Oral Presentation Australian & New Zealand Obesity Society 2014 Annual Scientific Meeting

Overweight and obesity in remote Indigenous Australia: Opportunity in a context of social inequity (#14)

Julie Brimblecombe 1

The food system for Indigenous Australians has changed drastically from a bio-diverse diet of lean animal foods and nutrient-rich plant foods to one characterized by much less variety and a proliferation of convenient, nutrient-poor, highly-refined processed foods. Such dietary changes have worsened health inequality of Indigenous peoples across the globe. In Australia, colonization of the diet has occurred in the living memory of Indigenous people, who now experience the highest burden of disease in Australia. Sixty-six percent of Indigenous Australians, similar to the rest of Australia, are overweight or obese. The consequences of this are devastating with those experiencing obesity 7 times more likely to have type 2 diabetes, and 5 times as likely to have a high triglyceride, compared to those with a normal weight - and still more likely than obese non-Indigenous Australians to experience chronic disease (e.g., 17% with type 2 diabetes compared to 11%; 20% with chronic kidney disease compared to 13%). Risk is increased again for Indigenous Australians living in remote communities. Diet is key to preventing this enormous burden of disease and the impact it has on the daily lives of people. Shifting diet is challenging and especially so for populations of lower socio-economic position. Food costs in remote communities are high meaning Australia’s poorest are paying the most for food. This inequity is widening with the increasing dominance of Australian supermarkets and their lower prices campaign. Remote communities however do have an advantage - they are uniquely placed to determine their food supply and make the healthiest choice the easiest choice for consumers. Firstly, their geographic remoteness, while it has its disadvantages in terms of freight costs and seasonal delivery disruptions, means that communities have relatively closed food systems. Secondly, the community stores are mostly community owned and governed by a store board comprising elected community members. Lastly, community leaders recognise the role of the store in the health and wellbeing of the community and are eager to support change. The ‘Good Food Systems: Good Food For All’ project developed an approach to capitalise on this opportunity and support store boards use the 4Ps of marketing to promote healthy food and use store sales data to track progress. This approach, when used in the context of supportive national and local policy and community wide nutrition promotion, looks promising. Dietary improvement for Indigenous Australians and closing the life expectancy gap will be achieved only with support for stores to provide an affordable food supply. A study funded by the National Health and Medical Research Council, SHOP@RIC, will provide much needed evidence on the role of price subsidies in improving diet in remote Indigenous Australia. This study has successfully been implemented in 20 remote communities in the NT. All communities received a 6 month 20% price discount on fresh and frozen fruit and vegetables, water and diet soft drinks. Ten communities also received a 6- month interactive nutrition education program. Study findings will be available in 2015.