Sharing the tracks to good tucker: identifying the benefits and challenges of implementing community food programs for Aboriginal communities in Victoria

A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities

Purpose: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. Study design: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010–2020. Results: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. Conclusions: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.

Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: a rapid review

Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from 6 databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. Twenty-five publications were included in this review, 24 reported on an intervention, while 9 were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty: Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. Small-scale food security interventions may not provide ongoing and sustained impact. Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left.

Putting urban Aboriginal and Torres Strait Islander food insecurity on the agenda

Food insecurity adversely affects diet quality, physical, mental and social wellbeing and the capacity to act on health advice recommended by primary healthcare providers. In this article, an overview of the neglected issue of food insecurity in urban Aboriginal and Torres Strait Islander communities is provided. Policy and action on food security for urban Aboriginal and Torres Strait Islander people is reviewed, and it is argued that for primary health care to better address food insecurity, an evidence base is needed to understand the experiences of individuals and households and how to work effectively to support food insecure clients.

Proximate determinants of tuberculosis in Indigenous peoples worldwide: a systematic review

BACKGROUND

Indigenous peoples worldwide carry a disproportionate tuberculosis burden. There is an increasing awareness of the effect of social determinants and proximate determinants such as alcohol use, overcrowding, type 1 and type 2 diabetes, substance misuse, HIV, food insecurity and malnutrition, and smoking on the burden of tuberculosis. We aimed to understand the potential contribution of such determinants to tuberculosis in Indigenous peoples and to document steps taken to address them.

METHODS

We did a systematic review using seven databases (MEDLINE, Embase, CINAHL, Global Health, BIOSIS Previews, Web of Science, and the Cochrane Library). We identified English language articles published from Jan 1, 1980, to Dec 20, 2017, reporting the prevalence of proximate determinants of tuberculosis and preventive programmes targeting these determinants in Indigenous communities worldwide. We included any randomised controlled trials, controlled studies, cohort studies, cross-sectional studies, case reports, and qualitative research. Exclusion criteria were articles in languages other than English, full text not available, population was not Indigenous, focused exclusively on children or older people, and studies that focused on pharmacological interventions.

FINDINGS

Of 34 255 articles identified, 475 were eligible for inclusion. Most studies confirmed a higher prevalence of proximate determinants in Indigenous communities than in the general population. Diabetes was more frequent in Indigenous communities within high-income countries versus in low-income countries. The prevalence of alcohol use was generally similar to that among non-Indigenous groups, although patterns of drinking often differed. Smoking prevalence and smokeless tobacco consumption were commonly higher in Indigenous groups than in non-Indigenous groups. Food insecurity was highly prevalent in most Indigenous communities evaluated. Substance use was more frequent in Indigenous inhabitants of high-income countries than of low-income countries, with wide variation across Indigenous communities. The literature pertaining to HIV, crowding, and housing conditions among Indigenous peoples was too scant to draw firm conclusions. Preventive programmes that are culturally appropriate targeting these determinants appear feasible, although their effectiveness is largely unproven.

INTERPRETATION

Indigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis.

FUNDING

Canadian Institutes of Health Research.

Measuring and Understanding Food Insecurity in Australia: A Systematic Review

The number of Australians seeking food aid has increased in recent years; however, the current variability in the measurement of food insecurity means that the prevalence and severity of food insecurity in Australia is likely underreported. This is compounded by infrequent national health surveys that measure food insecurity, resulting in outdated population-level food insecurity data. This review sought to investigate the breadth of food insecurity research conducted in Australia to evaluate how this construct is being measured. A systematic review was conducted to collate the available Australian research. Fifty-seven publications were reviewed. Twenty-two used a single-item measure to examine food security status; 11 used the United States Department of Agriculture (USDA) Household Food Security Survey Module (HFSSM); two used the Radimer/Cornell instrument; one used the Household Food and Nutrition Security Survey (HFNSS); while the remainder used a less rigorous or unidentified method. A wide range in prevalence and severity of food insecurity in the community was reported; food insecurity ranged from 2% to 90%, depending on the measurement tool and population under investigation. Based on the findings of this review, the authors suggest that there needs to be greater consistency in measuring food insecurity, and that work is needed to create a measure of food insecurity tailored for the Australian context. Such a tool will allow researchers to gain a clear understanding of the prevalence of food insecurity in Australia to create better policy and practice responses.

Sectoral system capacity development in health promotion: evaluation of an Aboriginal nutrition program

Issue addressed The study examined effective ways to build the capacity of health organisations and professionals in the public health sector to reduce Aboriginal chronic disease risk factors. It investigated the capacity-building strategies of the Victorian Aboriginal Community Controlled Health Organisation (VACCHO) nutrition team in the facilitation of the statewide implementation of the Victorian Aboriginal Nutrition and Physical Activity Strategy 2009-2014 (VANPAS). Methods Using a qualitative design, the study analysed the VACCHO program from 2009-2014 across five domains of capacity development: workforce, resources, organisations, partnerships and leadership. Data were sourced from archival program documents and 62 semi-structured participant interviews. Results Diverse Aboriginal and non-Aboriginal professional, organisation representatives and community participants engaged in the implementation of the VANPAS. The VACCHO team used the VANPAS to solidify participant buy-in, strengthen workforce effectiveness, increase health promotion and resource appropriateness, improve organisational policy and build an evidence-base through collaborative dialogue using action-reflection principles. Conclusion A credible, high-profile Aboriginal community led and evidence-based statewide program and a commitment to dialogue through action-reflection provided a meaningful basis for both Aboriginal community and mainstream organisational engagement. Upon this foundation, the VACCHO team built a coherent sectoral system with increased capacity to enhance the nutrition of Aboriginal Victorians. So what? In an historical context of mistrust and unmet expectations, program implementation methods that build confidence amongst collaborating Aboriginal and non-Aboriginal health agencies is fundamental to building capacity to enhance Aboriginal nutrition and health.

Is Aboriginal nutrition a priority for local government? A policy analysis

OBJECTIVE

The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy.

DESIGN

In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents.

SETTING

Victoria, Australia.

SUBJECTS

Local governments' public health policy documents (n 79).

RESULTS

A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment.

CONCLUSIONS

A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.

Culture and healthy lifestyles: a qualitative exploration of the role of food and physical activity in three urban Australian Indigenous communities

OBJECTIVE

1) To explore the links between Indigenous Australian children's perspectives on culture, and healthy lifestyle behaviours. 2) To provide insight into how to approach the development of a health intervention targeting lifestyle behaviours in Australian Indigenous children.

METHODS

Seven semi-structured focus groups sessions were conducted with Australian Indigenous children aged 5-12 years living on the South Coast of New South Wales. Audio-recordings were transcribed and thematic analyses were conducted and related to principles of grounded theory.

RESULTS

Participants had connections to aspects of Australian Indigenous culture that were embedded in their everyday lives. Healthy lifestyle behaviours (such as healthy eating and physical activity) were found to be interconnected with Australian Indigenous culture and positive emotional wellbeing was identified as an important outcome of connecting Australian Indigenous children to cultural practices.

CONCLUSION

Understanding the importance of culture and its role in healthy lifestyles is critical in the development of health interventions for Indigenous populations.

IMPLICATION

Health interventions embedded with Australian Indigenous culture may have potential to improve physical and emotional health within Australian Indigenous communities. However, it is unlikely that a 'one size fits all' approach to health interventions can be taken.