Aboriginal #Nutrition Health and #Sugar : @healthgovau Health Star Rating System review closes 17 August

 ” The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.”

See Sugar, sugar everywhere MJA insight article in full Part 3 below

  ” In 2012-13, Aboriginal and Torres Strait Islander people 2 years and over consumed an average of 75 grams of free sugars per day (equivalent to 18 teaspoons of white sugar)1. Added sugars made up the majority of free sugar intakes with an average of 68 grams (or 16 teaspoons) consumed and an additional 7 grams of free sugars came from honey and fruit juice. “

ABS Report abs-indigenous-consumption-of-added-sugars 

See Part 1 below for Aboriginal sugar facts

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system is undertaking a five year review of the HSR system.

The five year review of the system is well underway, with a public submission process opening on 8 June 2017 on the Australian Department of Health’s online Consultation Hub.

Since the consultation period has been opened there has been strong interest in the system from stakeholders representing a diverse range of views.

To ensure that as much evidence as possible is captured, along with stakeholders’ views on the system, a further two week extension to the consultation period has been agreed and it will now close on 17 August 2017

See full survey details Part 2 Below

Part 1 Aboriginal sugar facts

ABS Report

abs-indigenous-consumption-of-added-sugars

Aboriginal and Torres Strait Islander people consume around 14 per cent of their total energy intake as free sugars, according to data from the Australian Bureau of Statistics (ABS).

The World Health Organization (WHO) recommends that free sugars contribute less than 10 per cent of total energy intake.

Director of Health, Louise Gates, said the new ABS report showed Aboriginal and Torres Strait Islander people are consuming an average of 18 teaspoons (or 75 grams) of free sugars per day (almost two cans of soft drink), four teaspoons more than non-Indigenous people (14 teaspoons or 60 grams).

OTHER KEY FINDINGS

    • Aboriginal and Torres Strait Islander people derived an average of 14% of their daily energy from free sugars, exceeding the WHO recommendation that children and adults should limit their intake of free sugars to less than 10% of dietary energy.
    • Free sugars made the greatest contribution to energy intakes among older children and young adults. For example, teenage boys aged 14-18 years derived 18 per cent of their dietary energy from free sugars as they consumed the equivalent of 25 teaspoons (106 grams) of free sugars per day. This amount is equivalent to more than two and a half cans of soft drink. Women aged 19-30 years consumed 21 teaspoons (87 grams) of free sugars, which contributed 17 per cent to their total energy intake.
    • The majority (87%) of free sugars were consumed from energy dense, nutrient-poor ‘discretionary’ foods and beverages. Two thirds (67%) of all free sugars consumed by Aboriginal and Torres Strait Islander people came from beverages, led by soft drinks, sports and energy drinks (28%), followed by fruit and vegetable juices and drinks (12%), cordials (9.5%), and sugars added to beverages such as tea and coffee (9.4%), alcoholic beverages (4.9%) and milk beverages (3.4%).
    • Intakes were higher for Aboriginal and Torres Strait Islander people living in non-remote areas where the average consumption was 78 grams (18.5 teaspoons), around 3 teaspoons (12 grams) higher than people living in remote areas (65 grams or 15.5 teaspoons).
    • Aboriginal and Torres Strait Islander people consumed 15 grams (almost 4 teaspoons) more free sugars on average than non-Indigenous people. Beverages were the most common source of free sugars for both populations, however Aboriginal and Torres Strait Islander people derived a higher proportion of free sugars from beverages than non-Indigenous people (67% compared with 51%).

Part 2 @healthgovau Health Star Rating System review closes 17 August

Introduction

The Health Star Rating (HSR) Advisory Committee (HSRAC), responsible for overseeing the implementation, monitoring and evaluation of the HSR system, is undertaking a five year review of the HSR system. The HSR system is a front-of-pack labelling (FoPL) scheme intended to assist consumers in making healthier diet choices. The findings of the review will be provided to the Australia and New Zealand Ministerial Forum on Food Regulation (Forum) in mid‑2019.

In parallel with this consultation on the HSR system five year review, the HSRAC is conducting a dedicated investigation of issues and concerns raised about the form of the food (‘as prepared’) rules in the Guide for Industry to the HSR Calculator. These enable additional nutrients to be taken into account when calculating star ratings based on foods prepared according to on-label directions. A specific consultation process seeking input into this investigation opened on 19 May 2017 and will close at 11.59 pm 30 June 2017. The form of the food (‘as prepared’) consultation can be viewed on the Australian Department of Health’s Consultation Hub.

The HSR system

The HSR system is a public health and consumer choice intervention designed to encourage people to make healthier dietary choices. The HSR system is a voluntary FoPL scheme that rates the overall nutritional profile of packaged food and assigns it a rating from ½ a star to 5 stars. It is not a system that defines what a ‘healthy’ or ‘unhealthy’ food is, but rather provides a quick, standardised way to compare similar packaged foods at retail level. The more stars, the healthier the choice. The HSR system is not a complete solution to assist consumers with choosing foods in line with dietary guidelines, but should be viewed as a way to assist consumers to make healthier packaged food choices.  Other sources of information, such as the Australian Dietary Guidelines and the New Zealand Eating and Activity Guidelines, also assist consumers in their overall food purchasing decisions.

The HSR system aims to:

1. Enable direct comparison between individual foods that, within the overall diet, may contribute to the risk factors of various diet related chronic diseases;

2. Be readily understandable and meaningful across socio-economic groups, culturally and linguistically diverse groups and low literacy/low numeracy groups; and

3. Increase awareness of foods that, within the overall diet, may contribute positively or negatively to the risk factors of diet related chronic diseases.

The HSR system consists of the graphics, including the words ‘Health Star Rating’, the rules identified in the HSR system Style Guide, the algorithm and methodology for calculating the HSR identified in the Guide for Industry to the HSR Calculator, and the education and marketing associated with the HSR implementation.

The HSR system is a joint Australian, state and territory and New Zealand government initiative developed in collaboration with industry, public health and consumer groups. The system is funded by the Australian government, the New Zealand government and all Australian jurisdictions during the initial five year implementation period.

From June 2014, food manufacturers started to apply HSRs to the front of food product packaging. Further information on the HSR system is available on the HSR website. The New Zealand Ministry for Primary Industries (MPI) website also provides information on the HSR system in New Zealand.

Purpose and scope of the review
The five year review of the HSR system will consider if, and how well, the objectives of the HSR system have been met, and identify options for improvements to and ongoing implementation of the system (Terms of reference for the five year review).

With a focus on processed packaged foods, the objective of the HSR system is:

To provide convenient, relevant and readily understood nutrition information and /or guidance on food packs to assist consumers to make informed food purchases and healthier eating choices.

The HSRAC has agreed that the areas of communication, system enhancements, and monitoring and governance will be considered when identifying whether the objectives of the HSR system have been achieved.

Although HSRAC will need to be a part of the review process, a degree of independence is required and independent management and oversight of the review is an important factor to ensure credible and unbiased reporting. An independent consultant will be engaged to undertake the review. Specific detail about the scope of the review will be outlined in the statement of requirement for the independent consultant. A timeline for the five year review of the HSR system has been drafted and will be updated throughout the review.

Next steps in the review process

As part of the five year review, HSRAC is seeking evidence based submissions on the consultation questions provided in this discussion paper.

This consultation is open to the public, state and territory governments, relevant government agencies, industry and public health and consumer groups.

Making a submission

The HSRAC is seeking submissions on the merits of the HSR system, particularly in response to the consultation questions below. The aim of the questions is to assist respondents in providing relevant commentary. However, submissions are not limited to answering the questions provided.  Please provide evidence or examples to support comments. Some areas of this review are technical in nature therefore comments on technical issues should be based on scientific evidence and/or supported by research where appropriate. Where possible, please provide citations to published studies or other sources.

While the HSRAC will consider all submissions and proposals put forward, those that are not well supported by evidence are unlikely to be addressed as part of the five year review.

Enquiries specifically relating to this submission process can be made via email to: frontofpack@health.gov.au. Please DO NOT provide submissions by email.

After the consultation period closes the HSRAC will consider the submissions received and will prepare a summary table of the issues raised which will be published on the HSR website. All information within the summary table will be de-identifiable and will not contain any confidential material.

HSRAC will treat information of a confidential nature as such. Please ensure that material supplied in confidence is clearly marked ‘IN CONFIDENCE’ and is provided in a separate attachment to non-confidential material. Information provided in the submissions will only be used for the purpose of the five year review of the HSR system and will not be used for any other purpose without explicit permission.

Please see the Terms of Use and Privacy pages at the bottom of this page for further information on maintaining the security of your data.

For further information about the HSR system, including its resources and governance structure, please refer to the Australian HSR website and the New Zealand MPI website.

Part 3 Sugar Sugar MJA Insights

Originally published Here

IT’S hard to escape sugar, not only in what we eat and drink, but also in the daily news and views that seep into so many corners of our lives.

There’s nothing new about concern over sugar. I can trace my own fights with the sugar industry back to the 1960s, and since their inception in 1981, the Australian Dietary Guidelines have advised limiting sugary foods and drinks. The current emphasis in many articles in newspapers, magazines, popular books and online blogs, however, go further and recommend eliminating every grain of the stuff from the daily diet.

Taking an academic approach to the topic, the George Institute for Global Health has published data based on the analysis of 34 135 packaged foods currently listed in their Australian FoodSwitch database. They found added sugar in 87% of discretionary food products (known as junk foods in common parlance) and also in 52% of packaged foods that can be described as basic or core foods.

The George Institute’s analysis is particularly pertinent to the Department of Health’s Health Star Rating System, and found that some of the anomalies in the scheme could be eliminated by penalising foods for their content of added sugars rather than using total sugars in the product, as is currently the case.

The definition of “added sugars” used in Australia also needs attention, a topic that has been stressed in the World Health Organization’s guidelines. I will return to this later.

In Australia, the nutrition information panel on the label of packaged foods must include the total sugars present. This includes sugars that have been added (known as extrinsic sugars) as well as any sugars present naturally in ingredients such as milk, fruit or vegetables (intrinsic sugars).

There is no medical evidence to suggest that intrinsic sugars are a problem – at least not if they occur in “intact” ingredients. If you consume fruit, for example, the natural dietary fibre and the bulk of the fruit will limit the amount of the fruit’s intrinsic sugars you consume. However, if the sugar is extracted from the structure of the fruit, it becomes easy to consume much larger quantities. Few people could munch their way through five apples, but if you extract their juice, the drink would let you take in all the sugar and kilojoules of five apples in less than a minute.

The Australian Dietary Guidelines do not include advice to restrict fruit itself because there is high level evidence of its health value. The guidelines do, however, recommend that dried fruit and fruit juice be restricted – the equivalent of four dried apricot halves or 125 mL juice consumed only occasionally.

Contrary to the belief of some bloggers, Australia’s dietary guidelines have never suggested replacing fat with sugar. That was a tactic of some food companies who marketed many “low” or “reduced” fat foods where the fat was replaced with sugars or some kind of refined starch.

The wording of Australia’s guideline on sugar has changed. The initial advice to “avoid too much sugar” led to the sugar industry’s multimillion dollar campaign “Sugar, a natural part of life”. This included distributing “educational” material to the general public, politicians, doctors, dentists, pharmacists and other health professionals discussing the importance of a “balanced diet”.

In spite of fierce lobbying by the sugar industry, the next revision of the guidelines retained a sugar guideline, although it was watered down to “eat only moderate amounts of sugars”. Some school canteen operators reported that they had been confronted by sweet-talking sellers of junk foods omitting the word “only” from this guideline.

The evidence for sugar’s adverse effects on dental health have long been known, but the evidence against sugar and its potential role in obesity and, consequently, in type 2 diabetes and other health problems has grown stronger. The most recent revision of the National Health and Medical Research Council’s Dietary Guidelines, therefore, emphasises the need to “limit” added sugars and lists the foods that need particular attention.

Sugary drinks have been specifically targeted because the evidence against them is strong and extends beyond epidemiological studies. Double-blind trials now clearly link sugary drinks with weight gain, the only exceptions being a few trials funded by the food industry.

Added sugar is not the only topic for public health concern, and hence the government’s Health Star Rating System was set up to introduce a simple front-of-pack labelling scheme to assist Australians reduce their intake of saturated fat, salt and sugars from packaged foods.

A specially commissioned independent report (Evaluation of scientific evidence relating to Front of Pack Labelling by Dr Jimmy Chun Yu Louie and Professor Linda Tapsell of the School of Health Sciences, University of Wollongong) found that added sugars were the real problem, but the food industry argued that the scheme should include total sugars because this was already a mandatory inclusion on food labels and routine chemical analysis couldn’t determine the source of sugars.

This was a strange argument since food manufacturers know exactly how much sugar they add to any product, just as they know how many “offset” points the Health Star Rating System allows for the inclusion of fruit, vegetable, nuts or legumes. The content of these ingredients is only disclosed on the food label if used in the product’s name.

The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations.

Those of us working in public health question why obvious junk foods get any stars at all.

How can caramel topping or various types of confectionery, such as strawberry flavoured liquorice, each get 2.5 stars? Why do some chocolates sport 3.5 stars, while worthy products such as Greek yoghurt without any added sugars get 1.5 and a breakfast cereal with 27% sugar gets four stars?

The fact that over a third of Australian’s energy intake comes from discretionary products (40% for children) is the elephant in the room for excess weight. We need to reduce consumption of these products and allotting them health stars is not helping.

It’s clearly time to follow our dietary guidelines and limit both discretionary products and added sugar. Of the nutrients used in the current algorithm for health stars, the George Institute’s analysis shows that counting added rather than total sugars has the greatest individual capacity to discriminate between core and discretionary foods.

However, in moving to mandate added sugars on food labels and using added sugars in health stars, it’s vital to define these sugars. The World Health Organization has done so: “Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.

Regular sugar in Australia could be described as cane juice concentrate. It has no nutrients other than its carbohydrate. Fruit juice concentrates are also just sugars with no nutrients other than carbohydrates. At present the Health Star Rating System allows products using apple or pear juice concentrate to be counted as “fruit” and used to offset the total sugars. This is nonsense, and gives rise to confectionery, toppings and some breakfast cereals scoring stars they do not deserve.

Other ways to boost health stars also need attention. Food technologists boast they can manipulate foods to gain extra stars (Health Star Rating Stakeholders workshop, Sydney, 4 August 2016). For example, adding wheat, milk, soy or other protein powder, concentrated fruit purees or a laboratory-based source of fibre such as inulin will all give extra “offset” points to reduce adverse points from saturated fat, sugar or salt. Indeed, some food technologists have even suggested they could revert to using the especially nasty trans (but technically unsaturated) fatty acid from partially hydrogenated vegetable oils to replace naturally occurring saturated fat.

My alternative is to go for fresh foods and minimise packaged foods. If the stars look too good to be true, check the ingredient list. But remember that Choice found sugar may go by more than 40 different names. Buyer beware!

NACCHO Aboriginal Dental Health @AUS_Dental : It’s #DentalHealthWeek #SugaryDrinksProperNoGood

” Apunipima is participating in a range of activities over the next fortnight to celebrate Dental Health Week (7-13 August)

Our staff will be talking about the link between sugary drinks and tooth decay, and promoting the messages

#SugaryDrinksProperNoGood and #DrinkMoreWaterYoufla,

part of Apunipima’s Healthy Communities social marketing campaign, which aims to reduce sugary drinks consumption among Aboriginal and Torres Strait Islander people in Cape York.”

From Apunipima’s Healthy Communities Mob Part 2 below

 ” The National Oral Health Plan outlines guiding principles that will underpin Australia’s oral health system and provides national strategic direction including targeted strategies in six Foundation Areas and across four Priority Populations. Aboriginal and Torres Strait Islander People being a priority population.”

Download plan here

 Watch our interview with Aboriginal dentist Gari Watson on NACCHO TV

Part 1 : National Oral Health Plan identifes Aboriginal People as Priority Population

A proportion of Aboriginal and Torres Strait Islander people have good oral health. On average, however, Aboriginal and Torres Strait Islander people experience poor oral health earlier in their lifespan and in greater severity and prevalence than the rest of the population. Aboriginal and Torres Strait Islander people are also less likely to receive treatment to prevent or address poor oral health, resulting in oral health care in the form of emergency treatment.

  • There is limited representation of Aboriginal and Torres Strait Islander people in the oral health workforce and many dental services are not culturally sensitive. For example, strict appointment times and inflexibility regarding ‘failure to attend’ may result in a fee to the consumer.
  • Trends indicate that the high-level dental decay in deciduous (baby) teeth is rising
  • Aboriginal people aged 15 years and over, attending public dental services, experience tooth decay at three times the rate of their Non-Indigenous counterparts and are more than twice as likely to have advanced periodontal (gum) disease
  • Aboriginal people experience complete tooth loss at almost five times the rate of the non-Indigenous population
  • The rate of potentially preventable dental hospitalisations for Aboriginal and Torres Strait Islander people is higher than other Australians. Accessibility of services is a key factor contributing to the current gap between the oral health of Aboriginal and Torres Strait Islander people and the rest of the population.
  • More than two in five Aboriginal and Torres Strait Islander people over the age of 15 defer or avoid dental care due to cost. This is compared with one in eight (12.2%) who delayed or did not go to a GP.

Improving the overall oral health of the Aboriginal and Torres Strait Islander people will require more than a focus on oral health behaviours. Culture, individual and community social and emotional wellbeing, history, demography, social position, economic characteristics, biomedical factors, and the available health services within a person’s community all form part of the complex causal web which determines an individual’s oral health status.

“Reducing sugary drinks will not only protect their teeth but also their wider health.This is yet another justification for the introduction of a health levy on sugar-sweetened beverages as a preventive public health measure”

This Dental Health Week Michael Moore, CEO of the ( PHAA)  Public Health Association of Australia (PHAA) and other members of the Rethink Sugary Drink Alliance are urging Australians to reduce their consumption of sugary drinks.

Read over 25 NACCHO dental articles

Read over 25 NACCHO Nutrition  Articles

Read over 10 NACCHO Articles Sugar Tax

Dental Health Week Website

Dept of Health Dental Website

Part 2  #SugaryDrinksProperNoGood – It’s Dental Health Week!

Apunipima staff will run activities with children and young people as well as hold health information stalls in Weipa, Napranum and Mapoon to promote the campaign messages in Dental Health Week

‘The team will run a workshop for Western Cape College secondary students alongside Dr Matt More, Head of Dental Services for Torres and Cape Hospital and Health Service in Weipa,’ Apunipima Health Promotion Officer Kiarah Cuthbert said.

‘We will be talking to young people about the amount of sugar in popular drinks, such as soft drinks, sports drinks and energy drinks and the impact of that sugar on your teeth and overall health.’

‘From there, we will head to Mapoon to spend time at the primary school yarning with kids about the sugar in drinks. We will also invite the kids to take part in a local art competition with the winner’s work used to promote the #DrinkMoreWaterYoufla message in Mapoon.’

‘Apunipima staff will then hold a health information stall at Napranum store and run an after school activity at Napranum PCYC, where young people will also have the chance to take part in a local art competition to promote the #DrinkMoreWaterYoufla message.

These activities will be supported by Napranum Tackling Indigenous Smoking Health Worker, Ernest Madua who will also be yarning with people about what smoking can do to your teeth and mouth.’

Apunipima Child Health Nurse Robyn Lythall, Chronic Disease Health Worker Georgia Gibson and Dietitian Jarrah Marsh gave kids from Nola’s Daycare and George Bowen Memorial Kindergarten Apunipima ‘Drink More Water Youfla’ water bottles last week which will really save the staff lugging big containers of water!

The bottles are plastic, easily stored in the fridge and will have the children’s photos on them so the kids know which one is theirs!

Big esso (thank you) to the Apunipima teams that helped with this!

The few remaining water bottles are being kept for children receiving their four year old health checks and their immunisations to help them get healthy habits for school.

Staff are encouraging kids coming in for health checks and shots to fill their bottles from the watercooler at the Hopevale Primary Health Care Centre on their way out.

The Healthy Communities Project Team (Cara Laws, Tiffany Williams, Kiarah Cuthbert and Kani Thompson) would like to thank Hopevale staff for sharing the water bottles, which are merchandise from our Sugary Drinks Proper No Good – Drink More Water Youfla campaign.

Picture: Childcare worker Auntie Irene Bambie and Georgia Gibson

Acid, sugar in sugary drinks pose serious threat to teeth

Part 3 Australians urged to choose tap water this Dental Health Week

Many Australians know that sugary drinks are not a healthy dietary choice, but they may not realise the serious damage they cause to teeth.

In line with the theme of Dental Health Week (7–13 August 2017) – Oral Health for Busy Lives, the health and community organisations behind Rethink Sugary Drink are calling on Australians to think of their teeth before reaching for a sugary drink when out and about.

Chair of the Australian Dental Association’s Oral Health Committee, Professor David Manton, said sugary drinks contained sugar and acid that weakens tooth enamel and can lead to tooth decay.

“Dental decay is caused by sugars, especially the type found in sugary drinks. These drinks are often acidic as well. Sugary drinks increase the risk of decay and weaken the tooth enamel, so it’s best to avoid them,” Prof Manton said.

“The best advice is to stick to tap water. Carry a water bottle with you to avoid having to buy energy drinks, soft drinks, sports drinks and other sugary drinks when you’re on the go. You’ll be doing your bank balance a favour too.”

Chair of the Public Health Committee at Cancer Council Australia, Craig Sinclair, said knowing the oral health impacts associated with sugary drinks further highlighted the need for a health levy on these beverages in Australia.

“Australians, and our young people in particular, are drinking huge volumes of sports drinks, energy drinks, soft drinks and frozen drinks on a regular basis – some are downing as much as 1.5 litres a day,” Mr Sinclair said.

“While regular consumption is associated with increased energy intake, weight gain and obesity, it also heightens the risk of tooth decay.

“We know through economic modelling that a 20 per cent health levy on sugar-sweetened beverages could reduce consumption in Australia and prevent thousands of cases of type 2 diabetes, heart disease and stroke over 25 years, while generating $400-$500m each year.

“This extra revenue could be used for public education campaigns and initiatives to prevent chronic disease, reduce dental caries and address childhood obesity.

“While a health levy is not the only solution for reducing sugary drink consumption, if coupled with a range of strategies it could have a significant impact on the amount Australians are drinking and minimise their impact.”

The Rethink Sugary Drink alliance recommends the following actions in addition to a health levy to tackle sugary drink consumption:

  • A public education campaign supported by Australian governments to highlight the health impacts of regular sugary drink consumption
  • Restrictions by Australian governments to reduce children’s exposure to marketing of sugar-sweetened beverages, including through schools and children’s sports, events and activities
  • Comprehensive mandatory restrictions by state governments on the sale of sugar-sweetened beverages (and increased availability of free water) in schools, government institutions, children’s sports and places frequented by children
  • Development of policies by state and local governments to reduce the availability of sugar-sweetened beverages in workplaces, government institutions, health care settings, sport and recreation facilities and other public places.

Protect your teeth from sugary drinks with these tips:

  • Follow the Australian dietary guidelines: Focus on drinking plenty of tap water (it has no acid, no sugar and no kilojoules), limiting sugary foods and drinks and choosing healthy snacks (e.g. fruits and vegetables).
  • Find out how much sugar is in your favourite drink using the nutrition information panel on your drink or on the Rethink Sugary Drink website – it might surprise you
  • Carry a water bottle and fill up at the tap, so you don’t have to buy a drink if you’re thirsty.
  • Be aware of sugar disguised as a ‘healthy’ ingredient such as honey or rice syrup. It might sound wholesome but these are still sugars and can still cause decay if consumed frequently.
  • If you do drink sugary drinks, use a straw so your teeth are less exposed to the sugar and acid.
  • Take a drink of water, preferably tap water that has been fluoridated, after a sugary or acidic drink to help rinse out your mouth and dilute the sugars.
  • Do not sip a sugary or acidic drink slowly or over a long duration. Doing so exposes your teeth to sugar and acid attacks for longer.

For more information, visit http://www.dentalhealthweek.com.au/

About Rethink Sugary Drink: Rethink Sugary Drink is a partnership between the Apunipima, Australian Dental Association, Australian Dental and Oral Health Therapists’ Association, Cancer Council Australia, Dental Health Services Victoria, Dental Hygienists Association of Australia, Diabetes Australia, Healthier Workplace WA, Heart Foundation, Kidney Health Australia, LiveLighter, The Mai Wiru Sugar Challenge Foundation, Nutrition Australia, Obesity Policy Coalition, Stroke Foundation, Parents’ Voice, the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) and the YMCA to raise awareness of the amount of sugar in sugar-sweetened beverages and encourage Australians to reduce their consumption. Visit www.rethinksugarydrink.org.au for more information.

Part 4  : Sugary drinks erode more than tooth enamel poor oral health brings knock-on effects

This Dental Health Week the Public Health Association of Australia (PHAA) and other members of the Rethink Sugary Drink Alliance are urging Australians to reduce their consumption of sugary drinks. “Reducing sugary drinks will not only protect their teeth but also their wider health”, said Michael Moore, CEO of the PHAA. “This is yet another justification for the introduction of a health levy on sugar-sweetened beverages as a preventive public health measure”, he added.

Australia is in the top ten of countries with the highest level of soft drink consumption. Around a third of Australians regularly consume sugar-sweetened beverages (SSBs) such as soft drinks, flavoured waters and energy drinks. These drinks are widely recognised by dental experts as a major contributor to tooth decay and erosion.

Mr Moore said, “It’s well known that sugary drinks are linked to dental health problems which can lead to significant amounts of discomfort and disability in themselves. However poor oral health is also associated with major chronic health conditions such as heart disease, diabetes and respiratory disease. Additionally, there are often compounding health effects between these types of comorbidities. Sugary drinks also strongly contribute to weight gain and obesity, so they negatively impact on health in multiple ways”.

Mr Moore continued, “At the individual-health level, it’s very important people avoid consuming these drinks on a regular basis, while at the population-health level it’s time we introduce a health levy on sugar-sweetened beverages to reduce the harms they cause.”

“Research shows that a health levy on these drinks will effectively reduce their consumption, especially if implemented as part of a wider approach to address poor nutrition and diet-related disease. What is needed is a national nutrition policy, restrictions on the marketing of sugary drinks toward children, limiting their availability in schools and at events attended by children and young people and public education campaigns about the adverse health impacts of SSBs. These could easily be funded by the revenue generated by the levy”.

The theme of 2017 Dental Health Week is ‘Anywhere Anytime – Oral Health for Busy Lives’, which recognises that many Australians feel they don’t have time to properly care for their oral health due to their busy schedules. However, avoiding sugary foods and beverages which damage teeth is a simple preventive measure people can take and can be encouraged by governments.

“Along with maintaining proper oral health care, one of the easiest things people can do to protect their teeth and in turn their broader health, is to avoid sugar-laden drinks and to favour drinking tap water,” Mr Moore concluded.

 

NACCHO Research Alert : @NRHAlliance Aboriginal health risk factors #rural and #remote populations

 ” Health risk factors like smoking, excessive drinking, illicit drug use, lack of physical activity, inadequate fruit and vegetable intake and overweight have powerful influences on health, and there are frequently clear inter-regional differences between the prevalence of these.

While it can be argued that there is some degree of personal choice involved in whether individuals have a poor health risk profile, there is clear evidence that external factors such as environment, opportunity, and community culture each have very strong influences.

For example, access to affordable healthy food can often be poor in smaller communities and this, coupled with lower incomes in these areas, adversely affects the quality of peoples’ diets, the prevalence of overweight, and consequently the prevalence of chronic disease.”

From the National Rural Health Alliance Research View HERE

National data pertaining to personal health risk factors typically comes from the ABS National Health Survey and the AIHW National Drug Strategy Household Survey (NDSHS). Some State and Territory Health Departments run their own health surveys (which cannot be aggregated nationally with each other or with the ABS survey because of the different methodologies and definitions used (think different State rail gauges). Consequently data describing aspects of health in regional and especially remote areas can be thin (ie with imprecise estimates in some or all areas).

Example 1

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

Example 2

NACCHO provided graphic

Table 16 Below : Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59% )

At the time of writing, the most recent National Health Survey was conducted in 2014-15[1], while the most recent AIHW NDSHS[2] was conducted in 2016, with most recently available results from the 2013 NDSHS. The most recent ABS Australian Aboriginal and Torres Strait Islander Health Survey[3] was conducted in 2012-13.

Some organisations (eg the Public Health Information Development Unit (PHIDU)) have calculated modelled estimates for small areas (eg SLA’s and PHN’s), where the prevalence of some risk factors has been predicted based on the age, sex and socioeconomic profile of the population living there.

Some sites (eg ABS) present risk factor data as crude rates, other sites (eg PHIDU) present risk factor data as age-standardised rates.  The advantage of the age-standardised rates is that the effect of age is largely removed from inter-population comparisons.

For example, older populations (eg those in rural/regional areas) would be expected to have higher average blood pressure than younger (eg Major cities) populations even though the underlying age-specific rates happened to be identical in both populations (because older people tend to have higher blood pressure than younger people).

While crude rates for the older population will be higher, the age-standardised rates in such a comparison would be the same – indicating a higher rate that is entirely explainable by the older age of one of the populations.

Both crude and age standardised rates are useful in understanding the health of rural and remote populations.

 


[1] http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001

[3] http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocumentSmoking

Table 1: Smoking status, by remoteness, 2013 and 2014-15

MC

IR

OR/Remote

Percentage

Current daily smoker (18+) (crude) 2014-15 (a)

13.0

16.7

20.9

Current smoker (18+) (Age standardised) 2014-15 (b) (includes daily, weekly, social etc smoking)

14.6

19.0

22.4

MC

IR

OR

Remote+ Very Remote

Current smoker (daily, weekly, or fortnightly) 14+ (crude) 2013 (c)

14.2

17.6

22.6

24.6

Current smoker (daily, weekly, or fortnightly) 14+ (Age standardised) 2013 (d)

14.2

18.6

23.6

24.4

Mean number of cigarettes smoked per week, smokers aged 14 years or older 2013 (e)

85.9

113.1

109.4

126.2

Sources:

Compared with Major cities (13%), the prevalence of daily smoking by people 18 years and older in Inner regional (17%) and Outer regional/Remote areas (21%) is higher.

The NDSH survey reflects these trends albeit with a slightly different age group (14+) and a different definition of smoking (daily plus less frequently), but the NDSH survey adds detail for remote areas where smoking rates are higher again (around 25% versus around 23% in Outer regional).

In addition, the average number of cigarettes smoked by each smoker is higher in regional/rural areas (~110/week) than in Major cities (86/week), and higher again (126/week) in remote areas.

 

Smoking – exposure, uptake, establishment, quitting

Table 2: Smoking characteristics by Remoteness, 2013, 2014 and 2014-15

MC

IR

OR

remote

8.8

17.8

19.3

27.8

Proportion of pregnant women who gave birth and smoked at any time during the pregnancy (2013, crude, National Perinatal Data Collection, exposure tables, Table 5.1.2 )

8.5

17.0

18.9

27.5

Proportion of pregnant women who gave birth and smoked in the first 20 weeks of pregnancy (2013, crude, National Perinatal Data Collection) exposure tables, Table 5.2.2)

3.6

3.1

4.1

*9.4

Proportion of dependent children (aged 0–14) who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS exposure tables, Table 6.3)

2.5

2.0

2.7

*2.9

Proportion of adults aged 18 or older who live in a household with a daily smoker who smokes inside the home (2013, crude, NDSHS, exposure tables, Table 7.3)

16.2

15.4

14.7

15.5

Average age at which people aged 14–24 first smoked a full cigarette (2013, crude, NDSHS, uptake tables, Table 9.3)

17.8

22.7

17.8

28.3

Proportion of 12–17 year old secondary school students smoking at least a few puffs of a cigarette (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, uptake tables, Table 10.3

54.7

61.1

64.9

67.2

Proportion of persons (aged 18 or older) who have smoked a full cigarette (2013, crude,  NDSHS, uptake tables, Table 10.8)

2.5

3.4

2.5

3.7

Proportion of secondary school students (aged 12–17) who have smoked more than 100 cigarettes in their lifetime (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, transition tables, Table 2.3)

20.2

25.9

44.1

45.2

Proportion of young people (aged 18–24) who have smoked more than 100 cigarettes in their lifetime (2013, crude, NDSHS, transition tables, Table 2.6)

21.3

16.8

19.0

15.5

Quitting: Proportion successfully gave up for more than a month (2013, crude, NDSHS, cessation tables, Table 4.3)

29.2

34.2

31.7

32.9

Quitting, Proportion unsuccessful (2013, crude, NDSHS, cessation tables, Table 4.3)

46.3

48.0

47.4

45.2

Quitting: Proportion any attempt (2013, crude, NDSHS, cessation tables, Table 4.3)

35.2

36.3

36.1

36.0

Mean age at which ex-smokers aged 18 or older reported no longer smoking (2013, crude, NDSHS, cessation tables, Table 11.2)

53.1

51.5

46.3

45.0

The proportion of ever smokers aged 18 or older who did not smoke in the last 12 months (2013, crude, NDSHS, cessation tables, Table 12.3)

4.9

6.0

4.8

7.0

Proportion of secondary school students (aged 12–17) who were weekly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 1.3)

6.9

9.3

6.8

10.4

Proportion of secondary school students (aged 12–17) who were monthly smokers (2014, crude, Australian Secondary Students Alcohol and Drug Survey 2014, established tables, Table 13.3)

13.0

16.7

21.2

18.8

Proportion of adults aged 18 or older who are daily smokers (2014-15, crude, ABS NHS, established tables, Table 3.3)

10.9

7.8

2.9

n.p.

Proportion of smokers aged 18 or older who are occasional smokers (smoke weekly or less than weekly) (2014-15, crude, ABS NHS, established tables, Table 14.3)

40.1

44.7

42.3

52.7

Proportion of Aboriginal and Torres Strait Islander people aged 18 or older who are daily smokers (2012-13, crude, ABS Australian Aboriginal and Torres Strait Islander Health Survey 2012–13, established tables, Table 8i.3)

Source: http://www.aihw.gov.au/alcohol-and-other-drugs/data/ (sighted 11/7/17)
Note: Those estimates above with asterix have large standard errors and should be treated carefully.

Women in rural and remote areas were much more likely to smoke during pregnancy, with 28% of women in remote areas smoking during pregnancy, compared with 18-19% in regional/rural areas, and 9% in Major cities.

It is unclear whether exposure to environmental tobacco smoke varies by remoteness.

Young people outside major cities appeared to have their first cigarette at an earlier age (~15 years as opposed to ~16 years in Major cities.

Secondary school students in Inner regional (~23%) and remote (~28%) areas were more likely to have had at least a few puffs of a cigarette than those in major cities (~18%).

While 20% of young people in Major cities had smoked more than 100 cigarettes in their lifetime, 26%, 44% and 45% of young people in Inner regional, Outer regional and remote areas had done so.

People outside Major cities were as likely or slightly more likely to have attempted to quit smoking, but were less likely to be successful (and more likely to be unsuccessful).

A higher proportion of secondary students outside Major cities were weekly or monthly smokers (6%, 5% and 7% in IR, OR and remote areas versus 5% in Major cities weekly, 9%, 7%, and 10% in IR, OR and remote areas versus 7% in Major cities monthly).

Table 3: Current daily smoker, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness, 2012-13

MC

IR

OR

R

VR

Crude Percent

Current daily smoker

36.2

40.9

39.8

47.4

51.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Prevalence of smoking amongst Aboriginal and Torres Strait Islander people 15 years and older is around 35%-40% in Major cities and regional/rural areas, and close to 50% in remote areas. Note that while the pattern is similar in Table 2 and Table 3 above, the figures for 18+ and 15+ year olds are slightly different.

Smoking Trends

Table 4: Comparison of declines in smoking rate estimates across remoteness areas, people 18+, based on ABS NHS surveys, 2001 to 2011-12

Survey year

MC

IR

OR/Rem

Australia

Crude percent daily smokers

2001

21.9

21.9

26.5

22.4

2004-05

19.9

23.0

26.2

21.3

2007-08

17.5

20.1

26.1

18.9

2011-12

14.7

18.3

22.2

16.1

2014-15

13.0

16.7

20.9

14.5

Source: ABS National Health Surveys

From Table 4 above, rates of smoking have clearly declined in Major cities areas, but have been slower to decline in Inner regional and Outer regional/Remote areas. Rates of smoking in rural areas, apparently static last decade, now appear to be declining. Rates in Major cities and Inner regional areas have declined to 0.59 and 0.76 times the 2001 rates in these areas. The 2014-15 rate in Outer regional areas is 0.79 times the 2001 rate.

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Figure 1: Daily smokers 18 years and older, 2007-08, 2011-12 and 2014-15, NHS

Source: ABS NHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ established tables, Table 3.3 (sighted 11/7/17)

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Figure 2: Smokers 14 years and older, 2007, 2010 and 2013, NDSHS

Source: AIHW NDSHS http://www.aihw.gov.au/alcohol-and-other-drugs/data/ tobacco smoking table S3.12 (sighted 11/7/17)

Note: Smokers include daily, weekly and less frequent smokers.

Figures 1 and 2 above both show clear declines in Major cities and Inner regional areas, but the trend in Outer regional and Remote areas is less clear, with ABS data showing a decline in daily smoking rates for people aged 18+ between 2007-8 and 2014-15, but NDSHS data showing little change in smoking rates for people 14+ between 2007 and 2013.

Alcohol

Table 5: Alcohol risk status, by remoteness, 2013 and 2014-15

Alcohol consumption

MC

IR

OR/Rem

Exceeded 2009 NHMRC lifetime risk guidelines, people 18+, crude %, 2014-15 (a)

16.3

18.4

23.4

Exceeded 2009 NHMRC lifetime risk guidelines, people 15+, age standardised %, 2014-15 (b)

15.7

17.4

22.0

Exceeded 2009 NHMRC single occasion risk guidelines, people 18+, crude %, 2014-15 (a)

42.7

48.5

46

MC

IR

OR

R/VR

Abstainer/ex-drinker, crude %, 14+, 2013 (c)

23.1

18.9

20.5

17.5

Low lifetime risk, crude %, 14+, 2013 (c)

60.2

62

56.9

47.6

High lifetime risk, crude %, 14+, 2013 (c)

16.7

19.1

22.6

34.9

low single occasion risk, crude %, 14+, 2013 (c)

40.4

41.8

38.1

30.8

Single occasion risk less than weekly, crude %, 14+, 2013 (c)

23.5

24.4

23.6

22.8

Single occasion risk at least weekly, crude %, 14+, 2013 (c)

13

14.9

17.8

28.9

Sources:

Table 6: Alcohol consumption against 2009 NHMRC guidelines, Aboriginal and Torres Strait Islander people 15+ years, by Remoteness 2012-13

MC

IR

OR

R

VR

Percent

Exceeded lifetime risk guidelines

18.0

18.7

18.2

22.5

14.3

Exceeded single occasion risk guidelines

56.7

57.4

50.7

59.0

41.4

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

The figures in Table 6 are not strictly comparable with those for the total population in Table 5, because  Table 6 refers to people who are 15 years and older, while Table 5 refers to people who are 18 years and older.

The percentage of the 15+ ATSI population exceeding 2009 NHMRC Lifetime risk guidelines is around 15-20% with little apparent inter-regional variation, compared with, for the total population 18+,  16% in Major cities, increasing to 23% in Outer regional/remote areas.

The percentage of the 15+ ATSI population exceeding the 2009 single occasion risk guidelines is around 50-60%, and around 40% in Very remote areas, compared with, for the total population 18+,  40-50% in Major cities, rural and regional areas.

Alcohol trends

Table 7: Type of alcohol use and treatment for alcohol, by remoteness area (per 1,000 population)

MC

IR

OR

R/VR

single occasion risk (monthly) 2004

287

304

321

370

2007

285

292

312

437

2010

274

312

329

413

2013

250

273

315

422

lifetime risk 2004

200

215

234

262

2007

199

210

238

314

2010

189

225

251

310

2013

167

191

226

349

very high risk – yearly 2004

167

185

206

243

2007

172

183

206

288

2010

161

183

218

266

2013

151

166

194

258

very high risk – monthly 2004

77

84

104

130

2007

78

89

100

153

2010

79

94

113

154

2013

70

70

100

170

very high risk – weekly 2004

21

27

41

38

2007

24

28

24

50

2010

37

43

54

78

2013

27

28

38

70

Closed treatment episodes 2004–05

61

72

60

58

2007–08

76

84

80

129

2010–11

69

96

87

135

2013–14

68

79

93

155

Source: NDSHS,  http://www.aihw.gov.au/alcohol-and-other-drugs/data/  alcohol -supplementary data tables, Table S18

Notes:
Single occasion risk (monthly): Had more than 4 standard drinks at least once a month
Lifetime risk: On average, had more than 2 standard drinks per day
Very high risk (yearly): Had more than 10 standard drinks at least once a year
Very high risk (monthly): Had more than 10 standard drinks at least once a month
Very high risk (weekly): Had more than 10 standard drinks at least once a week

There is a clear increase in the prevalence of people who drink alcohol in such a way as to increase their single occasion risk (eg from car accident, assault, fall, etc) and their lifetime risk (eg from chronic disease – liver disease, dementia, cancer etc) as remoteness increases.

In 2013, single occasion risk ranged from 25% of people 14 years or older in major cities to 42% of people in remote areas, while lifetime risk increased from 17% in major cities to 35% in remote areas.

In 2013, The prevalence of people who drank more than 10 standard drinks in one sitting at least once per week, increased from just under 3% in Major cities to 7% in remote areas.

In 2013-14, there were just under 70 closed treatment episodes per 1,000 people living in Major cities, increasing to around 80 and 90 per 1,000 population in Inner and Outer regional areas, to 155 per 1,000 people living in remote Australia.

 

Illicit drug use 2013

Table 8: Illicit drug use, “recent users” 14+, 2013

MC IR OR remote

Crude percent

Cannabis

9.8

10.0

12.0

13.6

Ecstasy

2.9

1.5

1.6

*1.8

Meth/amphetamine

2.1

1.6

2.0

*4.4

Cocaine

2.6

0.8

*1.1

*2.5

Any illicit drug

14.9

14.1

16.7

18.7

Source: AIHW National Drug Strategy Household Survey, 2013. http://www.aihw.gov.au/alcohol-and-other-drugs/data/  Illicit drug use (supplementary) tables S5.6, S5.11, S5.17, S5.21, S5.26.

Note: * indicates large standard error (therefore some degree of uncertainty)

Illicit drug use appears to be higher in Outer regional and remote areas compared with Major cities and Inner regional areas, in large part due to higher rates of cannabis use in these areas, but with apparent lower use of ecstasy and cocaine in regional areas compared with Major cities.

 

Physical activity

Table 9: Physical inactivity, people 18+, 2014-15

MC

IR

OR/Remote

Percentage of people aged 18+ who undertook no or low exercise in the previous week (crude) (a)

64.3

70.1

72.4

Percentage of people aged 18+ who undertook no or low exercise in the previous week (age standardised) (b)

64.8

68.6

71

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that level of exercise is based on exercise undertaken for fitness, sport or recreation in the last week.

Physical inactivity appears to be more prevalent with remoteness, increasing from 65% of people in Major cities to 71% in Outer regional/remote areas.

Table 10: Average daily steps, 2011-12

MC

IR

OR/Rem

Average daily steps, 18+ years, 2011-12 (a)

7,393

7,388

7,527

Average daily steps, 5-17years, 2011-12 (b)

9,097

9,266

9,160

Sources:

In 2011-12, adults living in Outer regional/Remote areas took slightly more steps than those living in Major cities or Inner regional areas, while the number of steps taken by children and adolescents in regional/Remote areas was slightly greater compared with those in Major cities.

Table 11: Average time spent on physical activity and sedentary behaviour by persons aged 18+, 2011-12

MC

IR

OR/Remote

Australia

Hours

Physical activity(a)

3.9

3.4

3.9

3.8

Sedentary behaviour (leisure only)(b)

29.3

28.0

27.9

28.9

Sedentary behaviour (leisure and work)(b)

40.2

35.2

36.0

38.8

Notes:
(a) Includes walking for transport/fitness, moderate and vigorous physical activity.
(b) Sedentary is defined as sitting or lying down for activities.

Source: ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 5.1

Adults living in Inner regional and Outer regional/Remote areas were about as likely as (or very slightly less likely than) those in Major cities to be sedentary in their leisure time, but appeared to be slightly less likely to be sedentary overall (ie their work involved a greater level of physical activity).

Table 12: Whether children aged 2-17 years met physical and screen-based activity recommendations, 2011-12

MC

IR

OR/Rem

Crude percentage

Met physical activity recommendation on all 7 days(a)(b)

27.5

34.3

34.2

Met screen-based activity recommendation on all 7 days(b)(c)

28.0

29.7

31.0

Met physical activity and screen-based recommendations on all 7 days (a)(b)(c)

9.7

10.9

14.2

Notes:
(a) The physical activity recommendation for children 2–4 years is 180 minutes or more per day, for children 5-17 years it is 60 minutes or more per day. See Physical activity recommendation in Glossary.
(b) In 7 days prior to interview.
(c) The screen-based recommendation for children 2–4 years is no more than 60 minutes per day, for children 5-17 years it is no more than 2 hours per day for entertainment purposes.

Source:
ABS 2011-12 Australian Health Survey (Physical activity) http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0042011-12?OpenDocument  Table 14.3

Children in rural and regional Australia appeared more likely (34% vs 28%) to meet physical activity recommendations and slightly more likely (30%vs 28%) to meet screen-based activity recommendations than their Major cities counterparts.

 

Fruit and vegetable consumption

Table 13: Fruit and vegetable consumption, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Inadequate fruit consumption(a)

50.0

50.6

51.2

Inadequate fruit consumption(b)

50.4

48.3

48.0

Inadequate vegetable consumption(a)

93.4

93.5

89.3

Inadequate vegetable consumption(b)

n.p.

n.p.

n.p.

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) PHIDU (ABS NHS data) (http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas) sighted 18/7/2017

Note that adequacy of consumption is based on comparison with 2013 NHMRC guidelines.

Half of adult Australians eat insufficient fruit, with little clear difference between major cities and regional/rural areas.

Around 90% of adult Australians ate insufficient vegetables, with little clear difference between major cities and regional/rural areas.

Table 14: Fruit and vegetable consumption, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Inadequate daily fruit consumption (2013 NHMRC Guidelines)

59.0

60.6

56.9

54.9

49.1

Inadequate daily fruit consumption (2003 NHMRC Guidelines)

62.1

63.6

59.8

58.3

51.6

Inadequate daily vegetables consumption (2013 NHMRC Guidelines)

95.9

93.5

93.6

94.5

97.9

Inadequate daily vegetables consumption (2003 NHMRC Guidelines)

93.8

90.6

90.5

91.2

96.1

Source: http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0012012-13?OpenDocument Table 2 (sighted 12/7/17)

Roughly 60% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate fruit intake, closer to 50% in remote areas (compared with around 50% of all Australians 18+ in major cities and regional/rural areas).

Roughly 95% of Aboriginal and Torres Strait Islander Australians 15+ in Major cities and regional/rural areas have inadequate vegetable intake, perhaps higher (98%) in Very remote areas (compared with around 90%-94% of all Australians 18+ in major cities and regional/rural areas).

 

 

Overweight and Obesity

Table 15: Overweight and Obesity, people 18+ years, by remoteness, 2014-15

MC

IR

OR/Remote

Crude Percentage

Persons, overweight/obese (a)

61.1

69.2

69.2

Age standardised percentage

Males overweight (b)

43.8

41.1

34.3

Males obese (b)

25.8

33.1

38.2

Females overweight (b)

28.9

28.3

30.1

Females obese (b)

25.0

32.4

33.7

People  overweight (b)

36.2

34.4

31.4

People obese (b)

25.4

32.6

35.8

Sources:
(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Adults in rural/regional areas are more likely to be overweight or obese than people in Major cities (69% vs 61%).

However, there were inter-regional BMI and gender differences:

  • Compared with those in Major cities, males in Inner regional and especially Outer-regional areas were less likely to be overweight (41% and 34%, vs 44%) but much more likely to be obese (33% and 38% vs 26%).
  • Compared with those in Major cities, females in Inner regional and Outer-regional areas were about as likely to be overweight (~29%) but much more likely to be obese (~33% vs 25%).

 

Table 16: Overweight and Obesity, Aboriginal and Torres Strait Islander people 15+ years, 2012-13

MC

IR

OR

R

VR

Crude Percent

Overweight

27.5

28.8

30.1

32.5

26.4

Obese

37.9

41.3

36.2

33.1

32.3

Overweight/obese

65.4

70.1

66.2

65.6

58.8

Aboriginal and Torres Strait Islander people in rural/regional and Remote areas (29%-33%) were a little more likely to be overweight than those in Major cities (28%), with those in Very Remote areas (26%) least likely to be overweight.

Aboriginal and Torres Strait Islander people in Inner regional areas (41%) were more likely to be obese than those in Major cities (38%), but those in Outer regional (36%) and remote areas (~33%) were less likely to be obese.

Overall, Aboriginal and Torres Strait Islander people in Inner Regional areas were most likely to be overweight/obese (70%), those in Major cities, Outer Regional and Remote areas were less likely to be overweight/obese (~66%), while those in Very Remote areas were the least likely to be overweight/obese (59%).

These figures compare with 61% – the prevalence of overweight/obesity for (predominantly non-Indigenous) people living in Major cities.

 

High blood pressure

Table 17: High blood pressure, people 18+, by Remoteness, 2014-15

MC

IR

OR/Remote

Percentage

Crude % (a)

21.9

27.1

24

Age standardised % (b)

22.7

24.6

22.1

Sources:

(a) ABS NHS (http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012014-15?OpenDocument Table 6.3)
(b) ABS NHS http://phidu.torrens.edu.au/social-health-atlases/data#social-health-atlas-of-australia-remoteness-areas

Age for age, people in rural/regional Australia appeared to be as likely, or very slightly more likely to have high blood pressure than their counterparts in Major cities (~23% vs ~24%). However, because people in rural/regional areas are older (on average), the prevalence of people with high blood pressure is higher (~26% vs 22%) than

Updated 31/07/2017
To view archived Risk Factors click here

NACCHO Aboriginal Remote Health : Governments urged to fund dialysis treatment in remote communities

 ” The premature death of Dr G Yunupingu could have been prevented if recommended funding models for dialysis services were already in place, his doctor has said.

With a new funding model to increase the service in remote communities currently under consideration, Dr Paul Lawton urged swift government action to assist in Yunupingu leaving a legacy.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change. ”

Reports Helen Davidson from Darwin writing in the Guardian  See Full report Part 1 Below

The case for change

Aboriginal and Torres Strait Islander people experience disproportionate levels of CKD regardless of urban, region or rural locality. Compared with the general population, Aboriginal and Torres Strait Islanders are four times more likely to have CKD and develop ESKD

In remote and very remote areas of Australia, the incidence of ESKD for Aboriginal and Torres Strait Islander people is especially high with rates almost 18 times and 20 times higher than those of comparable non-Indigenous peoples.

The greater prevalence of CKD in some Aboriginal and Torres Strait Islander communities is due to the high incidence of risk factors including diabetes, high blood pressure and smoking, in addition to increased levels of inadequate nutrition, alcohol abuse, streptococcal throat and skin infection and poor living conditions.

See Kidney Health Australia Recommendation

Download full Budget submission Kidney Health Australia

3. Investing in appropriate patient support services in remote and regional locations

In remote areas, 78% of patients have to relocate to access dialysis or transplant services, compared with 39% of those who live in rural areas and 15% of urban Indigenous ESKD patients.

Separation from country creates significant biological, psychological, social and economic consequences on the health and wellbeing of consumers, their families, communities the wider health and welfare system.

At present, there is inadequate support for Aboriginal and Torres Strait Islander patients to assist and support the renal pathway journey, including emotional and social support.

Incidence of new Indigenous patients starting kidney replacement therapy. 2010-2014

A Patients Opinion

” One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.”

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. see Health Authority responses below part 2 

See also :  Indigenous health organisations unite to improve remote dialysis treatment 

Part 1 :Dialysis funding could have prevented Dr G Yunupingu’s death, says doctor

The musician’s doctor says his premature death would have been prevented if he could have been cared for on his home island

The 46-year-old Gumatj musician and singer from remote Arnhem Land died in Royal Darwin hospital last Tuesday, after battling kidney and liver illnesses.

He had been in Darwin for dialysis services because there was no service for him in his home community of Galiwink’u, on Elcho Island. His situation was a high profile example of the growing urgent circumstances for remote-living Indigenous renal patients.

Media reports aired questions about how Yunupingu spent his last days before being hospitalised, but his doctor Paul Lawton said Yunupingu was in control of his health decisions even if they weren’t always on his doctor’s terms, and suffered being away from home.

The kidney specialist said G Yunupingu – like Dr M Yunupingu who died in 2013 – advocated for better health outcomes and options for Indigenous people, and both would be proud to leave a legacy if their stories prompted change.

“Of course he would have been much happier not to have to have a legacy but to be home supported by family on Elcho Island. He may be alive today if that were possible,” he said.

“It could have been possible if there was a funding model that allowed that to happen. Such a funding model has been proposed, and it needs to be supported and agreed to by the minister forthwith.”

Indigenous Australians suffer kidney disease at rates up to 50 times that of non-Indigenous people. The rate of end-stage kidney disease is seven times higher for Indigenous people, and in very remote communities it is 30 times higher.

The number of people at end-stage is growing annually, forcing large numbers to travel into town centres for care, away from family, country, and culture.

“Every person from a remote community … when they end up in renal failure and have to start dialysis, the first thing people want to know is when and if they can get home and if they can receive treatment close to home,” Lawton said. “Dr Yunupingu was no different.”

In 2015 the federal government launched a review of more than 5,700 items on the Medicare Benefits Scheme to determine how they can be “aligned with contemporary clinical evidence and practice and improve health outcomes for patients”.

The review is led by expert panels exploring different areas of health, and has no mandate to find savings.

The expert panel on renal health has published its recommendations, including a new MBS item to provide dialysis in very remote areas by nurses, Aboriginal health practitioners and health workers.

The report noted the likelihood of direct costs of providing staffed dialysis services in very remote areas being much higher, but said no studies so far had considered the broader impact of relocating for treatment.

“It has undeniable social, economic and health consequences,” the report countered. “As a result of these social and economic costs, relocated patients often miss treatments, which has a negative impact on health outcomes.

“As requirements for dialysis can extend over many years, it makes sense to provide services where people live, have support and can continue to contribute to their communities.”

The report is open for public comment, and according to the department of health a final report will be delivered to the minister in December this year.

“It’s a big step forward potentially but one of the challenges in bureaucracies is that sometimes these things spend a lot of time going around in circles,” Lawton said.

Lawton said there had been a lot of work done in recent years – particularly by Miwatj Health and central Australia’s Purple House – to increase on-country dialysis support, including self-operated dialysis on Elcho Island.

“But unfortunately we weren’t able to get him home to Elcho Island because supported dialysis is not available. And clearly a blind man can’t do dialysis themselves.”

PART 2

Access To Specialist Healthcare in the Kimberley For Desert People.

I am an Aboriginal man living in the remote desert area of Mulan Aboriginal Community in the Tanami Desert. I live with my elderly wife and extended family. Mulan is our home.

For people living in very remote communities such as ours, English is a second or third language. Communication with mutual understanding is vital.

I’m sharing this story about our recent healthcare experiences so that frail persons don’t suffer as my wife did.

Recently my wife required a cardiac appointment in Broome.

This involved a morning flight from Mulan to Halls Creek; waiting for the Greyhound bus; then leaving at 10pm that evening to ride to Broome (8 hours to the west). All this was booked through the Patient Assisted travel Scheme office (PATS).

After her appointment my wife was left in Broome with no money, no return bus fare and no accommodation. She spent the night homeless. My wife was rescued by the local police who recognised she was hypoglycaemic and took her to Broome Hospital where she was stabilised.

With the help and intervention of a friend, PATS was contacted and a return bus fare was organised for that evening to Halls Creek where my wife was hospitalised for three days waiting for a flight back to Mulan. This could have been avoided with better planning, travel, accommodation and effective communication.

One possible solution is to explore the possibility of using the Kimberley Aboriginal Medical Services (KAMS) plane which arrives every Friday from Broome with medicines for the clinic, and transports nurses in and out.

Why can’t some of our mob go on that plane for appointments, so avoiding all those hours of travel, especially for our elderly?

My wife also suffers from serious kidney issues. We have been told that renal dialysis is the next step. This will involve twice weekly dialysis which would be done in Broome. For this treatment, we will be expected to leave our family, “country” and home to live in Broome, over 1000 kilometres away.

Kidney disease is a major health concern in our communities. My point is why can’t we have a dialysis machine in Balgo – our biggest community in the desert, 30 minutes from my community? This would reduce the number of patients and their carers travelling to a major town, so avoiding a lot of financial and other social situations. I know there are renal machines in other communities – it makes sense! In the long run, the money spent on transferring our mob across the Kimberley would surely pay for a machine and staff.

My wife will require ongoing medical care. Yet her experience is part of a much larger story where our younger people (who escort loved ones to towns for treatment) are subject to the vices a town offers. In going to town, many of them get lost from their cultural identity. Having services in country closer to home and keeping our families in community helps to avoid these social issues.

I hope that sharing our story will result in more effective planning and improved services in the future.

Response 1 to Mulan Man

Dear Mulan Man,

Firstly I want to apologise again for your wife’s experience in Broome. It was very good of your friend to notify us of your wife’s situation at the time, and I am pleased the PATS officer on the day was able to make contact with your wife and her escort to provide them with some refreshments and return tickets to Halls Creek. You are right, there was a communication issue in the arrangement of this trip, as the PATS staff had expected your wife to return to the PATS office directly after her appointment to retrieve her return ticket, but this was clearly not your wife’s expectation. We will work to improve this communication.

I would also like to thank you very much for engaging with us in this forum to share your story, which was clearly distressing, and yet also includes suggestions for improvement. Your story is a great example of what a forum like this can bring to the planning and delivery of health services.

The WA Country Health Service aims to provide care closer to home, where this is safe and feasible. We need to hear from the people living in communities like yours to be able to gain a real appreciation of the challenges you face, and work to ease your access to our services, either by better travel arrangements, or bringing the care closer to you.

Where possible, in new remote clinic builds or funded remote clinic refurbishments, we are ensuring there is the capacity for a dialysis room to accommodate home dialysis therapy on country. Examples of this are Wangkatjunka and Looma remote clinics. There are Renal Dialysis Hostels being built or already built in Kununurra, Fitzroy Crossing, Derby and Broome, to ease the burden of accommodation when people do need to attend the dialysis centres in those towns. WA Country Health Service is also developing a Renal Health Strategy, and will continue to work in close partnership with our renal service delivery providers.

I agree there are also opportunities for us to work more cohesively with other agencies in the Kimberley in undertaking the logistics of moving our consumers, equipment and those delivering care around the region. You have provided some very logical suggestions to resolve the issues you raised, and we would like to arrange to meet with you, and members of your community, to further identify the barriers you face accessing health care and your suggested solutions to those barriers.

You can contact me to discuss how to arrange this meeting. The other signatories to this reply will also attend to engage with you and your community.

Margi Faulkner, Broome Hospital Operations Manager

Dr David Gaskell, Kimberley Regional Medical Director

Carmen Morgan, Kimberley Regional Director of Nursing and Midwifery

Response 2

Dear Mr Mulan Man

We’ve had opportunity to talk together recently which I’ve valued.

Thanks to your help, I want to share here some of the changes we’ve made in improving our health services.

As you know, the Patient Assisted Travel Scheme (PATS) provides travel and accommodation subsidies to patients for whom specialist care is not locally available.

PATS is State-funded with one policy for all WA. All PATS staff are required to follow these State-wide rules. They seek to ensure a safe and planned journey when transporting clients from home to a health service and back.

PATS policy ensures that vulnerable patients can choose a family member as escort to accompany them. This escort is responsible for assisting the patient throughout the journey. Roles include assistance in communication, physical support, need for encouragement, and help with cultural needs. You have pointed out that some aboriginal people speak other languages more fluently than English (like Kukutja). PATS staff seek to identify need for a translator and so make necessary arrangements.

Yet there are many variables beyond our control which create uncertainty – like phone coverage, bus and plane operations, timings, the conduct of the escort and other people, or the weather. For the patient, navigating all this uncertainty only compounds the stress of suffering and separation from home. Of all this, I am mindful.

So, in response to the first part of your story, have we done anything to improve the provision and quality of our PATS services?

Yes, we have made several improvements. Here’s the current situation:

The PATS booking service has been increased from 5 days to every day of the week, from 0800hrs to 1600hrs, by phone or email. This ensures that, every day, a PATS officer is able to make a booking or assist a patient with their journey. We have extended the Aboriginal Liaison Officer (ALO) service from 5 days to every day of the week. ALO hours have been extended also. Broome now has 5 positions. Between them, they work every day, including weekends, from 0630 to 2200 hours. As this period covers the arrival and departure times of all scheduled Greyhound bus and plane services, an Aboriginal Liaison Officer is present to meet clients from their plane or bus and assist them with their onward journey. So transport home can be booked, our Aboriginal Liaison Officers inform all transiting clients to present to the PATS Front Office. With arrangements in place, patients return to and wait in the transit lounge. From there, an officer takes them to the bus or plane on time. Remoter health facilities do not have a PATS Office, of course, so the PATS team works closely with local staff to ensure that travel planning and documentation are explained clearly and in person to clients. A spare seat on the KAMS (Kalamunda Aeronautical Model Society) plane, when available, has been allocated to PATS clients and will be used for this purpose in the future. A major development just pre-dating your post was that WACHS Kimberley secured the Skippers Charter Plane service from Broome to Halls Creek via Fitzroy Crossing, 3 times weekly. This flight schedule had been at risk of closure.

Thanks for your engagement on and off line. I think that being in closer touch makes so much difference. I’m aware that your wife had an awful experience not long ago. I hope that she gains some peace of mind in knowing that you sharing her story has led to improvements which will help other patients on their travels to and from health care.

Regarding the need for dialysis care closer to home, we have spoken together. I need to post this now yet I wish to reassure you here that the ‘bigger picture’ is being looked at by all the key agencies – WA Department of Health, WA Country Health Service, Kimberley Aboriginal Medical Services overseeing the Kimberley Renal Service, and our visiting specialists from Royal Perth Hospital. Much thought and planning are going in to improving the delivery of quality-assured services closer to home. In the township of Fitzroy Crossing, for example, a new Renal Health Centre is soon to open with 4 dialysis chairs. Yet there are many communities (as in your desert community of Mulan in the Kutjungka) without access to a haemodialysis service nearby. We are acutely aware. All of us Kimberley Health providers want to deliver the State Government’s commitment to have a mobile dialysis unit operate here in the dry season, as soon as possible. This will allow dialysis patients to go home for a while so they can re-connect with family and friends on Country. Given the right resources, this will be delivered. I will keep in touch.

Would it be helpful if we meet together? If you would like this, if privileged to be invited, I will come to your Country soon.

With best wishes to you and your wife,

David

Dr David Gaskell

a/Regional Director, Regional Medical Director

WA Country Health Service, Kimberley

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