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Lee AJ, Rainow S, Balmer L, Hutchinson R, Bryce S, Lewis M, Herron LM, Torzillo P, Stevens R, Kavanagh M, Wells L, Kenny I. Making it on the breadline - improving food security on the Anangu Pitjantjatjara Yankunytjatjara Lands, Central Australia. BMC Public Health 2024; 24:3087. [PMID: 39516793 PMCID: PMC11545495 DOI: 10.1186/s12889-024-20495-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 10/23/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND This longitudinal case study describes the efforts and impacts of community-controlled service organisations on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in Central Australia to tackle food security since the 1980s, with a focus on the last decade, particularly during a year of concerted action from mid-2018. METHODS The co-designed study comprised an interrupted time series with controls. Availability, affordability, accessibility and sales of foods in the community retail stores on the APY Lands were monitored regularly from 2014 to mid-2022, including by local research teams. Store nutrition policy was updated early 2018. For a year from mid-2018, of the eight communities with stores: (i) two were the focus for concerted intervention, including support from a locally based project officer to help implement the policy and action 105 community requests for nutrition activities (ii) three received usual support to implement the policy; and (iii) three were subject to 'business as usual'. From mid-2019, all communities/stores received usual service, from 2020 with some restrictions related to the COVID-19 pandemic. Results were compared over time, across different community/store groups and with controls. RESULTS In the 12 months from mid-2018, all food security metrics improved most in the two focus communities. Impacts were less marked in the communities without additional support to implement the revised nutrition policy, and even less apparent, although more varied, in the other three communities/stores. Dietary intake improved only in the two focus communities. In all communities from early 2020 most gains eroded due to impacts of the COVID-19 pandemic and other external stressors. Food security metrics, including price of healthy food, appeared more resilient in the focus communities, although diet quality worsened. At all times assessed, healthy diets were unaffordable for welfare-dependant households. CONCLUSIONS This co-designed study demonstrates the effectiveness of community-led approaches, confirming that it is possible to improve food security and diet in remote Aboriginal communities. However, sustained action and monitoring, dedicated resources and employment of local people are critical for success. Results also highlight that low incomes are a major barrier to food security.
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Affiliation(s)
- Amanda J Lee
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia.
| | - Stephan Rainow
- Nganampa Health Council, Alice Springs, Northern Territory, 0870, Australia
| | - Liza Balmer
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Rhiannon Hutchinson
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Suzanne Bryce
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Meron Lewis
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Lisa-Maree Herron
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
| | - Paul Torzillo
- The University of Sydney, Newtown, NSW, 2042, Australia
| | - Robert Stevens
- Mai Wiru Regional Stores Aboriginal Corporation, Alice Springs, Northern Territory, 0870, Australia
| | - Margaret Kavanagh
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Lisa Wells
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
| | - Ingrid Kenny
- Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council, Alice Springs, Northern Territory, 0870, Australia
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Kenny TA, Little M, Lemieux T, Griffin PJ, Wesche SD, Ota Y, Batal M, Chan HM, Lemire M. The Retail Food Sector and Indigenous Peoples in High-Income Countries: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8818. [PMID: 33261090 PMCID: PMC7730644 DOI: 10.3390/ijerph17238818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Indigenous Peoples in high-income countries experience higher burdens of food insecurity, obesity, and diet-related health conditions compared to national averages. The objective of this systematic scoping review is to synthesize information from the published literature on the methods/approaches, findings, and scope for research and interventions on the retail food sector servicing Indigenous Peoples in high-income countries. A structured literature search in two major international databases yielded 139 relevant peer-reviewed articles from nine countries. Most research was conducted in Oceania and North America, and in rural and remote regions. Several convergent issues were identified across global regions including limited grocery store availability/access, heightened exposure to unhealthy food environments, inadequate market food supplies (i.e., high prices, limited availability, and poor quality), and common underlying structural factors including socio-economic inequality and colonialism. A list of actions that can modify the nature and structure of retailing systems to enhance the availability, accessibility, and quality of healthful foods is identified. While continuing to (re)align research with community priorities, international collaboration may foster enhanced opportunities to strengthen the evidence base for policy and practice and contribute to the amelioration of diet quality and health at the population level.
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Affiliation(s)
- Tiff-Annie Kenny
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
| | - Matthew Little
- School of Public Health and Social Policy, University of Victoria, Victoria, BC V8P 5C2, Canada;
| | - Tad Lemieux
- Department of English Language and Literature, Carleton University, Ottawa, ON K1S 5B6, Canada;
| | - P. Joshua Griffin
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Department of American Indian Studies, University of Washington, Seattle, WA 98195, USA
| | - Sonia D. Wesche
- Department of Geography, Environment and Geomatics, Faculty of Arts, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
| | - Yoshitaka Ota
- School of Marine and Environmental Affairs, University of Washington, Seattle, WA 98105, USA; (P.J.G.); (Y.O.)
- Nippon Foundation Ocean Nexus Center, EarthLab, University of Washington; Seattle, WA 98195, USA
| | - Malek Batal
- Département de nutrition, Faculté de médecine, Université de Montréal, Montreal, QC H3T 1J4, Canada;
- Centre de recherche en santé publique (CReSP), Montreal, Quebec, QC H3N 1X9, Canada
| | - Hing Man Chan
- Department of Biology, University of Ottawa, Ottawa, ON K1N 9A7, Canada;
| | - Melanie Lemire
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Quebec, QC G1V 0A6, Canada;
- Centre de recherche du CHU de Québec, Université Laval, Axe santé des populations et pratiques optimales en santé, Quebec, QC G1E 6W2, Canada
- Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec, QC G1V 0A6, Canada
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Needham C, Sacks G, Orellana L, Robinson E, Allender S, Strugnell C. A systematic review of the Australian food retail environment: Characteristics, variation by geographic area, socioeconomic position and associations with diet and obesity. Obes Rev 2020; 21:e12941. [PMID: 31802612 DOI: 10.1111/obr.12941] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/12/2019] [Accepted: 08/07/2019] [Indexed: 02/04/2023]
Abstract
There is strong support across multiple sectors for the implementation of policies to create healthier food environments as part of comprehensive strategies to address obesity and improve population diets. The existing evidence base describing food retail environments and their relationship with health outcomes is limited in several respects. This systematic review examines the current evidence regarding food retail environments in Australia, including associations with diet and people with obesity, and socioeconomic and geographic disparities. Three databases were searched and independently screened. Studies were included if they were undertaken in Australia and objectively measured the food retail environment. Sixty papers were included. The broad range of methodological approaches used across studies limited the ability to synthesize the evidence and draw conclusions. Results indicated that there is some evidence that disparities exist in food retail environments across measures of socioeconomic position and geographic area in parts of Australia. Overall, there were inconsistent findings regarding the association between the healthiness of food retail environments and diet or people with obesity. Findings support previous calls for standardized tools and measures for monitoring the healthiness of food retail environments. This is imperative to inform evidence-based policy and evaluation in this critical component of recommended obesity prevention strategies.
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Affiliation(s)
- Cindy Needham
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Gary Sacks
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Liliana Orellana
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, Australia
| | - Ella Robinson
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Abstract
Currently, an unhealthy diet is the largest modifiable factor in ill health and death globally. One of the important contributors to unhealthy diets is the pervasiveness of unhealthy food and drink in our daily food environments. Although efforts to build nutrition skills and education across communities are critical, they will be insufficient without substantial changes to the food environments themselves. Here, I discuss how we can improve our food environments by implementing a comprehensive, multilevel and multisetting approach. This approach needs to encompass the various policy contexts for improving population nutrition, from policy set by national governments to that introduced by local community organizations and food retailers. Clinicians can help implement and set healthy food policies across all our health-care settings, even in the absence of government action. To support a comprehensive suite of effective policies, we need to systematically develop and disseminate the evidence for the feasibility, effectiveness and sustainability of workable policies and to understand their role in the development of a healthier food system.
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Affiliation(s)
- Anna Peeters
- Faculty of Health, Deakin University, Geelong, Victoria, Australia.
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McMahon E, Wycherley T, O'Dea K, Brimblecombe J. A comparison of dietary estimates from the National Aboriginal and Torres Strait Islander Health Survey to food and beverage purchase data. Aust N Z J Public Health 2017; 41:598-603. [PMID: 29044897 DOI: 10.1111/1753-6405.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 04/01/2017] [Accepted: 07/01/2017] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We compared self-reported dietary intake from the very remote sample of the National Aboriginal and Torres Strait Islander Nutrition and Physical Activity Survey (VR-NATSINPAS; n=1,363) to one year of food and beverage purchases from 20 very remote Indigenous Australian communities (servicing ∼8,500 individuals). METHODS Differences in food (% energy from food groups) and nutrients were analysed using t-test with unequal variance. RESULTS Per-capita energy estimates were not significantly different between the surveys (899 MJ/person/day [95% confidence interval -152,1950] p=0.094). Self-reported intakes of sugar, cereal products/dishes, beverages, fats/oils, milk products/dishes and confectionery were significantly lower than that purchased, while intakes of meat, vegetables, cereal-based dishes, fish, fruit and eggs were significantly higher (p<0.05). CONCLUSION Differences between methods are consistent with differential reporting bias seen in self-reported dietary data. Implications for public health: The NATSINPAS provides valuable, much-needed information about dietary intake; however, self-reported data is prone to energy under-reporting and reporting bias. Purchase data can be used to track population-level food and nutrient availability in this population longitudinally; however, further evidence is needed on approaches to estimate wastage and foods sourced outside the store. There is potential for these data to complement each other to inform nutrition policies and programs in this population.
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Affiliation(s)
- Emma McMahon
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory
- Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Thomas Wycherley
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory
- Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Kerin O'Dea
- Centre for Population Health Research, School of Health Sciences, University of South Australia
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Royal Hospital Campus, Northern Territory
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Wycherley T, Ferguson M, O'Dea K, McMahon E, Liberato S, Brimblecombe J. Store turnover as a predictor of food and beverage provider turnover and associated dietary intake estimates in very remote Indigenous communities. Aust N Z J Public Health 2016; 40:569-571. [PMID: 27624683 DOI: 10.1111/1753-6405.12571] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/01/2016] [Accepted: 05/01/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Determine how very-remote Indigenous community (RIC) food and beverage (F&B) turnover quantities and associated dietary intake estimates derived from only stores, compare with values derived from all community F&B providers. METHODS F&B turnover quantity and associated dietary intake estimates (energy, micro/macronutrients and major contributing food types) were derived from 12-months transaction data of all F&B providers in three RICs (NT, Australia). F&B turnover quantities and dietary intake estimates from only stores (plus only the primary store in multiple-store communities) were expressed as a proportion of complete F&B provider turnover values. Food types and macronutrient distribution (%E) estimates were quantitatively compared. RESULTS Combined stores F&B turnover accounted for the majority of F&B quantity (98.1%) and absolute dietary intake estimates (energy [97.8%], macronutrients [≥96.7%] and micronutrients [≥83.8%]). Macronutrient distribution estimates from combined stores and only the primary store closely aligned complete provider estimates (≤0.9% absolute). Food types were similar using combined stores, primary store or complete provider turnover. CONCLUSIONS AND IMPLICATIONS Evaluating combined stores F&B turnover represents an efficient method to estimate total F&B turnover quantity and associated dietary intake in RICs. In multiple-store communities, evaluating only primary store F&B turnover provides an efficient estimate of macronutrient distribution and major food types.
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Affiliation(s)
| | - Megan Ferguson
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory
| | - Kerin O'Dea
- School of Health Sciences, University of South Australia
| | - Emma McMahon
- School of Health Sciences, University of South Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory
| | - Selma Liberato
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory
| | - Julie Brimblecombe
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Northern Territory
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McMahon E, Webster J, O'Dea K, Brimblecombe J. Dietary sodium and iodine in remote Indigenous Australian communities: will salt-reduction strategies increase risk of iodine deficiency? A cross-sectional analysis and simulation study. BMC Public Health 2015; 15:1318. [PMID: 26714467 PMCID: PMC4696303 DOI: 10.1186/s12889-015-2686-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/24/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Excess salt intake is a global issue. Effective salt-reduction strategies are needed, however, as salt is a vehicle for iodine fortification, these strategies may also reduce iodine intake. This study examines the case of the remote Indigenous Australian population; we employed an innovative, objective method to assess sodium and iodine intakes against requirements and modelled the potential effects of salt-reduction strategies on estimated sodium and iodine intakes. DESIGN Store-sales data were collected from 20 remote Indigenous community stores in 2012-14 representing the main source of food for 2 years for ~8300 individuals. Estimated average sodium and iodine intakes were compared against recommendations (nutrient reference values weighted to age and gender distribution). Linear programming was employed to simulate potential effects of salt-reduction strategies on estimated sodium and iodine intakes. RESULTS Estimated average sodium intake was 2770 (range within communities 2410-3450) mg/day, far exceeding the population-weighted upper limit (2060 mg/day). Discretionary (added) salt, bread and processed meat were the biggest contributors providing 46% of all sodium. Estimated average iodine intake was within recommendations at 206 (186-246) μg/day. The following scenarios enabled modelling of estimated average salt intake to within recommendations: 1) 67% reduction in sodium content of bread and discretionary salt intake, 2) 38% reduction in sodium content of all processed foods, 3) 30% reduction in sodium content of all processed foods and discretionary salt intake. In all scenarios, simulated average iodine intakes remained within recommendations. CONCLUSIONS Salt intakes of the remote Indigenous Australian population are far above recommendations, likely contributing to the high prevalence of hypertension and cardiovascular mortality experienced by this population. Salt-reduction strategies could considerably reduce salt intake in this population without increasing risk of iodine deficiency at the population-level. These data add to the global evidence informing salt-reduction strategies and the evidence that these strategies can be synergistically implemented with iodine deficiency elimination programmes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000694718.
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Affiliation(s)
- Emma McMahon
- Wellbeing and Preventable Disease Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia.
- Centre for Population Health Research, School of Health Sciences, University of South Australia, North Tce, Adelaide, SA, 5001, Australia.
| | - Jacqui Webster
- Food Policy Division, The George Institute for Global Health, The University of Sydney, Missenden Rd, Sydney, NSW, 2050, Australia.
| | - Kerin O'Dea
- Centre for Population Health Research, School of Health Sciences, University of South Australia, North Tce, Adelaide, SA, 5001, Australia. Kerin.O'
| | - Julie Brimblecombe
- Wellbeing and Preventable Disease Division, Menzies School of Health Research, PO Box 41096, Casuarina, NT, 0811, Australia.
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Scelza BA, Bird DW, Bird RB. Bush tucker, shop tucker: production, consumption, and diet at an Aboriginal outstation. Ecol Food Nutr 2014; 53:98-117. [PMID: 24437546 DOI: 10.1080/03670244.2013.772513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Foraging models have rarely been used to address how behavior is altered by the presence of non-foraged foods. Here, choices of store-bought and hunted foods in one Aboriginal community are analyzed. Hunting occurs frequently, but community residents also purchase food from the shop. Increases in the frequency of hunting certain large and small prey are associated with reduced access to food in the shop. Higher-variance hunt types are not associated with shop purchases, but continue to be acquired due to their cultural significance. The variation in these results highlights the complexity of dietary behavior in a mixed economy.
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Affiliation(s)
- Brooke A Scelza
- a Department of Anthropology , University of California Los Angeles , Los Angeles , California , USA
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Brimblecombe J, Ferguson M, Liberato SC, Ball K, Moodie ML, Magnus A, Miles E, Leach AJ, Chatfield MD, Ni Mhurchu C, O’Dea K, Bailie RS. Stores Healthy Options Project in Remote Indigenous Communities (SHOP@RIC): a protocol of a randomised trial promoting healthy food and beverage purchases through price discounts and in-store nutrition education. BMC Public Health 2013; 13:744. [PMID: 23938097 PMCID: PMC3751924 DOI: 10.1186/1471-2458-13-744] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/17/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Indigenous Australians suffer a disproportionate burden of preventable chronic disease compared to their non-Indigenous counterparts--much of it diet-related. Increasing fruit and vegetable intakes and reducing sugar-sweetened soft-drink consumption can reduce the risk of preventable chronic disease. There is evidence from some general population studies that subsidising healthier foods can modify dietary behaviour. There is little such evidence relating specifically to socio-economically disadvantaged populations, even though dietary behaviour in such populations is arguably more likely to be susceptible to such interventions.This study aims to assess the impact and cost-effectiveness of a price discount intervention with or without an in-store nutrition education intervention on purchases of fruit, vegetables, water and diet soft-drinks among remote Indigenous communities. METHODS/DESIGN We will utilise a randomised multiple baseline (stepped wedge) design involving 20 communities in remote Indigenous Australia. The study will be conducted in partnership with two store associations and twenty Indigenous store boards. Communities will be randomised to either i) a 20% price discount on fruit, vegetables, water and diet soft-drinks; or ii) a combined price discount and in-store nutrition education strategy. These interventions will be initiated, at one of five possible time-points, spaced two-months apart. Weekly point-of-sale data will be collected from each community store before, during, and for six months after the six-month intervention period to measure impact on purchasing of discounted food and drinks. Data on physical, social and economic factors influencing weekly store sales will be collected in order to identify important covariates. Intervention fidelity and mediators of behaviour change will also be assessed. DISCUSSION This study will provide original evidence on the effectiveness and cost-effectiveness of price discounts with or without an in-store nutrition education intervention on food and drink purchasing among a socio-economically disadvantaged population in a real-life setting. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12613000694718.
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Affiliation(s)
- Julie Brimblecombe
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Megan Ferguson
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Selma C Liberato
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Kylie Ball
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood Hwy, Burwood 3125, Australia
| | - Marjory L Moodie
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Anne Magnus
- Deakin Health Economics Faculty of Health, Deakin University, 221 Burwood Hwy, Burwood 3125, Australia
| | - Edward Miles
- Indigenous Community Volunteers Level 1, 29 Cavanagh St, Darwin, NT 0801, Australia
| | - Amanda J Leach
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Mark D Chatfield
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Kerin O’Dea
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- University of South Australia, Frome Rd, Adelaide, SA 5000, Australia
| | - Ross S Bailie
- Menzies School of Health Research, Building 58, Royal Darwin Hospital Campus, Rocklands Drive, Tiwi, NT 0810, Australia
- Charles Darwin University, Ellengowan Dr, Casuarina, NT 0810, Australia
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Brimblecombe JK, Ferguson MM, Liberato SC, O'Dea K. Characteristics of the community-level diet of Aboriginal people in remote northern Australia. Med J Aust 2013; 198:380-4. [PMID: 23581959 DOI: 10.5694/mja12.11407] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/04/2013] [Indexed: 11/28/2024]
Abstract
OBJECTIVE To describe the nutritional quality of community-level diets in remote northern Australian communities. DESIGN, SETTING AND PARTICIPANTS A multisite 12-04 assessment (July 2010 to June 2011) of community-level diet in three remote Aboriginal communities in the Northern Territory, linking data from food outlets and food services to the Australian Food and Nutrient Database. MAIN OUTCOME MEASURES Contribution of food groups to total food expenditure; macronutrient contribution to energy and nutrient density relative to requirements; and food sources of key nutrients. RESULTS One-quarter (24.8%; SD, 1.4%) of total food expenditure was on non-alcoholic beverages; 15.6% (SD, 1.2%) was on sugar-sweetened drinks. 2.2% (SD, 0.2%) was spent on fruit and 5.4% (SD, 0.4%) on vegetables. Sugars contributed 25.7%-34.3% of dietary energy, 71% of which was table sugar and sugar-sweetened beverages. Dietary protein contributed 12.5%-14.1% of energy, lower than the recommended 15%-25% optimum. Furthermore, white bread was a major source of energy and most nutrients in all three communities. CONCLUSION Very poor dietary quality continues to be a characteristic of remote Aboriginal community nutrition profiles since the earliest studies almost three decades ago. Significant proportions of key nutrients are provided from poor-quality nutrient-fortified processed foods. Further evidence regarding the impact of the cost of food on food purchasing in this context is urgently needed and should include cost-benefit analysis of improved dietary intake on health outcomes.
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Affiliation(s)
- Julie K Brimblecombe
- Wellbeing and Preventable Chronic Disease, Menzies School of Health Research, Darwin, NT.
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Abstract
OBJECTIVE To examine the feasibility of using point-of-sale data to assess dietary quality of food sales in remote stores. DESIGN A multi-site cross-sectional assessment of food and nutrient composition of food sales. Point-of-sale data were linked to Australian Food and Nutrient Data and compared across study sites and with nutrient requirements. SETTING Remote Aboriginal Australia. SUBJECT Six stores. RESULTS Point-of-sale data were readily available and provided a low-cost, efficient and objective assessment of food and nutrient sales. Similar patterns in macronutrient distribution, food expenditure and key food sources of nutrients were observed across stores. In all stores, beverages, cereal and cereal products, and meat and meat products comprised approximately half of food sales (range 49–57 %). Fruit and vegetable sales comprised 10.4 (SD 1.9) % on average. Carbohydrate contributed 54.4 (SD 3.0) % to energy; protein 13.5 (SD 1.1) %; total sugars 28.9 (SD 4.3) %; and the contribution of total saturated fat to energy ranged from 11.0 to 14.4% across stores. Mg, Ca, K and fibre were limiting nutrients, and Na was four to five times higher than the midpoint of the average intake range. Relatively few foods were major sources of nutrients. CONCLUSIONS Point-of-sale data enabled an assessment of dietary quality within stores and across stores with no burden on communities and at no cost, other than time required for analysis and reporting. Similar food spending patterns and nutrient profiles were observed across the six stores. This suggests potential in using point-of-sale data to monitor and evaluate dietary quality in remote Australian communities.
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BUTLER R, TAPSELL L, LYONS-WALL P. Trends in purchasing patterns of sugar-sweetened water-based beverages in a remote Aboriginal community store following the implementation of a community-developed store nutrition policy. Nutr Diet 2011. [DOI: 10.1111/j.1747-0080.2011.01515.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brimblecombe JK, O'Dea K. The role of energy cost in food choices for an Aboriginal population in northern Australia. Med J Aust 2009; 190:549-51. [PMID: 19450199 DOI: 10.5694/j.1326-5377.2009.tb02560.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 02/16/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the relationship between dietary quality and energy density of foods (MJ/kg) and energy cost ($/MJ) for an Aboriginal population living in a remote region of northern Australia. DESIGN For a 3-month period in 2005, we collected food and non-alcoholic beverage supply data from food outlets available to the study population. From these data, we compared the energy density of foods with their energy cost. MAIN OUTCOME MEASURES Energy density and energy cost of food purchases. RESULTS The diet of the study population was high in refined carbohydrates and low in fresh fruit and vegetables. Foods with high energy density were associated with lower costs and contributed disproportionately to energy availability. CONCLUSION The energy-cost differential between energy-dense, nutrient-poor foods and energy-dilute, nutrient-rich foods influences the capacity of Australian Aboriginal people living in remote communities to attain a healthy diet. This is consistent with the "economics of food choice" theory, whereby people on low incomes maximise energy availability per dollar in their food purchasing patterns, and has particular relevance for developing nutrition policy and strategies in Aboriginal communities, where poor nutrition is a major determinant of preventable chronic disease.
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Affiliation(s)
- Julie K Brimblecombe
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, NT, Australia.
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Webb KL, Leeder SR. New Year's resolution: let's get rid of excessive food prices in remote Australia. Med J Aust 2007; 186:7-8. [PMID: 17229023 DOI: 10.5694/j.1326-5377.2007.tb00776.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 11/16/2006] [Indexed: 11/17/2022]
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