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Hello, I'm Daniel Browning.
Welcome to this program on nutrition in Indigenous communities.
On behalf of everyone, I would like to acknowledge
that we are meeting on the land of the Wangal people.
The Wangal people are the traditional owners of this land,
and form part of the wider Aboriginal nation
commonly known as Eora.
We also acknowledge the elders and descendants of the Wangal people.
Eating healthy food is vital to increasing the life expectancy
of Indigenous Australians.
Good nutrition in mothers and babies
helps prevent infections and illness in children.
It also helps prevent the development of chronic disease in later life.
That may sound simple but in fact it's a complex business,
and that's what we're going to talk about in this program.
We'll look at some really good work that's being done
in rural and remote Australia to improve our people's health and nutrition.
You'll find useful links to resources
on the Rural Health Education Foundation's website:
Now let's meet our panel in order.
Andy Hume is a GP registrar and researcher
at the Menzies School of Health Research in Darwin.
His work as a doctor in the Northern Territory
made him aware of the massive burden of malnutrition
and associated lifestyle disease within communities
and the potential of community-grown fresh fruit and vegetables.
- Welcome, Andy. - Thanks, Daniel.
Anthea Fawcett is the founder and director
of the Remote Indigenous Garden Network.
She has 20 years of experience in sustainability, sustainable design,
critical studies and intercultural communication,
and she has a passion for local food production.
- Hello, Anthea. - Hello.
Ian Lacey is a Mandandanji and Waka Waka man from Queensland.
He's the manager of the Preventative Health team
of the Institute of Urban Indigenous Health in Brisbane.
He had to live a healthy lifestyle during his professional football career
with the Brisbane Broncos,
and he continues to encourage us all to live a healthy lifestyle.
- Welcome, Ian. - Thank you.
Kerin O'Dea is the director of the Sansom Institute for Health Research
at the University of South Australia.
Her current research is focused on diet and lifestyle
in the prevention and treatment of diseases such as obesity,
type 2 diabetes and cardiovascular disease.
She has a particular interest in the health potential of traditional diets.
Hello, Kerin.
Welcome to you all.
Kerin, to start, why is good nutrition so basic and so important
to our health and wellbeing?
It's the foundation of a healthy life.
That's why we have to start thinking about it very early in life.
I say to people, even pre-pregnancy and certainly in utero,
it's terribly important that mothers are healthy and happy.
Smoking is a real problem, and a lot of Aboriginal women smoke.
It's really important that they try and give up during pregnancy, for example.
Really, a mother's perceived stress is problematic.
Again, we really want happy pregnancies.
Then when the baby is born, breastfeeding is terribly important
for many reasons, but good nutrition is certainly one of them.
That is the best food for a baby.
Then on it goes. Thinking about weaning foods, healthy weaning foods,
then preschool, then when children go to school.
All of those things are terribly important.
Then we get to chronic disease.
If you have a very healthy start to life,
you're less likely to be at risk of chronic disease as you grow older,
particularly if you get into good habits early in life.
As we'll discuss later,
if you can afford healthy food, that is also a terribly important issue.
With chronic disease, we often hear the figure with diabetes,
which is my particular interest, that it's two to four times higher
in Aboriginal than in non-Aboriginal people in Australia.
Actually, it's much worse than that.
Early-onset diabetes means that in the 20- to 50-year age group,
Aboriginal people have ten times,
and sometimes more than ten times higher rates of diabetes.
That increases heart disease, it increases blindness, kidney failure,
all of the things that go along with it.
So early intervention and healthy nutrition is absolutely fundamental
to dealing with any of these questions.
I might go through the panel and ask you all individually
why nutrition is so important.
Ian, why do you think we need to be really careful about our nutrition?
As Kerin said,
we really need to watch what we eat because of the fact that
we don't understand what we're eating most of the time.
Some people think they're eating good foods
and displaying good habits, but they're not.
As Indigenous and Torres Strait Islander people,
we're very visual in our learning.
It's been passed down for generations.
We see what someone does, and we act upon it.
We see what our family does, and we act upon it.
If you display eating good food at an early age,
you'll be able to help close the gap.
People will follow you.
If you show interest in doing good things
and you are a good leader in communities,
people will follow the fact that you do that.
If you eat good food at an early age, display it, be proud of it,
people will follow what you do.
Anthea, some quick comments about why nutrition is so important?
Good nutrition, a good diet, the ability to eat well for good health,
it is a key social determinant of health.
It sets the platform for the rest of your life.
For many people in Indigenous communities,
it has a huge impact on whether people have the ability to enjoy life,
to participate in life, to be able to concentrate at school.
It's about all those broader social benefits
that impact on the opportunities you will have.
Andy?
I'd come at it from a medical perspective
of seeing a huge burden of cardiovascular disease
in Aboriginal populations in the Northern Territory.
For me, the link between good nutrition -
particularly fruit and vegetable intake - and ischemic heart disease
has now been well proven.
It's a fundamental point to me that by improving nutrition and diets
in Aboriginal people, and any people,
we can reduce the levels of those disease burdens in populations.
For me, from a clinical perspective, seeing that day to day,
it really brings home to me the benefits of lifestyle change
and how effective that change can be on a larger scale
on changing those disease burdens.
Kerin, what's the picture across Australia,
and does it differ between remote, urban and rural areas?
That's a really interesting question.
The only area where we've got good data is kidney failure, kidney disease.
That certainly indicates that there's much more kidney failure,
people undergoing dialysis,
who identify as Indigenous in very remote parts of the country.
We don't understand the reasons for that.
It could be a high burden of infectious disease
as well as all of the other risk factors.
With diabetes, what information we have -
we don't have really good population-based data
in non-remote areas, we do in some remote communities -
does indicate that there possibly is a gradient, but it is not as steep.
So wherever Indigenous people are in the country,
they have a lot of diabetes and heart disease.
Andy, are there any recent interesting research findings,
perhaps the EPIC data?
Funny you should ask. I have it here in front of me.
There is some very good new data that's come out of Europe.
This is a study of 300,000 people, which is a huge and very powerful study
that looked at the risk of dying from ischemic heart disease
in association with multiple risk factors,
including people's fruit and vegetable intake.
They found, after waiting about 8.5 years,
that people who ate more fruit and vegetables were much less likely to die
of a stroke or a heart attack,
to the point where if you eat one more serve of fruit and vegetables,
it reduces your absolute risk of death by 4% per year over that entire period.
They looked at the difference between people
who ate eight serves of fruit and vegetables -
and these are 80g serves, so pretty much the same size
as the Australian standard for what a fruit and vegetable serving is -
all the way down to people who ate less than three.
Across that range, there was a 24% decrease in cardiovascular death risk,
which is remarkable and very significant.
Finally, it's not proof, but it's a very strong association
between fruit and vegetable intake and risk of death, so that's quite exciting.
As a GP, what are some of those clinical indicators of poor nutritional health?
I guess clinically, it's often difficult to tell what people eat.
People often don't give you a very accurate assessment of what they eat.
Kerin can probably speak more about dietary recall,
and how accurate that is in different populations.
I see a broad range of people coming in
with undernutrition and obesity, often at the same time.
Although people are big and they're getting enough energy -
their calorific intake is more than adequate -
they're not actually meeting their nutritional needs.
KERIN: That's very true.
Kerin, what do we know about traditional diet,
the historical and social context here?
That it was a very healthy diet,
that it was a very different diet to what people are eating today.
It was a hunter-gatherer diet.
It's the diet to which humans were probably all adapted
until agriculture, for some parts of the world, began 10,000 years ago.
The hunter-gatherer diet has a lot of animal foods in it, wild animals.
They're very different to our domesticated animals.
Much less fat on a carcass, a lot of lean.
People ate everything on that carcass.
They ate all the offal.
It's fascinating to know that in liver -
and it isn't just kangaroo liver, it's any liver -
vitamin C is stable, for example.
It's a wonderful source of folate, of zinc and iron,
bioavailable sources of those nutrients.
It's a very low-cost food
that I would encourage Indigenous people to continue eating,
and other offal as well.
Brain, for example, is the richest source
of long-chain omega-3 fats you can get.
It's very important for brain development,
very important for eye development, so very important for human development.
People now, all of us, are eating much less, probably, than what we need.
Then, plant foods were much less than in our current diet,
but the ones that people had were slowly digested carbohydrate -
yams, for example - and had beautiful flavour.
Some of the fruits and vegetables, probably not as sweet
and as easy to eat as many of our own fruits today,
but rich in nutrients
and full of antioxidants and anti-inflammatory agents.
So it's the absolute opposite to the very poor-quality diet
that many Indigenous people,
particularly in remote communities today, are eating.
We'll talk about some of the pressures
pushing people towards those types of diets.
Ian, a question for you. What factors would influence a person's diet?
They might be geographic, they might be economic.
There are a lot of factors at play.
Definitely geographic, definitely economic.
You look at two opposite ends of the spectrum
when you talk about remote and urban communities.
In remote communities, it's very hard to get good fruit and vegetables,
good sources of meat and fish.
The opposite end of the spectrum, in urban, which is where I am,
although we have got all this good stuff,
we've got the bad stuff at our disposal.
We've got to combat that.
You talk about knowing what the good food is,
but a lot of people know the bad food.
A lot of people eat food not understanding what the food is.
They think it may be good for you, but they don't have a full understanding
and they can't relate it to chronic disease.
If you can educate them better, let them be aware of what they're eating,
then give them the choice, most people will take that right choice.
I'm not sure about this, but do you think there's a typical diet
for the urban Indigenous person?
Definitely not.
There's not a typical diet for anyone.
People go through their fads.
They'll hear something good, and think, I might try it.
I said earlier, we're very visual people.
If we see our family eating bad, we'll try that.
That's not necessarily just Indigenous, that's society.
People will try different things and try and get the best way,
and if it doesn't work, they'll try something else.
There's not really a typical diet.
Without being too obstructive, I agree there's no typical diet,
but there's certainly some patterns
that have been seen in remote places in terms of diet
that are quite concerning.
Kerin sounds like she wants to talk about that.
Very poor-quality diet.
For example, in recent surveys, some colleagues have found
that white bread is the major source of protein in some communities.
That's extraordinary, 'cause there's so little protein in white bread,
so they must be eating a huge amount.
We know that Indigenous people love meat.
Traditionally, they ate a lot of meat.
But it's very difficult to afford high-quality lean meat and fish today.
We know, sadly, that there's very low intakes of fresh fruit and vegetables,
and unfortunately, very high intakes of sugar-sweetened beverages.
Those are some qualities.
We can discuss some of the reasons for that ,
but sadly there are patterns that are really disturbing.
Do you think bush tucker is a relevant concept for most Aboriginal people?
I'd be interested in other people's views on this.
I find it a wonderful way to talk to people about good nutrition,
to have that as the benchmark, and to be able to explain the problems,
the positives and negatives of the Western diet,
in the context of the traditional hunter-gatherer diet.
That's become my benchmark.
That's become my benchmark for judging any diet now, in many ways.
Anthea, what do you think about that?
Bush tucker - is it relevant for the communities that you've dealt with?
Very relevant. The way Kerin has described the importance of bush tucker
on two levels - if you can access it, it probably is the ideal diet,
not just for Indigenous people, for all of us.
It's also a great way of having the conversation about food
in a culturally relevant way.
That is so important, that people feel comfortable with the ideas
and can relate to the ideas in their local context.
Through the work of the Remote Indigenous Garden Network -
and we're about local food production, not just gardens -
we often talk about fusion gardens, or fusion approaches to food.
By that we mean celebrating and making the most of bush foods,
plant- and animal-based,
in conjunction with exotics - fruit and vegetables that are introduced.
Many bush foods, the traditional lean-meat bush foods,
are so profoundly important.
In many communities, where the communities have grown in number
and become settled in a single place,
access to bush foods is not as great as it once was,
which is a really big issue.
Then there are bush foods that are available
which have fantastic nutritional properties,
like gubinge, with vitamin C.
We're moving on to our case study.
21-year-old Yvonne is three months
pregnant with her first child.
She is generally healthy
and a little overweight.
She reports smoking
about ten cigarettes a day.
She drank alcohol occasionally
but stopped when she discovered
she was pregnant.
Yvonne lives in a remote community
in NSW where there is little access
to fresh fruit and vegetables.
She sometimes eats fresh fish
when the river is running,
but for most meals, she is dependent
on the community store.
Yvonne comes into the community clinic for a check-up.
Andy, what do you think are Yvonne's nutritional requirements
at this stage of her life?
She's about the end of her first trimester.
She's got a higher folate requirement than the average person,
anywhere between .5mg and 5mg per day,
depending on her risk for neural-tube defects.
She's got a higher iron requirement through pregnancy
and through lactation, if she chooses to breastfeed, which we would support.
Her protein requirement and energy requirement do increase.
Towards the end of pregnancy in the second and third trimester,
they go up a fair bit,
but not to the point where she needs to eat for two.
That's a common fallacy.
So that's her need in an academic sense.
In terms of my advice to her, I'd say, stick to a balanced diet.
Fruit and vegetables, the old two-and-five adage.
Keeping up her calcium intake with dairy.
I'd also take the time to talk about smoking
and the massive impact that can have on her child.
- Alcohol, which is... DANIEL: She's not drinking anymore.
I'd encourage that, that's great.
I'd also use the time to go through some of the risks that she faces
through her pregnancy of being overweight.
She's got a BMI of 27,
which in many populations, doesn't put her at increased risk,
but as an Aboriginal person and some other groups,
particularly Indians and I'm sure there's other populations,
she's at greater risk of developing complications through her pregnancy.
Why is that? I'm fascinated to know that the BMI index is used
to determine whether we're overweight, but some Aboriginal morphology
is different to Torres Strait Islander.
Why are we at greater risk?
Good question. If you could answer that, you'd be a millionaire. Kerin?
Part of the answer is where some population groups deposit their fat.
What we've observed, and it was very interesting to bring in the analogy
with Indian populations, the same thing happens.
They talk about the Tamil tummy,
and the fact that people will deposit fat on their stomachs.
When it's in the abdomen, you don't have to gain much fat at all,
and you still don't look fat, yet it can be dangerous for you.
That's what causes the metabolic derangements
that eventually lead to diabetes.
So we would really caution an Aboriginal woman with a BMI of 27.
Some people might argue that's almost obese when you've got a fine frame.
When you're talking about morphology, what we're really talking about
is a body build that is narrow across the shoulders and hips
and a relatively shorter torso and long limbs.
It's very good for a hot climate,
but it is not meant to get fat, basically.
What happens is, the fat seems to really deposit around the stomach.
What are the things she's at risk of as the pregnancy develops?
Lots of things. If she's got a bit of extra weight on,
she's at greater risk of developing gestational diabetes,
and that carries lots of inherent risk.
Being heavier or gaining more weight through pregnancy
means her child is more likely to be a bigger baby.
She's also at more risk of getting hypertension or pre-eclampsia,
then the risk of the eclampsia from that.
If she goes through with her labour,
she's at more risk of having an obstructed labour,
because she's having a larger baby, potentially.
That carries all kinds of risks.
You've got a risk of caesarean, a complicated caesarean.
Once the baby is born, she's at greater risk of having a thromboembolic event.
She's also, as a larger person, at more risk of developing postnatal depression
and at more risk of having trouble breastfeeding.
That's Mum, that's Yvonne.
In terms of the child's risk, that's also significant.
If you're looking at nutrient status in the developing foetus,
a child who's growing up in an environment
with questionable nutritional status inside Mum,
is much more likely to develop high blood pressure, diabetes,
ischemic heart disease, metabolic syndrome in later life.
What's the role of the local primary health care practitioner
in improving people's nutritional intake for someone like Yvonne,
at this stage of her life?
It's a good opportunity to identify these issues early
and get Yvonne involved
in nutritional-intervention programs quickly.
I don't know if this is relevant,
but general practitioners provide a lot of nutritional advice.
Their role as often a central care provider shouldn't be undervalued,
but they need to work in conjunction with community programs
and with allied health professionals in changing the way things work.
We'll return to Yvonne. She's now given birth to her baby, Lucy.
The baby is five months old and is still being breastfed.
The community nurse visits Yvonne with an Aboriginal health worker
to discuss the nutritional needs of the baby and of Yvonne.
Yvonne is thinking of giving up breastfeeding
and wants to talk about introducing solids.
Andy, how would you discuss with Yvonne the nutritional needs
of that little baby of hers, Lucy?
It's challenging.
My main point here would be that I'd like her to keep on breastfeeding.
Breastmilk is designed perfectly for human development.
It's been around for a long time, a lot longer than bottled milk,
and it provides all the nutritional needs for a child.
It also confers immunity to a baby,
which has long-term developmental effects.
It's not just about nutrition.
That would be the focus of my attention.
I'd certainly support that - to keep breastfeeding for at least six months
in toto, but for longer if she can.
Then to think about the introduction of healthy foods,
not necessarily baby foods -
to mash up vegetables and mash up fruit.
It's then very good to give babies chunks of food
as they're starting to get their teeth.
They can get the texture of food.
Not to treat them as a different species, which we tend to do,
but to give them food.
What do you think the components of an educational program would be
for people like Yvonne - young Aboriginal women with babies?
I would again draw on the traditional models that I've learned about
from older Aboriginal women.
Children didn't eat anything different to adults,
but it would be pre-chewed and given to them, that sort of thing.
They would quite quickly learn to get food themselves.
Obviously it's different. People are not living traditional lifestyles now.
But it is a good model.
There are a lot of resources out there, Ian,
to help us make the right decisions when it comes to nutrition.
Can you talk about some of the resources that have been developed
where you are, in Queensland?
There's a lot out there, and it's important for people to realise
how much is out there and have access to it.
There are a few we use.
There's a simple pie chart we use.
We use that educational program and make them understand different food groups
and how to adapt that into meals.
That's a big issue out there at the moment.
Everyone knows there's a lot of fatty and sugary foods
but people think that's the norm.
It's about letting them know that this isn't the norm.
This is away from the circle.
This is the circle, this is what you need to be eating.
You should be eating this much of that, this much of that.
Making them aware of the ramifications if they don't eat this food
and if they eat sugary foods.
That's a really good resource.
The Living Strong program in Queensland is a pretty good resource also.
That program shows you all about what you need to do to burn off the food
that you eat - the bad foods you eat, the good foods you eat.
It does paint a picture to show you
that if you have a chocolate bar or a beer or a burger,
it shows you that you really have to work a long time to get that off.
It seems silly sometimes when you say, you just ate battered fish and chips,
you've got to work out for 4.5 hours.
It's pretty silly, but it's actually true.
Combine that with a can of Coke and a chocolate bar
and it becomes relevant
that these people have to do something about the food they're eating,
otherwise they'll get diabetes, become overweight, get the chronic diseases.
That resource is also pretty good.
Good Quick Tucker is another one
the Queensland Aboriginal Health Council is rolling out.
It's based on Jamie Oliver's Ministry Of Food,
where you get taught how to cook a meal within 30 minutes, cheap, accessible.
You learn how to do it, and you go teach someone, and they go teach someone.
It's a pyramid effect.
The theory is that if you teach a mother how to do it, she teaches her family,
they go teach their cousins.
It goes on like that. Hopefully, we can get healthier that way.
Anthea, you must have seen some good dietary resources over the years.
There's lots of interesting programs.
A lot of people are exploring and experimenting
with public health promotion programs.
There's a need for evaluation to find out which ones really hit the mark.
One program I came across recently is Crunch&Sip
from NSW Healthy Kids Association,
a really clever program where you stop class mid-morning.
It's a dedicated stop to get kids to eat fruit and to drink water.
In this conversation, drink water, drink water, drink water is so important.
The Jimmy Little Foundation Thumbs Up! program
is an integrated health- and nutrition-promotion program
around healthy living messages, again, fruit and veg and water,
that links across health services,
schools and food stores in remote communities.
Indigenous HealthInfoNet has a dedicated nutrition section
which is really important.
Northern Territory Department of Education
have launched the Thumbs Up! nutrition- education website for teachers.
There's lots out there.
And the Fred Hollows Foundation has this book,
which is a terrific book
because it is around cooking for a large
family up to a very large group.
It's all healthy cooking
with excellent recipes and excellent instruction.
DANIEL: From 6 people to 50? - Yeah.
It is important that people know about the good resources that are available.
DANIEL: They're certainly available.
KERIN: Breastfeeding, of course, that is by far, as Andrew said,
the best, healthiest start that an infant can have.
If you can possibly breastfeed,
and that's one of the really good messages in many remote communities
that women still do predominantly breastfeed,
that is a very, very positive trend.
All we have to do is encourage them to keep going.
After that, as we talked about, there are then healthy foods
as they are weaned and transitioned to a normal, healthy diet.
That weaning transition is often where you see failure to thrive in infants.
I think that's the problem.
A lot of the problem is at that time.
It's indicative of difficult access to food
and the difficulty in getting people educated about transition foods
to get kids going.
And why breastfeeding for as long as you can is so important.
It always is a backstop,
even if it won't be the entire diet after six months.
We've discussed the importance of supporting new mothers and babies.
It's also important to keep up good nutrition in growing children.
As we've heard, children's physical and cognitive development
relies on healthy food.
Let's go to northern New South Wales
to see what the Bulgarr Ngaru Aboriginal Medical Service in Grafton
has been doing to help families improve their nutrition.
What's in this one here?
ANDREW BLACK: The fruit and vegetable program was established initially
as a school-based program out at Baryulgil,
a small, Aboriginal community school about 80km away from Grafton.
When we looked at the diet of the children attending the school -
there's about 20 children there, all Aboriginal children -
their diet was fairly poor.
So we decided to do some studies.
We found that every child was deficient in vitamin C
and about 75% were deficient in iron as well.
Some banana.
ANDREW BLACK: Initially there was fruit at the school,
then meals were offered at the school,
then a garden was developed.
So it was a whole nutritional package at the school.
It seemed to make a big difference to the kids' health
over a 6- to 12-month period.
As a result of the success of that,
it was expanded to the other communities we serve,
the towns in the Clarence Valley - Grafton, Maclean, Yamba.
It was much more difficult to target the children,
because they're only a small percentage of the schools
at each of the schools in those towns.
Then it changed to become a family-based fruit and vegetable subsidy program.
- G'day, Deb. - G'day.
- How are you going today? - Good, thanks.
- I've got your box ready. - Beautiful.
ANDREW BLACK: We identified people who seemed to have the most need
from a health perspective
but also from a nutritional and financial perspective,
most likely to benefit from a program such as this.
How are you going? You here to fix up your AMS?
Yes, thanks.
As part of the program, they come and have a health assessment.
While they're having health assessments,
they'll also have hearing checks if it's indicated they haven't been done.
Hello.
ANDREW: Also, we have a dentist. We offer dental check-ups as well.
They have dental check-ups, and we have dieticians who work here,
so we can refer them to a dietician.
I also am doing a PhD,
looking specifically at the fruit and vegetable program,
and evaluation of that.
We try to do some kind of short program in each community in the Clarence Valley
at some time through the year.
This group in Mclean, we have a lot of the elders come.
Some of the younger people drop in as well.
We'd like to get more of the younger people coming in,
especially the mums with young children.
We provide lots of healthy ingredients.
There's usually lots of vegetables and fruit.
We try and promote some of the healthier cooking methods,
or we might to try to change some old favourites.
I just love it, and it's good time to myself.
When you've got three kids, you don't have time to yourself.
Sometimes when they want to help, it's good for them.
It gets them interested in healthy eating too, especially the vegies.
My daughters, they're cooking with bok choy now and things like that.
They're experimenting.
The more that we can get into schools and teach our children,
this becomes a part of their life.
OK. What have we got today?
Today we're going out to Baryulgil School,
we'll be cooking with the children out there.
Since we started the nutrition program,
we've noticed dramatic improvements in their health.
We want to maintain those improvements.
Each week, Carol, one of the teachers, cooks a healthy lunch on a Tuesday.
They will try different things if we encourage them,
and the staff at the school are very good at encouraging them.
When I asked them in previous sessions if they cook at home,
they say they do help out at home.
Could you please wash this lettuce for me?
MAN: I've been a doctor for 30 years.
It's the most dramatic thing that I've seen in my medical career
in terms of a simple intervention providing such a great health outcome.
Doc couldn't believe it,
because no more scripts had to be written out.
This program could go into any other schools
that have got Aboriginal, non-Aboriginal kids
that have problems with their skin,
sores, ears, the runny noses.
The kids were interested in getting in and planting some vegies.
If we can grow our own here and use that,
it's also a good skill that the kids can learn.
ANDREW: In terms of the outcomes,
there are a number of things that we found.
We did blood testing and diet histories
which showed that the children's nutrition seemed to improve
while they were on the program.
In the short-term, there were 30% - 50% decreases
in attendances to the hospital emergency department
in terms of skin infections
and the numbers of antibiotics that were prescribed.
We think these are not just statistically significant
but clinically relevant improvements in the children's health.
BOY: Can I have an apple? - Can you get me one too, please?
Our thanks to the Bulgarr Ngaru Aboriginal Medical Service
and the communities of Grafton, Mclean and Baryulgil
for allowing us to film their programs.
Andy, I wonder if you had any broad response
to the program being tried in Grafton?
Yeah. It's doing some amazing things.
Some of the fundamentals where I've been looking,
at the Top End of the Northern Territory,
I've been looking at remote food gardens north of Tennant Creek
and evaluating what makes them tick
and what people think makes them work or not work.
What these guys are doing is culturally appropriate.
It involves the community, it's empowering the community to change
in the long-term.
Those fundamentals are really important in setting up these programs.
If I may, I might talk briefly about some of the other things
that make these programs work.
Longer funding and training periods work well.
Often, especially in remote places, people see programs come and go.
They often are set up to fail because there's not enough time.
I see people talking about managerial processes
and people coming into communities and not engaging the community properly.
That's fundamental as well.
We'll speak about this later on,
but people working in food gardens want real jobs,
and they want to be paid for it equitably.
- We'll talk about that more later on. DANIEL: We certainly will.
We're going to move to the barriers in adopting healthy food choices.
Anthea, do you think improving our nutritional knowledge
is enough to improve nutrition on its own?
I think knowing about good nutrition is really important for anyone.
Reiterating what Andy has just said, however you impart knowledge
has to be done in a culturally appropriate, engaging way.
Aboriginal and Torres Strait Islander people do tend to be visual learners,
oral educators and learners,
very responsive to role models
and to peer relations and example.
So nutritional education has to be delivered in appropriate ways,
and in more engaging, relevant ways that people can relate to,
and in language and in English.
But nutrition education is not the whole story.
There's been an enormous amount done as well.
Sometimes to focus on getting more literature out there
is to miss the game a bit, really.
A lot of people do know what to eat, they just can't afford it,
and they just can't access it.
Kerin, what are some of the other barriers?
Anthea has touched on them.
The final points that Anthea made there about the cost of healthy food.
There's a slide that will be up in moment on that -
the economics of food choice.
What you'll see here is, over on the left,
oil, margarine, flour and sugar are the cheapest food in calories per dollar.
There's absolutely no question about that.
I'm sorry you probably can't read it well, but down on the right
are the foods we want people to eat -
fresh fruit and vegetables, but also lean meat and fish,
dairy foods, that type of thing.
They're much more expensive in terms of literally saying,
how much food can I get for my dollar?
People, when they're hungry, anywhere in the world,
will choose to maximise what they can buy.
People in the remote parts of the Northern Territory
actually call flour, sugar and white bread 'hungry foods'.
That's the way they describe it. That is their emergency foods.
Yet they tend to have to eat them a lot of the time.
Are there are other cultural factors that need to be addressed
in changing those nutritional patterns?
One of the other very interesting ones is the culture of sharing.
It's a very nice culture. I really like it.
It means that if you buy food and you cook it,
your relatives can come in and have some too.
We found that one of the reasons, in one remote community,
that people were often going to the takeaway
was because that tradition didn't extend to the takeaway.
If you bought a takeaway meal, you could eat it yourself.
Immediately we are saying, that's what we've got to focus on.
We've got to get healthy takeaways and reasonable prices as well.
Ian, can you tell us about the Deadly Choices program?
Great name. What's it all about?
It's very deadly.
Deadly Choices is the brand we've floated through south-east Queensland.
Out of Deadly Choices comes the programs, comes the education,
comes the community sports days, community events.
The Deadly Choices program is something
we're rolling out in communities
and schools. It's about empowering
community members
to make the right choice.
A lot of people know
it's not good to smoke,
it's not good to eat bad food,
but they don't understand why.
If we can give them education
to help them on their way,
they'll make the good choice,
the deadly choice.
Then it will flow
throughout the community.
Leadership is the first one
we talk about.
It's very important
to touch on the subject,
because there's good leaders
and bad leaders out there.
We want to empower people to identify
the fact that, I am a good leader,
I can show that in my community.
You don't have to be an elder.
You don't have to be male, female.
Just a kid going to school, eating breakfast.
That's showing good leadership in the community.
The more people we have showing these traits,
the better our communities are going to be.
We don't want to overwhelm with education.
It's about giving them the right education
so they can use it in their community.
We talk about leadership, chronic disease, smoking, nutrition,
physical activity, substance abuse.
We look at it as a holistic approach.
You can't treat one of these things
without the others.
We talk about smoking.
It's very bad in our communities at the moment
and it is a big issue.
But poor nutrition comes along with smoking.
Poor nutrition comes along with drinking.
People don't realise that
when you go for a night on the town, get on the drink,
you're doing more damage to yourself by stopping,
having McDonald's at four o'clock in the morning
than by having it during the day when you will go and burn it off.
It's empowering people with a bit of knowledge
so they can go out in communities, try it, and get other people to follow them.
What do you think key features
of successful healthy-lifestyle programs might be?
The programs have to be owned by the community. That's very important.
If the community don't own the program, they won't want to implement it.
Get the right people in the community to drive it,
use Aboriginal medical services, local community organisations,
get them to drive the programs. You just assist them.
You're not there to run the program.
You're there to show them, this is what we can do for you.
You drive it, we'll help you. You'll get better results that way.
Once people own a program, they get passionate about it.
You know they'll take it on board, and you'll get results.
If you tell someone, I'm going to make you eat well,
you're coming to this cooking program, you'll get no-one to show up.
If you say, this is how you'll benefit out of a good cooking program,
you're the ones doing the cooking, we'll just show you a little bit,
you'll get more people showing up and better results.
It's important that kids have good role models.
What did your career teach you about nutrition?
Did you learn about nutrition as a rugby league player?
Yeah, I was very lucky.
Sport has been my life for a long time.
I grew up playing sport.
Through school, I was playing that many different sports, it wasn't funny.
I moved into a professional organisation at the Broncos,
and we were taught how to eat well, how to maintain good health,
the right nutrition against the right amount of physical activity.
It's all about getting the balance.
I was privileged to have that information bestowed upon me.
The thing when you take these out to communities is,
a lot of people don't know that sort of stuff.
They haven't been given that education at a younger age.
For us to talk to them on a high level where they won't understand it,
you're not going to get much out of it.
It's all about knowing who your audience is,
knowing what information you can and can't give to them
and displaying it in the right way.
We'll move on now to a discussion about food security and community gardens.
Kerin, could I begin with you?
The World Health Organisation has defined food security.
It's a very broad principle. Can you tell us what it is?
They've basically said:
It's up on the slide now.
That's a wonderful principle, and we as a country subscribe to it.
It's very important that
we don't leave great sections of our populations behind.
It isn't just Indigenous people in remote parts of the country,
although they are a particularly at-risk and vulnerable group.
It's disadvantaged people, wherever they are in society.
- It is relevant to Indigenous people. - Very.
Anthea, you would also consider it to be highly relevant to Indigenous people?
- Food security? Absolutely. - Yeah.
Another definition - they all say much the same thing -
is the ability to access, afford and to utilise.
That breaks down into all the things we're talking about tonight.
You need to know what to eat,
you need to be able to access it physically and economically,
you need to be able to afford it,
you need to be able to cook, use, consume it.
The point about the sharing culture is really interesting, that Kerin raised.
It's hugely important to people in remote communities.
We have to assume fuel prices aren't going down.
We have got climate change adaptation
and significant changes happening across northern Australia.
I don't think it's too hokey to say that all of us, wherever we live,
should be looking at how growing our own food in different ways,
from small-scale self-provisioning
through to commercial initiatives over time,
can all contribute to our food systems and our food security,
and include principles about food sovereignty
which respect Indigenous people's traditional food systems.
What public health measures are needed to improve access to healthy food?
The issues are complicated, but quickly?
- Public health measures? - Yeah.
The infrastructures, both physical and also of human personnel,
need to be invested in.
That's happening very extensively
through the healthy and active lifestyle workforces and so forth,
which is fantastic.
In other areas, it's happening through CDP programs,
but I'm referring specifically to remote communities here
and picking up on Andy's point.
There's a need to invest in people's skills,
to support communities to grow their own food as they want to for the long-term.
There's also a number of moves to get stores more efficient
and accountable, and serving communities' needs
much more directly than they necessarily have been in the past,
through outback stores and ALPA, organisations like that
working for the communities.
Absolutely. Food store reform is a central plank,
along with other local initiatives.
Let's look at an example of a horticulture course in Broome
that's attracting Indigenous students interested in developing food gardens
in their own communities.
This course is being run in cooperation with traditional elders
by the Broome Campus of the Kimberley Training Institute.
It's been recognised for quite a few years now
that we've got diet-related health problems in remote communities,
we've got all sorts of social problems with people needing to do things.
We could see as horticulturalists, as gardeners,
that setting up food gardens was an answer.
So we run a horticultural training program
which includes certificates 1 through to 4,
a very practical training program
which is all about encouraging the growth and development
of community food gardens, fresh food gardens,
particularly geared towards remote, Aboriginal communities.
This is a gubinge tree, flowering in our new season.
When we started doing it, there was this feeling that,
you can't grow food in remote communities. It's too hard.
We tried to do it before. The plants weren't watered and they died.
But that to me was a challenge.
We've got wonderful technology of irrigation, automatic watering systems.
Through training, we were able to install those watering systems,
demonstrate that yes, you can grow things.
That was one of the more satisfying parts of it all.
Just patience. Take your time.
There's no rush.
We've got a number of students
that have maintained a long-term association with us.
Merridoo Waibidi is one who is there now, from Bidyadanga.
He is of the last traditional people to come out of the Great Sandy Desert.
He's really embraced this, which has been very encouraging for us,
to have traditional people really embrace and support what we're doing.
Thousands of years, people are living on the food until today.
That tree over there is always a healthy tree,
always a healthy tree.
You live off the land, you live off here, this food.
They're always healthy, and you don't get diabetes or whatever,
kidney or heart.
That's what our main aim is,
showing our young ones.
We don't want to see our young generation or anyone
ending up with that.
Have a look. Is that your little sugarbag bees?
Yeah. Sugarbag.
This is basically a taster. It's not a big area at all.
It's less than an acre, but it's a model of what people can do.
We've got a range of local bush plants, we've got mangoes,
we've got all sorts of fruit and veg that we rotate through the year.
A lot of the green leafy stuff during the dry season -
peas, beans, corn, sweet potatoes.
You might come here and pick up food, and it's always fresh, you know?
What they grow here is here about a month.
People can come and get food and take him home.
It's healthy, you know?
We'll show you how to grow your conventional fruit and vegies,
but we also started working with traditional people
who were telling us about their traditional plants.
Growing the gubinge has been a really remarkable story.
We started growing a few here and there, and in the meantime,
this great interest came through with gubinge researched by the CSIRO.
They confirmed its wonderful nutritional value,
its wonderful antioxidant levels.
So suddenly we found ourselves in the right place at the right time,
having pioneered the cultivation of this bush fruit.
Suddenly it was something everyone wanted more of.
This is another great success for us,
in that we're doing a culturally appropriate plant,
working together with Indigenous people
in an area that's really presenting some great commercial potential.
I've put them in the ground, on the land,
and I can see what I've achieved myself, and I'm proud of it.
Working in horticulture, with TAFE, there's plenty to do.
This is an answer, and to really make it go
and to really make it work, we've got to create jobs in communities.
We've got to create businesses.
Remote communities spend a fortune on bringing in fruit and vegies
that's poor-quality, very expensive.
We need people to see that,
and to recognise this as a way of doing something useful and positive.
You can't expect people who are just working for the dole
to keep going year after year, which is what's been happening -
not getting any real jobs out of it.
We need to create positions where people who we've trained
can go back to a community and get a paid job.
Then we can keep supporting them.
That's the missing link at the moment.
We really embrace that whole idea,
and there's no reason why communities right across Australia can't have this,
and it can't become part of the culture in years to come, and I think it will.
But we've got to push it. It won't happen by itself.
You know, just do it step by step and you get there.
Our thanks to Kim Courtenay, Merridoo Waibidi
and the students and staff in Broome.
Andy, do you reckon the one being tried in Broome, quickly, is a good model?
There's many things that go into good, solid garden models,
and what they're doing there is sustainable
and changing the way people think about food
and giving them the power to go out and change their food environment.
Is there a role for horticulturists, in particular Indigenous horticulturists,
in remote communities doing this type of work?
Definitely, and there are many Indigenous horticulturists
in remote communities.
Across the top of country in tropical environments,
who knows how many remote food gardens there are? Lots.
I know of at least 35 in the top end of the Territory.
Let's move on now to the question-and-answer segment.
Your questions have been coming in whilst the panel were talking.
We're also going to ask questions of you, the audience.
You can answer these questions by clicking on the circle
next to each of your answers - don't type the answer -
into the LiveTalk text box.
We'll kick off with a general question for the audience:
To the panel, we've touched on some really important issues,
but there were some things that we didn't pick up on.
Subsidisation of food was a key issue,
and I don't think we've dealt with that in enough depth.
It's a very important issue.
Some people talked about prescriptions of healthy food through primary care.
I really like that idea,
except I'm very nervous of overmedicalising healthy food
and people thinking that somebody else
has to take responsibility for those choices.
So while I can imagine it very importantly for a malnourished child,
somebody in an acute situation where it was highly justified,
I'd prefer subsidies of some sort.
The other side of it is that we could put taxes on unhealthy foods.
This is being seriously considered in other countries.
Denmark has introduced taxes on high-sugar and high-fat foods.
The United States is considering it in a number of places,
particularly on sugar-sweetened drinks.
The most important thing is, if we do introduce these taxes, in a way -
beneficial ones, subsidies, and actual taxes -
we have to find out whether they are effective. We must evaluate.
That's one of the things we haven't been very good at doing
with many of the programs, exciting as they are, in the past.
Roy Price from Ethical Nutrition Services in Alice Springs says
research in the Northern Territory suggests that, in general,
community-based Aboriginal people
have a very good understanding of healthy eating
and the components of a healthy diet,
but it's poverty that's been identified as the key driver
in food choice and eating behaviour.
Roy asks the panel, isn't it time that healthy foods are not only prescribed,
as you were talking about, but subsidised and prescribed,
just as the drugs are which are used to manage the symptoms of these diseases?
How would a healthy prescription work?
Would you go to the doctor and say, what's your prescription?
Maybe he's saying it's a mixture of the two.
Certainly, what we spend on drugs is phenomenal.
It would be interesting to do the sums on that.
If we could prescribe healthy food,
or have systems that supported the acquisition of healthy food.
I've thought of a frequent-flyer card,
where people could be rewarded for healthy choices of food,
and have more money put on their card, so they would then have that to spend.
There are many ways it could be done.
I agree. As you say, the medicalisation of it probably outlines the issue
that diet does impact on health,
but medicalising is not going to solve the broader problem.
Broadly, you need to change diet in large numbers of people,
not just those people who attend a GP or a doctor.
A subsidy can be done at many levels - at the individual level, at the store.
Perhaps that's what we're talking about here,
the idea of subsidising the ability to purchase food.
Another type of subsidy,
which is very relevant when we're talking about remote communities,
is that effectively, many public services and goods
are already subsidised through infinite numbers of government programs.
I say, bring on the subsidy for the jobs,
for the people to work in the gardens,
and that will flow through into the emerging micro-enterprises
and existing food stores.
We've got a question from Dr Ray Jones and Fiona Smith from Bulgarr Ngaru AMS.
They ask, has a fruit and vegetable subsidy program
similar to the one in Grafton been trialled elsewhere in Australia?
And is there any other evidence from studies in Australia and internationally
to show that subsidising fruit and vegetables has health benefits?
Kerin?
In answer to the first one, I'm not aware,
but I'm sure there are other programs where there have been subsidies.
But I don't think they've been evaluated and written up.
That's one of the things we do need to do.
That's one of the wonderful things about the program we saw,
that Andrew Black is doing his PhD.
I do think it's going to be a landmark study,
and they are to be commended on it.
And your responses to our first poll question are in.
Our question was, where are you located?
25% of you live in remote areas, 20% in rural areas,
20% also in regional areas, and 35% in metropolitan areas.
Another question for you all out there:
Jill from Canberra asks - this is interesting.
'The Department of Agriculture, Fisheries and Forest
is developing Australia's first ever national food plan.
What do you think is important to include in this food plan?' Anthea?
I'd refer you to the RIG Network submission to the national food plan.
I think it's really exciting Australia is developing a national food plan.
It's kicking off all sorts of strategic conversations that need to happen
across the spectrum of issues relevant to food and the food system.
From a remote perspective,
which is where I've been focusing at consultations with people,
there's a whole range of measures that I think we need,
but perhaps foremost to hand are perhaps two I would focus on.
One is, when we think of what a national food plan should incorporate,
it shouldn't just be cast in a business-as-usual imaginary
of how the food system works,
and that it explicitly needs to incorporate the values and practices
of food sovereignty which really do value and recognise local food systems
and that they work differently in different places,
and in turn require support.
Further to which, my second point would be
for remote Indigenous communities to be producing more food in and by them,
we need to invest in the long-term capacity-building and training
and support for Indigenous horticulturalists
to own, run and deliver what they and their communities
want to own, run and deliver for the long-term.
Food sovereignty, just explain that for us.
That is where they are self-sustaining and they grow their own food?
Food sovereignty comes out of an indigenous movement in South America.
DANIEL: I love the word sovereignty.
It's the idea that everyone, however powerful you are or are not,
has a stake in this fundamental human right
and a stake in their local food system.
It's about valuing food producers, valuing food,
valuing the health of the environment, valuing the rights of others,
recognising complexity and hybrid systems,
that we're not all in one, modernist view of the world.
KERIN: Can I make a comment on that?
We have to focus on health
and the benefit of the whole community.
Some of the discussions I've been listening to on it,
although I haven't read it in depth, are really not focusing on that.
It's around the economics and that type of thing,
which is obviously important,
but we don't just want a food system driven by profit,
we want a food system that looks much more holistically at our future.
Barbara Humphrey asks,
'Why are Indigenous people more susceptible to diabetes?
Is there a genetic disposition?'
Quite a lot of people would think there was a genetic predisposition,
but before we go to that,
we have to think about all of the environmental factors
that are at play into the whole situation.
We know that low birth weight increases your risk.
We know that poor nutrition in early life increases your risk.
There are a whole lot of things
that maybe are genetic in the epigenetic sense of things,
how your environment increases your genetic risk,
but I would want to look at those things where we can intervene first
before just falling back on saying, there's not much we can do
because they're at high risk genetically.
ANDY: I would agree with that.
It's an interesting academic question,
but fundamentally, it shouldn't change our practice.
There's so many modifiable risk factors causing these diseases
that to attribute it, as you say, to genetics, it's like giving up.
DANIEL: Simplistic. - It's a bit simplistic, yeah.
We do have some answers to the second poll question. Coming in thick and fast.
The question was:
26% of you said it was limited access
to fresh fruit and vegetables in local shops,
15% said lack of knowledge and understanding,
15% said food preferences,
31% said low income,
8%, overcrowded housing,
14%, limited use of traditional foods
and 9%, eating too much takeaway.
Anthea, any responses to the results of that poll question?
I like them.
It confirms some of the things that various research,
formal and informal, that we do, would suggest,
and certainly that work like Dr Julie Brimblecombe and others are saying.
What I like about that response is that
eating too much takeaway was the lowest-rated one.
So often you'll hear people saying, you can't get them off that takeaway.
It's very patronising, and it's just wrong.
IAN: I'd like to add something.
I didn't like the fact that low income was the highest one there.
That comes back to education and understanding.
While yes, low income is a problem in our communities,
that's not the be all and end all of why people are eating bad.
It's because there are easier food choices to go and get,
so they get that one.
There is a difference between rural, remote and urban,
but so many people will take the easy choice most of the time.
Low income does not mean
you can't put a healthy meal on the table for your family.
It's a very big pet hate of mine that people say,
I haven't got enough money to buy the good stuff.
I live in an urban area, so that's what I'm talking about.
I can't speak for remote.
People in our areas, they can eat right, they just don't understand how to.
I must say that I think in remote areas,
it is very difficult to afford a healthy diet.
We've done the sums on this,
and people are already spending up to 50% of their income on food.
They'd have to spend, we've worked out, probably another 20%.
And that would be a very challenging healthy diet.
It wouldn't be as much lean meat as they wanted,
or as much of all the good foods.
I do think we've got to take that into account,
the income side, in remote communities in particular.
You've also got to take into account what else they spent their money on.
A lot of families are spending money on smokes and alcohol.
Take them things out of the equation, food might not...
No, I agree with that. There's no question.
Tobacco is one of the main consumer items in remote stores, that's true.
On that point of pricing,
there's good evidence around alcohol pricing altering consumption patterns.
If we could use a similar model in food...
Either the carrot or the stick.
There's lots of room to move in changing people's purchasing behaviours
through pricing intervention.
We've got to look at, as Kerin is saying, is it going to work,
and how effective is it going to be,
and what's the cost benefit to the community as a whole for that?
When that data comes in, we'll find that it's very economically sustainable
for government to start looking at this, but it needs to be proven well first.
Ian's point about a low income, particularly in an urban context,
is not a reason out of eating better is a really strong and important point.
There's a lot you can do through knowledge is power -
just by knowing what things you can substitute affordably.
We've got another poll question for you:
What do you think about those
modifiable lifestyle risk factors?
Is heavy use of alcohol a modifiable lifestyle risk factor for diabetes?
Heavy use of alcohol probably doesn't come out as an independent risk factor
except that it's associated with so many of the others.
It's associated with being inactive, with poor-quality diet
and being centrally fat. There's no question about that.
Alcohol certainly damages the liver,
and that's part of being associated with abnormal metabolism leading to diabetes.
So they're probably all in there, and many of them are related.
Smoking actually stimulates central fat deposition.
Alcohol and smoking do that because they stimulate cortisol,
they stimulate the stress axis.
So we have all of these things working together.
That's valid too in that they all work together
and they need to be fixed together.
Targeting these things individually might look good on paper,
but in reality, people's lifestyle needs to be modified as a whole.
Like Ian is saying, programs that look at one thing or another thing
often miss out on the global picture.
Another question from Barbara, who asked a question earlier. She's a dietician.
She asks, 'Would it be feasible to ban soft drinks sold by retailers
in remote and rural areas?'
ANDY: What a good idea.
It would be terrible to do it without community support.
It would just cause resentment and anger, very understandably.
There is a community in Central Australia -
I don't know if it's still happening - that did a very novel thing.
They banned, by agreement,
the three top-selling sugar-sweetened drinks.
That was published,
in The Australian and New Zealand Journal of Public Health recently.
Over a 12-month period -
I predicted they would swap to something else, but they didn't -
there was an almost 50% reduction in the sugar consumption from soft drinks
that was maintained over 12 months.
That tells us there are different ways you can do it.
What we know about soft drinks is that if you do increase the price,
people do reduce their consumption.
There's lots of evidence on that around the world.
That's a very good target for price increases
rather than banning it absolutely at the moment.
This idea of imposing anything upon any population in Australia is outdated.
We've got to look more at Australia as a whole.
Targeting Aboriginal people and changing their lives is not on anymore.
People have got to take control of their own lives.
- It's been tried enough, surely. - It hasn't worked well.
ANTHEA: It's their business.
Further to what Kerin said,
I know of a number of community-owned, very small stores in WA
where the women who run them have banned soft drinks.
Here are your responses to our third poll question, which was:
19% of you said smoking.
35% of you said poor-quality diet.
33% of you said physical inactivity.
25%, central obesity.
And 17%, the heavy use of alcohol.
Kerin, what do you think that says about those modifiable lifestyle risks
and what the audience is saying?
I think our audience is really very perceptive.
They do all interact.
If you're spending money on cigarettes,
you're not spending money on healthy food.
That's a really important point.
Then of course, it stimulates the stress axis
and aggravates central obesity.
So does alcohol.
And of course the other three are linked, there's no question about that.
Another question from our audience.
Jafiq asks, 'Good tucker needs good money.
How to sort out poverty issue in Indigenous people?'
I guess this is really the elephant in the room.
Yeah, and it's really what we've been talking about quite a bit.
I don't think there's any question about it,
but I agree it's not just a black-and-white issue.
Another question, Olga Ischenko.
She asks, 'How do you get sufficient supply of fresh fruit and vegies
to remote communities at reduced cost?'
I guess the costs are eaten up in freight and...
Why is it so expensive?
Remoteness is a huge issue.
Transport costs and refrigeration costs in areas which are super-remote,
in the middle of nowhere, are astronomical.
But that's not the only reason why.
There's a lot of structures in place which make it difficult for communities
to access food, which go beyond pricing
and into the way that stores and shops and corporations manage food supply.
The driver for profitability often pushes up prices for foods
which are unhealthy.
From my perspective, a great way to get food into communities
cheaply and affordably is to grow it in communities.
ANTHEA: Have it locally. - Yeah, have it there.
Then you don't have to transport it anywhere, just pick it up and eat it.
One of the drivers for starting the RIG Network
was a very simple response to food security
and the ridiculous food miles of most food
that has gone into remote communities.
The cost of fuel is not going to go down unless it gets hugely subsidised.
KERIN: It won't.
And do we want that? Probably not, from a climate change perspective.
The food miles in food transported into remote communities is huge.
Freight costs are enormous.
Further to what Andy said, and that's a core assumption of RIG Network as well,
if you grow your own food in a variety of ways -
we're not suggesting that communities will solve all
their food security problems through growing their own food -
but growing your own food can augment local food supply
and it can augment your family income, and that's really important.
Also, food grown locally is probably nutritionally better
than food transported in.
I'd also add to that
that I'd advocate that communities think much more broadly
about their own food supply -
coastal communities with fish farming
and the long history of success in the cattle industry.
There are many possibilities that extend beyond fresh fruit and vegetables
that are going to probably make them even more self-sufficient.
I agree with that. Looking at any individual point,
it's a system of food.
People are getting food from lots of places at the moment.
You've got to use those systems to your best advantage.
One more question from our audience, and Deanne Minniecon asks,
'Are there good programs or resources targeting pregnant women, babies
and young children?'
We touched on some of those, but can you think of any others, Kerin?
Every jurisdiction I know of has programs like that.
It's recognised as absolutely fundamental.
Just go locally to where you are and you'll find them.
All the health departments are supporting them.
Deanne also asks a question of you, I think, Ian -
'How successful has Deadly Choices been, and is it being evaluated currently?'
Evaluation is a thing that's come up again and again.
Definitely. It has been pretty successful.
It has exploded in a short amount of time throughout our region.
We've had some good feedback, we've had some bad feedback.
We're always looking to improve,
and we are going through the evaluation stages.
The program is only just over 12 months old,
so there's a lot more that has to be done to it.
As I say, it's sort of exploded.
We started off as a simple, school-based program,
then Deadly Choices became the brand and just took off.
We are evaluating it, and we are going to put those evaluation results up
once we get them in.
The program, we didn't expect it to go so well so quick, but it has.
So we're having to adapt to how much it's exploded,
and we can now look at getting what we think is a good resource out
to different parts of Queensland, Australia, wherever.
In the end, whether you're rural, remote or urban,
the message is still fairly similar.
It's about empowering our people to make the right choices.
Gone are the days when - Andy touched on it before -
we've got to stop telling people how to do things.
If we empower our communities to do stuff,
get them to take it on board, you'll get better results that way.
That's all we've done with the Deadly Choices program,
and it's had good results.
This is a really interesting question
and I hope we can answer it fairly quickly.
'Has anyone on the panel experienced a counterproductive shame
associated with fruit and vegetable subsidy programs in rural communities?'
- Andy? - No, I haven't.
It would only be if it was forced on a community without their support.
That would be the only reason I could imagine it.
I certainly haven't heard of anything like that.
Normally communities are really keen to get something like that.
With community-run programs, they're excited and keen to get on board.
Is hepatitis included in Deadly Choices?
When we touch on the different topics such as chronic disease,
then to a further extent, substance abuse,
it does get brought up.
Because we're still tweaking the program...
We did have *** health in the program at one stage.
We've taken it out at the moment
'cause we're looking at how to better implement it into the program.
It is such a touchy subject, and if you don't deliver it right,
it can have some pretty bad results.
So, we do touch on hepatitis. It does get brought up.
In how much detail?
Depending on the audience and how perceptive they are to it.
If they're taking an interest to it, we'll go into more detail.
That's how the program is run. It's very adaptable.
Whatever the target audience is taking a liking to.
If we need to go into more content, we'll do so. I hope that answers it.
One last question from the audience -
'What percentage of food in remote Aboriginal communities can be supplied
through local food production?' Anthea, what do you reckon?
It's a bit of a nebulous question.
Technically, I suppose a hundred per cent.
Before white man came to Australia, Aboriginal people supplied their own.
They've been the greatest hunters and gardeners for hundreds of years.
Andy and I were at a workshop a week or so ago
where Leonie Norrington was talking about - it's not so long ago
that 99%, or 98% of all communities had robust market gardens,
which included protein sources
along with fishing and other traditional foods.
It's not so long ago that it was a very substantial portion.
It would be a very healthy diet,
but it would be a very un-Western and atypical diet,
because it would exclude all processed food.
I mean, I'd be delighted,
but it would be a bit of a hard call, I think.
ANDY: But potentially...
But grains. It would mean...
That's the thing. We do say wholegrain cereals, that sort of thing.
Realistically, we could think about meat, fruit and vegetables.
It would be fantastic. And fish.
Kerin O'Dea, what's your take-home message?
It's healthy and nutritious foods over the lifespan.
Really looking at the very broad base of those,
and going beyond fruit and vegetables, which are incredibly important
but they're not the only thing.
We do need what we've been talking about - lean meat and fish,
probably also wholegrain cereals and related foods like that.
DANIEL: Ian Lacey?
Understand what a healthy diet is, understand what healthy food is,
and be proud of the fact that you go out and eat healthy food.
The more you can show in your community that you're doing the right thing,
and you know what healthy food is and you're eating healthy food,
people will follow you.
- It's the role model model. KERIN: It's a great model.
DANIEL: Anthea?
Support and enable local solutions by local people focusing on food,
for all sorts of reasons - social, economic, health and environment.
DANIEL: Andy Hume?
I'd say, eat your fruit and vegetables, as your mother probably told you.
It really does have long-term impacts on your health.
We've now begun to quantify those.
I hope you've enjoyed this program
on nutrition and its importance for good health.
Thank you for watching.
The filming of case studies was done by media@work
and Spinning Reel productions.
This program is funded by
the Department of Health and Ageing
with additional support
from the St George Foundation
and the Marian and EH Flack Trust.
More information about the issues raised in this program is available
on the Rural Health Education Foundation website, at:
Go to the Good Tucker program page, and click on Resources.
If you are a health worker, don't forget to complete and send in
your evaluation forms, which can be found on the web page.
You'll receive a certificate of attendance, and if eligible, CPD points.
I'm Daniel Browning. Good night.
Funded by the Australian Government Department of Families, Housing,
Community Services and Indigenous Affairs.
Captions by Captioning & Subtitling Internationa�