NACCHO Aboriginal Health and #Sugarydrinks : @BakerResearchAu Study reveals the damaging effects for inactive, young, obese people who consume soft drink regularly : What’s going on inside your veins ?

“ With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,”

Professor Bronwyn Kingwell, the study’s senior author : See Baker Institute Press Release Part 1

If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop.

Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out

Professor Bronwyn Kingwell. See SMH Article Part 2 What’s going on inside your veins after you drink a soft drink

See NACCHO Nutrition ,Obesity , Sugar Tax,, Health Promotion 200 + articles published over 6 years and see our policy below

 ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Press Release : Study reveals the damaging metabolic effects for inactive, young, obese people who consume soft drink regularly

We know drinking soft drink is bad for the waistline, now a study by Baker Heart and Diabetes Institute researchers provides evidence of the damaging metabolic effects on overweight and obese people who regularly consume soft drink and sit for long periods.

Researchers have quantified the detrimental effects on glucose and lipid metabolism by studying young, obese adults in a ‘real-world’ setting where up to 750ml of soft drink is consumed between meals daily and where prolonged sitting with no activity is the norm.

The results, outlined by PhD candidate Pia Varsamis in the Clinical Nutrition journal, show how habitual soft drink consumption and large periods of sedentary behaviour may set these young adults on the path to serious cardiometabolic diseases such as fatty liver disease, type 2 diabetes and heart disease.

Whilst most studies to date have focused on the relationship between soft drink consumption and obesity, the large amount of added sugars contained in these drinks has additional implications beyond weight control.

Watch TV Interview

Senior author, Professor Bronwyn Kingwell, who heads up the Institute’s Metabolic and Vascular Physiology laboratory, says the acute metabolic effects of soft drink consumption and prolonged sitting identified in this latest study are cause for concern.

“With lifestyle-related diseases such as obesity rising rapidly and sugar sweetened beverages the largest source of added sugars in Western diets, understanding the ‘real world’ health impact is critical in determining ‘real world’ prevention and intervention strategies,” Professor Kingwell says.

She says this study quantified the effects of soft drink consumption compared to water on glucose and lipid metabolism in a context that was reflective of typical daily consumption levels, meal patterns and activity behaviours such as sitting for long periods.

The study, involved 28 overweight or obese adults aged 19–30 years who were habitual soft drink consumers. They participated in two separate experiments on different days drinking soft drink on one and water on the other both mid-morning and mid-afternoon during a 7-hour day of uninterrupted sitting.

Professor Kingwell says the combination of soft drink and prolonged sitting significantly elevated plasma glucose and plasma insulin, while reducing circulating triglycerides and fatty acids which indicates significant suppression of lipid metabolism, particularly in males.

She says the metabolic effects of a regular diet of soft drink combined with extended periods of sitting may contribute to the development of metabolic disease in young people who are overweight or obese, including predisposing men to an elevated risk of fatty liver disease.

“The acute metabolic effects outlined in this study are very worrying and suggest that young, overweight people who engage in this type of lifestyle are setting themselves on a path toward chronic cardiometabolic disease,” Professor Kingwell says. “This highlights significant health implications both for individuals and our healthcare system.”

Part 2 : Here’s what’s going on inside your veins after you drink a soft drink

Orginally published Here

Half an hour after finishing a can of soft drink, your blood sugar has spiked.

So you’re probably feeling pretty good. Your cells have plenty of energy, more than they need.

Maybe that soft drink had some caffeine as well, giving your central nervous system a kick, making you feel excitable, suppressing any tiredness you might have.

But a clever new study, published this week, nicely illustrates that while you’re feeling good, strange things are going on inside your blood vessels – and in the long run they are not good for you.

For this study, 28 obese or overweight young adults agreed to sit in a lab for a whole day while having their blood continuously sampled.

The volunteers ate a normal breakfast, lunch and dinner. At morning tea and afternoon tea, researchers from Melbourne’s Baker Heart and Diabetes Institute gave them a can of soft drink.

Their blood samples revealed exactly what happened next.

Sugar from, say, a chocolate bar is released slowly, as your digestive system breaks it down.

With a can of soft drink, almost no break-down time is needed. The drink’s sugar starts to hit your bloodstream within about 30 minutes. That’s why you get such a big spike.

Your body responds to high levels of blood sugar by producing a hormone called insulin.

Insulin pumps through the bloodstream and tells your cells to suck in as much sugar as they can. The cells then start burning it, and storing what they can’t burn.

That quickly reduces the amount of sugar in the blood, and gives you a burst of energy. So far so good.

But the sugar keeps coming. High levels of blood sugar will quickly damage your blood vessels, so the body keeps making insulin.

In fact, just having two cans of soft drink meant the volunteers’ insulin stayed significantly higher than usual – all day.

After lunch, and another soft drink for afternoon tea, their sugar and insulin levels spiked again.

And, once again, over the next few hours blood sugar dropped but insulin levels stayed stubbornly high – right through to late afternoon, when the study finished.

The study demonstrates that two cans of soft drink is all it takes to give your pancreas – the crucial organ that produces insulin – a serious workout, says Professor Bronwyn Kingwell, the study’s senior author.

Watch Video 

We get more sugar each year from beverages than all the sweet treats you can think of combined.

“If you did this day in, day out, your pancreas would be under considerable stress – and this is how diabetes can develop,” says Professor Kingwell. “Having a little can of soft drink in the morning is going to have lasting effects throughout the day.”

If your diet has too much sugar in it, forcing your body to keep your insulin high all the time, eventually your cells will grow insulin-resistant. That forces the pancreas to make even more insulin, adding to its workload. Eventually, it will burn out.

But something else interesting is happening inside your body as well.

Insulin tells your body to burn sugar. But it also tells it to stop burning fat.

Normally, the body burns a little bit of both at once. But after a soft drink, your insulin stays high all day – so you won’t burn much fat, whether you’re on a diet or not.

One of the study’s participants, Michelle Kneipp, is now trying as hard as she can to kick her soft-drink habit.

She’s switched soft drinks for flavoured sparkling water. “It still tastes like soft drink, and it’s still got the fizz,” she says.

“But it’s hard, because sugar’s a very addictive substance.”

 

NACCHO Aboriginal Health and #Cancer Policies , Strategies and Future directions : Latest @HealthInfoNet review shows many cancers are preventable among Aboriginal and Torres Strait Islander people

‘The review shows that cultural safety in service provision, increased participation in breast, bowel and cervical screening and reduction in risk factors will improve outcomes for cancer among Aboriginal and Torres Strait Islander people.

The good news is that many cancers are considered to be preventable. Lung cancer is the most commonly diagnosed cancer among Aboriginal and Torres Strait Islander people, followed by breast cancer, bowel cancer and prostate cancer.

Tobacco smoking is still seen as the greatest risk factor for cancer’.

HealthInfoNet Director, Professor Neil Drew

Read over 75 Aboriginal Health and Cancer articles published by NACCHO last 6 years

“Aboriginal and Torres Strait Islander Community Controlled Health Services

Aboriginal and Torres Strait Islander Community Controlled Health Services are located in all jurisdictions and are funded by the federal,state and territory governments and other sources [91].

They are planned and governed by local Aboriginal and Torres Strait and Torres
Strait Islander communities and aim to deliver holistic and culturally appropriate health and health-related services.

Services vary in the primary health care activities they offer. Possible activities include: diagnosis and treatment of illness or disease; management of chronic illness; transportation to medical appointments; outreach clinic services; immunisations; dental services; and dialysis services.

Aboriginal and Torres Strait Islander cancer support groups have been identified as important for improving cancer awareness and increasing participation in cancer screening services [92].

Aboriginal women attending these support groups have reported an increased
understanding of screening and reported less fear and concern over cultural appropriateness, with increases in screening rates [19].

Support groups have also been found to help in follow up and ongoing care for cancer survivors [19, 93], particularly where they are shaped to meet the needs of Aboriginal and Torres Strait Islander people [73, 94].”

See Page 12 of Review

Download Review+of+cancer+among+Aboriginal+and+Torres+Strait+Islander+people

The Australian Indigenous HealthInfoNet (HealthInfoNet) at Edith Cowan University has published a new Review of cancer among Aboriginal and Torres Strait Islander people.

The review, written by University of Western Australia staff (Margaret Haigh, Sandra Thompson and Emma Taylor), in conjunction with HealthInfoNet staff (Jane Burns, Christine Potter, Michelle Elwell, Mikayla Hollows, Juliette Mundy), provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people.

It provides detailed information on the extent of cancer including incidence, prevalence and survival, mortality, burden of disease and health service utilisation.

This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people.

The review provides:

  • general information on factors (historical/protective/risk) that contribute to cancer among Aboriginal and Torres Strait Islander people
  • detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation
  • a discussion of the issues of prevention and management of cancer
  • information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people
  • a conclusion on the possible future directions for combating cancer in Australia

Selected Extracts

Policies and strategies

There are very few national policies and strategies that focus specifically on cancer in the Aboriginal and Torres Strait Islander population. The National Aboriginal and Torres Strait Islander Cancer Framework is therefore significant as the first national approach to addressing the gap in cancer outcomes that currently exists between Aboriginal and Torres Strait Islander people and the non-Indigenous population [132]. However, over the past 30 years, there have been a number of relevant strategies and frameworks developed addressing cancer in the general population, and broader aspects of Aboriginal and Torres Strait Islander health. A selection of national policy developments relevant to addressing cancer among Aboriginal and Torres Strait Islander people are described briefly below.

Selected national policy developments relevant to addressing cancer among Aboriginal and Torres Strait Islander people

2018 Lung Cancer Framework: Principles for Best Practice Lung Cancer Care in Australia is released
2016 National Framework for Gynaecological Cancer Control is released
2015 First National Aboriginal and Torres Strait Islander Cancer Framework is released
2015 Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan is released
2014 Second Cancer Australia Strategic Plan 2014–2019 is published
2013 First National Aboriginal and Torres Strait Islander Health Plan 2013–2023 is published
2011 First Cancer Australia Strategic Plan 2011–2014 is published
2008 National Cancer Data Strategy for Australia is released
2003 Report Optimising Cancer Care in Australia is published
1998 First National health priority areas cancer control report is published
1996 Cancer becomes one of four National health priority areas (NHPA)
1988 Health for all Australians report is released
1987 First National Cancer Prevention Policy for Australia is published

 

It was not until the late 1980s that national cancer control strategies and policies began to be developed [133]. In 1987, the first National Cancer Prevention Policy for Australia, was published by the Australian Cancer Society (ACS) (now the Cancer Council Australia) based on a series of expert workshops [134].

It outlined what prevention activities were currently being undertaken, what should be undertaken and suggested a number of goals, targets and strategies in the areas of cancer prevention and early detection and screening. This policy has been updated many times over the years [133] and is still in publication as the National cancer control policy [135].

The following year, in 1988, the Health for all Australians report, commissioned by the Australian Health Ministers’ Advisory council (AHMAC), recognised that cancers could be influenced by primary or secondary prevention strategies [136]. The report recommended nine goals and 15 targets related to cancers, based on those put forward by the National Cancer Prevention Policy for Australia. Cancer prevention and strategies relating to breast, cervical and skin cancer and tobacco smoking were recommended as initial priorities under the National Program for Better Health. These were then endorsed at the Australian Health Ministers Conference and funding was provided.

In 1996, cancer control was identified as one of four National health priority areas (NHPA). This led, the following year, to the publication of the First report on national health priority areas 1996, which outlined 26 indicators spanning the continuum of cancer care, and included outcome indicators, indicators relating to patient satisfaction and the creation of hospital based cancer registries [137].

In 1998, the first NHPA cancer control report was produced [138]. It identified a number of opportunities for improvements in cancer control, including within ‘special populations such as Indigenous people’ [138].

In 2003, the report Optimising cancer care in Australia was jointly developed by The Cancer Council Australia, the Clinical Oncological Society of Australia (COSA) and the National Cancer Control Initiative (NCCI), with strong consumer input [139]. This report made 12 key recommendations, including that the needs of Aboriginal and Torres Strait Islander people be the focus of efforts to bridge gaps in access to and utilisation of culturally sensitive cancer services.

In 2008, the National Cancer Data Strategy for Australia aimed to provide direction for collaborative efforts to increase data availability, consistency and quality [140]. It reported that although Indigenous status is recorded by cancer registries, data quality is poor, and recommended that the quality of Indigenous markers in hospital and death statistics collections needs to improve if cancer registries are to have better data.

In 2011, Cancer Australia published the first Cancer Australia strategic plan 2011–2014, which aimed to identify future trends in national cancer control and to outline strategies for the organisation to improve outcomes for all Australians diagnosed with cancer [141]. It was followed in 2014, by the Cancer Australia Strategic Plan 2014–2019, which had an increased focus on improving quality of cancer care and outcomes for Aboriginal and Torres Strait Islander people [142].

In 2013, the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (the Health plan) was developed to provide a long-term, evidence-based policy framework approach to closing the gap in disadvantage experienced by Aboriginal and Torres Strait Islander people [143].

The Health plan emphasises the importance of culture in the health of Aboriginal and Torres Strait Islander people and the rights of individuals to a safe, healthy and empowered life. Its vision is for the Australian health system to be free of racism and inequity and all Aboriginal and Torres Strait Islander people to have access to health services that are effective, high quality, appropriate and affordable. This led to the publication of the Implementation plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023 in 2015 [90], which outlines the strategies, actions and deliverables required for the Australian Government and other key stakeholders to implement the Health plan.

The first National Aboriginal and Torres Strait Islander Cancer Framework (the Framework­) was released in 2015, to address disparities and improve cancer outcomes for Aboriginal and Torres Strait Islander people [56]. It provides strategic direction by setting out seven priority areas for action and suggests enablers that may help in planning or reviewing strategies to address each of the priority areas. The Framework aims to improve cancer outcomes for Aboriginal and Torres Strait Islander people by ensuring timely access to good quality and appropriate cancer related services across the cancer continuum.

In 2016, Cancer Australia released the National Framework for Gynaecological Cancer Control to guide future directions in national gynaecological cancer control to improve outcomes for women affected, as well as their families and carers [144]. It aims to ensure the provision of best practice and culturally appropriate care to women across Australia by offering strategies across six priority areas, of which one pertains specifically to improving outcomes for Aboriginal and Torres Strait Islander women.

In 2018, Cancer Australia released the Lung Cancer Framework: Principles for Best Practice Lung Cancer Care in Australia [145]. It aims to improve the outcomes and experiences of people affected by lung cancer by supporting the uptake of five principles: patient-centred care; multidisciplinary care; timely access to evidence-based care; coordination, communication and continuity of care and data-driven improvements.

Future directions

The National Aboriginal and Torres Strait Islander Cancer Framework (the Framework­) provides guidance for individuals, communities, organisations and governments [56]. The Framework was developed in partnership with Menzies School of Health Research, and was informed by a systematic review of the evidence and extensive national consultations. The parties involved in these consultations included Aboriginal and Torres Strait Islander people affected by cancer, health professionals working with Aboriginal and Torres Strait Islander people and experts in Indigenous cancer control. The Framework outlined seven evidence-based priority areas for action as follows:

  • improving knowledge and attitudes about cancer
  • focusing prevention activities
  • increasing participation in screening and immunisation
  • ensuring early diagnosis
  • delivering optimal and culturally appropriate treatment and care
  • involving, informing and supporting families and carers
  • strengthening the capacity of cancer-related services to meet the needs of Aboriginal and Torres Strait Islander people.

Each of these priorities was accompanied by a number of enablers to assist in planning or reviewing strategies to address that priority. The enablers provide flexible approaches to meeting the priorities that allow for local context and needs.

The development of the Framework has been responsible for gathering national support and agreement on the priorities and for creating a high level of expectation around the ability to address the growing cancer disparity [146]. Cancer Australia has since commenced a number of projects and initiatives that focus on one or more of the priorities identified by the Framework. One project aims to identify critical success factors and effective approaches to increasing mammographic screening participation for Aboriginal and Torres Strait Islander women [147]. A leadership group on Aboriginal and Torres Strait Islander cancer control tasked with driving a shared agenda to improve cancer outcomes has also been established [148]. In addition, the development of a monitoring and reporting plan for the Framework is underway.

Quality data are critical to understanding the variations in cancer care and outcomes of Aboriginal and Torres Strait Islander people, and to inform policy, service provision and clinical practice initiatives to improve those outcomes. However, it has been repeatedly reported in the literature and by the Framework, that current data are inadequate or incomplete, and there is a significant need for improved local, jurisdictional and national data on Aboriginal and Torres Strait Islander people with cancer [56149-151]. In particular, the need for primary healthcare services to address the under identification of Aboriginal and Torres Strait Islander status in data registries. A project currently underway in SA, which is likely to have relevance to other regions, aims to develop an integrated comprehensive, cancer monitoring and surveillance system for Aboriginal people, while also incorporating their experiences with cancer services [149].

Both the Framework and the literature have identified a need for a more supportive and culturally appropriate approach across the cancer care continuum for Aboriginal and Torres Strait Islander people [5677151152]. The Wellbeing Framework for Aboriginal and Torres Strait Islander Peoples Living with Chronic Disease, (Wellbeing framework), aims to assist healthcare services to improve the quality of life and quality of care, as well as health outcomes, for Aboriginal and Torres Strait Islander people living with chronic disease [153]. This addresses the identified need for more supportive and culturally appropriate care as it attempts to incorporate the social, emotional, cultural and spiritual aspects of health and wellbeing, as well as the physical aspects.

The Wellbeing framework is underpinned by two core values, which are considered fundamental to the care of Aboriginal and Torres Strait Islander people [153154]. These core values highlight that wellbeing is supported by:

  • upholding people’s identities in connection to culture, spirituality, families, communities and country and
  • having culturally safe primary healthcare services in place.

The Wellbeing framework consists of four essential elements for supporting the wellbeing of Aboriginal and Torres Strait Islander people living with chronic disease [153154]. These show the importance of having:

  • locally defined, culturally safe primary health care services
  • appropriately skilled and culturally competent health care teams
  • holistic care throughout the lifespan
  • best practice care that addresses the particular needs of a community.

The Wellbeing framework suggests a number of practical and measurable applications for applying or achieving the underlying principles of each element. It has the capacity to be adapted by primary healthcare services, in consultation with the communities they serve, to more effectively meet the chronic and cancer care needs of their communities [153154].

 

The Leadership Group on Aboriginal and Torres Strait Islander Cancer Control was established in 2016-17 to:

  • provide strategic advice and specialist expertise in Indigenous cancer control
  • encourage cross-sector collaboration in addressing the priorities in the National Aboriginal and Torres Strait Islander Cancer Framework
  • share knowledge across the sector to leverage opportunities.

Concluding comments

Despite considerable improvements in cancer detection and treatment over recent decades, Aboriginal and Torres Strait Islander people diagnosed with cancer generally experience poorer outcomes than non-Indigenous people for an equivalent stage of disease [2797]. This is highlighted by statistics which showed that, despite lower rates of prevalence and hospitalisation for all cancers combined for Aboriginal and Torres Strait Islander people compared with non-Indigenous people, between 1998 and 2015, the age-standardised mortality rate ranged from 195 to 246 per 100,000 while the rate for non-Indigenous people decreased from 194 to 164 per 100,000 [2].

Furthermore for 2007–2014, while 65% of non-Indigenous people had a chance of surviving five years after receiving a cancer diagnosis, only 50% of Aboriginal and Torres Strait Islander people did [2].

The disparities are particularly pronounced for some specific cancers – for lung cancer the age-standardised incidence rate for Aboriginal and Torres Strait Islander people was twice that for non-Indigenous people, while for cervical cancer the rate was 2.5 times the rate for non-Indigenous people for 2009–2013 [2].

The factors contributing to these poorer outcomes among Aboriginal and Torres Strait Islander people are complex. They reflect a broad range of historical, social and cultural determinants and the contribution of lifestyle and other health risk factors [6], combined with lower participation in screening programs, later diagnosis, lower uptake and completion of cancer treatment, and the presence of other chronic diseases [2798155]. Addressing the various factors that contribute to the development of cancer among Aboriginal and Torres Strait Islander people is important, but improvements in some of these areas, particularly in reducing lifestyle and behavioural risk factors, are likely to take some time to be reflected in better outcomes.

Current deficiencies in the prevention and management of cancer suggest there is considerable scope for better services that should lead to improvements in the short to medium term. Effective cancer prevention and management programs that are tailored to community needs and are culturally appropriate are vital for the current and future health of Aboriginal and Torres Strait Islander people [5657]. Providing effective cancer prevention and management also requires improved access to both high quality primary health care services and tertiary specialist services. Effective and innovative programs for the prevention and management of cancer among Aboriginal and Torres Strait Islander people do exist on an individual basis and, in some cases, the efforts made to engage Aboriginal and Torres Strait Islander people in screening programs, in particular, are impressive. However, a more coordinated, cohesive national approach is also required.

Reducing the impact of cancer among Aboriginal and Torres Strait Islander people is a crucial aspect in ‘closing the gap’ in health outcomes. The National Aboriginal and Torres Strait Islander cancer framework [56] may be an important first step in addressing the current disparity in cancer outcomes and raises the probability of real progress being made. Cancer Australia has recently released the Optimal Care pathway for Aboriginal and Torres Strait Islander people which recommends new approaches to cancer care and with the aim of reducing disparities and improving outcomes and experiences for Aboriginal and Torres Strait Islander people with cancer [156]. As encouraging as these developments are, substantial improvements will also depend upon the effective implementation of comprehensive strategies and policies that address the complexity of the factors underlying the disadvantages experienced by Aboriginal and Torres Strait Islander people.

Action beyond the health service sector that addresses the broader historical, social and cultural determinants of health are also required if real progress is to be made [6].

 NACCHO Aboriginal Health and Food security #IndigenousNCDs : Welfare reform is targeting many remote-living Aboriginal people impoverishing them and resulting in the consumption of unhealthy foods that are killing them prematurely from non-communicable diseases

What national and average Closing the Gap figures do not tell us is just how badly the estimated 170,000 Indigenous people in remote and very remote Australia are faring. This region where I focus my work covers 86 per cent of the Australian continent.

In the last decade new race-based instruments have been devised to regulate Indigenous people including their forms of expenditure (via income management), forms of working via the Community Development Programme (CDP) and their places of habitation, where they might access basic citizenship services.

All these measures have implications for consumption of market commodities, including food from shops, and of customary non-market goods, including food from the bush.

Owing to deep poverty, many people can only purchase relatively cheap and unhealthy takeaway foods that are killing them prematurely from non-communicable diseases, like acute heart and kidney disorders, followed by lung cancer from smoking.

With income management Aboriginal people are being coerced to shop at stores according to the government’s rhetoric for their ‘food security’. Before the introduction of this regime many more people were exercising their ‘food sovereignty’ right to harvest far healthier foods from the bush.

Extracts from Jon Altman a research professor in anthropology at the Alfred Deakin Institute for Citizenship and Globalisation at Deakin University, Melbourne.

From New Matilda Read and subscribe HERE

A version of this article was first published in the Land Rights News

READ over 5 Articles NACCHO Aboriginal Health and Nutrition 

READ Articles NACCHO Aboriginal Health and Welfare Card 

” NACCHO is strongly opposed to the current cashless debit card trials as well as any proposal to expand. We also note that Aboriginal people are disproportionately affected by the trials and that they are in and proposed for locations where the majority participants are Aboriginal. Whilst it is not the stated intent of the trials, its impact is discriminatory.

NACCHO knows that some Aboriginal people and communities need additional support to better manage their lives and ensure that income support funds are used more effectively.

However, NACCHO is firmly of the view that there are significantly better, more cost efficient, alternative approaches that support improvements in Aboriginal wellbeing and positive decision making.

Aboriginal Community Controlled Health Services would be well placed to develop and implement alternative programs. We firmly believe that addressing the ill health of Aboriginal people, including the impacts of alcohol, drug and gambling related harm, can only be achieved by local Aboriginal people controlling health care delivery.

We know that when Aboriginal and Torres Strait Islander people have a genuine say over our lives, the issues that impact on us and can develop our own responses, there is a corresponding improvement in wellbeing. This point is particularly relevant given that the majority of trial participants are Aboriginal. “

Selected extracts from Submission to the Senate Community Affairs Legislation Committee Inquiry into the Social Services Legislation Amendment (Cashless Debit Card Trial Expansion) Bill 2018 

Download HERE 

NACCHO submission on cashless debit card final

As is the case in many countries, Indigenous people in Australia, New Zealand, United States of America and Canada are disproportionately affected by NCDs.

Diabetes, cardiovascular disease, cancer,  smoking related lung disease and mental health conditions are the five main NCDs identified by the World Health Organisation (WHO), and these are almost uniformly experienced by Indigenous peoples at higher rates than other people.

Indigenous people globally are disproportionately affected by diabetes. In Australia, Aboriginal and Torres Strait Islander peoples are 6 times more likely than the non-Indigenous population to die from diabetes. In Canada, Indigenous peoples are 3-5 times more likely to have diabetes than other citizens.

Indigenous people are also more likely to have Cardiovascular disease. Cardiovascular disease accounts for almost a quarter of the mortality gap between Aboriginal and Torres Strait Islander peoples and other Australians. Maori people are 3-4.2 times more likely to die from cardiovascular disease than other people in New Zealand.

These numbers are not improving, despite national rates of smoking decreasing, and increased social marketing aimed at reducing sugar consumption and increasing physical activity.

Mainstream solutions do little to reduce the burden of NCDs for Indigenous populations. The broader social determinants of health have a huge role to play, and until these are addressed in a meaningful way, Indigenous peoples will continue to experience an inequitable burden.

With colonisation having had a devastating impact on Indigenous peoples, and mainstream solutions unable to significantly reduce the rates of NCDs experienced by Indigenous peoples, a new paradigm is urgently required.

What is required is not more state based solutions but Indigenous led solutions.

Summer May Finlay Croakey 

Welfare reform is targeting many remote-living Aboriginal people impoverishing them and resulting in the consumption of unhealthy foods that are killing them prematurely from non-communicable diseases

Rome (Canberra) continues to fiddle while Black Australia burns. Professor Jon Altman weighs in on the ongoing disasters of government policy that have a tight grip on remote living Indigenous people.

In the last month I participated in two workshops. I used what I observed on my latest visit to Arnhem Land and what people were telling me to inform what I presented at the workshops.

The first workshop explored issues around excessive consumption by industrialised societies globally and how this is harming human health and destroying the planet. Workshop participants asked how such ‘consumptogenic’ systems might be regulated for the global good? My job was to provide a case study from my research on consumption by Indigenous people in remote Australia.

The second workshop looked at welfare reform in the last decade in remote Indigenous Australia. In this workshop I looked at how welfare reform by the Australian state after the NT Intervention was creatively destroying the economy and lifeways of groups in Arnhem Land who are looking to live on their lands and off its natural resources.

Here I want to share some of what I said.

BROADLY speaking Indigenous policy in remote Australia is looking to do two things.

The first is to Close the Gaps so that Indigenous Australians can one future day have the same socio-economic status as other Australians. In remote Australia this goal is linked to the project to ‘Develop the North’ via a combination of opening Aboriginal communities and lands to more market capitalism and extraction, purportedly for the improvement of disadvantaged Indigenous peoples and land owners.

While remote-living Indigenous people have economic and social justice rights to vastly improved wellbeing, in such scenarios of future economic equality based on market capitalism, the downsides of what I think of as ‘consumptomania’ are never mentioned.

The second aim of policy is the extreme regulation of Indigenous people and their behaviour, when deemed unacceptable. In a punitive manifestation of neoliberal governmentality, the Australian state, and its nominated agents, are looking to morally restructure Indigenous people to transform them into model citizens: hard-working, individualistic, highly educated, nationally mobile at least in pursuit of work (not alcohol), and materially acquisitive.

This paternalistic project of improvement makes no concessions whatsoever to cultural difference, colonial history of neglect, connection to country, discrimination, and so on.

In the last decade new race-based instruments have been devised to regulate Indigenous people including their forms of expenditure (via income management), forms of working via the Community Development Programme (CDP) and their places of habitation, where they might access basic citizenship services.

All these measures have implications for consumption of market commodities, including food from shops, and of customary non-market goods, including food from the bush.

We have all heard the bad news, year after year, report after report, that the government-imposed project of improvement, called ‘Closing the Gap’ and introduced by Kevin Rudd in 2008, is failing.

Using the government’s own statistics, after 10 years only one target, year 12 attainment, might be on track. I say ‘might’ because ‘attainment’ is open to multiple interpretations: is attainment just about attendance or about gaining useful life skills?

What national and average Closing the Gap figures do not tell us is just how badly the estimated 170,000 Indigenous people in remote and very remote Australia are faring. This region where I focus my work covers 86 per cent of the Australian continent.

What we are seeing in this massive part of Australia according to the latest census are the very lowest employment/population ratios of about 30 per cent for Indigenous adults (against 80% for non-Indigenous adults) and the deepest poverty, more than 50 per cent of people in Indigenous households currently live below the poverty line.

This is also paradoxically where Indigenous people have most land and native title rights, a recent estimate suggests that 43 per cent of the continent has some form of indigenous title; and is dotted with maybe 1000 small Indigenous communities with a total population of 100,000 at most.

Native title rights and interests give people an unusual and generally unregulated right to use natural resources for domestic consumption.

This form of consumption might include hunting kangaroos or feral animals like the estimated 100,000 wild buffalo in Arnhem Land.

Such hunting is good for health because the meat is lean and fresh; it is also good for the environment because buffalo eat about 30kg of vegetation a day and are environmentally destructive; and it is good for global cooling because each buffalo emits methane with a carbon equivalent value of about two tonnes per annum.

The legal challenge of gaining native title rights and interests is that claimants must demonstrate continuity of customs and traditions and connection to their claimed country. But in remote Australia, culture and tradition have been identified as a key element of the problem that is exacerbating social dysfunction. (That is unless tradition appears as fine art ‘high culture’ which is imagined to be unrelated to the everyday culture and is a favourite item for consumption by metropolitan elites.)

Hence the project of behavioural modification to eradicate Indigenous cultures that exhibit problematic characteristics, like sharing and a focus on kinship and reciprocity, to be replaced by western culture with its high consumption, individualistic and materially acquisitive characteristics.

Connection to country, at least if it involves living on it, is also deemed highly problematic by the Australian state if one wants to produce western educated, home-owning, properly disciplined neoliberal subjects — terra nulliusis now to be replaced by terra vacua, empty land.

Such empty land would be ripe for resource extraction and capitalist accumulation by dispossession Despite all the talk of mining on Aboriginal land, there are currently very few operating mines on the Indigenous estate. This is imagined as one means to Develop the North, but recent history suggests that the long-term benefits to Aboriginal land owners from such development will be limited.

MUCH of what I describe above in general terms resonates with what I have observed in Arnhem Land where I have visited regularly since the Intervention; and what I hear from Aboriginal people and colleagues working elsewhere in remote Indigenous Australia.

From 2007 to 2012 all communities in Arnhem Land were prescribed under NT Intervention laws. Since 2012, under Stronger Futures laws legislated in force until 2022, the Aboriginal population has continued to be subject to a new hyper-regulatory regime: income management, government-licenced stores, modern slavery-like compulsory work for welfare, enhanced policing, unimaginable levels of electronic and police surveillance, school attendance programs and so on.

The limited availability of mainstream work in this region as elsewhere means that most adults of working age receive their income from the new Community Development Program introduced in 2015. Weekly income is limited to Newstart ($260) for which one must meet a work requirement of five hours a day, five days a week if aged 18-49 years and able-bodied.

Of this paltry income, 50 per cent is quarantined for spending at stores where prices are invariably high, owing to remoteness.

The main aim of such paternalism is to reduce expenditure on tobacco and alcohol which cannot be purchased with the BasicsCard.

Shop managers that I have interviewed tell me that despite steep tax-related price rises (a pack of Winfield blue costs nearly $30) tobacco demand is inelastic and sales have not declined.

Since the year 2000, Noel Pearson has popularised his metaphor ‘welfare poison’. Pearson is referring figuratively to what he sees as the negative impacts of long-term welfare dependence. In Arnhem Land welfare is literally a form of poison because in the name of ‘food security’ people are forced to purchase foods they can afford with low nutritional value from ‘licenced’ stores.

However, paternalistic licencing to allow stores to operate the government-imposed BasicsCard is not undertaken equitably by officials from the Department of Prime Minister and Cabinet.

So one sees large, long-standing, community-owned and operated and mainly Indigenous staffed stores being rigorously regulated, managers argue over-regulated. Such stores are highly visible, as are their accounts.

But small private-sector operators (staffed mainly by temporary visa holders and backpackers) that have been established as the regional economy has been prised open to the free market appear under-regulated, even though they are also ‘licenced’ to operate the BasicsCard.

These private sector operators compete very effectively with community-owned enterprises because they only have a focus on commerce: all the profits they make and most of the wages they pay non-local staff leave the region.

Owing to deep poverty, many people can only purchase relatively cheap and unhealthy takeaway foods that are killing them prematurely from non-communicable diseases, like acute heart and kidney disorders, followed by lung cancer from smoking.

With income management Aboriginal people are being coerced to shop at stores according to the government’s rhetoric for their ‘food security’. Before the introduction of this regime many more people were exercising their ‘food sovereignty’ right to harvest far healthier foods from the bush.

This dramatic transformation has occurred as an unusual form of regional economy that involved a high level of customary activity has been effectively destroyed by the dominant government view that only prioritises engagement in market capitalism — that is largely absent in this region.

On one hand, we now see the most able-bodied hunters required to work for the dole every week day with their energies directed from what they do best.

On the other hand, the greatly enhanced police presence is resulting simultaneously in people being deprived of their basic equipment for hunting — guns and trucks — regularly impounded because they are unregistered or their users unlicenced.

People are being increasingly isolated from their ancestral lands and their hunting grounds.

Excessive policing, growing poverty, dependency and anomie are seeing criminality escalate with expensive fines for minor misdemeanours further impoverishing people and reducing their ability to purchase either more expensive healthy foods or the means to acquire bush foods.

A virtuous production cycle that until the Intervention saw much ‘bush food consumption’ has been disastrously reversed. Today, we see a vicious cycle where people regularly report hunger while living in rich Australia; people’s health status is declining.

Welfare reform and Indigeneity is indeed a toxic mix, poison, in remote regions like Arnhem Land.

I WANT to end with some more general conclusions.

On the regulation of Indigenous expenditure, we see a perverse policy intervention: the Australian government is committing what are sometimes referred to as Type 1 and Type 2 errors.

The former sees the government looking to regulate Indigenous consumption using the expensive instrument of income management that has cost over $1.2 billion to date, despite no evidence that it makes a difference.

The latter sees an absence of the proper regulation of supply in licences stores evident when stores with names like ‘The Good Food Kitchen’ sell cheap unhealthy take-aways.

In my view the racially-targeted and crude attempts to regulate Indigenous expenditure are unacceptable on social justice grounds.

Two principles as articulated by Guy Standing stand out.

‘The security difference principle’ suggests that a policy is only socially just if it improves the [food]security of the most insecure in society. Income management and work for the dole do not do this.

And ‘the paternalism test’ suggests that a policy like income management would only be socially just if it does not impose controls on some groups that are not imposed on the most-free groups in society.

Paternalistic governmentality in remote Australia is imposing tight regulatory frameworks on some people, even though the justifying ideology suggests that markets should be free and unregulated.

Sociologist Loic Wacquant in  Punishing the Poor shows how the carceral state in the USA punishes the poor with criminalisation and imprisonment; the poor there happen to be mainly black.

In Australia, punitive neoliberalism punishes those remote living Aboriginal people who happen to be poor and dependent on the state.

Once again there is a perversity in policy implementation.

Hence in Arnhem Land, people maintain strong vestiges of a hunter-gatherer subjectivity that when combined with deep poverty makes them avid consumers of western commodities that are bad for health (like tobacco that is expensive and fatty, sugary takeaway food that is relatively cheap).

At the same time commodities that might be useful to improve health, like access to guns and trucks essential for modern hunting, are rendered unavailable by a combination of poverty and excessive policing.

Australian democracy that is founded on notions of liberalism needs to be held to account for such travesties.

Long ago in 1859, John Stuart Mill, the doyen of liberals, wrote in  On Liberty: “…despotism is a legitimate form of government in dealing with barbarians, providing the end be their improvement and the means justified by actually effecting that end”.

In illiberal Australia today, authoritarian controls over remote living Indigenous people and their behaviour are again viewed as legitimate by the powerful now neoliberal state, even though there is growing evidence from remote Australia that things are getting worse.

I want to end with some suggested antidotes to the toxic mix that has resulted from welfare reform that is targeting many remote-living Aboriginal people and impoverishing them.

First, in my view despotism for some is never legitimate, so people should be treated equally irrespective of their ethnicity or structural circumstances.

Second, the Community Development Programme is a coercive disaster that is far more effective at breaching and penalising the jobless for not complying with excessive requirements than in creating jobs. CDP is further impoverishing people and should be replaced, especially in places where there are no jobs, with unconditional basic income support.

Third, people need to be empowered to find their own solutions to the complex challenges of appropriate development that accord with their aspirations, norms, values, and lifeways. Devolutionary principles of self-government and community control, not big government and centralised control, are needed.

Fourth, the native title of remote living people should be protected to ensure that they benefit from all their rights and interests. There is no point in legally allocating property rights in natural resources valuable for self-provisioning if people are effectively excluded from access to their ancestral lands and the enjoyment of these resources.

Finally, governments should support what has worked in the past to improve people’s diverse culturally-informed views about wellbeing and sense of worth.

While such an approach might not close some imposed ‘closing the gap’ targets, like employment as measured by standard western metrics, it will likely improve other important goals like reducing child mortality and enhancing life expectancy and overall quality of life.

 

 

NACCHO Aboriginal Health : Download @CSIROnews #FutureofHealth Report that provides a new path for national healthcare delivery, setting a way forward to shift the system from illness treatment, to #prevention.

Australians rank amongst the healthiest in the world with our health system one of the most efficient and equitable. However, the nation’s strong health outcomes hide a few alarming facts: 

  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander people
  • Australians spend on average 11 years in ill health – the highest among OECD countries
  • 63% (over 11 million) of adult Australians are considered overweight or obese
  • 60% of the adult population have low levels of literacy 
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

From CSIRO Future of Health report

Download HERE full 60 Page Report NACCHO INFO FutureofHealthReport_WEB_180910

The CSIRO Future of Health report provides a list of recommendations for improving the health of Australians over the next 15 years, focussed around five central themes: empowering people, addressing health inequity, unlocking the value of digitised data, supporting integrated and precision health solutions, and integrating with the global sector.

CSIRO Chief Executive Dr Larry Marshall said collaboration and coordination were key to securing the health of current and future generations in Australia, and across the globe.

“It’s hard to find an Australian who hasn’t personally benefitted from something we created, including some world’s first health innovations like atomic absorption spectroscopy for diagnostics; greyscale imaging for ultrasound, the flu vaccine (Relenza); the Hendra vaccine protecting both people and animals; even the world’s first extended-wear contact lenses,” Dr Marshall said.

“As the world is changing faster than ever before, we’re looking to get ahead of these changes by bringing together Team Australia’s world-class expertise, from all sectors, and the life experiences of all Australians to set a bold direction towards a brighter future.”

The report highlighted that despite ranking among the healthiest people in the world, Australians spent on average of 11 years in ill health – the highest among OECD countries.

Clinical care was reported to influence only 20 per cent of a person’s life expectancy and quality of life, with the remaining 80 per cent relying on external factors such as behaviour, social and economic support, and the physical environment.

“As pressure on our healthcare system increases, costs escalate, and healthy choices compete with busier lives, a new approach is needed to ensure the health and wellbeing of Australians,” CSIRO Director of Health & Biosecurity Dr Rob Grenfell said.

The report stated that the cost of managing mental health related illness to be $60 billion annually, with a further $5 billion being spent on managing costs associated with obesity.

Health inequities across a range of social, economic, and cultural measures were found to cost Australia almost $230 billion a year.

“Unless we shift our approach to healthcare, a rising population and increases in chronic illnesses such as obesity and mental illness, will add further strain to the system,” Dr Grenfell said.

“By shifting to a system focussed on proactive health management and prevention, we have an exciting opportunity to provide quality healthcare that leaves no-one behind.

“How Australia navigates this shift over the next 15 years will significantly impact the health of the population and the success of Australian healthcare organisations both domestically and abroad.”

CSIRO has been continuing to grow its expertise within the health domain and is focussed on research that will help Australians live healthier, longer lives.

The Future of Health report was developed by CSIRO Futures, the strategic advisory arm of CSIRO.

More than 30 organisations across the health sector were engaged in its development, including government, health insurers, educators, researchers, and professional bodies.

Australia’s health challenges:

  • Australians spend on average 11 years in ill health – the highest among OECD countries.
  • 63 per cent (over 11 million) of adult Australians are considered overweight or obese.
  • There is a 10-year life expectancy gap between the health of non-Indigenous Australians and Aboriginal and Torres Strait Islander peoples.
  • 60 per cent of the adult population have low levels of health literacy.
  • The majority of Australians do not consume the recommended number of serves from any of the five food groups.

The benefits of shifting the system from treatment to prevention:

  • Improved health outcomes and equity for all Australians.
  • Greater system efficiencies that flatten the cost curve of health financing.
  • More impactful and profitable business models.
  • Creation of new industries based on precision and preventative health.
  • More sustainable and environmentally friendly healthcare practices.
  • More productive workers leading to increased job satisfaction and improved work-life balance.

More info : www.csiro.au/futureofhealth

NACCHO Aboriginal Children’s Health : Dr @SandroDemaio presents a five-point policy plan using a lifeSPANS approach to address child obesity in Australia: #NCDs #EnoughNCDs @FAREAustralia @AHPA_AU @SaxInstitute

 

” The answer to obesity will never be in telling people what to do, guilting them for making unhealthier choices in a confusing consumption landscape, or by simply banning things. We also know that education and knowledge will get us only so far.

The real answers lie not even in inspiring populations to make hundreds of healthier decisions each and every day in the face of a seductively obesogenic, social milieu.

If we are to drive long‐term, sustained and scalable change, we must tweak the system to ensure those healthier choices become the path of least resistance—and eventually preferred. And I believe we must focus, initially, on our kids.

It is time for a lifeSPANS approach to addressing obesity in Australia.”

Dr Alessandro Demaio ” A $100 Million question ” see Bio in full Part 2

Download this Paper HERE : Demaio-2018-Health_Promotion_Journal_of_Australia

Listen to Dr Sandro’s childhood obesity Podcast HERE 

  ” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Compelling populations, individuals or even ourselves to act pre‐emptively on the urgent and massive challenges of tomorrow is notoriously difficult.

The concept is called temporal or future discounting, and it is well documented.1 It is the idea that we prioritise our current comfort and happiness over our future and seemingly distant safety or wellbeing.

This psychological shortcoming plays out in many ways. At the micro level, we may defer until next week what we should do today—that run, drinking more water or the dentist check‐up—as it may not reap benefits for months, or ever. Eventually, we may act on some of these but whether delayed, deferred or denied, it can reap serious health consequences.

At the macro level, it becomes even more problematic. When we combine this “delay what’s beyond tomorrow” phenomenon with short‐term political cycles in the context of systems‐based, slowly evolving and largely invisible future threats, important but not yet imminent issues are not just postponed, but ignored.

Few challenges are a greater threat to the health of Australians, nor better define future discounting, than obesity. At the individual level and in our modern, obesogenic societies, weight gain has become the norm—the biological and social path of least resistance.

Food systems have shifted from a focus on seasonal, fresh and relatively calorie‐poor staples with minimal processing or meat, to an environment where junk foods and processed foods are ubiquitous, heavily advertised, hugely profitable and, for many communities, the only feasible “choice”.

Poor nutrition is now the leading risk factor for disease in our country.2City living has come with benefits, but along with an increasingly automated and digitalised lifestyle, has seen physical activity become something we must seek out, rather than an unavoidable component of our daily lives. Factors such as these have made individual action difficult for most of us and combined with our biology, have contributed to obesity rates more than doubling in Australia since 1980 alone.3

At the policy level, a dangerous, pernicious and unhealthy status quo has evolved over decades. One which sees a population increasingly affected by preventable, chronic disease. One which can only be solved through difficult decisions from politicians and the public to make the short‐term, passive but unhealthy comfort harder; and the long‐term promise of wellbeing more attractive.

One which must see sustained public demand and political commitment for a distant goal and best scenario of nil‐effect, in the face of constant, coordinated and powerful pushback, threats and careful intimidation from largely unprecedented policy counter‐currents.

But opportunities do exist; levers throughout this gridlocked policy landscape that can be utilised to move the obesity agenda forward.

One of those is our kids.

We know that if we cannot prevent obesity in our children, those young Australians will likely never achieve wellbeing.

We know that one in four of our children is overweight or obese and that while 5% of healthy weight kids become obese adults, up to 79% obese children will never realise a healthy weight.45 We know that the school years are a time when major weight gain occurs in our lifecourse and almost no one loses weight as they age.6

Recent evidence suggests early, simple interventions not only reduce weight and improve the health for our youngest kids, but also reduce weight in their parents.78 An important network of effective implementation platforms and primed partners already exist in our schools and teachers around the nation.

Finally, a large (but likely overstated) proportion of Australians may call “nanny state” at even the whiff of effective policies against obesity, but less so if those policies are aimed at our children.

With this in mind, I was recently invited to Canberra to present on how I would spend an extra $100 million each year on preventive health for the nation.

This is the five‐point policy plan I proposed; a lifeSPANS approach to addressing child obesity—and with it, equipping a new generation of Australians to act on tomorrow’s risks, today. This is an evidence‐based package to reduce the major sources of premature deaths, starting early.

1 .SCHOOLS AS PLATFORMS FOR HEALTH

  • $3 million to support the revision and implementation of clear, mandatory guidelines on healthy food in school canteens
  • $3 million to coordinate and support the removal of sales of sugary drinks
  • $13 million to expand food and nutrition programs to remaining primary schools
  • $40 million as $5000‐10 000 means‐tested grants for infrastructure that supports healthy eating and drinking in primary schools
  • $130 million to cover 1.7 million daily school breakfasts for every child at the 6300 primary schools nationally910
  • $140 million left from sugary drink tax revenue for school staffing and programs for nutrition and physical activity

Schools alone cannot solve the child obesity epidemic; however, it is unlikely that child obesity rates can be reversed without strong school‐based policies to support healthy eating and physical activity. Children and adolescents consume 19%‐50% of daily calories at school and spend more time there than in any other environment away from home.11 Evidence suggests that “incentives” are unlikely to result in behaviour change but peer pressure might.12 Therefore, learning among friends offers a unique opportunity to positively influence healthy habits.

Trials have demonstrated both the educational and health benefits of providing free school meals, including increased fruit and vegetable consumption, knowledge of a healthy diet, healthier eating at home and improved school performance. Providing meals to all children supports low‐income families and works to address health inequalities and stigma.10

School vending machines or canteens selling sugary drinks and junk foods further fuel an obesogenic, modern food environment. Sugary drinks are the leading source of added sugar in our diet in Australia and are considered a major individual risk factor for non‐communicable diseases, such as type 2 diabetes.13 Removing unhealthy foods and drinks from schools would support children, teachers and parents and send a powerful message to communities about the health harms of these products.

Finally, it is not only about taking things away but also supporting locally driven programs and the school infrastructure to support healthier habits. Drinking fountains, play equipment and canteen hardware could all be supported through small grants aimed at further empowering schools as decisions makers and agents for healthier kids.

2.PRICING THAT’S FAIR TO FAMILIES

  • 20% increase in sugary drinks pricing with phased expansion to fast foods over three years, unlocking approximately $400 million in annual revenue to add to existing $100 million for prevention
  • More than $600 million in annual health savings expected from sugary drinks price increase of 20%
  • $10 million for social marketing campaigns to explain the new policy measures, and benefits to community
  • Compensation package for farmers and small retailers producing and selling sugary drinks (cost unknown but likely small)
  • Such legislation would also support industry to reformulate or reshape product portfolios for long‐term market planning

Today’s food environment sees increased availability of lower cost, processed foods high in salt, fats and added sugars.14 People have less time to prepare meals and are influenced by aggressive food marketing. This leads to food inequality with those from low socioeconomic backgrounds at greater risk from obesity. Obesity increases the risks of cardiovascular disease, type 2 diabetes, stroke, cancer, mental health issues and premature death.15 There are also wider societal and economic costs amounting to an estimated $8.6 billion spent in the health sector alone annually.16

Food prices should be adjusted in relation to nutritional content. Policy makers must shift their pricing focus to integrate the true societal cost of products associated with fiscally burdensome disease. In 2016, a WHO report highlighted that a 20% increase in retail price of sugary drinks lowers consumption as well as obesity, type 2 diabetes and tooth decay.17

The landmark peso per litre sugar tax from Mexico highlighted the behaviour change potential such policies possess. Sales of higher priced beverages decreased substantially in subsequent years. Importantly, the most significant decreases occurred among the poorest households.18 For Australia, a similar approach is estimated to lead to $609 million in annual health savings and raise $400 million in direct revenue.16

These legislative approaches should be framed as an expansion of our existing GST and would encourage industry to reformulate products, positively influencing the food environment.131517

This is not a sin tax or ban, it is an effective policy and pricing that is fair to families. It is also backed by evidence and supported by the public.19

3. ADVERTISING THAT SUPPORTS OUR KIDS

  • End all junk food marketing to children, and between 6 am and 10 pm on television
  • End the use of cartoons on any food or drink packaging
  • $30 million to replace junk food sponsorship of sport and arts events with healthy messaging and explanation of lifeSPANS policy approach
  • Phased expansion of advertising ban over three years to all non‐essential foods (GST language)

The food industry knows that marketing works, otherwise they would not spend almost $400 million annually on advertisements in Australia alone.20

Three of four commercial food advertisements are for unhealthy products and evidence suggests that food advertising triggers cognitive processes that influence our food choices, similar to those seen in addiction. Studies also demonstrate that food commercials including the use of cartoons influence the amount of calories that children consume and the findings are particularly pronounced in overweight children.21

Fast food advertising at sporting and arts events further reinforces a dangerous and confusing notion that sees the direct association between societal heroes or elite athleticism and the unhealthiest of foods.

Ending junk food advertising to children, including any use of cartoons in the advertisement of food and drinks, is an important step to support our kids.

4.NUTRITION LABELLING THAT MAKES SENSE TO EVERYONE

  • Further strengthen existing labelling approaches, including mandatory systems

Nutritional information can be confusing for parents, let alone children. Food packaging often lists nutritional information in relation to portion size meaning a product with a higher figure may simply be larger rather than less healthy. While the Health Star Rating system, implemented in 2014, has made substantive progress, it remains voluntary.22

Efforts should be made to strengthen the usability of existing efforts and make consistent, evidence‐based and effective labelling mandatory. Such developments would also provide stronger incentives for manufacturers to reformulate products, reducing sugar, fat and salt content.

Clearer and consistent information would help create a more enabling food environment for families to make informed choices about their food.

5.SUPPLY CHAIN SYSTEMS AS SOLUTION‐CATALYSTS

  • Utilise procurement and supply chains of schools and public institutions to drive demand for healthier foods
  • Leverage the purchasing power of large organisations to reduce the costs of healthy foods for partner organisations and communities

Coordinated strategies are needed to support the availability of lower cost, healthy foods for all communities. Cities and large organisations such as schools and hospitals could collaborate to purchase food as collectives, thus driving demand, building market size and improving economies of scale.23

By leveraging collective purchasing power, institutions can catalyse the availability of sustainable and healthy foods to also support wider, positive food environment change.

Part 2

Dr Alessandro Demaio, or Sandro, trained and worked as a medical doctor at The Alfred Hospital in Australia.

While practicing as a doctor he completed a Master in Public Health including fieldwork to prevent diabetes through Buddhist Wats in Cambodia. In 2010, he relocated to Denmark where he completed a PhD with the University of Copenhagen, focusing on non-communicable diseases. His doctoral research was based in Mongolia, working with the Ministry of Health.

He designed, led and reported a national epidemiological survey, sampling more than 3500 households. Sandro held a Postdoctoral Fellowship at Harvard Medical School from 2013 to 2015, and was assistant professor and course director in global health at the Copenhagen School of Global Health, in Denmark.

He established and led the PLOS blog Global Health, and served on the founding Advisory Board of the EAT Foundation: the global, multi-stakeholder platform for food, health and environmental sustainability.

To date, he has authored over 23 scientific publications and more than 85 articles and blogs. In his pro bono work, Dr Demaio co-founded NCDFREE, a global social movement against noncommunicable diseases using social media, short film and leadership events – crowdfunded, it reached more than 2.5 million people in its first 18 months.

Then, in 2015, he founded festival21, assembling and leading a team of knowledge leaders in staging a massive and unprecedented, free celebration of community, food, culture and future in his hometown Melbourne. In November 2015, Sandro joined the Department of Nutrition for Health and Development at the World Health Organization’s global headquarters, as Medical Officer for noncommunicable conditions and nutrition.

From 2017, he is also co-host of the ABC television show Ask the Doctor – an innovative and exploratory factual medical series broadcasting weekly across Australia. Sandro is currently fascinated by systems-innovation and leadership; impact in a post-democracy; and the commercial determinants of disease. He also loves to cook.

NACCHO Aboriginal Children’s Health #Nutrition #Obesity : @IndigenousPHAA The #AFL ladder of sponsorships such as soft drinks @CocaColaAU and junk food @McDonalds_AU endangers the health of our children

 “Aboriginal and Non- Aboriginal kids are being inundated with the advertising of alcohol, junk food and gambling through AFL sponsorship deals according to a new study.

With obesity and excessive drinking remaining a significant problem in our communities, it’s time for the AFL ladder of unhealthy sponsorship (see below) to end,

Children under the age of eight are particularly vulnerable to advertising because they lack the maturity and mental skills to evaluate the messages. Therefore, in the case of the AFL, they begin to associate unhealthy products with their favourite sport and players

We need to ask ourselves why Australia’s most popular winter sport is serving as a major advertising platform for soft drink, beer, wine, burgers and meat pies. It’s sending the wrong message to Australians that somehow these unhealthy foods and drinks are linked to the healthy activity of sport,”

Says the Public Health Association of Australia (PHAA).

Read all NACCHO Aboriginal Health Nutrition / Obestity articles over 6 years HERE 

In the study published this week in the Australian and New Zealand Journal of Public Health, Australian researchers looked at the prevalence of sponsorship by alcohol, junk food and gambling companies on AFL club websites and on AFL player uniforms.

The findings were used to make an ‘AFL Sponsorship Ladder’, a ranking of AFL clubs in terms of their level of unhealthy sponsorships, with those at the top of the ladder having the highest level of unhealthy sponsors.

The study clearly demonstrated that Australia’s most popular spectator sport is saturated with unhealthy advertising.

Download PDF Copy of report NACCHO Unhealthy sponsors of sport

Ainslie Sartori, one of the authors involved in the research confirmed, “After reviewing the sponsorship deals of AFL clubs, we found that 88% of clubs are sponsored by unhealthy food and beverage companies. A third of AFL clubs are also involved in business partnerships with gambling companies.”

Recommendation 

Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand.

The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable.

Policy makers are encouraged to consider innovative health promotion strategies and work
with sporting clubs and codes to ensure healthy messages are prominent

 

The study noted that children are often the targets of AFL advertising. This is despite World Health Organization recommendations that children’s settings should be free of unhealthy food promotions and branding (including through sport) due to the known risk it poses to their diet and chances of developing obesity.

PHAA CEO Terry Slevin commented, “When Australian kids see their sports heroes wearing a uniform plastered with certain brands, they inevitably start to associate these brands with the player they look up to and with the positive and healthy experience of the sport.”

He added, “The AFL is in a unique position to positively influence the health of Australian kids through banning sponsorship by alcohol, junk food and gambling companies. It could instead reinforce the importance of a healthy lifestyle for them.”

“Australian health policy makers need to consider innovative health promotion strategies and work together with sport clubs and codes to ensure that unhealthy advertising is not a feature. We successfully removed tobacco advertising from sport and we can do it with junk food and gambling too,” Mr Slevin said.

The recently released Sport 2030 plan rightly identifies sport as a positive vehicle to promote good health. But elite “corporate sport” plays a role of bypassing restrictions aimed at reducing exposure of children to unhealthy product marketing.

“The evidence is clear – it’s time for Australia to phase out all unhealthy sponsorship of sport,” Mr Slevin conclude

NACCHO Aboriginal Health and #Nutrition: #Sugar and #Salt are killing our mob, so let’s #Rethinksugarydrink and #unpackthesalt #GHC2018 @DeadlyChoices

 ” At least 1.1 million litres of so-called “full sugar” soft drink was sold in remote community stores last financial year. One remote community store drawing half of total profits from soft drink sales,

I think particularly in remote communities and very remote communities sugar is just killing the population.

[It’s] putting them into that very high risk area before they get to an age where those chronic diseases are evident.

But I think we are on the crest of the wave of understanding in the communities of the connection between health outcomes and the sort of foods you eat “

In the wake of recent progress report on Closing the Gap, the Indigenous Affairs Minister Nigel Scullion made this observation

“I think we can all agree that poor diet in communities with consumption of fat, salt and sugar has a large impact on life expectancy in communities,” he said.

“Full sugar soft drinks are a major contributor.”

Outback Stores, which runs 36 small supermarkets in remote Aboriginal communities,the company’s chief executive Steven Moore told the committee the figures for soft drink sales are “astounding”.

” An inspiring television campaign featuring Victorian Aboriginal community members sharing how cutting back on sugary drinks has helped their health and wellbeing was launched early this year .

The ‘Our Stories’ campaign features local Aboriginal health champions yarning about their personal journeys of cutting back on sugary drinks and creating healthier environments for Aboriginal communities.

The Victorian Aboriginal Community Controlled Health Organisation Inc (VACCHO) and 17 other leading health bodies working on Rethink Sugary Drink are behind the campaign.” 

 View the Rethink Sugary Drink campaign and details of their Webinar Part 2 Below 

 ” Government to work with the food industry and community stores to implement retail intervention strategies to positively influence access to and consumption of healthy food choices for Aboriginal and Torres Strait Islander communities “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

Amata SA was an alcohol-free community, but some years earlier its population of just under 400 people had been consuming 40,000 litres of soft drink annually.

See NACCHO Story

Read and or Subscribe to 50Aboriginal Health and Nutrition articles 

Read and or Subscribe to 27 NACCHO Aboriginal Health and sugar tax articles 

Read over 50 NACCHO Aboriginal Health and Obesity articles published in past 6 years 

 ” Given the high rates of hypertension, CVD and CKD in the Indigenous Australian population, particularly in remote communities, lowering salt intake could significantly reduce chronic disease burden.

Salt intakes of the remote Indigenous Australian population are far above recommendations, likely contributing to the high prevalence of hypertension and cardiovascular mortality experienced by this population.

Salt-reduction strategies could considerably reduce salt intake in this population without increasing risk of iodine deficiency at the population-level.

Indigenous Australians experience premature mortality due to chronic disease at a highly disproportionate rate, and much earlier age, compared with non-Indigenous Australians .

 Risk of cardiovascular disease (CVD) mortality in Indigenous Australians is nearly twice that of non-Indigenous Australians [2], and CVD is responsible for approximately 3 years of the life-expectancy gap experienced by this population .

 The high prevalence of chronic kidney disease (CKD) in the Indigenous Australian population is growing concern, particularly in very remote areas; nearly four in ten Indigenous Australians living in very remote Australia have indicators of CKD .

Dietary improvement strategies are a priority for reducing chronic disease risk and improving health equity between Indigenous and non-Indigenous Australians.”

Read research in full HERE

Part 1: Draft salt targets for food manufacturers are welcome but regular monitoring is key to success, says the Heart Foundation, VicHealth and The George Institute for Global Health

 

Draft salt targets for food manufacturers are welcome but regular monitoring is key to success, the Heart Foundation, VicHealth and The George Institute for Global Health said last week

The call came with the release of a recent consumer survey by VicHealth, which found that more than 70 per cent of people want home brand products to contain less salt, and 60 per cent would pick a low- salt product off the supermarket shelf over a salty version.

At a parliamentary breakfast , the coalition of organisations representing the Victorian Salt Reduction Partnership supported the Federal Government’s current consultation on draft salt targets for a range of processed and packaged foods including ready meals, pizza, processed meats and baked goods.

The consultation is part of the Healthy Food Partnership, under which the Government, the public health sector and the food industry work together to encourage healthy eating.

The coalition encouraged the Federal Government to:

  1. Set and monitor targets to reduce salt in identified food categories
  2. Measure and monitor changes in population salt intake, and
  3. Highlight the importance of reducing salt as part of a national healthy eating campaign

Heart Foundation CEO Victoria Kellie-Ann Jolly welcomed the Federal Government’s public consultation on draft targets.

“We have long advocated for food reformulation and are pleased to see the Government taking steps to address this issue. We know adopting targets to reduce hidden salt in processed and packaged foods is an effective way to reduce Australia’s average salt intake at a population level,” Ms Jolly said.

“Seventy-five per cent of the salt in our diets is hidden in processed and packaged foods. Excess salt can increase your blood pressure, which is a major risk for heart attack, stroke and kidney disease.

“Through our Unpack the Salt campaign, we’ve seen how benchmarking products like pasta sauces opens up a dialogue with manufacturers and is key for encouraging them to consider reducing salt in their processed and packaged foods. If salt levels are adjusted incrementally over time, consumers’ taste expectations adjust accordingly.”

VicHealth CEO Jerril Rechter said community attitudes towards salt are changing. “Consumers are becoming more health conscious which in turn, drives demand for healthier, packaged and processed foods, putting pressure on food manufacturers to reformulate their products,” Ms Rechter said.

“With the majority of consumers calling for healthier, reduced salt products on our supermarket shelves, it’s time that industry and the Government meets this demand.

“We also know that not everyone understands the impact of too much salt on their health. A national healthy eating campaign is needed to ensure people can make an informed decision about the food they eat.”

The George Institute for Global Health’s Dr Jacqui Webster warned Australia seriously lags in its efforts to address salt intake at a population level.

“The United Kingdom has one of the lowest salt intakes of any developed country. They achieved a 15 per cent reduction through strong government leadership that set salt targets for the food industry and actively monitored their progress,” Dr Webster said.

“If Australia is to meet its commitment to the World Health Organization target of a 30 per cent reduction in salt by 2025, then we need more urgent action. That’s why we welcome the Federal Government’s commitment through the Healthy Food Partnership to drive change through targets for sodium levels in foods.

“To ensure the success of these targets, we need the Federal Government to commit to funding implementation and monitoring as well as delivering a national healthy eating campaign, with a focus on the importance of reducing salt.

“Eating too much salt increases blood pressure which is one of the biggest contributors to premature death and disability in Australia. Reducing Australian salt consumption would save thousands of lives each year as well as millions in healthcare costs.”

For more information about salt reformulation please visit Unpack the Salt website.

Part 2 Re Think sugary drink Webinar 

An inspiring new television campaign featuring Victorian Aboriginal community members sharing how cutting back on sugary drinks has helped their health and wellbeing was launched early this year .

The ‘Our Stories’ campaign features local Aboriginal health champions yarning about their personal journeys of cutting back on sugary drinks and creating healthier environments for Aboriginal communities.

View Video 2

The Victorian Aboriginal Community Controlled Health Organisation Inc (VACCHO) and 17 other leading health bodies working on Rethink Sugary Drink are behind the campaign.

Michelle Crilly is a young Yorta Yorta woman who features in one of the three advertisements. She shares her experience in making the choice to switch from sugary drinks to water.

“I was driving home one day, probably about three years ago. I was 20, and I had some chest pain. And being so young I got really worried,” Ms Crilly said.

“I used to be addicted to Slurpees. I’d also drink about 4–5 cans of soft drink every day… [Now] I exercise every day and I don’t have as much anxiety and I don’t feel depressed anymore.”

In the advertisement, Michelle urges others in the Aboriginal community to follow her lead.

“Keep going with your healthy lifestyle changes. It doesn’t happen overnight but eventually it will become a part of your daily routine,” she said.

Around two thirds of Aboriginal and Torres Strait Islander people aged 14–30 regularly drink sugary drinksi.

“Given the considerable burden of overweight and obesity-related chronic disease in the Aboriginal population, targeted campaigns are required to increase awareness and reduce consumption of sugary drinks among the Victorian Aboriginal community,” said Louise Lyons, Director of Public Health and Research at VACCHO.

“Some people might not realise but sugary drinks, like soft drinks, energy drinks and sports drinks, are loaded with ridiculous amounts of sugar. All that extra sugar is no good for our bodies, so drinking too much can lead to tooth decay and weight gain, increasing the risk of type 2 diabetes, heart and kidney disease, stroke and some cancers.”

Sugary drinks are a major contributor to Australia’s obesity problem, said Craig Sinclair, Chair of the Public Health Committee at Cancer Council Australia – a partner of Rethink Sugary Drink.

“The ‘Our Stories’ campaign shows there is no need for any kind of sugary drinks in a healthy diet. We recommend Australians take a look and see just how much sugar is in these drinks – some have as many as 17 teaspoons of sugar – and choose water instead.”

The advertisements ran for two months on regional WIN television in Victoria and were shared widely on social media by health and community organisations.

How much sugar is in your drink?

Find out how much sugar is in your favourite drink using the table above – it might surprise you.

If you’re ordering a fast food meal, don’t go with the default regular/sugar soft drink, see what other options there are.

Carry a water bottle, so you don’t have to buy a drink if you’re thirsty.

If you’re thirsty, have some water first.

Be wary of any health or nutrition claims on the drinks you buy. Many producers are now trying to make their sugar sweetened beverages sound healthier than they actually are. Refer to the amount for sugar on the nutrition panel if in doubt and consider the size of the bottle as well

If you consume sugary alcoholic drinks, see if there are lower sugar options. Even alcohol alone is loaded with kilojoules so cutting back on the booze is also good.

Try to avoid going down the soft drink aisle at the supermarket and beware the specials at the petrol station.

 

Sport, physical activity and nutrition go hand-in-hand so sports clubs and recreation centres play a vital role in helping people lead healthy and active lives.

Selling sugary drinks in a sporting environment undermines the healthy choices Australians are making. It is more important than ever to make sports clubs and recreation centres part of the solution.

In this webinar, on 5 September, our knowledgeable presenters discuss ways sport and recreational environments can implement or maintain changes they have made to reduce sugary drink availability.

The presentation will celebrate the success of thriving organisations and offer practical tips and strategies for sport and recreational groups looking to reduce the availability of sugary drinks.

We are also excited to launch a Rethink Sugary Drink competition. The Victorian based competition serves as a great opportunity for sports clubs and recreation centres to reduce their sugary drink availability or celebrate the changes these organisations have made. Tune in to see what prizes are in store!

DATE: Wednesday 5 September 2018

START TIME: 1pm

WEBINAR DURATION: 1 hour and 10 minutes

REGISTER ONLINE HERE

PRESENTERS:

We welcome your comments below on solutions

NACCHO Aboriginal Health celebrates #AMAFDW18 AMA Family Doctor Week : @amapresident Speech to @PressClubAust #NPC Includes support #ulurustatement #prevention investment #obesity #Chronic Disease funding #MentalHealth

 

” I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.”

AMA President Dr Tony Bartone speaking at the National Press Club 25 July 2018

 ” This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

GPs of Australia, I salute you. We all salute you.

Your hard work and dedication is highly valued. The AMA will always support you and promote you.

Your GP – your family doctor – will ensure that your health needs are met throughout all stages of your life.

Be it immunisation, preventative health care, age specific medical checks, chronic disease management, or aged care, the life long relationship with your GP underpins continuous and appropriate care.

This is especially the case for patients who are from culturally or linguistically diverse backgrounds. For them, GPs truly are their trusted health advocates.”

 ” The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese. ”

Full Speech : Health reform: Improving the patient journey

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders past and present.

It is a humbling experience to be elected President of such a proud and respected organisation as the AMA.

It is an equally humbling experience to speak here at the National Press Club in Canberra. I thank the Press Club for this opportunity.

I am a GP, and I have been in practice in the northern suburbs of Melbourne for more than 30 years.

Some of you may know that I was inspired to become a GP by watching my own family doctor, who cared for my ill father when I was growing up.

Even now, my mother reflects on the care and dedication my family GP displayed in caring for her family. It’s no surprise that he became an early mentor in my professional life.

I have seen it all as I have looked after the health of my community and my patients, including generations of the same families.

I like to think that my experience has given me some credibility in knowing what works and what doesn’t work in the health system, especially in primary care.

My overarching concern has always been the patient journey – ensuring that people get the right care at the right time in the right place by the right practitioner.

The priorities for me are always universal access to care, and affordability.

Today, I will share my views on what can be done to make our great health system even better – how to improve the patient journey.

I will also introduce you to some of my patients, and reflect on the barriers in their access to timely care, to further illustrate our concerns.

General practice and primary care reform

On the day I was elected, I made it very clear that one of the hallmarks of my Presidency would be stridently advocating for significant investment in general practice.

This week just happens to be AMA Family Doctor Week – a tribute to hardworking GPs.

see intro for text

However, there is something really crook about how GPs have been treated by successive Governments.

They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs.

General practice has been the target of continual funding cuts over many years. These cuts have systematically eaten away at the capacity of general practice to deliver the highest quality care for our patients.

They threaten the viability of many practices.

I talk to my GP members regularly, both metropolitan and rural.

The message is simple – some are at a tipping point and have a very bleak view of the future.

They see general practice becoming increasingly corporatised, burdened with more red tape, and GPs are less able to spend the necessary time with patients.

This is not the future that GPs want to see.

This is not the future that our patients want to see.

We can and must avoid these bleak predictions, but it requires significant real and immediate investment from the Government with a clear pathway to long-term reform.

Let me be very clear about this: we must put general practice front and centre in future health policy development.

We have seen too many mistakes. Too many poor policy decisions.

Despite the Government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients.

Instead of real investment, the Trial largely shifted existing buckets of money around.

It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.

There is no doubt that the challenge of transforming general practice was severely underestimated by policy makers. At least with this model.

But general practice still needs transformation and rejuvenation to meet growing patient demand and to keep GPs working in general practice.

The AMA has a plan for reform of general practice and primary care.

It is patient-centred and focuses on better access to long-term continuous quality care and managing patients more effectively in the community.

It takes the best elements of the ‘medical home’ concept and adapts them to the Australian context.

It is a plan that will require upfront and meaningful new investment, in anticipation of long-term savings in downstream health costs.

In the short term, the AMA plan for general practice will involve:

  • significant changes to Chronic Disease funding, including a process that strengthens the relationship between a patient and their usual GP, and encourages continuity of care;
  • cutting the bureaucracy that makes it difficult for GPs to refer patients to allied health services;
  • formal recognition in GP funding arrangements of the significant non-face-to-face workload involved in caring for patients with complex and chronic disease;
  • additional funding to support enhanced care coordination for those patients with chronic disease who are at risk of unplanned hospital admission – a similar model to the Coordinated Veterans Care Program funded by the Department of Veterans Affairs;
  • a properly funded Quality Improvement Incentive under the Practice Incentive Program – the PIP;
  • changes to Medicare that improve access to after-hours GP care through a patient’s usual general practice;
  • support for patients with chronic wounds to access best practice wound care through their general practice;
  • better access to GP care for patients in residential aged care; and
  • annual indexation of current block funding streams that have not changed for many years … including those that provide funding to support the employment of nursing and allied health professionals in general practice.

In the longer term, we need to look at moving to a more blended model of funding for general practice.

While retaining our proven fee-for-service model at its core, the new funding model must have an increased emphasis on other funding streams, which are designed to support a high performing primary care system.

This will allow for increasing the capability and improving the infrastructure supporting general practice to allow it to become the real engine room of our health system.

It is about scaling up our GP-led patient-centred multidisciplinary practice teams to better provide the envelope of health care around the patient in their journey through the health system.

A good example is the Blacktown Hospital Diabetes Outpatient Clinic in New South Wales.

This Clinic has a waiting time of less than a week because the service is distributed to its catchment GPs with the appropriate funding and support for both personnel and infrastructure.

This is a small example, but a significant one when you consider the scale and prevalence of diabetes across Australia, let alone the western suburbs of Sydney, and the average access times for outpatient hospital clinics.

We cannot continue to do things the way we always have.

The bulk-billing rate should not be the metric by which we judge the performance of general practice.

Chronic conditions have become more prevalent in Australia. The ones causing most concern are:

  • arthritis;
  • asthma;
  • back pain and problems;
  • cancer;
  • cardiovascular disease;
  • chronic obstructive pulmonary disease;
  • diabetes; and
  • mental health conditions.

One in two people now report having at least one of these eight common chronic conditions.

These conditions account for around 60 per cent of the total disease burden, and they contribute to nearly 90 per cent of deaths in Australia.

We must reshape our primary care system to meet these challenges.

We must put in place the funding support that general practice needs to better manage patients in the community – and keep people out of hospital.

Our plan is a smarter and more sustainable blueprint … a better plan for general practice. A better plan for Australians.

Public hospitals

We also need a better plan for public hospitals.

In an election year, voters tend to focus very closely on public hospitals when they are comparing health policies.

Public hospitals are a critical part of our health system. They are highly visible. They are greatly loved institutions in the community. They are vote changers.

The doctors, nurses, and other staff who work in our public hospitals are some of the most skilled in the world.

In 2016-17, public hospitals provided more than six and a half million episodes of admitted patient care. They managed 92 per cent of emergency admissions.

If the state of general practice is crook, then our public hospitals are on permanent code yellow.

Despite their importance, and despite our reliance on our hospitals to save lives and improve quality of life, they have been chronically underfunded for too long.

Between 2010-11 and 2015-16, average annual real growth in Federal Government recurrent funding for public hospitals has been virtually stagnant – a mere 2.8 per cent.

The AMA welcomes that, between 2014-15 and 2015-16, the Federal Government boosted its recurrent public hospital expenditure by 8.4 per cent.

But a one-off modest boost from a very low base is not enough.

I deal with the results of stressed public hospitals every day and manage the impact it has on my patients.

Ollie is a patient with well-controlled Parkinson’s disease. He now also has a recently diagnosed lung cancer, which has been caught early, resected, and appropriately managed.

But he has been denied care for his resulting poor control of his Parkinson’s disease in the same hospital’s neurology outpatient department and referred back to me.

I have been advised that I must source an alternative option for his neurological care.

Another of my patients, Carlo, is a victim of the never ending Federal-State buck passing when it comes to health.

Having developed poorly controlled reflux and having been referred to the local hospital outpatient department for a gastro consult, Carlo was referred back to me.

I was advised that I had to arrange a referral at the same hospital’s diagnostic imaging service for a possible coordination and swallowing problem, which ultimately proved correct.

He was then referred back to the gastroenterology department to manage his newly diagnosed oesophageal condition.

Barbara is another very common example of the funding chaos.

She is a very active 68-year-old lady who was troubled by severe osteoarthritis of the knee for many years. She was placed on a waiting list for surgery two years ago.

She has had to attend our practice regularly for pain management and supportive referrals for physiotherapy, while I continued to manage the consequences of her inability to lose weight due to her exercise restrictions and worsening diabetes and blood pressure profile.

She has just finally had her knee joint replaced.

These are the experiences of everyday patients.

They underpin the troubling headlines that came from the AMA’s 2018 Public Hospital Report Card. Our hospitals are stretched to the limit.

Likewise, the AMA’s Safe Hours Audit is a window into the lived experience of dedicated doctors, struggling to deliver quality care in over-crowded, under-funded hospitals.

But instead of helping the hospitals improve safety and quality, governments decided to financially punish hospitals for poor safety events.

There is no evidence to show that financial penalties work.

Health care is complex. Not all patient complications can be avoided.

The 2020-25 hospital funding agreement does little to improve the situation.

Funding levels stay the same, but public hospitals will have to do more with it to help coordinate patient care post-discharge.

The AMA supports better discharge planning and integrated care, especially for patients with complex and chronic disease.

But this will cost money – and public hospitals need extra funding.

The AMA calls on the major parties to boost funding for public hospitals beyond that outlined in the next agreement.

There must be a plan to lift public hospitals out of their current funding crisis, which is putting doctors and patients at risk.

Governments must stop penalising hospitals for adverse patient safety events.

We need policies to fully fund hospitals. We must help them improve patient safety and build their internal capacity to deliver high value care in the medium to long term.

They must link up and work with primary care to deliver better coordinated care.

I note that Labor has pledged an extra $2.8 billion for public hospitals.

I expect that the Coalition will match that as the election draws nearer.

They do not want another Medi-scare style campaign.

Medical care for older Australians

Older Australians are voters, too.

Aged care was, until very recently, one of the highest profile segments of the health system – but for all the wrong reasons.

It is now emerging as an area in need of significant reform as the population ages and lives longer.

Older Australians all too frequently do not have the same access to medical care as other age groups – a longstanding result of inadequate funding in the aged care system.

This inequity will likely only grow as the Australian population ages with more complex, chronic medical conditions requiring more medical attention than ever before.

We have witnessed numerous consultations and reviews.

Enough! Now is the time for action.

There is already sufficient information to underpin the final recommendations. It is simply unfair and unjust to delay this any further.

An increase in funding for GP visits to aged care facilities would result in many savings, including from reduced ambulance transfers to hospital emergency departments.

Changes to after-hours care remuneration must consider services that are currently provided under ‘urgent’ item numbers to patients in aged care facilities.

We also need to ensure that the critical role that nurses play in caring for older Australians is recognised in those facilities.

The AMA wants to see Medicare rebates that adequately cover the time that doctors spend with the patient assessing and diagnosing their condition and providing medical care.

We want new telehealth Medicare items that compensate GPs, and other medical specialists, for the time spent organising and coordinating services for the patient.

This includes the time that they spend with the patient’s family and carers to plan and manage the patient’s care and treatment.

There must be funding for the recruitment and retention of quality, appropriately trained aged care staff.

And we must reverse the decline in the proportion of Registered Nurses in aged care.

The AMA Aged Care Survey, released today, shows that AMA members who work in aged care have identified the shortage of Registered Nurses – who should be available 24 hours a day – as the biggest priority for aged care reform.

The survey also shows that one in three doctors are planning to cut back on, or completely end, their visits to patients in aged care facilities over the next two years.

This is largely because the Medicare rebates are inadequate for the amount of time and work involved.

The AMA will ensure that aged care gets the attention and profile it deserves in the election campaign.

Private health insurance:

Private health insurance has been in the headlines for much of the past year – again, for all the wrong reasons.

The AMA has always called for a simpler and fairer private health insurance system.

Without the private system, the public system would likely collapse.

But we cannot expect the private system to thrive – or even survive – if there is not value in insurance policies.

Patients are smart – they know there is no point outlaying thousands of dollars every year if the coverage isn’t there.

Affordability means very little without value.

We are clearly at a crisis point in private health insurance. And the Government knows it.

Hence the latest Review, and the recent announcement by the Minister of new categories of policies … and greater transparency.

We support the concept of developing Gold, Silver, and Bronze insurance categories.

We can’t expect consumers to understand the many different definitions, the carve outs, and exclusions of some 70,000 policy variations.

Australians want reasonable and simple things from their insurance.

They want coverage.

They want a choice of the practitioner, and a choice of the hospital.

They want treatment when they need it.

We can’t have patients finding out they aren’t covered after the event, or when they require treatment and it’s all too late.

To that end, we have been very clear – we don’t support the use of restrictions in Gold, Silver, and Bronze.

Restrictions lead people to believe they are covered, when in reality they are exposed to additional costs.

We don’t support junk policies. If a Basic policy category doesn’t provide much coverage, that should be made crystal clear.

We don’t support dismantling community rating. This must be protected to maintain equity of access to private health treatment.

When the objective is to support a strong private health sector to take pressure off the public sector, it makes no sense to financially discourage the patients who are most likely to need access to private health.

We support standard clinical definitions. Whatever is involved for coverage for heart conditions should not vary between insurers and policies.

I urge the Government to continue to work with the Colleges to ensure that these definitions are robust.

There is increasing corporatisation of private health and the market power is shifting in favour of private health insurers.

Insurers, whether private or via Medicare, cannot determine the provision of treatment in Australia.

They cannot and must not interfere with the clinical judgement of medical practitioners.

Australians do not support a US-style managed care health system. Neither does the AMA.

One area we are disappointed with in the recent announcements is pregnancy cover.

It does not make sense to us, as clinicians, to have pregnancy cover in a higher level of insurance only.

Many pregnancies are unplanned – meaning people are caught out underinsured when pregnancy is restricted to high-end policies.

Pregnancy is a major reason that the younger population considers taking up private health insurance.

They are less likely to be able to afford the higher-level policies. We need to make sure it is within reach.

I having female reproductive services at a different level to pregnancy coverage is, to us, problematic, and will leave a lot of people caught out.

There will be much more to talk about as the private health reforms are finalised and bedded down.

Mental Health

As a suburban GP who sees the whole range of health ailments and conditions, an area of special interest to me is mental health.

I do not think the unique role and special skills of GPs are used enough at the front line of mental health care.

The AMA earlier this year called for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.

Almost one in two Australian adults – that is more than seven million people – will experience a mental health condition in their lifetime.

Almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague.

The statistics are startling. For example:

  • More than half a million children and adolescents, aged four to 17, experienced mental health disorders in 2012-13.
  • Australians living with schizophrenia die 25 years earlier than the general population, mainly due to poor heart health.

And yet mental health and psychiatric care are grossly underfunded.

Strategic leadership is needed to integrate all components of mental health prevention and care.

For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.

There is no vision of what the mental health system will look like in the future.

Poor access to acute beds for major illness leads to extended delays in emergency departments.

Poor access to community care leads to delayed or failed discharges from hospitals.

And poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.

Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.

We have repeatedly called for support for carers of people with mental illness, which is often the result of necessity, not choice.

Access to respite care is vital for many people with mental illness and their families, who are the ones who bear the largest burden of care.

Indigenous health

I am very pleased that one of my first announcements as AMA President was the AMA endorsement of the Uluru Statement from the Heart.

The Uluru Statement expresses the aspirations of Aboriginal and Torres Strait Islander people with regard to self-determination and status in their own country.

The AMA has for many years supported Indigenous recognition in the Australian Constitution.

The Uluru Statement is another significant step in making that recognition a reality.

The AMA is committed to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples.

It is simply unacceptable that Australia, one of the wealthiest nations in the world, cannot solve a health crisis affecting fewer than three per cent of its citizens.

Prevention

There is not enough time today to cover all the issues I would like to cover in one speech.

I could deliver a whole speech on each of the following topics – medical workforce, rural health, medical research, genetic testing, e-cigarettes and vaping, opioids, medicinal cannabis, scope of practice, asylum seeker health, the NDIS, or palliative care, to name just a few.

I could probably manage a few words about the My Health Record, too. No doubt there will be questions about that.

But I have to talk to you about prevention, if only briefly.

The burden of chronic disease in Australia is significant.

Chronic disease is responsible for around 83 per cent of premature deaths and 66 per cent of the burden of disease.

Chronic disease has a significant impact on the health system, but the reality is that most of these conditions can be prevented.

It simply makes enormous sense to invest in prevention.

Taxes collected from tobacco and alcohol excise generate around $16 billion each year for the Government.

In return, total Government spending on prevention is around $2 billion a year, which equates to about $89 per person.

This amounts to a measly 1.34 per cent of all health spending. This is considerably less than comparable countries such as Canada, the United Kingdom, and New Zealand.

If we are to reduce the impact of chronic disease in Australia, all our governments must invest more in prevention.

Tackling obesity is a priority.

Doctors are well placed to identify and support patients who are overweight or obese. Two thirds of adults are either overweight or obese.

The evidence shows that advice to lose weight given by a doctor increases the motivation to lose weight. It also increases engagement in weight loss behaviours.

But the support and advice from doctors can only achieve so much.

Population level measures are needed. We need to see action on a sugar tax, banning junk food advertising to kids, and improving urban planning to help get people moving and active.

Governments have the tools to implement these measures. A sugar tax would be a good start.

In closing, I know the challenges ahead for the health system.

I will dedicate my Presidency to improving health policy so that we have a system that delivers the best possible care to our patients.

The AMA will be a very strong and loud advocate.

There is nothing like a Federal election to help our political leaders share the public’s interest in good health policy.

The election will happen within twelve months, possibly this year.

Along with the members of the National Press Club, the AMA will be watching the political events of this weekend and the coming months with very close interest.

NACCHO Aboriginal Health and Obesity NEWS : 1.Network Submission to the Select Committee’s #Obesity Epidemic in Australia Inquiry and our 13 recommendations: 2.Healthy Food Partnership Survey

 

” The 2012-13 Health Survey identified that Indigenous adults were 1.6 times as likely to be obese as non-Indigenous Australians, with the prevalence increasing more rapidly in Aboriginal school-aged children.

Overweight and obesity in childhood are important predictors of adult adiposity, increasing the risk of developing a range of medical conditions, each of which is a major cause of morbidity, mortality and health expenditure.

While it is surprisingly clear what needs to be done to improve the health of Indigenous children, recent cuts to Indigenous preventative workforce and nutrition programs throughout Australia have severely reduced the capacity to respond.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care.

The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve. “

Extract from NACCHO Network Submission to the Select Committee’s Obesity Epidemic in Australia Inquiry. 

Download the full 15 Page submission HERE

Obesity Epidemic in Australia – Network Submission – 6.7.18

 ” The Healthy Food Partnership is a mechanism for government, the public health sector and the food industry to cooperatively tackle obesity, encourage healthy eating and empower food manufacturers to make positive changes.

The Healthy Food Partnership’s Reformulation Working Group has developed draft reformulation targets for sodium, sugars and/or saturated fats, in 36 sub-categories of food.  These food categories are amongst the highest contributors of sodium, sugars and saturated fat to Australian population level intakes.”

See Healthy Food Partnership Survey Part 2 Below

Read over 50 NACCHO Aboriginal Health and Obesity articles published in past 6 years 

 

Introduction to NACCHO Network Sumission and selected extracts 

The National Aboriginal Community Controlled Health Organisation (NACCHO) is the peak body representing 143 Aboriginal Community Controlled Health Services (ACCHSs) across Australia.

ACCHSs provide comprehensive primary health care to Aboriginal and Torres Strait Islander people through over 300 Aboriginal medical clinics throughout Australia.

ACCHSs deliver three million episodes of care to around 350,000 people each year, servicing over 47% of the Aboriginal population, with about one million episodes of care delivered in remote areas.

The Aboriginal Community Controlled Health Service (ACCHS) sector is the largest single employer of Indigenous people in the country, employing 6,000 staff, the majority of whom are Aboriginal or Torres Strait Islander.

The evidence that the ACCHS model of comprehensive primary health care delivers better outcomes than mainstream services for Aboriginal people is well established.

Without exception, where Aboriginal people and communities lead, define, design, control and deliver services and programs to their communities, they achieve improved outcomes.

The ACCHS model of care has its genesis in Aboriginal people’s right to self-determination, and is predicated on principles that incorporate a holistic, person-centred, whole-of-life, culturally secure approach.

The ACCHS principles of self-determination and community control remain central to wellbeing and sovereignty of Aboriginal people. Equipped with inequitable levels of funding and resources ,

ACCHSs continue to meet the ongoing challenges of addressing the burden of disease in Aboriginal communities.

Executive summary

The National Aboriginal Community Controlled Health Organisation (NACCHO) welcomes the opportunity to provide input into the Inquiry into the Obesity epidemic in Australia.

Aboriginal and Torres Strait Islander people represent approximately 3% of the Australian population yet are disproportionately over-represented on almost every indicium of social, health and wellbeing determinant.

Social determinants and historical factors such as intergenerational trauma, racism, social exclusion, and loss of land and culture are commonly recognised as causative factors for these disparities.

In 2008 the Council of Australian Governments (COAG) committed to addressing the health disparity between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by adopting the Closing the Gap initiative. Whilst gaining some success in achieving convergence for some health indicators, wide health and wellbeing disparity still remains for both children and adults.

The life expectancy gap between Indigenous and non-Indigenous Australians remains 10.6 years for males and 9.5 years for females.

As a major contributor to morbidity and mortality among Indigenous Australians, obesity is estimated to account for 16% of the health gap between Aboriginal and Torres Strait Islander peoples and the total Australian population.

Comprehensive primary health care is a key strategy for improving the health of Indigenous Australians and is an important platform from which to address complex health and social issues associated with obesity.

Closing the Gap, including the gap attributable to obesity, requires ensuring the ACCHS sector is resourced to deliver the full range of core services required under a comprehensive and culturally safe model of primary health care. The effectiveness of ACCHSs has long been recognised, with many able to document better health outcomes than mainstream services for the communities they serve.

Combating the burden of obesity and its health effects for Indigenous Australians demands a strategic and coordinated whole-of-society approach at a national level by the Federal Government.

Without coordinated, sustained national action, efforts to improve the health status of Aboriginal children are likely to fail. In recognising the need to seriously address this critical and increasing gap in Indigenous health, NACCHO welcomes this inquiry and proposes the following recommendations:

  1. Government to work in partnership with NACCHO and the ACCHS sector to develop policies and plans that are responsive to the needs of Aboriginal communities
  2. A commitment to increase the understanding of Aboriginal and Torres Strait Islander peoples of the health significance of overweight and obesity, and facilitating access for these communities to resources which support healthy eating and physical activity
  3. Additional investment to build organisational capacity within the ACCHS sector and to increase the capacity of Aboriginal Health Promotion Officers to maintain a focus on public health initiatives
  4. Government to encourage professional support systems for, and assist Aboriginal Health Worker’s and other primary care workers to provide advice to adults and children about weight management as part of existing health checks and screening programs – this may be achieved by encouraging the MBS Aboriginal Health Check item to communicate more effectively the importance of physical activity, nutrition and weight management
  5. Fund the development of Aboriginal and Torres Strait Islander cultural awareness training for health care professionals covering care, education and information relating to food, physical activity, lifestyle choices and health service arrangements
  6. In understanding that health promotion is more difficult in regional and rural Australia, targeted funding should be dedicated to these areas to overcome the pervasive problems associated with distance
  7. A commitment to ongoing consultation with Aboriginal communities on what can be achieved at a local level to effectively promote healthy eating and physical activity for children
  8. Facilitate access for Aboriginal and Torres Strait Islander communities to resources which support lifestyle changes, including access to information, physical activity opportunities, and healthy food choices
  9. The prevalence of childhood obesity and the absence of culturally specific programs for Aboriginal and Torres Strait Islander people warrants further work in the development of culturally appropriate programs and tailored communication strategies alongside mainstream campaigns and messages
  10. Given the paucity of studies on Indigenous children, there is a need for further research on effective obesity prevention interventions for Indigenous families. This requires commitment to more detailed monitoring of young Indigenous children’s diets and their physical activity
  11. Government to work with the food industry and community stores to implement retail intervention strategies to positively influence access to and consumption of healthy food choices for Aboriginal and Torres Strait Islander communities
  12. Consider mechanisms to sustain programs on physical activity, nutrition and weight management that have proven effective
  13. Ensure significant participation of Aboriginal and Torres Strait Islander people in national surveys and evaluations by enhancing the sampling frame and applying culturally appropriate recruitment strategies

Evidence-based measures and interventions to prevent and reverse childhood obesity, including experiences from overseas jurisdictions

Evidence-based profiling of obesity and overweight in Indigenous Australian children has been poor, with very little known about the effectiveness of culturally adapted children’s interventions. Given the impact on health, finances and community, the need for better strategies and interventions to manage obesity are now being recognised by the entire health system.

Historically, initiatives have focused on nutrition or physical activity as separate entities and have shown modest effects. In recent years, global interventions considering the wider ‘obesogenic environment’ have been recommended, with policymakers and public health practitioners increasingly turning to evidence-based strategies to discover effective interventions to childhood obesity.

It is important to note, however, that the rapidly growing body of literature has meant many recommendations for childhood obesity have often relied on research that has not been systematically reviewed and focused more on assessing the internal validity of study results than on evaluating the external validity, feasibility or sustainability of intervention effects.

Experience in several countries has shown that successful obesity prevention during childhood can be achieved through a combination of population-based initiatives.li There is strong evidence for the effectiveness of school-based strategies, acting as an ideal setting for interventions to support healthy behaviours, and can also potentially reach most school age 9 children of diverse ethnic and socioeconomic groups. The Centre for Disease Control and Prevention (CDC) recommends a curriculum that is culturally appropriate and a school environment that reflects the culture within the community by demonstrating cultural awareness in healthy eating and physical activity practices.l

Examples of school-based strategies include policies that limit student access to foods and beverages that are high in fats and sugar, contributing to decreased consumption during the school dayliii, and efforts to increase physical activity leading to a lowered body mass indexliv and improved cognitive abilities,lv especially in younger children. An evaluation of a school-based health education program for urban Indigenous youth found compromising results in physical activity, breakfast intake and fruit and vegetable consumption, all of which are core components of healthy weight management.lvi

Studies have examined the effectiveness of culturally specific versions of programs to tackle obesity, including a US study comparing a mainstream program with a culturally adapted version. Findings were that cultural adaptations improved recruitment and retention numbers, with the authors recommending that to improve program design, ethnic communities and organisations should be approached to collaborate with researchers in design, modifications, recruitment techniques, implementation, evaluation and interpretation of results.lvii

A 2013 Canadian pilot evaluation of a whole-school health promotion program, Healthy Buddies, involved researchers consulting Aboriginal community members about how the program could be more effective, sustainable and culturally appropriate, resulting in a new version called Healthy Buddies – First Nations. Prior to implementation, communities were able to review the program and tailor its cultural appropriateness. Lesson content and visual aids were amended to resemble Aboriginal children, as well as Aboriginal food and activities.lviii In promoting social responsibility through the buddy system, the program showed a significant lowering in BMI and waist circumference and was considered particularly important for remote communities.

Systematic and evidence-based reviews have suggested promise in tailoring programs to be more culturally appropriate for specific ethnic and culturally diverse groups. The 2014 Global Nutrition Report, which examined the limited access to supermarkets and a reliance on fast-food as contributing to the growing prevalence of obesity in American Indian communities, recommended that interventions need to be multi-faceted, culturally sensitive, grounded in cultural traditions, and developed with full participation of American Indian communities.lix

Similar recommendations were made in a review by Toronto Public Health, identifying that interventions targeting children from low socioeconomic or culturally diverse backgrounds can positively impact on physical activity levels and dietary intake. This highlights the need to consider focusing on specific cultural backgrounds, like Indigenous Australians, when planning obesity prevention interventions to achieve better outcomes.

The role of the food industry in contributing to poor diets and childhood obesity in Australia

Improving the access to and availability of nutritious food is a vital step to combating the prevalence of obesity. Indigenous people living in rural and remote areas in particular face significant barriers in accessing nutritious and affordable food.

The level and composition of food intake is influenced by socio-economic status, high prices, poor quality fruit and vegetables in community stores, and unavailability of many nutritious foods.lxi This is indeed exacerbated by the exposure to high levels of unhealthy food marketing across a range of media. 10

The ubiquitous marketing of unhealthy food creates a negative food culture, undermining nutrition recommendations.

Substantial research documents the extensiveness and persuasive nature of food marketing in Australia; importantly, the vast majority of all food and drink marketing, regardless of medium or setting, is for food and drinks high in fat, sugar and/or salt.lxii Australian children are exposed to high levels of unhealthy food marketing through a range of mediums, including sponsorship arrangements with children’s sport. With research identifying a logical sequence of effects linking food promotion to individual-level weight outcomes,lxiii it is clear that food marketing influences children’s attitudes and subsequent food consumption.

Australia’s National Preventative Health Taskforce has highlighted the importance of restricting inappropriate marketing of unhealthy food and beverages to children as a cost-effective obesity prevention strategy.lxiv Clear affirmative action in Australia to such marketing has been lacking to date, compounding the need for Government to explore options for regulating the production, marketing and sale of energy-dense and nutrient-poor products to reduce consumption.

Research has shown that the prevalence of obesity increases and consumption of fruit and vegetables decreases with increasing distance to grocery stores and supermarketslxv and a higher density of convenience stores and take-away food outlets.lxvi Cost is also a major issue, with the price of basic healthy foods increased by 50% or more in rural and remote areas where there is a higher proportion of Indigenous residents compared to non-Indigenous residents than in urban areas.lxvii The purchasing behaviour of children is particularly sensitive to price, and can have significant effects over time.

Foods of better nutritional choice, including fresh fruits and vegetables, are often expensive due to transportation and overhead costs, or only minimally available.lxviii Comparatively, takeaway and convenience food, often energy-dense and high in fat or sugar, are less affected by cost and availability.

A study of intake of six remote Aboriginal communities, based on store turnover, found that intake of energy, fat and sugar was excessive, with fatty meats making the largest contribution to fat intake.lxx Compared with national data, intake of sweet and carbonated beverages and sugar was much higher in these communities, with the proportion of energy derived from refined sugars approximately four times the recommended intake.

Recent evidence from Mexico indicates that implementing health-related taxes on sugary drinks and on ‘junk’ food can decrease purchase of these foods and drinks.lxxi A recent Australian study predicted that increasing the price of sugary drinks by 20% could reduce consumption by 12.6%.lxxii Revenue raised by such a measure could be directed to an evaluation of effectiveness and in the longer term be used to subsidise and market healthy food choices as well as promotion of physical activity.

It is imperative that all of these interventions to promote healthy eating should have community-ownership and not undermine the cultural importance of family social events, the role of Elders, or traditional preferences for some food. Food supply in Indigenous communities needs to ensure healthy, good quality foods are available at affordable prices.

In Summary

It is widely understood that many Aboriginal and Torres Strait Islander people, predominantly children, are at high-risk of ill-health due to overweight and obesity. This is likely to lead to a widening gap in health outcomes for Indigenous Australians if prevention efforts are not improved. Despite the identified health and economic gains which can be achieved by using a social determinants and culturally appropriate approach, Australia is yet to embed such thinking in health policy.

Policy in isolation will not solve the epidemic of childhood obesity for Indigenous children. What is required, is urgent action to address poverty, education, unemployment and housing, all of which are factors that shape a child’s ability to engage with healthy behaviours. There also needs to be close ongoing national monitoring through the collection of comparable data; more detailed monitoring of the composition of young Indigenous children’s diets and physical activity is necessary to determine whether patterns are changing in response to interventions.

Undeniably, strategic investment is needed to implement population-based childhood obesity prevention programs which are effective and also culturally appropriate, evidence-based, easily understood, action-oriented and motivating. Interventions must be positioned within broad strategies addressing the continuing social and economic disadvantages that many Indigenous people experience and need to have an emphasis on training community-based health workers, particularly in the ACCHS sector who are best placed to respond to the increasing rates of obesity and associated health concerns for Aboriginal and Torres Strait Islander people.

The ACCH sector has a central role in promoting and improving health outcomes for Indigenous people yet requires additional targeted funding and resources to implement new initiatives, including intervention, education, and research to encourage physical activity and healthy nutrition. Indeed, multifaceted strategies involving the public, private and ACCHS sector, along with community participation and government support, are required to gradually reverse this trend.

NACCHO and its Affiliates in each State and Territory appreciate the opportunity to make this submission on behalf of our member services. With circumstances unimproved after years of policy approaches, the need remains to overturn the prevalence of overweight and obesity of Indigenous people. There needs to be a commitment at all levels of government in terms of funding, policy development, and support for the implementation of culturally appropriate programs and services. There must be a recognition that self-determination of Aboriginal and Torres Strait Islander people will be the foundation of true progress.

NACCHO strongly recommend that Government engage in meaningful dialogue with NACCHO, NACCHO’s Affiliates in each State and Territory and ACCHSs in relation to the proposals canvassed in this response; and work in partnership to address the significant prevalence of obesity in Aboriginal and Torres Strait Islander people, especially children

 

Part 2 Overview Healthy Food Partnership Survey 

The Healthy Food Partnership is a mechanism for government, the public health sector and the food industry to cooperatively tackle obesity, encourage healthy eating and empower food manufacturers to make positive changes.

The Healthy Food Partnership’s Reformulation Working Group has developed draft reformulation targets for sodium, sugars and/or saturated fats, in 36 sub-categories of food.  These food categories are amongst the highest contributors of sodium, sugars and saturated fat to Australian population level intakes.

Please note the different closing dates relating to feedback on the various nutrient targets.

Why We Are Consulting

The Healthy Food Partnership (Partnership) recognises that many companies are already reformulating their products to improve the nutritional quality and aims to build on (rather than replicate) these efforts.

It is not the intention of the Partnership to disadvantage companies that are already reformulating, but to recognise and support their efforts to date, and encourage those companies that are yet to engage in reformulation activities to move towards improving the nutritional profile of their products.  Targets will create certainty for industry of what they, and their competitors, should be aiming for.

Feedback is sought on the feasibility of the draft targets, the appropriateness of the draft category definitions (including products which are included or excluded), and the proposed implementation period (four years).  Consultation feedback will inform the final recommendations of the Reformulation Working Group, to the Partnership’s Executive Committee.

Deidentified information from submissions will be provided to the Reformulation Working Group and other committees involved with the Healthy Food Partnership.

Submissions will be published at the end of the consultation period, unless confidentiality has been requested.

Begin survey

NACCHO Aboriginal Health and #Obesity : Contributions to the Select Committee into the #obesity epidemic in Australia close 6 July

” More than two-thirds (69%) of Aboriginal and Torres Strait Islander adults were overweight or obese (29% overweight but not obese, and 40% obese). Indigenous men (69%) and women (70%) had similar rates of overweight and obesity (ABS 2014a).

One-third (32%) of Indigenous men and more than one-quarter (27%) of Indigenous women were overweight but not obese, while 36% of Indigenous men, and 43% of Indigenous women were obese ”

See NACCHO Aboriginal Health article

There is clear and robust evidence that children’s exposure to unhealthy food advertising influences their food choices, influences their diets, and can contribute to poor diets, overweight and obesity.

Despite Australian children’s high rates of overweight and obesity, there are few controls on advertising practices targeting advertisements for unhealthy foods and beverages to children in Australia and much is left up to self-regulation by the food and beverage industry.

The Obesity Policy Coalition advocates for improved regulatory controls to reduce children’s exposure to this type of harmful advertising

SEE OPC Page

“Sixty-three per cent of Australian adults and 27 per cent of our children are overweight or obese.

This is not surprising when you look at our environment – our kids are bombarded with advertising for junk food, high-sugar drinks are cheaper than water, and sugar and saturated fat are hiding in so-called ‘healthy’ foods. Making a healthy choice has never been more difficult.

The annual cost of overweight and obesity in Australia in 2011-12 was estimated to be $8.6 billion in direct and indirect costs such as GP services, hospital care, absenteeism and government subsidies.1 “

 OPC Executive Manager Jane Martin 

Download the report HERE  tipping-the-scales

Read over 90 Aboriginal Health Obesity articles published over the past 6 years

The Senate is currently holding a Select Committee into the Obesity Epidemic in Australia, with a focus on childhood obesity. The Committee will be exploring the prevalence, causes, harm and economic burden of childhood obesity. They will also be exploring the effectiveness of existing policies and programs to address childhood obesity and role of the food industry in contributing to childhood obesity.

The Select Committee provides a valuable opportunity for us to show that there is an urgent need for action to prevent obesity, particularly among children. It also comes at a critical time when pressure is mounting on the Australian Government to act.

Submissions to the Inquiry are due by Friday 6 July 2018. Submissions can be made to Committee Secretary at obesitycommittee.sen@aph.gov.au. You can also find out more about the Committee here.

If you want to put in a submission please use one of the following:

Please use this opportunity to encourage others to make a submission on this important issue, the more submissions the better.

If you want to share this with your colleagues through your website or bulletins, here is some material to use.

Tipping the Scales report

In September 2017 more than 35 leading community, public health, medical and academic groups united for the first time to call for urgent Federal Government action to address Australia’s serious obesity problem.

In the ground-breaking report, Tipping the Scales, the agencies identify eight clear, practical, evidence-based actions the Australian Federal Government must take to reduce the enormous strain excess weight and poor diets are having on the nation’s physical and economic health.

Led by the Obesity Policy Coalition and Deakin University’s Global Obesity Centre (GLOBE), Tipping the Scales draws on national and international recommendations to highlight where action is required.

Tipping the Scales: Australian Obesity Prevention Consensus

This consensus document delivers a rigorous and evidence-based agenda to our Federal Government and establishes the key elements to include in a national strategy, as well as the basis for an ongoing dialogue, about the best ways to address the obesity epidemic.

Tipping the Scales: summary sheet

Summary document of the Tipping the Scales eight key points.