Aboriginal and Torres Strait Islander Health Performance Framework (HPF) 2012
Tier 2—Health behaviours—2.19 Dietary behaviours
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 2006b; 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, perinatal 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. Inadequate nutrition during pregnancy is one factor that has been associated with low birthweight in babies (see measure 1.01). 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 2003b).
Findings:In 2004–05, in non-remote areas, 42% of Aboriginal and Torres Strait Islander peoples 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 one serve or less per day). This proportion had increased since it was measured at 18% in 2001 (ABS 2001). 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 one serve or less per day) in 2004–05, up from 56% in 2001.
Food supply is more limited in rural and remote areas including quality, variety and cost of fresh fruit and vegetables (Scelza 2012; Meedeniya et al. 2000). The 2008 NATSISS found that 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, with 15% of Indigenous Australians in remote areas reporting no usual daily intake, compared with 2% in non-remote areas.
After adjusting for differences in the age structure of the two populations, 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 2006b).
The 2004–05 NATSIHS 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 9%) and no usual daily vegetable intake (8% compared with less than 1%). Low fruit and vegetable intake was also associated with smoking and risky/high risk alcohol consumption.Top of Page
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 et al. 2004). People in vulnerable groups may therefore simultaneously be overweight or obese and experience food insecurity (AIHW 2012a).
In Qld 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.
The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP) 2000–2010 provided a framework to improve Aboriginal and Torres Strait Islander health and wellbeing through better nutrition. A major achievement supported by the NATSINSAP was the Remote Indigenous Stores and Takeaways project, which took place between 2005 and 2008. This project aimed to improve access to good quality, healthy foods and discouraged the availability of energy dense/nutrient poor food and drinks in remote Indigenous communities by developing guidelines, standards and staff training packages for community stores and takeaways.
In 2009–10, the Australian Government completed an evaluation of the NATSINSAP which examined how effectively it was implemented and identified ways it could be more effective and responsive to the current environment.
The National Strategy for Food Security in Remote Indigenous Communities, a schedule to the National Indigenous Reform Agreement, was agreed by the Council of Australian Governments in December 2009. This strategy identifies specific actions that can be taken by all relevant jurisdictions to improve food security, including access to nutritious food, in remote Indigenous communities (COAG 2009a). The Anangu Pitjantjatjara Yankunytjatjara (APY) Lands Food Security Strategic Plan 2011–2016 is designed to guide the work of the South Australian Government in meeting the goals set out in the National Strategy in the APY Lands. This plan includes initiatives to promote community knowledge about nutrition, food preparation, and gardening for food production (Department of Premier and Cabinet, SA 2010).Top of PageThe 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 have been translated into nine non-English languages and have been adapted for Indigenous communities. The Indigenous resources are expected to be available in late 2012.
In March 2011, the Swap It Don’t Stop It campaign was launched. The campaign has a dedicated page on its website where print advertising relating to swapping fried food for fresh may be downloaded and a radio advertisement may be heard. The webpage also outlines the LiveLonger campaign which delivers healthy eating messages specifically for Aboriginal and Torres Strait Islander peoples.
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 a Healthy Lifestyle workforce, which is being rolled out in Regional Tackling Smoking and Healthy Lifestyle teams across 57 regions nationally. Healthy Lifestyle Workers are delivering health promotion and community education activities to reduce chronic disease risk factors. This includes promoting improved nutrition and increased physical activity.
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 proportion of their income on food and contributes to concerns among Indigenous Australians of going without food (Brimblecombe et al. 2009). An estimated 30% of Aboriginal adults worry at least occasionally about going without food (Strategic Inter-Governmental Nutrition Alliance 2001).Top of Page
Figure 132—Usual daily intake of vegetables and fruit, Indigenous Australians aged 12 years and over, non-remote areas, 2001 and 2004–05
Source: AIHW analysis of 2001 NHS (Indigenous supplement) and 2004–05 NATSIHSTop of Page
Figure 133—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 NATSIHSTop of Page