‘ It is important to note that from all the available evidence reviewed, that the most important factor determining the success of Aboriginal and Torres Strait Islander food and nutrition programs is community involvement in the program initiation, development and implementation, with community members working in partnership across all stages of development’.

HealthInfoNet Director, Professor Neil Drew

The Australian Indigenous HealthInfoNet (HealthInfoNet) at Edith Cowan University has published a new Review of programs and services to improve Aboriginal and Torres Strait Islander nutrition and food security.

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This review is a companion document to the recent Review of nutrition among Aboriginal and Torres Strait Islander people published in February 2018. It builds on the broad discussion in that review by capturing a wider sample of evaluated programs and services and providing more detail about successful programs.

Written by Amanda Lee from the Australian Prevention Partnership Centre, The Sax Institute and Kathy Ride from the HealthInfoNet, the review highlights that improving diets, food supply and food 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 people.

This review identifies that many Aboriginal and Torres Strait Islander communities are motivated to tackle diet-related health issues and they recognise the importance of improving nutrition to prevent and manage growth faltering and chronic disease. However, community effort needs to be supported through the building of an Aboriginal and Torres Strait Islander nutrition workforce, and adequate government investment of funds and policy commitment to sustain improvement of nutrition and diet-related health.

Improving diets, food supply and food 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
people.

Effective action requires a whole-of-life approach, across the whole health continuum, including: preventive community interventions; public health nutrition policy actions; nutrition promotion; and quality clinical nutrition and dietetic services .

Previous reviews of Aboriginal and Torres Strait Islander food and nutrition programs have consistently noted the lack of availability of rigorously-evaluated interventions, especially with respect to long term evaluations .

Quality evaluations with practical recommendations are critical to helping the workforce build on what has been learnt. Evaluation reports and recommendations need to be publically available for policy makers and practitioners to learn from, apply and build on .

Other reviews have found that most nutrition interventions have focused on remote settings despite most Aboriginal and Torres Strait islander people living in urban and regional areas.

Most of these employed a comprehensive, whole-of-population approach – combining provision and promotion of healthier options in community food stores with nutrition education – which was found to be effective .

As with all health programs, nutrition programs should be developed with the target communities, be delivered according to cultural protocols, be tailored to community needs, and not be forced, or perceived to be forced, upon communities (see Box 1)

A major success factor is community involvement in (and, ideally, control of) decisions relating to all stages of program initiation, development, implementation and evaluation [9; 10; 14]. Program implementation methods that build confidence among collaborating Aboriginal and Torres Strait Islander and non-Indigenous health agencies are fundamental to building capacity to enhance Aboriginal and Torres Strait Islander nutrition and health .

The typical short-term funding cycles experienced in this area are at odds with the time required for community stakeholders to develop capacity to mobilise and build momentum for specific interventions.

An effective ecological approach to chronic disease prevention also requires inter-organisational collaboration in planning and implementation . While many programs targeting nutritional issues are implemented as healthy lifestyle programs to address obesity, it must be remembered
that diet is more than a ‘lifestyle’ choice – it is determined by the availability of and access to healthy food, and by having the infrastructure, knowledge and skills to prepare healthy food.

To improve diet-related health sustainably it will be necessary to take a food systems approach .

The underlying factors influencing nutrition and food security in Aboriginal and Torres Strait Islander communities include socioeconomic factors such as income and employment opportunities, housing, over-crowding, transport, food costs, cultural food values, education, food and nutrition literacy, knowledge, skills and community strengths.

Key points

• Nutrition, public health and Indigenous health experts are calling for a nationwide, comprehensive, sustained effort to address Aboriginal and Torres Strait Islander nutrition.

Primary prevention of diet-related disease and conditions

• The most effective community-based programs tend to adopt a multi-strategy approach, addressing both food supply (availability, affordability, accessibility and acceptability of foods), and demand for healthy foods.
• Supply of micronutrient supplements rather than food does not address the underlying issues of food insecurity, poor dietary patterns or high rates of obesity.
• The population health intervention of folate fortification of bread flour has had the desired effect of increasing folate status in the Australian Aboriginal population.
• Analysis of remote store sales data during the Northern Territory Emergency Response found that income management provided no beneficial impact in relation to purchasing of tobacco, soft drink or fruit and vegetables.
• Nutrition programs implemented at the community level mainly focus on improving food supply and/or increasing demand for healthy food.
• As with all health programs, all nutrition programs should be developed with communities, be delivered according to cultural protocols, be tailored to community needs, and be directed by the communities.

Primary health care and clinical nutrition and dietetic services

• Primary health care services for Aboriginal and Torres Strait Islander people need to deliver both competent and culturally appropriate dietetic and chronic disease care.
• Health services run by Aboriginal and Torres Strait Islander communities provide holistic care that is relevant to the local community and addresses the physical, social, spiritual and emotional health of the clients.
• The involvement of Aboriginal and Torres Strait Islander Health Workers has been identified by health professionals and patients as an important factor in the delivery of effective clinical care to Aboriginal and Torres Strait Islander people, including in dietetics and
nutrition education.

Aboriginal and Torres Strait Islander nutrition workforce

• A trained, well-supported and resourced Aboriginal and Torres Strait Islander nutrition workforce is essential to deliver effective interventions.
• It is estimated that less than 20 Aboriginal and Torres Strait Islander people have ever trained as nutritionists and/or dietitians in Australian universities.

NACCHO Example from Nhulundu Health Service

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