Major review of Aboriginal and Torres Strait Islander nutrition

The new look Australian Indigenous HealthInfoNet has published Professor Amanda Lee's comprehensive and up-to-date Review of nutrition among Aboriginal and Torres Strait Islander people 

It includes statistical data on food and nutrient intakes, as well as comprehensive discussions on food security, policies (or the lack of policies), future directions, programs and services. 

See key facts listed below.

Aboriginal and Torres Strait Islander people continue to suffer the worst diet-related health of all population groups in Australia.

Poor nutrition is an important factor contributing to overweight and obesity, malnutrition, cardiovascular disease, type 2 diabetes, and tooth decay.

Poor diet relates to five of the seven leading risk factors contributing to the health gap between Aboriginal and Torres Strait Islander and non-Indigenous Australians - obesity, high blood cholesterol, alcohol, high blood pressure, and low fruit and vegetable intake.

Many factors influence poor diet and nutrition. Socio-economic disadvantage is a key issue, as are other geographical, environmental and social factors.

The elimination of overcrowding in housing and the provision of appropriately designed, constructed and maintained homes is essential for the safe storage, preparation and consumption of food.

In Aboriginal communities only six per cent of houses have all of the functioning health hardware needed to store, prepare and cook food, such as cupboards, bench space, refrigeration and a functioning stove and sink.

Access to water for drinking and washing, and safe sewage and garbage disposal are also critical to health.

Two thirds of Aboriginal and Torres Strait Islander people live in rural or remote areas.   

Those living in remote or very remote areas experience a reduced variety and quality of nutritious foods. Healthy food baskets cost up to 50 per cent more in remote areas than in major cities. It has been estimated that 34-80 per cent of Aboriginal family incomes in remote areas is needed to maintain a healthy diet.  That's at least twice that required by non-Indigenous families in urban areas.

Factors contributing to the higher costs of foods in rural and remote areas are: increased freight costs; higher store overheads; greater wastage of food stock; store management practices; and the reduced economies of scale for purchasing and retailing in small remote communities.

Some healthy food items are less available in remote stores, particularly fresh fruit and vegetables, whole grain cereals, lean meats and low fat dairy products.

Communities in remote areas may also be without food for extended periods due to weather or road conditions, such as during the wet season.  Recent Northern Territory Market Basket surveys suggest this may be improving.

The Review of nutrition among Aboriginal and Torres Strait Islander people highlights the importance of nutrition promotion and the prevention of diet-related disease.

It provides information on relevant programs, services, policies and strategies that help improve food supply, diet and nutritional health among Aboriginal and Torres Strait Islander people.

Lead author Professor Amanda Lee is a Senior Advisor at the Australian Prevention Partnership Centre at the Sax Institute and has more than 35 years’ experience as a practitioner and academic in nutrition, obesity and chronic disease prevention, Aboriginal and Torres Strait Islander health and public health policy.

The review can be accessed free on the HealthInfoNet website and is also published in the January-March edition of the HealthBulletin.

The nutrition portal on the HealthInfoNet contains a wealth of other information relating to Aboriginal and Torres Strait Islander nutrition, including: programs and projects; health promotion and health practice resources; policies and strategies; and publications (including grey literature).

Key Facts

• Aboriginal and Torres Strait Islander people continue to suffer the worst diet-related health of all population groups in Australia.
• Diet-related chronic diseases - such as cardiovascular disease, type 2 diabetes, chronic kidney disease and some cancers - are responsible for at least 75 per cent of the mortality gap between Aboriginal and Torres Strait Islanders and other Australians.
• In 2011, 13 dietary factors were identified as being risk factors for the Australian population (out of 29 risk factors). The joint effect of all dietary risks combined contributed 9.7 per cent to the burden of disease for Aboriginal and Torres Strait Islander people.
• The nutrition burden among Aboriginal and Torres Strait Islander adults is underscored by malnutrition, which includes both over-nutrition (particularly over-consumption of unhealthy ‘discretionary’ foods) and under-nutrition (dietary deficiencies related to inadequate intake of healthy foods).
• In 2012-13, very few Aboriginal and Torres Strait Islander adults or children consumed adequate amounts of healthy foods consistent with recommendations of the Australian Dietary Guidelines. Furthermore, over two-fifths (41 per cent) of total daily energy reported by Aboriginal and Torres Strait Islander people came from unhealthy foods and drinks classified as ‘discretionary’.
• The current situation is in marked contrast to the situation prior to European settlement of Australia. All available evidence suggests that Aboriginal and Torres Strait Islander Australians were traditionally healthy; enjoying varied dietary patterns of fresh plant and animal foods, low in energy density and rich in nutrients.
• Many historical, socioeconomic, environmental and geographic factors contribute to the current poor diet, nutrition and food security experienced by Aboriginal and Torres Strait Islander people.
• In 2012-13, 66 per cent of Aboriginal and Torres Strait Islander people aged 15 years or older were classified as overweight (29 per cent) or obese (37 per cent); a further 30 per cent were normal weight and 4 per cent were underweight. In addition, 30 per cent of Aboriginal and Torres Strait Islander children aged 2-14 years were overweight (20 per cent) or obese (10 per cent); 62% per cent were in the normal weight range and 8% were underweight.
• Prevalence of poor pregnancy outcomes and infant malnutrition remains high in many areas. Low birthweight, failure to thrive and poor child growth are still serious concerns in many Aboriginal and Torres Strait Islander communities.
• In 2012-13, 83 per cent of Aboriginal and Torres Strait Islander children aged 0-3 years had been breastfed, compared with 93 per cent of non-Indigenous children. Of those who were breastfed, Aboriginal and Torres Strait Islander infants were less likely than non-Indigenous infants to have been breastfed for 12 months or more (12 per cent compared with 21 per cent).
• Based on self-reported usual serves of vegetables eaten per day, only 8 per cent of Aboriginal and Torres Strait Islander people met the vegetable intake recommended in the Australian Dietary Guidelines. Mean reported vegetable intake was less than a third of the recommended amount.
• Based on self-reported usual serves of fruit eaten per day, 54 per cent of Aboriginal and Torres Strait Islander people met the fruit intake recommended in the Australian Dietary Guidelines. Mean reported fruit intake was around half the recommended amount.
• One-quarter (25 per cent) of grain (cereal) foods consumed by Aboriginal and Torres Strait Islander people were from wholegrain and/or high fibre varieties, compared to the recommended 50 per cent or more.
• The average daily consumption of milk, yoghurt, cheese and alternatives for each age-sex group of Aboriginal and Torres Strait Islander people, with the exception of children aged 2-3 years and girls 4-8 years, was considerably lower than the respective recommend number of serves.
• The average daily consumption of lean meats and meat alternatives for each age-sex group of Aboriginal and Torres Strait Islander people, with the exception of girls 2-3 years, was less than the respective recommendations; intake was relatively high in remote areas.
• On average, Aboriginal and Torres Strait Islander people 2 years and over reported consuming an average of 75 grams (18 teaspoons) of free sugars per day, which equates to an average of 14 per cent of dietary energy, nearly 50 per cent more than World Health Organization (WHO) recommendations. Two-thirds of Aboriginal and Torres Strait Islander people’s free sugar intake came from sugary drinks.
• In 2011-2013, 22 per cent of survey respondents said they had run out of food and couldn’t afford to buy more in the last 12 months. Aboriginal and Torres Strait Islander people in remote areas were more likely to run out of food than those in non-remote areas (31 per cent and 20 per cent respectively).
• The underlying causes of food insecurity in Aboriginal and Torres Strait Islander communities include factors such as low income and unemployment, inadequate housing, overcrowding, lack of educational opportunities, transport, high food costs, cultural food values, food and nutrition literacy, knowledge and skills
• A range of general Australian Government Department of Health programs contribute to the prevention and management of diet-related disorders among Aboriginal and Torres Strait Islanders at a national level. However, since the expiry of the National Aboriginal and Torres Strait Islander nutrition strategy and action plan 2002-2010, there has been no national coordination of nutrition efforts in Australia.
• Several community-based nutrition programs have demonstrated positive outcomes in the past. The most effective programs have adopted a multi-strategy approach, addressing both food supply (availability, accessibility and affordability of foods) and demand for healthy foods. A major success factor is community involvement in (and, ideally, control of) all stages of program initiation, development, implementation and evaluation, to ensure the intervention is culturally appropriate and tailored to community needs.
• Programs to improve food supply have included a focus on: food retail outlets; local food production, such as school or community gardens; food provided by Aboriginal and Torres Strait Islander and community organisations; and food aid. Community store nutrition policies have been shown to be important influences on the food supply and dietary intake in remote areas.
• While nutrition education alone will not improve food security or dietary intake, it can be effective when combined with a range of other strategies to help people access healthy food, such as cooking programs, peer education, budgeting advice, and group-based lifestyle modification programs.
• A well-supported, resourced and educated Aboriginal and Torres Strait Islander nutrition workforce is essential for the success of nutrition interventions.
• There is a long history of effort to improve nutrition and food security among Aboriginal and Torres Strait Islander people, however there is no current national nutrition policy or strategy in place.
• Improving food supply and security to better prevent and manage poor nutrition and diet-related disease is vital to the current and future health of Aboriginal and Torres Strait Islander Australians. Food and nutrition programs play an important role in the holistic approach to improving health outcomes for Aboriginal and Torres Strait Islander people.