Aboriginal and Torres Strait Islander Health Performance Framework - 2010
Why is it important?:Many of the principal causes of ill-health among Aboriginal and Torres Strait Islander peoples are nutrition-related diseases, such as heart disease, Type 2 diabetes and renal disease. While a diet high in saturated fats and refined carbohydrates increases the likelihood of developing these diseases, regular exercise and intake of fibre-rich foods, such as fruit and vegetables, can have a protective effect against disease. The National Health and Medical Research Council’s Australian Dietary Guidelines recommend that adults eat a minimum of five serves of vegetables and two serves of fruit per day (ABS 2006a; ABS & AIHW 2008).
The Burden of Disease and Injury in Aboriginal and Torres Strait Islander Peoples 2003 (Vos et al. 2007) attributed 3.5% of the total burden of disease in the Aboriginal and Torres Strait Islander population to low fruit and vegetable consumption. Its impact is largely as a risk factor for ischaemic heart disease (Vos et al. 2007). Diet-related diseases are caused by combinations and interactions of environmental, behavioural, biological, social and hereditary factors. There is a substantial quantity of evidence that associates dietary excesses and imbalances with chronic disease. Of particular relevance in Indigenous communities are factors such as socioeconomic status and other risk factors including insulin resistance, glucose intolerance, obesity (especially central fat deposition), hypertension, high blood triglycerides, prenatal and postnatal nutrition and childhood nutrition (NHMRC 2000; Longstreet et al. 2008). Good maternal nutrition and healthy infant and childhood growth are fundamental to the achievement and maintenance of health throughout the life cycle. A mother’s nutritional status is one factor that has been associated with low birthweight in babies. Growth retardation among Indigenous infants after the age of 4 to 6 months has consistently been noted. Relatively poor growth has also been shown to persist in older children, although overweight and obesity are also increasing (NHMRC 2003).
Findings:In 2004–05, in non-remote areas, 42% of Aboriginal and Torres Strait Islander people were eating the recommended daily intake of fruit (2 or more serves) and 10% the recommended daily intake of vegetables (5 or more serves). The majority of Indigenous Australians aged 12 years and over reported eating vegetables (95%) and/or fruit (86%) daily. However, 24% of those in non-remote areas reported a low usual daily vegetable intake (does not eat vegetables or eats 1 or less serves per day). This proportion had increased since it was measured at 18% in 2001 (ABS 2002). A higher proportion (58%) of Indigenous Australians aged 12 years and over in non-remote areas reported a low usual daily fruit intake (does not eat fruit or eats 1 or less serves per day) in 2004–05, up from 56% in 2001.
Fruit and vegetables may be less accessible to Indigenous Australians in remote areas. In remote areas, 20% of Indigenous Australians aged 12 years and over reported no usual daily fruit intake compared with 12% in non-remote areas. The disparity was even greater for vegetables, where 15% of Indigenous Australians in remote areas reported no usual daily intake compared with 2% in non-remote areas.
After adjusting for differences in age structure, Indigenous Australians aged 12 years and over were twice as likely as non-Indigenous Australians, to report no usual daily fruit intake and 7 times as likely to report no daily vegetable intake (ABS 2006a).
The 2004–05 National Aboriginal and Torres Strait Islander Health Survey found an association between dietary behaviour and income, educational attainment and self-assessed health status. For example, Indigenous Australians aged 15 years and over in the lowest quintile of income were much more likely than Indigenous Australians in the two highest quintiles of household income to report no usual daily fruit intake (17% compared with 8%) and no usual daily vegetable intake (8% compared with 0.8%). Low fruit and vegetable intake was also associated with smoking and risky/high risk alcohol consumption.
Implications:Evidence suggests that people living in poverty tend to maximise calories per dollar spent on food. Energy-dense foods rich in fats, refined starches and sugars represent the lowest cost options, while healthy diets based on lean meats, whole grains and fresh vegetables and fruits are more costly (Drewnowski & Specter 2004).
Key Results Area Six of the NSFATSIH outlines action plans for partnerships between the media, the health sector, schools, and Indigenous Australian communities, to encourage understanding of nutrition and healthy eating for children and parents and to promote healthy food choices. In Queensland the ‘Healthy Jarjums’ school-based nutrition program was designed by a local Indigenous teacher in consultation with nutritionists and the community. Its evaluation concluded that it could be successfully implemented in other disadvantaged areas with a high Indigenous population.
A major achievement of the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action plan 2000–2010, a component of Eat Well Australia, was the Remote Indigenous Stores and Takeaways project that aimed to improve access to good quality, affordable healthy food in remote Aboriginal and Torres Strait Islander communities. Guidelines and resources were developed to assist store and takeaway managers and health/nutrition stakeholders to improve freight, stocking, promotion and monitoring of healthy food sold in remote communities.
The Get Up and Grow: Healthy Eating and Physical Activity for Early Childhood resources were launched in October 2009, providing evidence-based practical information to support healthy behaviours in children attending early childhood education and care services. The resources are currently being translated into nine non-English languages and there are plans to produce an adapted version of the resources for Indigenous communities.
Under the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes, the Commonwealth, States and Territories have committed to preventive health as a key priority area. For example, the Commonwealth’s Indigenous Chronic Disease Package, includes funding for community education activities to reduce risk factors through a new Healthy Lifestyle workforce to promote improved nutrition.
A person’s access to a healthy diet can be influenced by a range of socioeconomic, geographical, environmental factors. Food security, food access and food supply issues are of particular importance in rural and remote areas. Remote stores often have a limited range of foods, particularly perishable foods such as fresh fruit, vegetables and dairy foods, and purchase prices are usually higher. Low income combined with high food costs result in many Indigenous Australians spending a large percentage of their income on food and contributes to concerns among Indigenous Australians of going without food (Brimblecombe & O'Dea 2009). An estimated 30% of Aboriginal adults worry at least occasionally about going without food (Strategic Inter-Governmental Nutrition Alliance 2001).
Figure 126 – Percentage of Indigenous Australians aged 12 years and over, by usual daily intake of vegetables and fruit, non-remote areas, 2001 and 2004–05
Source: AIHW analysis of 2001 National Health Survey (Indigenous supplement) and 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 126 (TXT 1KB)
Figure 127 – Age-standardised proportion of persons aged 15 years and over who ran out of food and couldn’t afford to buy more at some time over the last year, 2004–05
Source: AIHW analysis of 2004–05 National Aboriginal and Torres Strait Islander Health Survey
Text description of figure 127 (TXT 1KB)
Table 56 – Selected dietary habits, by remoteness, Indigenous persons aged 12 years and over, Australia, 2004–05
|Eats vegetables daily|
|Eats fruit daily|
Usual type of milk consumed
|Total drinks milk|
|Does not drink milk|
Salt added after cooking