w ide surveillanc e o f c hronic d isea ses & a ssoc iate d d et ermina nts, NPHIWG , 2005, p.17

2 Healthy Weigh t 2008 , DOHA, 2003. p .19.

3 Rural, Reg ional a nd Rem ote Hea lth. Informa tion Frame wo rk a nd ind ic a to rs. Version 1 AIHW, PHE No 44, 2003, pp .18-35.

4 Nationa l Health Performanc e Frame wo rk Rep ort , NHPC, Q ueenslandHea lth, 2001.

5 A p ropo sa l for the A ustralian Health M ea sureme nt Survey Program . AHMSWorking Paper Series No. 8. PHIDU, Adelaide,2003.

6 Ea t Well Australia A Strat eg ic Fram ew ork for Pub lic Hea lth Nutrition 2000/2010. NPHP, 2001.


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inc luding the nee d fo r na tional foo d a nd nutritioninformation systems 7.

Nationa l Pub lic Hea lth Informa tion Developm ent Plan , p rep a red jointly by AIHW and NPHIWG: the

purpose of this doc ume nt wa s to identify the ac tionsneed ed to imp rove pub lic health informa tion inAustralia 8.

Be Ac tive Australia: A Fram ew ork fo r Hea lth Sec to r Ac tion for Physica l Ac tivity 2005-2010: a na tionalphysic al ac tivity ac tion p lan d evelope d b y theStrate g ic Inte rgovernmenta l Forum for Physica lAc tivity a nd Hea lth (SIGPAH) fo r the NPHP a ims top rovide a na tiona l foc us on p hysic a l ac tivity forhea lth that respond s to the need for urge nt ac tion to

sup port a ll Australians in a c hieving improved andsusta inab le hea lth outc om es.

As rec ent ly a s Ma rc h 2005, the Australia and New Foo dZea la nd Foo d Reg ula tion Ministe rial Co unc il a sked theAustralian Hea lth M iniste rs Co nferenc e to c onsider theesta b lishme nt of a nat iona l foo d and nutritionmonitoring and surveillanc e system as a high priority.This wa s in rec og nition of t heir need to have up-to-da ted a ta to a ssist in formulating food reg ula tion polic y.

Desp ite the se long -sta nd ing a nd reg ular ca lls for ana tiona l system , the c ollec tion and rep orting o f foodand nutrition informa tion rem a ins ad hoc and un-c oo rdinat ed in Austra lia .

Numerous c ountries with simila r pub lic he a lth p rob lem sto those c urrently enc ounte red in Austra lia a lrea dyhave in plac e a n ongoing program of food a ndnutrition m onito ring . While the spec ific deta ils of thesep rog rams va ry from c ountry to c ountry, a p rog ra m o freg ula r nat iona l nutrition surveys is c ent ra l to a ll of them .For exam ple, hea lth a nd food reg ula tory authorities inNew Zea la nd, the United Kingd om , the Netherlandsand the United Sta tes of A me ric a a ll co nsid er that suc ha p rog ram p rovides the o nly reliab le m ea ns of

7 Nationa l Ab origina l an d Torres Strait Island er Nutrition Strate gy an d Ac tion Plan2000/2010, NPHP, 2001.

8 National Public Health Information Development Plan. AIHW, Cat. No. HWI22, 1999.


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c ollec ting the d eta iled da ta o n individ uals need ed forthe d evelopm ent of soundly ba sed food and nutritionpolic y and reg ula tion (see a ppend ix 4).

1.2 COSTS AND RISKS ASSOCIATED WITH NO SYSTEM

Sta keholders c onsulted during the d eve lop me nt of theframe wo rk noted a numb er of signific a nt c osts andd isadva ntage s of no t ha ving a nat iona l FNMS.

Firstly, a number of sta kehold ers c om mented tha t, inthe a bsenc e o f c urrent informa tion, there is a red uc edab ility to app rop ria tely de velop , target and monitor theoutc om es of p ub lic hea lth nutrition interventions. While

hea lth a utho rities, na tiona lly and interna tiona lly, a repromoting evide nc e-ba sed po lic ies and prac tic e,Australia is often reliant on da ta c ollec ted in 1995 a sevid enc e to supp ort the developm ent ofrec om mend ations and prac tic e som e te n yea rs late r.

A rela ted risk is the lat e d ete c tion o f new , orac c elera ting, nutrition p rob lem s in the c om munity, andthe lac k of trend informa tion a bout t he p ossib le c auses.For exam ple, a re c hanges in ob esity leve ls linked to c ha nges in c erta in d iet p a tte rns or exerc ise o r both? Is there a n em erging p rob lem with, for insta nc e, Vita min D, iod ine or fola te?

Sec ond ly, a number of sta keholders highlightedpa rtic ula r c onc ern that foo d reg ula tory dec isions a rebe ing b ased on inc rea singly outda ted da ta from the1995 Nationa l Nutrition Survey. Effec tive risk a ssessmentfor food additives, fortification with vitamins andminera ls, chem ica l residues, nove l food s a nd so onc annot b e c a rried out without current da ta on foodand nutrient intake. This is bec ause risk ana lysis dep end son a c c ura te d ieta ry expo sure a ssessments whic h a reonly po ssib le if there is c urrent knowled ge o f food intakeand c om position, pa rticularly of food s which haveem erge d rec ently in the ma rketplac e.

From industrys sta nd point, there is a c onc ern tha t theintroduction of new technologies, initiatives orinnova tions ma y be inhibited bec ause, in the absenc eof c urrent d a ta , risk assessments must e rr on the side of

caution.


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Third ly, given the c onside rab le resourc es tha t ha vebee n alloc ated to d eveloping and implementinginitia tives suc h a s Healthy Weight 2008 and Ea t We ll Australia, it is imp erative that c hange s in the foo d andnutrition situa tion a re m onitored ove r time , and tha tthese trends a re rela ted to the ob jec tives of na tionalpublic hea lth po lic ies and p rog rams.

Other risks a rising from the a bsenc e o f a c oo rd inate dfoo d and nutrition mo nitoring a nd surve illa nc e systeminclude: the invisibility of som e food and nutrition p rob lem s an inability to d evelop p olic y and progra m

responses lead ing to polic y inertia an inab ility to determine c lea r p riorities for resourc e

allocation ineffective/ inap propriate food reg ulation la c k of c red ibility of p ublic hea lth me ssage s an inability to p roperly assess existing p olicy initia tives

and p rograms an ina bility to reliab ly de te rmine trend s over time .

Moreover, in the p ast dec ad e, experienc e ha s show nthat relianc e on a d hoc and stop-gap ap proa c hes,d esp ite c onsiderab le e xpend iture of resourc es, has lednot o nly to loss of c orporate me mo ry and sta ff with theunique skills req uired for nutrition monitoring but a lso toan inc rea singly inad eq ua te informa tion b ase forevid enc e-ba sed de c ision ma king.

For the ove rwhe lming m a jority of the w ide range o fstakeholders c onsulted during the d eve lop me nt of thisrep ort, the c osts and risks of not having a system fa routw eighed the c osts of e sta b lishing a n ong oing a ndsusta inab le food and nutrition m onitoring andsurveillanc e system.

1.3 HOW TO SELL THE CASE FOR AN ONGOING SYSTEM

The interna tiona l c onsultations revea led tha t there w ereseveral c ritic a l fac tors when t rying to sell the c a se fo r anong oing fo od a nd nutrition mo nitoring system / surveyprogram:


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the nee d to show c lea rly that the informa tion tha twill be c ollec ted c annot b e p rovided from anothersource;

the nee d to highlight a nd list ALL the ways in which

the da ta c an b e used with exam ples of topica lissues; the nee d to find c ham pions within the p rinc ipa l

funding a ge nc y/ ies; the ne ed to g et key sta keholders ta lking to releva nt

Ministers; and the nee d to sta rt sma ll.


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2 the framework for a national system

This sec tion set s out a frame wo rk for a na tiona l food

and nutrition m onitoring a nd surveillanc e system. Thefram ewo rk is de rived from the c onc ep tual mod el of therelationship b etwe en food and health that w aspub lished in the 1995 plan for a na tiona l food andnutrition monitoring program 9. The m od el, dep ic ted infigure 1, c onta ins four elem ents: food supp ly : informa tion on the ava ilab ility of

foodstuffs and the c om position of Austra lia n foo ds food purc hasing/ ac quisition : informat ion on

expenditure o n food , type s of foo d purcha sed , pric eand q uantities boug ht; food sec urity

food and physica l ac tivity behaviours : informa tionon fo od and nutrient intakes; physic a l ac tivity

nutritiona l sta tus : informa tion on individua lsb iolog ic a l me asures.

Figure 1 framework for a national food & nutrition monitoring system

food

supply

foodpurchasing

&acquisition

food &physical

activitybehaviours

nutritional

status

During c onsulta tions on the develop me nt of this rep ort,there was rem arkab le c onsistenc y a mo ng the d iverserange of sta keholders on o ne p oint: a c om prehensive,na tiona l system req uires ong oing informa tion on ea c hof the eleme nts.

There w as a lso g ene ra l sup port for a num ber of

p rinc ip les to g uid e the deve lop me nt of the system : sta rt o ff with a minima list-ba seline m od el with the

mo st imp ortant elem ents that c an be built upo nove r time

fund ame nta l to t he system is the e sta b lishment o f anong oing c om prehensive d ieta ry survey p rog ram

9 Co les-Rutishauser, I & Lester, I Plan for a Nationa l Foo d and Nutrition Monitoring Program . Australian Institute o f Health & Welfare, Nov em b er1995.


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the system should inc lude the c olla tion a ndsecondary analysis of existing data collections

to b e susta inab le, the system req uires a perma nent ,ded ic ated c oordinating unit.

The framework in this report is found ed on the sep rincip les. The fram ew ork doe s not purport to ad d ressa ll of the informat ion need s and sugg ested p rioritiestha t emerged from c onsulta tions on a d ra ft frame wo rk.Ra ther, a minima list or ba seline m od el that c ould b ebuilt up on over time is p roposed . This baselineframew ork c om prises seve n broa d p rop osa ls forimp roving da ta o n food and nutrition. A set o finstitutiona l and go vernanc e a rra nge me nts is p rop osedto und erpin the system s viab ility a nd susta inab ility.

Figure 2 - Summary of proposals for implementing a baselinenational food & nutrition monitoring

food supplyfood

purchasing &acquisition

food & physicalactivity

behaviours

nutritionalstatus

Availability offoodstuffs

Composition ofAustralian foods

i n f o r m a

t i o n

o n :

1. Reinstate theApparent Consumption of Foodstuffs in Australia

2. Strengthen theongoing updateof foodcomposition data

p r o p o s a

l s :

Expenditure bytypes andquantities of food

Food security

3. Conduct routinesecondaryanalysis ofHouseholdExpenditureSurvey (HES)data

4. Develop methodsfor monitoringcommunity foodaccess and foodsecurity

Food & nutrientintakes

Physical activity Food habits

5. Establish arollingcomprehensivedietary surveyprogram

6. Provide technicaladvice on shortsurvey questionson selected food& physicalactivitybehaviours

Biologicalmeasures

7. Include biologicalmeasures in thenational dietarysurvey program

SeeSECTION 3.1

SeeSECTION 3.2

SeeSECTION 3.3

SeeSECTION 3.4

Figure 2 p rovid es an a t-a-g lanc e summ ary of p rop osa ls,under ea c h eleme nt, for the de velopm ent of a nationalfoo d a nd nutrition mo nitoring and surve illa nc e system.The informa tion o n the p roposa ls in figure 2 iselab orated in sec tion 3.


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2.1 USES OF A NATIONAL SYSTEM

The p otent ia l sta kehold ers in, and uses of d a ta from , anong oing c oo rd inate d FNMS a re show n in ta b le 1. Theseuses have b een ad ap ted from wo rk by the Ministry of

Hea lth in New Zea land a nd inco rpo rate feed ba c k fromsta keholders and the stee ring c om mittee during thed eve lop me nt of this frame wo rk.

Table 1 Potential users and uses of data from a food & nutritionmonitoring system 10

Stakeholder Uses

CommonwealthGovernment

Food:

Developm ent, monitoring and enforc ement offood reg ulations and sta nda rds (food safet yrisk a ssessme nt, food c om position dat abasema intena nc e a nd lab eling requireme nts),deve lopm ent o f fortific ation and health claimspolic y, and other food reg ulation po lic y issues,c ontribution to internationa l foo d sta nda rds(Codex), provision of Ministeria l ad vice .

Nutrition:

Developm ent of national food a nd nutritionguidelines, nutrient reference values, nutritiongo a ls and ta rge ts, nutrition p olic ies, strate giesand p rogram s (e.g . EWA & NA TSINSAP), hea lthpromotion, provision of nutrition services,

Ministeria l adv ice .Nutrition relat ed hea lth sta tus:

Developm ent of health strate gies (e.g. fo rc hronic d isea se p reve ntion and a ddressinginequalities between population sub-groups),mee ting international repo rting ob liga tions(OECD/ WHO/ FAO).

Sta te & Territo ry& p ublic healthunits & p rima ryc are provide rs

Strat eg ic de velopm ent o f p ublic hea lth nutritionDevelopm ent of nutrition educ at ion, healthpromotion programsEnforc em ent of foo d stand ards

Developm ent o f reg iona l and spe c ific settingsfood and nutrition hea lth p olic ies and strate giesGuida nc e for servic e p lanning, resourcealloc at ion, and a ba sis for client a dvic e.

10 Adapted from Food and Nutrition Monitoring in New Zealand, PublicHealth Intelligence Occasional Bulletin No 19, Ministry of Health , Wellington2003 ( http://www.moh.govt.nz )


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Stakeholder Uses

Foo d industry(pa ddoc k to

plate)

Guiding p rima ry p rod uc e resea rc h andde velopm ent a nd m arketing and distributionstrategies

Food product developm ent, lab eling, andma rketing (Australia and ove rsea s)

Resea rc h, develop ment a nd innovation

Non-government

and c onsumerorganisations

Basis for nutrition a nd hea lth prom otion p olic iesand programs and provision of a dv ic e to t hege neral p ublic

Resea rc h a ndacademicinstitutions

Ident ifying releva nt d irec tions for ap pliedresea rc h inc luding me thod s resea rc h for healthand nutrition mo nitoring and for healthprofessiona l t raining


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3 proposals for the core elements of a food andnutrition monitoring and surveillance system

As noted in sec tion 2, the framew ork p resented in thisrep ort is a ba seline m od el for a minimum da ta set t omeet user needs. Accordingly, the proposals describedin this sec tion c an be rega rd ed a s c ore elements tha tc ould be expa nded and built on over time.

The p rop osa ls a re c onsidered in turn for ea c h of the foureleme nts of the frame wo rk introd uc ed in sec tion 2.

3.1 THE FOOD SUPPLY

Informa tion on food supp ly fa lls into two c a teg ories: informa tion on c hange s in foo dstuffs ava ilab le for

consumption informa tion on c hange s in the c om position o f food s.

These two element s a re c onsidered in turn.

3.1.1 Foo dstuffs ava ilab le for c onsump tion :

In Australia, the p rima ry time series d a ta for desc ribingquantita tive c hange s in the foo d supp ly ove r the lastha lf-c entury has bee n the App arent Consump tion o f Food stuffs and Nutrients series, published by ABS fromthe mid-1930s unt il 1993-94 (ABS Ca ta log ue No. 4306.0,1997). AIHW too k ove r responsibility for pub lica tion o fthe nutrient d a ta from 1994-95 onwards while the ABSc ontinued p rod ucing the Ap pa rent Co nsump tion of Foodstuffs series until the year 1998-99 (ABS CatalogueNo. 4306.0, 2000).

The series wa s based on a c om pila tion o f d a ta from awide range of sourc es, the sc op e a nd c overag e o fwhic h d iffered for different d a ta item s. Source sincluded not only ABS sta tistica l collec tions suc h a s theAg ricultura l Co mm od ity Survey a nd the Survey ofInventories and ProductionFood and BeverageMa nufac turers, but a lso d a ta from industry a ssoc iationsand government reg ula to ry authorities. The o riginalpurpose o f the series wa s to p rod uc e na tional foodba lanc e sheet da ta, whic h take ac c ount of annual

p rod uc tion, imp orts, expo rts and non-food uses to

foodsupply

foodpurchasing &

acquisition


behaviours

nutritionalstatus


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estima te the a mo unt of all food ava ilab le forc onsump tion in Austra lia in kg p er head of p op ula tion,per yea r.

While muc h of the ba sic c om mo dity da ta a re still

c ollec ted and published (Agric ultura l Commo dities, ABSCa ta log ue No. 7121.0), and used for interna tiona lreporting p urpo ses, an ABS rev iew o f the sources andresourc es need ed to c om pile reliab le d a ta on the tota lava ilab le food supp ly led to the Ap pa rentConsumption of Foodstuffs compilation beingd isc ont inued from 2000. During c onsultations on thedeve lop me nt of this rep ort, a numb er of sta keholderssaw the reinsta tement o f this series a s a p riority fo r ana tiona l monitoring a nd surveillanc e system. This was in

rec og nition o f the va lue tha t a long -sta nding t ime serieshas a s a too l for monitoring key c hang es in the ove ra llAustralian food supp ly.

PROPOSAL 1:

Reinstate the c ompilation and reporting of time series da taApparent Consumption of Foodstuffs in Australia from2000/ 03.Key fea tures: Publication: five ye a rly, to reflec t c ha ng es in the

freq uenc y/ sa mp le size o f som e o f the sta tistica l co llec tionsused by ABS to c om p ile the da ta .

Nutrient estima tes: Onc e the series ha s b ee n re-insta ted ,investiga te t he ne ed a nd fea sibility of using the d ata toestima te m a c ronutrients and alco hol ava ila ble forc onsump tion (e.g. fat, ca rb ohydrates and protein).

(Note : Estima tion o f m icronutrien ts from this c ollec tion is mo rediffic ult b ec ause o f the nee d to identify food s in greate r de tailtha n is a va ila b le from the ma jority of c om mo d ity surveys).

3.1.2 Foo d Composition DataA w id e range of stakeholders noted the funda me ntalimp ortanc e of ac c urate food c omp osition da ta to: ident ify trend s in the nutrient (a nd non-nutrient)

c om position o f the foo d supp ly ove r time derive nutrient intakes of t he p op ula tion from d ieta ry

survey da ta estima te risks of ov erexposure to spec ific

c omp ounds in food .


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While FSANZ c urrently ha s responsibility for ma inta iningthe Australian Nutrient Da ta Bank (ANDB), this is no t itsc ore func tion, whic h is the d evelopm ent of foo dsta nd a rds. FSANZ ha s only been a b le to d irec t limitedfunds from its c ore b udg et for ana lytic a l work to fill da taga ps for nutrients or othe r b ioac tive substa nc es tha t a rethe subjec t of a pp lic a tions or prop osa ls to a me nd thefood stand ards c od e.

Ac c ord ingly, there is a need for an ongo ing p rog ra m o freg ular food c omp osition d ata review and foodanalyses. Specifically, this could entail: upd a ting ANDB and the 1995 survey da ta base

AUSNUT with key ne w food s and da ta for existingfoods available in various fortified forms for use in thefirst round of the p rop osed rolling survey p rog ram(see sec tion 3.3)

ac c eleration of the prog ram for d ate stam ping andarchiving o f food c om po sition d ata

c om missioning c a tc h up ana lyses to fill ga ps for thebaseline d a ta set

c om missioning ana lyses for new foo d s rep orted inthe rolling survey p rog ram

instituting a p rog ram for reg ula r a na lysis of key foo dsto assess trends in composition in the food supply.

PROPOSAL 2:

Strengthen the ongoing maintenance and updating offood composition data.

Key fea tures:

This p rop osa l is over a nd a b ove the resp on sibilities a ndfunc tions of FSANZ in ma inta ining a nd up d a ting the Australia nNutrient Da ta Ba nk (ANDB), a nd o the r foo d c om p osition da tab a ses derived from it (e .g. NUTTAB). Prep aration of ba seline survey d ata ba se a nd regula r

updates for priority nutrients, non-nutrients and key foodsshould b e on a key foo d s b a sis ; tha t is, whe rec om po sition d a ta a re la c king for foo ds that a re c omm onlyc onsumed , as ide ntified in previous surveys or ma rketinforma tion, or for foo d s whic h ma y present a foo d sa fetyrisk. Amon g key foo d s , the highest p riority for up d a tes arefor nutrien ts or non-nutrien ts of c urren t o r em erging p ub lichea lth c onc ern. This wo uld inc lud e c hem ic a l a na lyses offortified foo d s to verify their nutrient c ont ent , given the irp ot ential to c ont rib ute sub sta ntially to intakes of p a rticularnutrients. It is rec om me nd ed tha t c riteria for de terminingp riorities for upd ating foo d c omp osition d ata be ba sed onthose rec omm end ed for New Zea la nd.


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Ac c eleration of da te-stamp ing and a rchiving of surveyd a ta b a ses ra ther tha n c ont inua l sub stitution of late stfigures, so that c hang es in foo d c om p osition b etwe ensurvey rep orts c a n b e id entified and mo nitored ove r time.

Collab oration with New Zea land : Bec ause foo d sta nda rd sfor bo th Austra lia and New Zea la nd a re no w d evelop edb y FSANZ the fo od c om p osition da ta b a se p rog ra ms ofbo th c ountries co uld be c oordinated to p rovidec onsid erable savings, and a void d uplic a tion of e ffort a ndg a p s in d a ta b a se p riorities.

3.2 FOOD PURCHASING/ ACQUISITION

Informa tion req uired on foo d purc hasing a ndac quisition falls into tw o c a tegories:

informa tion o n c hange s in expe nditure, type s offood a nd qua ntities of food purcha sed a nd pric e informa tion on food sec urity 11 .


3.2.1 Expend iture, types, price and qua ntity

In Australia , informa tion about household expenditure onfood is collec ted at period ic interva ls as part of the ABS

Household Expenditure Survey (econom ic surveyprog ram). The data from this survey are currently under-utilised for food and nutrition monitoring in pa rt bec ausethe HES does not include data on the quantity of food spurc hased and bec ause the desc ript ion of food s is notsuffic iently de ta iled to derive nutrient/ non-nutrient c ontent.

Recognising the value of information about householdfood purc hasing to an understanding o f trends inhousehold food sec urity ac ross soc ioec onomic stra ta , and

the potentia l va lue of the ABS period ic Household Expend iture Survey and the ABS soc ial survey prog ram forthis and related purposes, it is prop osed tha t sec ond aryanalyses of d ata from the HES be routinely inc luded as partof the food a nd nutrition monitoring system .

11 Foo d sec urity refers to the ac c essibility and av ailab ility of nutritiona llyad equa te a nd c ulturally ac ce pta ble food for all peo ple by soc iallyac cep table means

food

purchasing &acquisition

food supply


behaviours

nutritionalstatus


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PROPOSAL 3:Conduct routine sec ondary analyses of HouseholdExpenditure Survey data

Key fea tures:Routine secondary analyses of household expenditure surveyd ata c ould p rovide estima tes, over time , of tota l householdexpe nditure o n food and selec ted food groups, and theprop ortion of inc om e sp ent on food and p artic ula r foodgroup s b y househo ld c ha ra c teristics (e.g. level ofdisa dva ntag e, reg ion, etc) 12 . The prop osed na tionalc oo rdination c entre (see sec tion 4) c ould und ertake sucha na lyses, c om mission ABS to d o so , or liaise with a no the r groupto c ond uc t a nd rep ort these a nalyses. Explore with ABS the p otential to e xtend the c ollec tion and

reporting of HES data: to include q uantities of foo dsp urc hased , and to rep ort finer food c ate go ries suitab le fornutrition purposes. New survey technologies may supportthis a d d ition with little extra c ost. Suc h d a ta wo uld ena b lethe c om p a risons of q ua ntities of va rious typ es of fo od spurchased across households with different characteristics,a s we ll a s c a lc ula tion of p ric es p a id b y househo ld s forsimila r foo d s, and the estimat ion of ho useho ld d iet q ua lityb y nutrient s a va ila b le for co nsump tion in househo ld s ofva rious typ es. Suc h da ta wo uld e na b le rep orting o f theextent to which ho usehold food purcha sing hab its a rec hang ing relative t o po pulation nutritionrec om me nd a tions, (e.g . dieta ry guide lines, the Australian Guide to Hea lthy Ea ting ) an d the typ es of ho useho ld s mo sta t risk of fo od insec urity 1.

3.2.2 Foo d sec urity

Over the la st de c ad e there ha s be en a growing foc uson fa c tors a t the c om munity leve l, which ma y limitac c ess to a n afforda ble a nd q uality food supp ly forsom e household s. This is often d esc ribe d in te rms offood sec urity.

While som e fo od ac c ess issues (e .g. the p rices of b a sicfoo dstuffs in va rious typ es of fo od out let s, and the p riceof a ma rket ba sket of food s which m eet the d ieta ryguide lines) a re w ell d esc ribed for som e rura l andrem ote c om munities, inc luding those w ith a highp roportion o f Ind igenous residents, there is limited

12 simila r to a d hoc sec ond a ry ana lyses repo rted p reviously by Pow les J etal Health related expend iture p atte rns in selecte d migrant g roup s: da tafrom the Househo ld Expe nd iture Survey 1984. Co mm unity Hea lthStud ies1990;XIV(1):1-7; and b y Stic kney et a l Foo d and Nutrition in NSW; ac ata logue of d ata , NSW Hea lth Dep t. 1994


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national informa tion on a spec ts of food a c c ess tha td irec tly relate to food sec urity. In fac t, the o nly c urrentna tiona l informa tion about fo od insec urity in Australiac om es from one question in the 1995 Nat iona l NutritionSurvey a nd na tiona l hea lth surveys.

During sta kehold er consultations on the p rop osedframe wo rk, the inc lusion of streng thened nat iona linforma tion on food sec urity w as see n to be a p riority.How ever, it wa s ac know led ge d that foo d a c c ess andsec urity issues a re highly loc a lised a nd may be b eyo ndthe p urview of a na tiona l monitoring a nd surveillanc esystem.

Ac c ordingly, in line w ith the p rinc ip le tha t the p rop osed

framew ork rep resent s a minima list mod el, thefollow ing p rop osa l is deve lop me nta l in na ture a ndsugg ests d rawing o n the New Zea land expe rienc e.

PROPOSAL 4:FNMS coordinating unit develop methods for monitoringcommunity food ac cess sec urity and food sec urityKey Fea tures:

The p rop osed na tiona l c oo rd ina tion ce ntre (see sec tion 4)wo rking w ith oth er g roup s tow a rd s the use o f ap p rop ria te a ndc om p arab le me thod s for mo nitoring c om munity food a c c ess in a ra ng e o f c om munities a c ross Austra lia a ndp ot en tially linking with the ind ex of reta il p ric e surveys.Survey questions on ho useh old a nd individua l foo d insec uritysimila r to those used in New Zea la nd need to be de velope da nd te ste d . This c ou ld involve: lia ison w ith ABS in assoc iation with a resea rc h g roup to

und ertake th e t esting o f the foo d sec urity survey q uestionsused in new Zea la nd ;

lia ison w ith ABS reg a rd ing integ ra tion o f the se q ue stionsinto the mo st a p p rop ria te survey (e .g. the soc ia l survey

program); and/or lia ison w ith NPHIWG a nd the na tiona l CATI te c hnic a l

reference group on rec om mend ations for foo d sec uritymo nitoring in sta te s a nd te rritories.


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3.3 FOOD AND PHYSICAL ACTIVITY BEHAVIOURS &NUTRIENT INTAKE

It is p rop osed tha t informat ion on food and p hysic a lac tivity b eha viours in the na tional food and nutrition

monitoring a nd surveillanc e system c om prise tw ocomponents: a c ontinuous p rog ram of c om p rehensive d ieta ry

surveys short survey q uestions/ mod ules included in he a lth

and other population surveys on behaviours relatedto foo d and physic al ac tivity.


3.3.1 Continuous die tary survey prog ram

The overwhe lming m a jority of sta keholders c onsultedexpressed the ne ed for an ong oing, c om prehensived ieta ry survey p rog ram, inc luding physic a l ac tivityme asures, a s the funda me nta l c om ponent of amonitoring system. Indeed , for ma ny sta keholders, anutrition survey wa s synonymo us with a foo d a ndnutrition m onito ring and surve illanc e system.

The c ont inuous survey p rog ram p rop osed d iffers fromprevious surveys c ond uc ted in Australia in that a samplewo uld be rec ruited every yea r rather than onc e e veryfive or ten yea rs. The a dva ntage s of this app roa c h a rethat o nc e estab lished the program w ould be ong oing,a llow the rete ntion of c ritic a l expertise a nd be flexib leenough to a c c om mo da te em erging issues. Bec auserec ruitme nt is ong oing the size of the p rop osed annualsamp le is muc h sma ller tha n for a one -off survey, butwould g ene ra te d a ta for 10,000 individua ls a fte r 5 yea rs

and 20,000 a fte r ten ye a rs.

A c ont inuous survey prog ra m w a s see n a s the only wa yto ob ta in regular, de ta iled informa tion for use inmonitoring p rog ress in chronic d isea se p revention, a swe ll as to formulate and upd a te regulations to p rotec tthe sa fety of the food supp ly, and to identify em erg inghea lth a nd nutrition issues tha t require ne w polic yresponses.

food &physicalactivity

behaviours

food supply

food purchasing& acquisition

nutritionalstatus


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To d a te, there has been no system a tic or coo rd ina tedap proac h to the c ollec tion a nd reporting of informa tionabout the foo d a nd p hysic a l ac tivity be hav iours or thenutritiona l c ontent o f the d iets of the Australianpop ula tion. The only nat iona lly rep resenta tive d a ta onfood a nd nutrient intakes wa s c ollec ted in the 1995Nationa l Nutrition Survey (NNS), info rma tion which isnow outd ated for polic y development, and forestima ting c urrent risks of p rop osed c ha nges in foodregulations.

While v a rious agenc ies includ ing the ABS and sta te andterritories c ollec t limited informa tion in hea lth surveysand ha ve e sta b lished me c hanisms to w ork tow ardsbetter selection and standardisation of survey

mea sures, suc h group s have no ong oing a c c ess totec hnic a l expe rtise in food and nutrition m onitoring a ndsurveilla nc e. Conseq uently, a s note d by m anysta keholders, the re is no sta nda rd ised app roa c h to themea surem ent or rep orting o f these b eha viours, limitingtheir c om parability a nd use in monitoring trend s ove rtime.

While there wa s wide sp rea d a greem ent on the needfor a c ont inuous c om prehe nsive d iet a ry a ssessme nt

survey, there w as c onsiderab le d iversity o f view s on thestructure a nd d esign of the survey p rog ra m. In line w iththe p rincip le tha t the FNMS be susta ina b le a nd be likelyto win funding support, the proposed continuous surveyprog ram rep resents a baseline mo del, whic h iselabo rate d in p rop osa l 5 be low :The mo del is ba sed on a samp le o f 2,000 ad ults orc hild ren rec ruited every year from a ll sta tes andterritories throughout the yea r to p rov ide a t lea st 200individuals in the primary sub-groups of interest (e.g.

nutrient refe renc e va lue a ge-sex group s, SEIFA q uintilesby sex).

The c ontent of the survey will invo lve : a 24 hour multip le pass rec a ll proc ed ure fo llow ed by

a sec ond 24 hour rec all c ond uc ted by telepho neinterview

a short set of sta nd a rd ised questions on fo od andphysic a l ac tivity b eha viours


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mea sured we ight a nd height.

This ba seline m od el is c osted in sec tion 6.

It is imp ortant t o no te tha t the baseline m od el is not

tot a lly c om prehensive. It d oes not inc lude spec ia lgroup s for whom d ifferent a pp roa c hes for samp lingand / or dieta ry a ssessme nt a re req uired (e.g . for the 0-2yea r age g roup , pa rtic ula rly on infant fee d ingprac tices; Ind igenous Australians; pe op le with p hysic a llyand intellectual disabilities; hard-to-reachdisa dva ntag ed groups).

Mo reo ve r, as d isc ussed in sec tion 5, the p rop osedbaseline sa mp ling me thodolog y will not yield suffic ient

numb ers for reliab le e stima tes to be m ade fo r theterritories, smaller states and some population sub-group s a fte r the first round . Further, the baseline surveystructure w ould req uire tw o round s for ad ults and threeround s for child ren b efo re reliab le e stima tes forinfreq uent ly c onsume d foo ds will be p ossible.

Sec tion 5 p rov ides som e op tions for wa ys in whic h the seissues could be addressed: over-sampling sma ller jurisd ictions

over-samp ling key migrant g roup s. inc rea sing the numb er of 24 hour rec a lls from two to

four in the f irst survey round for c hild ren.

Sec tion 5 also c onside rs the possibility of a fourth op tionof c ollec ting b iologic a l samp les only in every sec ondsam pling year. This ap proac h c ould be ad vanta ge ouspa rticularly d uring the first two yea rs of the surveyprog ram b y red uc ing the d em ands on b oth survey sta ffand respond ent s until the first p op ulation samplingc ycle has bee n com pleted.

The ind ica tive c osts a ssoc iate d with the se fo ur op tionsa re d esc ribed in sec tion 6. Co st estima tes for sp ec ialgroup s suc h a s 0-2 yea rs will nee d to be d evelop edindividually to ta ke ac c ount o f the d ifferenc es inapp roa c hes for samp ling and / or d ietary a ssessme ntreq uired for ea c h group.


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PROPOSAL 5:Establish a continuous comprehensive dietary surveyprogram, including assessment of physical ac tivity (seesec tion 6 for description of basic option and options formodifying)

Key Fea tures: Design: A sa mp le of 2,000 ad ults or c hild ren will p rov ide

na tiona l estima tes of fo od a nd nutrient inta kes a fter oneyea r for ma les a nd fem a les:

o b y the a g e g roup s d efined b y NHMRC nutrientrefe renc e va lues for Australia .

o by SEIFA quintileso by remote , rura l a nd urba n plac e o f resid enc eo b y sea son ANDo som e regiona l a nd p op ula tion sub -group estima tes.

Data c ollection: should b e c ont inuous, that is, not a one -off

survey w ith no p la ns for a rep ea t. This c ould b e a c hieve deither by:o sequential surveying of specific sub-groups e.g. children

in selec te d yea rs, ad ults in others) or b yo surveying of rep resenta tive sa mp les of the who le

po pulation with rep orting on p op ulat ion sub-groupswhe n the sa mp le size is a d eq ua te fo r tha t p urp ose.

The c ostings in sec tion 6 a re b a sed on the first o f the se twoapproaches.

Reporting cycle: A c hild / a d ult seq uent ia l survey p rog ra mc ould rep ort eve ry three -five ye a rs a s p er the sc hed ule insec tion 5.

Stand -a lone or linked : The survey p rog ra m c ould either besta nd -alone o r 'ad d ed onto existing surveys tha t ha vec ont inuous d a ta c ollec tion', suc h a s the ABS Nationa lhea lth survey. A sta nd -alone survey ha s b ee n c osted insec tion 6.

Survey c ontent Dietary assessment: would b e b ased on the 24 hour

multip le p a ss rec a ll p roc ed ure used for the 1995 NNS with asec ond 24 hour rec a ll c ond uc ted by te lep hone interviewon a ll resp on d ents (CATI). This wo uld p rov ide mo re p rec iseinforma tion for d ete rmining t he p op ula tion distrib ution ofusual intake for foods, as well as nutrients, and enable thefood reg ulato ry ag enc y to ob ta in mo re stab le e stima tes ofthe prop ortion of the ad ult p op ulation a t risk of ove r-c onsump tion o f selecte d bioa c tive c om po unds of interest.(NB: de velopm ent of spe c ia lised me thod s wo uld bereq uired for sam pling a nd to c ollec t informa tion a bo utd ieta ry intake for the 0-2 yea r a ge group and other groupsnot included in the b a seline m od el).

The 24 hour rec a ll will inc lud e a ll foo d s a nd b eve ra ge sc onsumed inc luding nutrient supp leme nts and wa ter andthe TGA numb er will be used to id entify sup p lem ent s.

o A foo d freq uenc y que stionna ire w ill be included toa ssess usua l freq uenc y of inta ke o f foo d s a nd to id ent ifynon-c onsume rs of sp ec ific foo d s.


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Physical activity: a sho rt set of sta nd a rd ised q uestions ofknown va lid ity, ca p a b le o f a t least c la ssifying ind ivid ua lsinto sed enta ry, lig ht, mo d erate or vig orous p hysic a lactivity. In the context of 24-hour recall dietary assessment,the usua l leve l of p hysica l ac tivity informa tion is usefu l fo rinte rp reting informa tion a b out ene rg y intake (i.e. to a ssess

und er-rep orting). The c on sulta tion pha se, how ever, a lsoind ic ate d a strong c all for a p hysic al ac tivity co mp onentto b e included in the monitoring system be c a use of itsimp ortanc e a s a n ind ep end ent predicto r of hea lth sta tus(see section 3.3.2.

Demo graphic and anthropo metric information: to enab led esc rip tion of po p ula tion sub -group s, a nd w eight sta tus(me a sured height, we ig ht, wa ist c irc umfe renc e). Bloo dpressure measurements would also be desirable.

3.3.2 Short survey questions and mod ules on selec tedfood & physica l ac tivity behaviours.

Short survey questions are useful for monitoring specific a spec ts of foo d a nd p hysic a l a c tivity be haviour a s we lla s p rog ress toward s d ieta ry and p hysica l ac tivityrec om me nd a tions. The short survey q uestions c an b eused in a w ide ra nge o f survey vehicles, inc lud ing CATIsurveys and a s pa rt o f existing hea lth surveys.

How ever, to b e useful for national nutrition mo nitoringthe same questions need to b e used ove r time a ndbetwee n surveys. For this rea son it is p roposed tha texisting me c hanisms for the deve lop me nt o f suc hquestions be streng thened with tec hnic a l input from thena tiona l FNMS c oo rd ination c ent re.

Mo reo ve r, it is c ruc ia l tha t short survey q uestions aboutfood hab its are p eriod ic ally eva luated / re-evaluate dagainst more detailed dietary assessment methods toa ssess their performa nc e and how this ma y c hangeove r time. For this rea son, it is p roposed tha t thec om prehe nsive d ieta ry survey prog ram d isc ussed in

sec tion 3.3.1 include app roxima te ly six to10 que stionson selec ted food b eha viours.

There w as strong support d uring c onsulta tions on thed ra ft fram ew ork for the inc lusion of short q uestions onphysica l ac tivity, both to monitor trends in keybeha viours a s out lined in nationa l polic y guidelines onphysica l ac tivity, and to a ssist in inte rp ret ing the d ieta ryintake d a ta (pa rticula rly to a ssess und er-rep orting ofene rgy intake). The key g oa ls wo uld be to deve lop

age-ap p rop ria te short questions on b oth foo d a nd


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physic a l ac tivity b eha viours, valida te them period ic a lly,ma inta in c onsistenc y ove r time to e nab le trends to b ed etermined o ver the long-term, and to m ove to wa rdssta nda rd isa tion of survey questions on fo od andphysica l ac tivity behaviours, ac ross surveys with simila robjectives.

Sta nda rd ised app roa c hes to a na lysis and rep ortingwo uld a lso be desirab le, e.g. for infant feed ingprac tices a s me asured in the NHS and by Sta te CATIsurveys. Physica l ac tivity questions should b e selec ted inc onside ra tion o f instruments ava ilab le a nd those in usec urrent ly (see append ix 5). The v a lid ity of the physica lac tivity survey q uestions selec ted should b e a ssessedand periodically re-evaluated, using a relatively simple

but more d eta iled physica l ac tivity a ssessment in a sub -samp le o f the survey po pula tion, suc h a s da ilyped om ete r rea d ings (see a ppend ix 5).

PROPOSAL 6:FNMS coordination centre provide technical advice onshort survey questions on selec ted food and physicalactivity behavioursKey Fea tures:

Proc ess: FNMS p rov ide te c hnica l expe rtise to set p riorities forfood a nd physic al ac tivity be haviours to b e m onitored , andd eve lop / selec t ap p rop ria te q uestions or mod ules for these forinc lusion in nationa l a nd sta te/ territory p op ula tion hea lth a ndsc ho ol surveys. This sho uld ena b le freq uent rep orting onselec ted b eha viours, inc lud ing c om p a risons b etw ee n reg ions,and po pulation sub-groups.This c ould b e a c hieve d through esta b lishing links b etw ee n theproposed national c oordination c entre and the a ge ncies andc oo rd ina ting group s who p la n or ove rsee c hronic d isea se-relate d mo nito ring , e.g. NPHIWG, or p a rticular da ta c ollec tionsor surveys, e.g . NPHP Nat iona l CATI te c hnic a l refe renc e g roup ,ABS Nationa l Survey Prog ra ms, sta te a nd te rritory hea lth a nded uc a tion surveys.Validity Testing/ c alibration: Rec omm end a nd/ or undertakep eriod ic testing of fo od a nd p hysic a l a c tivity survey q uestionsag a inst mo re de ta iled me a sures of foo d a nd nutrient intake(preferab ly inc lude fo od ha b its q uestions in the na tiona lc om p rehe nsive d ieta ry surveys, a long with ind ep end entme a sures of p hysic a l a c tivity, e.g., p ed om ete r c hec ks) toa ssess their va lid ity a nd how this ma y c ha ng e o ver time .Rep ort find ings and ma ke rec om mend ations reg ardingq uestions, resp onse c a teg ories, ana lysis a nd rep orting.


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3.4 NUTRITIONAL STATUS

Dieta ry surveys c an only identify dieta ryinadeq uac ies/ excess by c om parison w ith nutrientrefe renc e va lues (NRV). Moreo ver, for som e nutrient sd ieta ry assessme nt is not a goo d indica tion of nutritiona lsta tus. Biolog ica l measures of nut ritiona l sta tus a retherefore ne ed ed to a ssess/ c onfirm the extent o f theadverse e ffec ts on the he a lth o f the pop ula tion. For thisrea son it is p rop osed tha t the na tiona l monitoring andsurveillance system include relevant biologicalmea sures of nutritiona l sta tus a nd tha t the se a re b estc ollec ted in the c ontext of a c om prehensive d ieta rysurvey.

PROPOSAL 7:

Inc lude biological measures in the ongoing dietary surveyprogram.Key Fea tures

Criteria for selec tion of b iologic al m ea sures: for b iologica lmea sures other than we ight and height, whic h a refunda menta l to the interpretat ion o f dieta ry da ta , inc lusion o fsuc h me a sures is on t he b a sis o f a set of a g ree d c riteria , andwith ad vic e o f a c om mittee with tec hnic al expertise innutritional status measurement and surveying, chronic diseaseprevention, and po lic y de velop ment.The fo llow ing c riteria a re sug g ested to gu id e t he selec tion of

b iolog ic a l me a sures: nutrients for whic h the re is relia b le evide nc e of

inad eq uac y in a signific a nt p rop ortion o f one or morep op ulation sub -group s (e.g. iod ine)

rec og nised risk fac tors for diet relate d c hronic d isea se (e.g.b loo d lip id s, wa ist c irc umfe renc e, b lood p ressure)

nutrient s of p ub lic hea lth sig nific a nc e fo r whic h fac torsothe r than d iet (e.g. supp lem ent intakes, biolog ic a lva riation , smo king , disea ses, drug-nutrien t interac tions, etc )influenc e n utritiona l sta tus ( e.g. fo la te a nd iron)

for nutrients where there are problems in estimatingap propriate / ad eq uate intake from food intake data (e.g.sod ium, c a rote noid s).

Sa mp le restric tion: In rec og nition o f the tend enc y ofbiological measures to reduce survey response rates,p a rticularly whe n c ond uc ted in a ssoc ia tion with ot her surveys,and the high c ost o f b loo d c ollec tion, ha ndling and assays, itis rec omm ende d that b iolog ica l measures be co nduc ted onthe sma llest sa mp le req uired to show key d ifferenc es ofinterest, and tha t me a sures only be d one on releva ntp op ula tion sub -group s, e.g . not e veryone should b e te sted foriron, o r iod ine. We ha ve a ssume d a sa mp le of 500 for c osting-

see a pp end ix 7.

nutritionalstatus

food supply

food purchasing& acquisition


behaviours


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4 institutional and governance arrangements

Figure 3 d ep ict s a mo del of institutiona l andgo vernanc e a rrang eme nts for the p rop osed nationalfoo d a nd nutrition mo nitoring and surve illa nc e system.

Figure 3 A model of governance and institutional arrangements for anational food and nutrition monitoring and surveillance system

STEERING COMMITTEE(funders, stakeholders)

NFNMScoordinating

centre(eg AIHW)

Technicaladvisorygroups

Surveymanagement& field work

Foodcomposition

data(FSANZ)

Existing datasources (egABS, states)

NPHIWG;CATI TRG

The key fea tures of the mod el are: a sma ll na tiona l c oo rd inat ion c entre or unit w ith

responsibility for c oo rd ination of the system,reporting and dissemination

a stee ring c om mittee c om prising the fund ers andstakeholders

tec hnic a l groups to a dvise on spec ia l a spe c ts of theFNMS (e.g. survey design, sampling)

a c ontrac tua l relationship w ith a spec ia list a ge nc yto m ana ge and c ond uc t the rolling survey p rog ram

c oo rd inat ing relationships with o ther age nc ies tha tp rovide da ta for the FNMS (e.g. FSANZ foodc om p osition d a ta ; ABS na tiona l hea lth surveydata )

advisory links with existing bod ies responsible for thede velopm ent of health da ta stand ards andc ollec tions (e .g . NPHIWG, CATI TRG).

Eac h o f these key fea tures sha ll be elab orated .


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4.1 FNMS COORDINATION CENTRE

It is p rop osed tha t a sma ll c oo rd ination c ent re o r unit isesta b lished with responsibility for the m a intenanc e a ndd evelopm ent of the ongoing food and nutrition

monito ring and surveillanc e syste m. This is in line w ithone of the mo st c onsistent them es em erging fromc onsulta tions on the deve lop me nt o f this rep ort: theneed for a p erma nent, de dic ate d unit that c an ensurethe susta inab ility of the system.

The spec ific role a nd func tions of the unit w ould ne edto b e d ete rmined a s pa rt of the forma lisa tion o f thego vernanc e a rra nge me nts, possib ly via a c ontrac t withthe fund ing bod ies. Broa d ly, it is p rop osed tha t the roleencompass: prod uc ing na tional food and nutrition surveilla nc e

rep orts d rawing o n existing and new da ta source s liaising with the a genc y responsible for the d ay-to-

day administration o f the rolling d ieta ry surveyprogram.

liaising w ith FSANZ on the foo d c om position da taand food reg ula tion ma tters pertinent to themonitoring system

c onve ning te c hnic a l advisory groups on thede velopm ent a nd imp leme ntation of the system

providing tec hnic a l ad vic e on foo d and nutritionmo nitoring a nd surveilla nc e to othe r bod ies suc h a sthe Nat iona l Pub lic Hea lth Informa tion WorkingGroup

liaising with ABS and other da ta p rov iders on d a tac ollec tions releva nt to the FNMS (e.g . nationa l hea lthsurvey).

Critic a lly, it is no t prop osed tha t the c entre will a c tua llyma nag e the dietary survey p rog ram or other da tac ollec tions; nor it is anticipa ted tha t the c entre haveresponsibility for tec hnica l oversight o f the d ieta rysurvey. Ra the r, it is see n a s a sma ll c oord inat ing a ndrep orting bod y c om prising four to five sta ff with skillsand experienc e in: food and nutrition mo nitoring and surveillanc e public hea lth nutrition


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nutrition d a ta a na lysis and rep orting ep idem iology and b iosta tistics.

Possible candidates for housing the unit include existing

bod ies suc h a s the Australian Institute of Hea lth a ndWelfare. The role of the p rop osed c oo rd ina tion c entre isc onsistent with the ma nda te of the Institute a s thena tiona l ag enc y for hea lth sta tistics a nd informa tion.The Institute a lrea d y ha s esta b lished workingrelat ionships with relevant b od ies and sta ff withexpertise in da ta c olla tion ana lysis a nd rep orting .App ointme nt of staff w ith the a bo ve e xpe rtise w ould berequired.

4.2 STEERING COMMITTEEThe c oo rd ina tion c ent re w ill rep ort to a steeringc om mittee c om prising rep resenta tives of the fundingbod ies and other key sta keholders. The c ent re srelat ionship w ith the steering c om mittee w ill bec omp lemented b y a pe rforma nce a greement orc ontrac t with the princ ipa l funding ag enc y.

The g ove rnanc e a rrange me nts wo uld idea lly integ ra tewith p re-existing a rrange me nts if the c entre we re t o be

loc a ted , as p rop osed , within a n Austra lian gove rnmentage nc y (e.g. AIHW) or in a n a ge nc y with a n existingc ont rac tua l relat ionship with the Australiangovernment.

The role of the steering c om mittee w ill be to : provide d irec tion to the c entre in its c oo rd ina tion of

the FNMS ap prove a nd m onitor the c oo rdination c entre s wo rk

program review the c oo rd ina tion c entres rep orts.

Id ea lly, the stee ring c om mittee w ould include publichea lth expertise, in order to be ab le to m ake anassessme nt o f the utility a nd p ra c tica b ility of t he a dv ic erec eived from the te c hnic a l ad visory group s.

To ensure na tiona l releva nc e, it is a lso imp orta nt toha ve rep resenta tion from a ll releva nt jurisd ict ions a ndthe Nat iona l Pub lic Hea lth Pa rtnership.


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4.3 TECHNICAL ADVISORY GROUPS

Tec hnic a l ad visory group s will provide advic e to thec entre on the deve lop me nt of the FNMS and , in

pa rticular, the c ontinuous d ieta ry survey p rog ram.The g roup s will c omprise p a nels of e xpe rts inc ludingac ad em ic s, resea rc hers and sta te/ territoryrep resenta tives on tec hnic a l a spec ts of food andnutrition mo nitoring a nd surve illanc e inc luding, forexample, survey d esign, sampling , da ta ana lysis andreporting.

4.4 CONTINUOUS SURVEY PROGRAM ADMINISTRATION

As note d above , it is not p rop osed tha t thec oo rd ina tion c entre be responsib le for the d ay-to-dayad ministrat ion o f the survey p rogram. This will be theresponsibility of a spec ialist a genc y, suc h a s theAustralian Burea u o f Sta tistic s or CSIRO, who would bec ontrac ted to c a rry out the survey fieldw ork.

4.5 RELATIONSHIPS WITH DATA PROVIDERS

The frame work proposed in sec tion 3 prov ides for theFNMS to: draw o n da ta from existing d a ta p rovide rs and

c ollec tions (e.g. for food supp ly monitoring; g ene ra lhea lth surveys; sta te and te rritory da ta )

streng then o r supp lem ent the food and nutritionda ta c ollec ted in existing c ollec tions (e.g . FSANZ sfood c om position d a ta , ABS s na tiona l hea lthsurvey).

Ac c ordingly, the FNMS c oo rdination c entre will nee d to

ma inta in and ma nag e forma l relationships with othe rag enc ies that c ontribute d ata to the nationa lmonitoring system.


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5 options for structuring the dietary surveyprogram

A number of op tions for struc turing the ong oing d ieta rysurvey prog ram ha ve b ee n c onsidered . The b asicop tion a dop ted for costing purposes a ssumes anannua l na tiona lly rep resenta tive samp le of 2,000individua ls. The samp le c ould inc lude individua ls of a llages or be from a d ifferent ma jor sub -group o f inte restea c h yea r. For exam ple c hild ren and a dults c ould besamp led in a lternate yea rs of the p rog ram. The o p tionsd esc ribe d be low a ssume this ap proac h is ad op ted butthe d a ta outc om es and c osts wo uld be e ssentially thesame if 2,000 ind ividua ls of a ll ages we re samp led ea c hyear.

5.1 NUTRIENT INTAKE DATA BY AGE/ SEX SUB-GROUP

If the samp le is stratified by the 16 age/ sex group sneeded to a llow c om parisons with Nutrient Referenc eValues (ta b le 5.1). A nat iona lly rep resent a tive samp le o f2,000 child ren or adults would yield da ta for ~250c hild ren or adults per NRV a ge/ sex g roup . This numberper sub-g roup , is ge nera lly c onsidered adeq uate fo rrep orting purposes.

2,000 child ren would yield ~250 child ren per NRVage/ sex group a fter one ye a r and ~ 250 adults per NRVage/ sex group a fter 2 yea rs of o peration o f the surveyprogram.

Table 5.1 Nutrient reference value (NRV) age groups

In the 1995 NNS the age/ sex group with the sma llestnum ber of respondents (16-18 yea rs) c onsisted of 215ma le a nd 218 fema les.

Based on da ta from the 1995 NNS (ABS Ca ta log ue No.4805.0, 1998), an effective sample of 250 respondentsfor ea c h ag e/ sex group wo uld give estima tes of me an

NRV ag e g roupsBoys 1-3 years and 4-8 yearsGirls 1-3 years and 4-8 yearsBoys 9-13 years and 14-18 years

Girls 9-13 yea rs and 14-18 yearsMen 19-30 years, 31-50 years, 51-70 years and >70 yearsWomen 19-30 years, 31-50 years, 51-70 years and >70 years


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intake with rela tive sta nd a rd errors (RSE) of b etween 1and 2.5% for energy a nd 4-8% for pro-vita min A. Thesenutrients usua lly rep resent the extrem es of va riab ility innutrient intake. A samp le of 2,000 c hild ren o r ad ultswo uld ge nerate suffic ient d ata for rep orting at nationalleve l ag a inst NRV c riteria by a ge and sex; and for SEIFAquintile, rura l, rem ote a nd urba n residenc e a nd sea sonby sex only.

5.2 NUTRIENT INTAKE DATA BY MAJOR POPULATIONSUB-GROUPS (ADULTS)

Tab le 5.2 shows for key p opulat ion sub -group s, theexpec ted numbe r of respo ndents that w ould b egene ra ted from a sample o f 2,000 adults (19 yea rs and

over) afte r 1, 2 and 3 yea rs of sampling, ba sed on 1995estima tes for po pulation d istribution in the releva nt sub -g roups (ABS, 1998).

Table 5.2 Cumulative number of respondents expected from asample of 2000 adults after one, two and three years of sampling

Expec ted numb er of adultrespond ents (men a nd wom en)

at end of:Pop ulation sub-group

1 Year 2 Years 3 YearsState & Territory: New Sou th Wales 687

Victoria 503Queensland 365South Austra lia 161 322Western Austra lia 186 372Ta smania 51 101 152*Northern Territory 16 32 48*Austra lian Ca p ita l Territo ry 30 60 90*Part of Sta te Ca pita l c ity 1284Rest of Sta te 716Rural, remo te a nd met rop olitan: Metropo litan (c entres with pop ulation of

100,000)

1437

Rural ce ntre (area s with a n urba ncentre 10,000)

235

Rura l and rem ote (all areas withcentres


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It is c lea r from ta b le 5.2 tha t the numb er of respond entsin the sta tes with the sma llest p op ulation, in thete rritories and in the sma llest c ountry of b irth g roup islikely to b e less tha n 200-250 eve n a fte r three yea rs ofsamp ling . For nutrient intake d a ta by sex eve n mo reyea rs of sampling a re req uired .

While inc rea sing the a nnua l sa mple size is an op tion, it ismuc h less effic ient tha n over-samp ling the releva nt sub -group s, since e ven a 50% increa se in the annua l sa mp lewo uld not yield a n ad eq uate numb er of respo nde nts(200) for the territories and the smallest country of birthgroup a fter three ye a rs of samp ling. For the c ostings ofenha nc em ent op tions in sec tion 7, we have e stima tedthe c ost o f ove r-samp ling to ob ta in 200-250 ad ult

respond ent s of e ac h sex for all pop ulation sub -group s inta b le 5.2, in ea c h yea r tha t a dults a re samp led .

5.3 ESTIMATES OF FOOD INTAKE

Unlike nutrient s, most food s a re not c onsume d on ad a ily b asis a nd therefore the numb er of respond entsreq uired to ob ta in mean estima tes of inta ke forind ividua l food s with simila r p rec ision to those o b ta inedfor nutrient inta ke req uires either a muc h la rger numb er

of respond ents or more da ys of foo d intake d a ta .Experienc e w ith the 1995 NNS and rec om me nd a tionsfrom the Europ ea n Foo d C onsump tion Survey Method(EFCO SUM) p rojec t (Vo lat ier et a l , 2002) suggests tha t ~2000 respond ents per group a re need ed to p rovidereliab le estima tes of mea n inta ke for mo st foo ds ofinterest inc luding tho se tha t a re no t c om mo nly orfrequently consumed.

In the 1995 NNS, for exam ple, while e stima te s of mea nintake for all ma jor food groups had ac c ep tab lerelat ive sta nd a rd errors (RSE) fo r all ag e/ sex g roup s, theRSEs for ma le and fem a le a dolesc ents aged 16-18 yea rswere g rea te r tha n 25% for 37 and 40 resp ec tively of the86 sub -ma jor foo d g roup s rep orted (~200 respond ent sper group ). In c ont ra st, only 5 of the 86 estima tes ofmea n intake fo r sub -ma jor food g roup s ha d RSE >25%for men and wo me n a ged 25-44 years (~ 2,000respond ents per group). All of these we re for food sconsumed by 2% or less of the respondents.


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Collec ting a sec ond d ay of food intake da ta for a llind ividua ls in the samp le w ill inc rea se the p rop ortion o fc onsume rs of less freq uent ly c onsumed foo d s, and thusthe numb er of indi

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