Dear Ministry of Health,

This request is directed to Deputy Director-General – Maree Roberts, who is responsible for Strategy Policy and Legislation and staff within this directorate.

Please do not forward this to another department within the Ministry of Health. This request is specifically aimed to this directorate to understand the extent of information held by the Directorate responsible for leading long-term strategy, setting direction and priority areas for investment and leading Ministry policy advice across a range of areas including workforce, disability, family and community health and COVID-19.

As public servants this department is tasked with improving, promoting, and protecting public health under the Health Act 1956. Ultraprocessed food is a recognised driver of both metabolic syndrome and mental illness. These conditions can present as a cluster of associated multimorbid conditions that drive health and wellbeing loss. Therefore, it is to be expected that this information would be held by your department so as to inform long-term strategy and direction setting.
Please supply:
1. Budget for this team for the current and estimated next (2024/2025) financial year.

2. Income of the Deputy Director-General Strategy Policy and Legislation, and numbers of team members and the incomes of the senior leadership team.

3. Terms of reference/expectations for this team and the name of the head of department that established the terms of reference/expectations for this directorate and team.

4. Information (for populations older than, and under 18 years) held by or requested by this directorate including research/memos/advice/emails as relating to:

a. The prevalence of metabolic syndrome in New Zealand, a cluster of symptoms characterised by central obesity, dyslipidaemia, hypertension and insulin resistance.
b. Current and predicted cost to the health system from metabolic syndrome which presents as multimorbidity (i.e. cost of multimorbidity for those diagnosed with metabolic syndrome).
c. Metabolic syndrome and multimorbidity as a risk factor for viral and bacteriological infections.
d. Metabolic syndrome as a risk factor for poor mental health.
e. Socioeconomic status as a predictor for metabolic syndrome.
f. Diet high in ultraprocessed food as a predictor for metabolic syndrome.
g. Population level data relating to nutrient deficiency (which may include but is not limited to vitamins B,D,C and iron) by age and socio-economic status.

5. Information held by or requested by this directorate including research/memos/advice/emails for long-term strategy, setting direction and priority areas for investment and policy implementation. Scoping or cost/benefit analyses undertaken:
a. Reducing ultraprocessed food consumption to improve mental health and/or metabolic syndrome, for example based on reduction of years of healthy life lost due to disability (YLDs) and years lost due to premature mortality (YLLs).
b. Public education campaign: Diet quality/nutrition status as a predictor for mental health risk; diabetes risk; and/or cancer risk.
c. Public education for healthy cooking and food preparation. Primary, secondary and for expectant parents.
d. Potential for medical practices to staff publicly funded nutritionists/dieticians to support dietary changes in patients diagnosed with mental illness, diabetes and cancer.

6. Analyses/Reviews/Reports received or undertaken by this directorate to understand international developments:
a. Meta-analyses to identify effectiveness of nutrition as protective for mental health.
b. Countries that tax ultraprocessed food (UPF) and/or sugar sweetened beverages; tax levels, food products targeted for taxation, year established, end-point.
c. White paper/scientific reviews on the effectiveness of UPF tax policies in OECD nations.
d. OECD countries that provide healthy vegetable and meat-based school lunches.

Thank you

Yours faithfully,

J Bruning

Dear Manatū Hauora OIA Services,

How do you classify, or what term do you use to classify the cluster of symptoms characterised by central obesity, dyslipidaemia, hypertension and insulin resistance?

Yours sincerely,

J Bruning

Dear OIA Team,

I have amended my request as follows which is specifically directed to MoH Strategy policy & legislation Deputy Director General Maree Roberts and her directorate team.

Many medically trained doctors and many nutritional experts are interested in the outcome of these questions. We suspect that much of this information may be refused as the information is not held by Maree Roberts or her staff.

We are also aware that Maree Roberts and her staff will comprise a department that is not extensive. Thus, these questions do not involve searches through the entire Ministry of Health.

Therefore, the search may not be as onerous as anticipated.

4. Information (for populations older than, and under 18 years) held by or requested by this directorate including research/memos/advice/emails as relating to:

a. Metabolic syndrome is recognised by the World Health Organization. Any reports and white papers held which reference metabolic syndrome (a cluster of symptoms characterised by central obesity, dyslipidaemia, hypertension and insulin resistance).

b. Current and predicted cost to the health system from multimorbidity (i.e. cost of multimorbidity) for those diagnosed with Cardiovascular Disease or at risk for Cardiovascular Disease.

c. Diabetes status as a risk factor for viral and bacteriological infections.

d. Diet/nutrition status as a risk factor for poor mental health.

e. Socioeconomic status as a predictor for cardiovascular disease.

f. Diet high in ultraprocessed food as a predictor for cardiovascular disease.

g. Population level data relating to nutrient deficiency (which may include but is not limited to vitamins B,D,C and iron) by age and socio-economic status.

5. Information held by or requested by this directorate including research/memos/advice/emails for long-term strategy, setting direction and priority areas for investment and policy implementation. Scoping or cost/benefit analyses undertaken:

a. Reducing ultraprocessed food consumption to improve mental health and reduce cardiovascular disease, for example based on reduction of years of healthy life lost due to disability (YLDs) and years lost due to premature mortality (YLLs).

b. Public education campaign: Diet quality/nutrition status as a predictor for mental health risk; diabetes risk; and/or cancer risk.

c. Public education for healthy cooking and food preparation. Primary, secondary and for expectant parents.

d. Potential for medical practices to staff publicly funded nutritionists/dieticians to support dietary changes in patients diagnosed with mental illness, diabetes and cancer.

6. Analyses/Reviews/Reports received or undertaken by this directorate to understand international developments:

a. Meta-analyses to identify effectiveness of nutrition as protective for mental health.

b. Countries that tax ultraprocessed food (UPF) and/or sugar sweetened beverages; tax levels, food products targeted for taxation, year established, end-point.

c. White paper/scientific reviews on the effectiveness of UPF tax policies in OECD nations.

d. OECD countries that provide healthy vegetable and meat-based school lunches.

We emphasise the information requested concerns matters of great importance for policy formulation.

References unpacking the relationship between ultraprocessed food and non-communicable disease and mental illness are surging in the scholarly literature, and it would be surprising if this was not a focus of the Strategy policy & legislation Directorate. Therefore, it is in the public interest that this information is disclosed.

Thank you

Yours faithfully,

J Bruning