A review of the implementation of Sustainable Development Goal 2: Addressing pre-obesity and obesity

This review by the National Audit Office focuses on Sustainable Development Target 2.2, which aims to end all forms of malnutrition. In Malta, and the European Union, the prominent nutritional issue is overweight, comprising pre-obesity and obesity. The high prevalence of adult, adolescent and child overweight in Malta, the associated cost burdens on public expenditure, and the impact of obesity on morbidity, quality of life, mental wellbeing and life expectancy underlie the decision to focus this review on the Government’s efforts aimed at reducing the prevalence of overweight.

The NAO ascertained that, over recent years, the pre-obesity, obesity and overweight indicators for children, adolescents and adults registered increasing trends. The only exception is that of the child obesity indicator, which remained stable. This Office’s overall assessment of the achievement of the targets set in the Healthy Weight for Life Strategy is similarly negative, with only one of the four targets set, that relating to adolescent obesity, met. In considering the lack of progress registered, the NAO recognises that the failure to reduce overweight prevalence rates is not unique to Malta. Moreover, this Office acknowledges the complex nature of overweight, the pervasive and strong presence of an obesogenic environment that is not entirely within the control of the Government, as well as the element of personal responsibility and choice.

As to the sufficiency and effectiveness of Government’s work, the NAO acknowledges the investment and efforts undertaken, including legislative changes, policy developments, as well as implemented projects, measures and initiatives. However, sustained high prevalence rates raise concerns about whether Government is fully cognisant of the scale of the problem and taking sufficient action. Stakeholders highlighted gaps in funding, human resources and service provision, and issues related to lack of policy coherence. Of concern to the NAO are the limited legislative changes implemented, reduced in scope from that intended in the original private member’s bill tabled to address obesity. This Office advocates for strengthened political will to make the address of overweight an overarching priority across all sectors of Government, and for the allocation of appropriate resources and funding, as well as the undertaking of sufficient efforts in this respect. While the Government has undertaken several measures that address the vulnerabilities of particular groups, disaggregated statistics and stakeholder feedback provide insight into the systemic disadvantages of specific groups, highlighting the need for varied and sustained targeted efforts to effectively reach these groups.

The Advisory Council on Healthy Lifestyles provides an adequate framework for enabling communication, coordination and cooperation within Government and for promoting a whole-of-government approach to addressing overweight. The strengthening of the Council could help secure more impactful outputs and positive outcomes in terms of the set targets. This Office recognises the need for the Council to widen its consultative processes, and to introduce a more robust monitoring and implementation framework. While the NAO notes the efforts undertaken to promote whole-of-government cooperation and a health-in-all-policies approach, this Office acknowledges stakeholder concerns regarding elements of incoherence in the wider policy framework, shortcomings in policy implementation and inconsistencies between policy frameworks and major projects design. The NAO therefore advocates for further cooperation across ministries and entities within the Ministry for Health and across Government at the level of policy implementation and service provision.

The NAO noted that the consideration of non-governmental stakeholders when designing policy and action is central to Government’s approach to tackling overweight, and recommends for these considerations to be sustained. Moreover, this Office recognises the efforts undertaken by the Advisory Council to consult and foster cooperation with actors external to the Government; however, contends that there is scope for more impactful consultative practices. The scope for such practices also applies more broadly to legislative drafting, policy formulation and service design, delivery and evaluation across Government sectors. With respect to successful areas of cooperation for implemented actions, the NAO commends the progress registered, albeit limited, in private sector settings and with non-governmental stakeholders. Nevertheless, there is ample scope for Government to further collaborate and partner with non-governmental stakeholders, to capitalise on all available resources, overcome capacity shortages and ensure a holistic, effective and sustainable approach towards tackling overweight. Specifically, this Office supports the view that by involving businesses as stakeholders, through consultation, as well as incentive and support schemes, it becomes possible to leverage their expertise, resources, and reach to effect positive change.