Australian Aboriginal Food and Nutrition Policy - Research Paper Example

High Fibre Intake Program for Aboriginal and Torres Strait Islander People Introduction In Australia, Aboriginal and Torres Strait Islander people are classified as vulnerable groups due to disadvantages of income, socioeconomic status, employment and education. In addition, the Aboriginal and Torres Strait Islander people have changed their lifestyles and patterns of food consumption, gradually moving from a hunter-gatherer lifestyle to a settled Western-style existence since European colonists began to settle in Australia (Lee et al 1994). In other words, the Aboriginal diet has altered from a nutrient-dense diet which is high in fibre and low in fat and refined carbohydrate, to an energy-dense diet which is high in fat and refined sugars. These factors have strongly influenced the incidence of diet-related diseases such as cardiovascular disease, hypertension and type II diabetes. These diseases are now prevalent among Aboriginal and Torres Strait Islander populations. Lee et al (1994) investigated apparent per capita food and nutrient intake in six remote Australian Aboriginal communities. They found that in comparison to the rest of the Australian community, intake of sugars and sweetened soft drinks were much higher, and intake of whole grains, fruit and vegetables were much lower in Aboriginal communities. Furthermore, they found that white sugar, white flour, bread and meat provided over 50% of the apparent total energy intake for the people of these Aboriginal communities. The high intake of refined carbohydrates and the high percentage of energy intake from meat with excessive visible fat may help explain the prevalence of obesity, diabetes and cardiovascular disease in Aboriginal communities. Hence there is a real need in these communities for a program that will help people modify their patterns of food consumption. A high fibre intake program is proposed to promote consumption of whole grains, vegetables and fruit in Aboriginal population, in order to reduce the prevalence of diet-related diseases. To improve nutrition and public health for all Australians, the Eat Well Australia (EWA) program has been developed by the Strategic Inter-Governmental Nutrition Alliance (SIGNAL) (National Public Health Partnership 2001). This action plan has been developed for all Australians, and the promotion of Indigenous health is also included; the companion document to the EWA program is the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP). The proposed high fibre intake program is intended to reinforce the importance of a diet rich in fruits, vegetables and whole grain products as outlined by the EWA program, and to improve the accessibility of these foods in remote and rural communities to meet the dietary needs of Aboriginal and Torres Strait Islander people. Program aim The high fibre intake program aims to increase the intake of dietary fibre in Aboriginal communities by promoting consumption of whole grain products, fresh vegetables and fruit in order to reduce and eventually eliminate the health gap between Aboriginal and Torres Strait Islander people and the rest of the Australian population. It is hoped that modifying consumption patterns in this way will reduce the incidence of diet-related diseases in these populations. Program objectives Increase the availability of whole grain products in remote and rural food retail sectors. Increase the availability of fresh vegetable and fruit, and also increase the proportion of caned vegetables and fruit, or dry vegetables and fruit, and juices without added sugar in remote food retail sectors. Disseminate the concept of high fibre intake among the Aboriginal and Torres Strait Islander communities. Promote a dietary shift from high fat and high refined carbohydrates to high fibre, low fat, and low refined carbohydrate in the Aboriginal and Torres Strait Islander populations. Rationale A great deal of scientific research has been dedicated to the study of the relationship between dietary fibre and diabetes or coronary heart disease. Diet not only influences body weight, but is also recognized as a modifiable risk factor for type II diabetes (Manson and Spelsberg, 1994). A study conducted by Meyer et al (2000) supports the idea that consumption of grains (particularly whole grains), cereal fibre and dietary magnesium (present in grains) play a role in delaying or preventing the development of diabetes in older women. Dietary fibre improves glycemic response and insulin release by slowing the absorption and digestion of food and by regulating several metabolic hormones (Anderson and Akanji 1991). Several studies indicate a correlation between fibre intake and the risk of heart disease and high cholesterol levels. A study by Kushi et al (1999) suggested that a high fibre diet reduced the risk of coronary heart disease, and a second by Erkkila et al (1999) also found that dietary fibre intake was inversely correlated with total cholesterol concentration and serum triglycerides. Additionally, Kleemola et al (1999) demonstrated that regular consumption of ready-to-eat breakfast cereals was related to a reduction in intake of total and saturated fat, and a reduction in serum cholesterol levels. In summary, these scientific studies have proven that consumption of dietary fibre is beneficial for the regulation of both blood sugar and serum cholesterol levels. These results indicate that fibre can reduce the risks of some diet-related diseases, including coronary heart disease and type II diabetes. Statistical studies carried out by the Australian Bureau of Statistics (ABS) show that the proposed program has the potential to produce positive results for Australia's Indigenous populations; this is of course dependent upon those populations accepting the program and modifying their dietary patterns based upon its recommendations. In recent years, the ABS carried out two studies: A National Health Survey (NHS) in 2001, and the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) in 2004-05. These studies shows similar results, with 11-12% of Indigenous Australians reporting a long-term health condition associated with the circulatory system. Additionally, in both studies Indigenous Australians were over three times more likely to report diabetes than non-Indigenous Australians. The 2001 NHS did not collect diet data from Indigenous Australians living in remote areas. However, the 2004-05 NHS found that 20% of Indigenous people in remote areas did not eat at least one serving of fruit daily, compared to 12% in non-remote areas. For vegetables, 15% of Indigenous Australians living in remote areas did not eat at least one serving daily, compared to just 2% in non-remote areas. Even in non-remote areas, only 42% of the surveyed population met the recommended daily fruit intake, and just 10% met the recommended daily vegetable intake. Overall, the data indicate that Indigenous Australians do not include enough vegetables and fruits in their daily diets, and as a consequence, the incidence of diet-related diseases has not declined in this population. Although the Health and Welfare of Australia's Aboriginal and Torres Strait Islander People 2005 reported that education, employment and mortality statistics had improved between 1994 and 2002, a significant gap still existed between the Indigenous and non-Indigenous populations. For example, the mean gross household income for Indigenous people was equal to just 59% of that for non-Indigenous people in 2002. The mortality rate of endocrine, nutritional and metabolic diseases for Indigenous males and females were approximately 7 and 11 times, respectively, higher than those for non-Indigenous male and females. Furthermore, the life expectancy of the Indigenous population was approximately 17 years less than the non-Indigenous Australian population. For these reasons, disseminating information on the importance of a high fibre diet to the Aboriginal and Torres Strait Islander people is an important undertaking. In addition, the factors of influence on food consumption pattern for the Aboriginal and Torres Strait Islander communities are not only social, economic and cultural, but also include knowledge of and attitudes to food and nutrition. Thus, for reducing the incidence of diet-related diseases and improving the health of the Indigenous population, a high fibre intake program should concentrates not only on increasing fibre intake, but on understanding the reasons for doing so. Program action In remote food sectors, stores and takeaway outlets Provide financial support to enable remote food sectors to sell affordable healthy food. Develop an incentive system to encourage the sale of whole grain products, vegetables and fruits. Reduce the availability of sweetened soft drinks and increase the availability of juice without added sugar in remote stores. Encourage food stores and takeaway outlets to supply or use whole grain product such as wholemeal flour, bread, toast, sandwiches and traditional foods in remote and rural areas. Develop food and nutrition guidelines for remote stores and takeaway outlets to effectively manage food supply and storage. Advertise the benefits of whole grains, vegetables and fruits in stores, community centres and local newspaper and media. In Aboriginal and Torres Strait Islander communities Establish a partnership between government and communities to support the high fibre intake program. Target Indigenous family networks, because family has a strong influence in Aboriginal society. Set up communication channels to disseminate the concept of the benefits of fibre and other health issues, and get feedback or obtain useful information from Indigenous communities. Organize and implement a system to review progress and assess the health of Aboriginal communities to determine the efficacy of the program, and to make any changes needed to meet the Aboriginal population's current. Select and train Aboriginal people to assist the program and communicate with Aboriginal and Torres Strait Islander communities and population. Key partners for promoting consumption of whole grains, vegetables and fruits Supplier sectors: Department of Agriculture regional Officers, growers and grower associations, producers of canned, frozen and other vegetable and fruit products. Transport sectors: Goods delivery associations, freight transportation companies. Distribution sectors: local fruit and vegetable shops, remote supermarket or fruit and vegetable markets. Food service sectors: local restaurants, takeaway outlets, Cafeterias and school canteens. Promotion sectors: local government and non-government organizations, local food promotion groups, community representatives, health workers, area health services, Aboriginal medical services. Media: local media including TV, radio, newspapers and magazines. Cooperation with health policies and strategies Eat Well Australia and NATSINSAP (2000-2010) Aboriginal Health and Wellbeing Strategic Plan (2000-2010) National Indigenous Health Information Plan (1997) National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (1997) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (2003) National Aboriginal and Torres Strait Islander Health Survey (2004-05) for Australia, New South Wales, Victoria, Queensland, South Australia, Tasmania, Northern Territory and Australian Capital Territory The Australian Guide to Healthy Eating (1998) New Dietary Guidelines for Australian Adults (2003) New Dietary Guidelines for Children and Adolescents in Australia (2003) National Diabetes Strategy (1999) (online information accessed 30 April 2006 at http://www.abs.gov.au) Conclusion The prevalence rate of diet-related disease in Aboriginal and Torres Strait Islander populations is significantly higher than in non-Indigenous Australian populations, and life expectancy is significantly reduced in Indigenous populations compared to the non-Indigenous population. Causes include social, economic and cultural factors. Moreover, knowledge of and attitude to food and nutrition also have a strong impact on food choice and consumption. The pattern of food intake in Aboriginal population has already changed from traditional bush food to settled Western food, resulting in a higher intake of fat and refined carbohydrates, and decreased fibre intake. A combination of these factors has caused an increase in the incidence of diet-related diseases such as coronary heart disease, hypertension and type II diabetes in Indigenous populations. For example, Wolever et al (1997) surveyed the North American Aboriginal population and concluded that the high prevalence of diabetes in this population was due to the adoption of a high fat, low fibre diet, which in turn was due to recent changes in lifestyle. According to this and other evidence, dietary modifications are an essential step in reducing the incidence of dietary diseases in Indigenous populations. There is a great deal of data that indicate the existence of a strong need for a high fibre intake program targeted to Aboriginal and Torres Strait Islander people. Implementing such a program will require extensive cooperation with other policies and strategies, government and non-government organizations, aboriginal communities, and food sectors including growers, producers, transporters and distributors. Price (2004) indicates that community stores in Aboriginal communities are key sources of nutrition for communities, and should be viewed as essential services. Community stores, therefore, are key players in providing a variety of affordable, accessible high fibre products. However, providing healthy foods including whole grain products, fresh fruit and vegetables, is not enough. It is also important to change attitudes to and knowledge of food and nutrition. This will require working with communities and family networks to ensure they feel comfortable with the program and with making significant dietary changes. For this reason, training people within Aboriginal communities will be an effective and sustainable way of disseminating dietary information. In conclusion, the implementation of a program promoting high fibre intake is suggested to improve health and decrease the incidence of diet-related diseases among Indigenous Australian populations, and to decrease the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Once implemented, this program must be continually reviewed to determine how effective each aspect of the program is, and whether further changes should be made to meet the needs of Indigenous populations. References Anderson JW and Akanji AO. 1991 Dietary fibre- an overview. Diabetes Care, 14:1126-1131. Australian Bureau of Statistics 2006 National Aboriginal and Torres Strait Islander Health Survey, 2004-05 (online accessed 25 April 2006) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12004-05OpenDocument Australian Bureau of Statistics 2002 National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001 (online accessed 25 April 2006) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12001OpenDocument Erkkila AT, Sarkkinen ES, Lehto S, Pyorala K & Uusitupa MI.1999 Dietary associates of serum total, LDL, and HDL cholesterol and triglycerides in patients with coronary heart disease. Prev Med 28: 558-565. Kleemola P, Puska P, Vartiainen E, Roos E, Luoto R, & Ehnholm C 1999 The effect of breakfast cereal on diet and serum cholesterol: a randomized trial in North Karelia, Finland. Eur. J Clin. Nutr. 53: 716-721 Kushi LH, Meyer KA and Jacobs DR.1999 Cereals, legumes, and chronic disease risk reduction: evidence from epidemiological studies. Am J Clin Nutr., 70: 451S-458S. Lee AJ, O'Dea K and Mathews JD 1994 Apparent dietary intake Aboriginal communities Australian Journal of Public Health 18:190-197 Manson JE and Spelsberg A. 1994 Primary prevention of non-insulin-dependent diabetes mellitus. Am J Prev Med; 10:172-84. Meyer KA, Kushi LH, Jacobs DR, Slavin J, Sellers TA & Folsom AR 2000 Carbohydrates, dietary fibre, and incident type 2 diabetes in older women Am J Clin Nutr, 71:921-930 National Health and Medical Research Council. 2000 Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: National Health and Medical Research Council, Canberra. (Online, accessed 28 April 2006) http://www.nhmrc.gov.au/publications/synopses/n26syn.htm National Public Health Partnership 2001 Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000-2010 Strategic Inter-Governmental Nutrition Alliance of the National Public Health Partnership (online accessed 23 April 2006) http://www.dhs.vic.gov.au/nphp/publications/signal/eatwell1.pdf National Public Health Partnership 2001 National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan: a summary the National Aboriginal and Torres Strait Islander Nutrition Working Party (online accessed 23 April 2006) http://www.nphp.gov.au/publications/signal/natsinsa2.pdf Price R 2004 Food Alliance for Remote Australia: a voice for food security issues in remote Australia The National SARRAH Conference, Alice Springs, Central Australia (online accessed 1 May 2006) http://www.ghwatch.org/english/casestudies/remote_aus.pdf Wolever TMS, Hamad S, Gittelsohn J, Gao J, Hanley AJG, Harris SB & Zinman B 1997 Low dietary fibre and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community Am J Clin Nutr, 66: 1470-1474 Read More