Improving the health of indigenous communities

Aboriginal and Torres Strait Islander people have significantly poorer health and lower life expectancy than other Australians. But while reducing these inequalities is a priority for governments, national policy has neglected nutrition, one of the most important determinants of health.

Recent reports estimated a life expectancy gap of 11.5 years for Aboriginal males and 9.7 years for Aboriginal females compared to non-Aboriginal Australians. About 80% of this difference is due preventable chronic conditions, such as type 2 diabetes and cardiovascular disease.

The reasons for the difference are made apparent in the recently released results from the Aboriginal and Torres Strait Islander Health Survey. These suggest one in ten adults in this population group has diabetes, a prevalence three times higher than that of the non-Indigenous population. Aboriginal Australians are also developing diabetes 20 years earlier than other Australians.

The main driver of this increase is obesity. The survey shows that it’s more commonamong Aboriginal and Torres Strait Islander people in every age group, including children. The survey showed 60% of Aboriginal and Torres Strait Islander men and 81% of women had a high waist circumference, putting them at risk of chronic disease.

Nutrition is a major contributor to these conditions.

The fall and rise of nutrition

Programs to improve nutrition for Aboriginal and Torres Strait Islander people were once considered a policy priority. But our research, which examined health strategies and plans aimed at this population published between 2000 and 2012, shows while nutrition was initially a priority, it fell off the radar in the second half of the period under examination.

Diet contributes to maternal health, birth weight, child development and oral health, as well as prevention and management of chronic disease. In fact, the World Health Organisation considers “dietary risks” as the leading cause of illness and death in Australia, surpassing both smoking and obesity.

Unfortunately, the impact of poor nutrition has not been adequately evaluated in the estimates of burden of disease in the Aboriginal and Torres Strait Islander population. This has significant implications for setting priorities in the health policy agenda.

Nonetheless, the previous Labor government’s Aboriginal and Torres Strait Islander Health Plan, which was released in July 2013, refocused on improving nutrition. The plan was supposed to replace the previous ten-year policy framework and guide action over the next decade towards achieving the health-related targets for bridging the gaps in health and mortality between the Aboriginal and Torres Strait Islander population and the rest of Australia.

The plan was generally hailed as a step forward as it emphasised the centrality of Aboriginal and Torres Strait Islander culture and resilience to health and well-being. It included a commitment to address the social determinants of health, such as housing, education and employment.

Another strength of the plan is that it was developed in consultation with Aboriginal and Torres Strait Islander people and their peak organisations, which ultimately endorsed itand called for bipartisan support. The plan acknowledged the widespread problem of food insecurity and prioritised nutrition in the early years of life.

The way ahead

The government changed soon after the Health Plan was released. Over a year later, it is yet to be implemented. In fact, the Coalition criticised the plan when it was released.

Assistant Health Minister Fiona Nash announced in May that the government would develop a blueprint for implementing the Health Plan by the end of 2014. With only two months remaining, this implementation plan has still not seen the light of day.

In the meantime, the government has decided to replace 150 Indigenous affairs programs with just five, resulting in $239 million in cuts, and an additional $165 million reduction to the Aboriginal health budget.

Improving Aboriginal and Torres Strait Islander health requires coordination, sustainable funding and a well-trained workforce. Implementing the 2013 Health Plan in the way its creators intended is key to improving nutrition for this population and closing the life expectancy and health gap.

Published in collaboration with The Conversation

Author: Jennifer Browne is a public health nutritionist based at the Victorian Aboriginal Community Controlled Health Organisation in Melbourne. Deborah Gleeson is a Lecturer in the School of Public Health and Human Biosciences at La Trobe University.

Image: A child sits in the community centre at “Hidden Valley” aboriginal camp on the outskirts of the central Australian town of Alice Springs July 3, 2007. REUTERS/Tim Wimborne