Food Insecurity among Older Aboriginal and Torres Strait Islanders

Analysis of Food Security of Older Rural Indigenous People in Latin America and the Caribbean

Food insecurity is a critical issue in the Americas, with severe impacts in the Caribbean, Mesoamerica, and South America, particularly affecting older adults in Indigenous and rural contexts where it intersects with poverty, gender, and ethnicity. This study aims to provide an in-depth understanding of the current research about food insecurity among older Indigenous adults in Latin America and the Caribbean. A comprehensive literature review was conducted, utilizing specific search queries and the population, intervention, comparison, and outcome (PICO) strategy across multiple databases to identify the pertinent studies. The findings indicate an increase in academic output on this topic since 2018, with significant emphasis on the interplay between climate change and food insecurity. The review highlights the importance of developing targeted food programs, reforming policies, and fostering collaboration between academia and local communities to implement practical interventions. Despite the growing body of literature, a notable research gap persists in rural areas of Latin America and the Caribbean. This study underscores the necessity of balancing the geographic distribution of research and emphasizes the preservation of cultural practices and the adaptation of public policies to support traditional food practices. It advocates for culturally sensitive interventions and interdisciplinary collaboration to formulate comprehensive strategies. The originality and value of this study lie in its focused analysis of older Indigenous adults, contributing crucial insights to the international literature on food security.

Changes in household food grocery shopping patterns in Melbourne, Australia during COVID-19 restrictions in 2020

OBJECTIVE

To investigate the impact of COVID-19 restrictions in Melbourne, 2020, on food grocery purchases.

METHODS

Grocery purchase data for 2019 and 2020 were accessed for 1,413 Melbourne households (NielsenIQ Homescan Consumer Panel) and linked to a nutrition composition database (FoodSwitch).

RESULTS

Per capita expenditure and dietary energy from groceries increased by 21.2% and 17.7%, respectively, during lockdowns, with marginally larger increases in expenditure and energy purchases from unhealthy products than healthy products (21.9% and 18.0% v 20.2% and 17.5%). The most socioeconomically disadvantaged households spent the least on but purchased the most energy from unhealthy products during lockdowns ($108 and 109MJ per capita per month), with the inverse found for the most advantaged households ($121 and 102MJ per capita per month). An increase in the overall proportion of total expenditure from unhealthy products during lockdowns was identified (+0.7%); however, there was no evidence of a difference in the proportion of energy purchased from unhealthy products. For most quintiles of household socioeconomic disadvantage/advantage, there were no statistically significant changes in the contribution of unhealthy products to total expenditure and energy purchases.

CONCLUSIONS

There was no substantial deterioration in the healthiness of grocery purchases during COVID-19 lockdowns in Melbourne. However, any additional purchases of unhealthy products are a concern. Further research on other sources of foods and drinks is also required to ascertain impacts on broader dietary patterns.

IMPLICATIONS FOR PUBLIC HEALTH

The increase in energy purchased may have implications for overweight and obesity as a risk factor for COVID-19 and chronic diseases. Governments and retailers may need to consider measures to encourage improved diet quality during future crises.

Review: Can digital mental health interventions bridge the 'digital divide' for socioeconomically and digitally marginalised youth? A systematic review

BACKGROUND

Digital mental health interventions (DMHIs) have the potential to improve the efficiency, accessibility and effectiveness of mental health services for young people, with the potential to reach socioeconomically and digitally marginalised young people with mental health needs who would otherwise not seek help in person. This review aims to investigate the characteristics, acceptability and efficacy of DMHIs specifically developed for socioeconomically and digitally marginalised youth.

METHOD

Key databases were searched widely and systematically (EMBASE, MEDLINE, PsycINFO, OpenGrey). Final inclusion in this review required studies to evaluate DMHIs specifically targeting socioeconomically and digitally marginalised children and young people through a broad range of research designs.

RESULTS

Ten studies, describing seven DHMIs, were included in this review. Studies varied in terms of methodology, population, intervention, outcome measures, technologies used and methodological quality. Qualitative and quantitative results are synthesised across three key phenomena of interest: effectiveness, acceptability and feasibility. Findings suggest that there is moderate but limited evidence supporting DMHIs for improving mental health outcomes among these populations.

CONCLUSIONS

While there is moderate evidence suggesting that digitally delivered interventions can be effective in improving mental health outcomes among socioeconomically and digitally marginalised youth, more high-quality research is needed in order to determine whether DMHIs can fully bridge the so-called 'digital divide'.

How gender, education and nutrition knowledge contribute to food insecurity among adults in Australia

Food and nutrition insecurity occurs when healthy and safe food cannot be obtained by socially acceptable means and arises as a result of complex interactions between socioeconomic and demographic determinants. These factors contribute to discrepancies in health and well-being between men and women and may also explain differential rates of food insecurity. The objectives of this cross-sectional study were to investigate the intersection between gender, education, nutrition knowledge and food security status within a high-income country context. Australian adults over 16 years of age who identified as having primary responsibility for food in their household were recruited via social media and a panel. Respondents completed a self-administered survey that included sociodemographic data, nutrition-related knowledge and food security status. Food security was measured using the Australian Household Food and Nutrition Security Scale an adapted version of the United States Department of Agriculture Household Food Security Survey. Among the 1010 survey respondents, household food insecurity (HFI) was highly prevalent (43% were food insecure, with 26% of these severely food insecure). Gender may affect associations between education, nutrition knowledge and HFI. Education was significantly associated with HFI among women but not among men. Conversely, nutrition knowledge was significantly inversely associated with food security among men but not among women. Differences in determinants of HFI exist between men and women, and programs aimed at addressing food insecurity may be more effective if tailored accordingly to account for the social and demographic factors associated with HFI.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

A Food Relief Charter for South Australia-Towards a Shared Vision for Pathways Out of Food Insecurity

Chronic food insecurity persists in high-income countries, leading to an entrenched need for food relief. In Australia, food relief services primarily focus on providing food to meet immediate need. To date, there has been few examples of a vision in the sector towards client outcomes and pathways out of food insecurity. In 2016, the South Australian Government commissioned research and community sector engagement to identify potential policy actions to address food insecurity. This article describes the process of developing a co-designed South Australian Food Relief Charter, through policy–research–practice collaboration, and reflects on the role of the Charter as both a policy tool and a declaration of a shared vision. Methods used to develop the Charter, and resulting guiding principles, are discussed. This article reflects on the intentions of the Charter and suggests how its guiding principles may be used to guide collective actions for system improvement. Whilst a Charter alone may be insufficient to create an integrated food relief system that goes beyond the provision of food, it is a useful first step in enabling a culture where the sector can have a unified voice to advocate for the prevention of food insecurity.

A Food Insecurity Systematic Review: Experience from Malaysia

Living free from hunger is a basic human right. However, some communities still experience household food insecurity. This systematic literature review explored different aspects of household food insecurity in Malaysia including vulnerable groups, prevalence, risk factors, coping strategies, and the consequences of food insecurity. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Thirty-three relevant articles were selected from scientific databases such as CINAHL, Pubmed and Google Scholar, scrutiny of reference lists, and personal communication with experts in the field. The prevalence of household food insecurity in Malaysia was unexpectedly reported as high, with affected groups including Orang Asli, low-income household/welfare-recipient households, university students, and the elderly. Demographic risk factors and socioeconomic characteristics included larger household, living in poverty, and low education. Coping strategies were practices to increase the accessibility of food in their households. Consequences of household food insecurity included psychological, dietary (macro- and micronutrient intakes), nutritional status, and health impacts. In conclusion, this review confirmed that household food insecurity in Malaysia continues to exist. Nevertheless, extensive and active investigations are encouraged to obtain a more holistic and comprehensive picture pertaining to household food security in Malaysia.

Ageing of the Aboriginal and Torres Strait Islander population: numerical, structural, timing and spatial aspects

OBJECTIVES

To assess levels of numerical, structural, timing and spatial aspects of ageing of the Aboriginal and Torres Strait Islander population.

METHODS

Population projections for 15 Australian regions were created by a multi-state cohort-component model.

RESULTS

The older (45-plus) population grew from 29,815 in 1986 to 167,259 in 2016. In the subsequent 30 years, we project growth to 448,785 people. Growth rates of the older population vary: from 200% in the 60-64-year-old group to 800% growth in the 85-plus age group by mid-century. This strong numerical ageing is reflected in a shift in structural ageing by about six percentage points. Selected areas outside of capital cities are structurally older than many cities. Numerical ageing is strongest in capital cities and New South Wales. Cohort flow is the primary driver of ageing.

CONCLUSIONS

Numerical and structural ageing is projected to increase significantly to mid-century with important spatial variations. Population ageing is largely irreversible. Implications for public health: High numerical growth in the older Aboriginal and Torres Strait Islander population poses implications for increased demand for a range of health and care services. Variations in spatial and timing aspects of ageing indicate demand will peak earlier in some geographical locations relative to others.

Exploration of Food-Seeking Behaviour, Food Preparation, and Restrictions to Sufficient Food among the Jahai Sub-Tribe (Indigenous People) in Gerik, Malaysia

Access to food has been determined to be a factor that strongly influences the dietary intake and eating habit of indigenous people (Orang Asli, OA). This study explored food acquisition and the barriers in obtaining traditional and market foods among the Jahai subtribe (within the Negrito ethnic group) via a qualitative approach. Twenty-eight OA (14 males and 14 females) from Gerik, Perak, Malaysia participated in four focus group discussions (FGDs; two male-only and two female-only groups; seven informants in each FGD). Thematic analysis was adopted to analyse the gathered data. The results found that the Jahai applied both modern (buying and receiving food assistance) and traditional (gathering, farming, fishing, and hunting) methods in obtaining food. The barriers they faced in gathering sufficient food supply included low purchasing power, high demand for food, high transport costs, depletion of food supplies in their surroundings, threats from wild animals on the farm and during food searching activities, and food sharing. Food preparation methods practiced by the OA include roasting and grilling, frying, simmering (gulai), and boiling. In conclusion, this study enhances our understanding of the dietary behaviour of the Jahai subtribe and highlights restricted food access among the OA, which demands urgent attention.

Population-based interventions addressing food insecurity in Australia: A systematic scoping review

AIM

Food insecurity (FI) is a critical public health issue in Australia. Population-based interventions aiming to address the socio-ecological determinants of FI are critical for relieving and preventing it. This review aimed to map and summarise the characteristics of population-based interventions addressing household and/or community FI in Australia.

METHODS

A systematic scoping review was undertaken. Five databases, selected for range and relevance to FI in Australia ("CINAHL plus", "Ovid MEDLINE", "Sociological Abstracts", "Australian Public Affairs Information Service", and "Rural and Remote Health") were searched in May 2018 using the terms and relevant synonyms "FI" and "interventions". In addition a systematic grey literature search using multiple Google searches was undertaken. Data synthesis included categorisation and counting intervention type. Interventions were defined and charted by influence of at least one dimension of food security and impact on the socioeconomic, cultural and environmental conditions.

RESULTS

A total of 3565 published and grey literature records were identified, with the final 60 records describing 98 interventions. Few national interventions were identified, with approaches predominantly in Victoria, Northern Territory and Tasmania. Determinants related to living and working environments, food availability and food utilisation were most frequently addressed. Interventions addressing the key determinant of FI economic access were limited. A number of interventions did not appear to be associated with rigorous evaluation.

CONCLUSIONS

While there is evidence of population responses to FI in Australia, the effectiveness of these remains limited. Importantly there is a lack of coordinated and coherent national responses that address the range of FI determinants.

Addressing Food and Nutrition Security in Developed Countries

The guest editors of the special issue on Addressing Food and Nutrition Security in Developed Countries reflect on the 26 papers that were published as part of this issue and the scope of research contained therein. There is an extensive body of work, which focuses on topics ranging from the prevalence of food insecurity in developed countries, associations and determinants, measurement and monitoring, to reports of the lived experience and coping strategies of people who are living with food insecurity or and those who are a part of the charitable food sector. Very few solutions to address the problem of food insecurity in developed countries were offered, and many challenges highlighted. Further research is required to find the solutions to address the problem of food insecurity in developed countries, and important principles and values are proposed for those undertaking this work to embrace.

Food Insecurity and Hunger in Rich Countries-It Is Time for Action against Inequality

Household food insecurity is a serious public health concern in rich countries with developed economies closely associated with inequality. The prevalence of household food insecurity is relatively high in some developed countries, ranging from 8 to 20% of the population. Human rights approaches have the potential to address the structural causes, not just the symptoms of food insecurity. Despite most developed countries ratifying the Covenant on Economic, Social and Cultural Rights over 40 years ago, food insecurity rates suggest current social protections are inadequate. The contemporary framing of the solution to food insecurity in developed countries is that of diverting food waste to the hungry to meet the United Nations Sustainable Development Goals agenda (Goals 2 and 12.3). An estimated 60 million people or 7.2% of the population in high income countries used food banks in 2013. Although providing food assistance to those who are hungry is an important strategy, the current focus distracts attention away from the ineffectiveness of government policies in addressing the social determinants of food insecurity. Much of the action needed to improve household food security falls to actors outside the health sector. There is evidence of promising actions to address the social determinants of food insecurity in some developed countries. Learning from these, there is a strong case for government leadership, for action within and across government, and effective engagement with other sectors to deliver a coordinated, collaborative, and cooperative response to finding pathways out of food insecurity.

Social Assistance Payments and Food Insecurity inAustralia: Evidence from the HouseholdExpenditure Survey

It is widely understood that households with low economic resources and poor labour market attachment are at considerable risk of food insecurity in Australia. However, little is known about variations in food insecurity by receipt of specific classes of social assistance payments that are made through the social security system. Using newly released data from the 2016 Household Expenditure Survey, this paper reports on variations in food insecurity prevalence across a range of payment types. We further investigated measures of financial wellbeing reported by food-insecure households in receipt of social assistance payments. Results showed that individuals in receipt of Newstart allowance (11%), Austudy/Abstudy (14%), the Disability Support Pension (12%), the Carer Payment (11%) and the Parenting Payment (9%) were at significantly higher risk of food insecurity compared to those in receipt of the Age Pension (<1%) or no payment at all (1.3%). Results further indicated that food-insecure households in receipt of social assistance payments endured significant financial stress, with a large proportion co-currently experiencing “fuel” or “energy” poverty. Our results support calls by a range of Australian non-government organisations, politicians, and academics for a comprehensive review of the Australian social security system.

Food Security Experiences of Aboriginal and Torres Strait Islander Families with Young Children in An Urban Setting: Influencing Factors and Coping Strategies

Evidence on Aboriginal and Torres Strait Islander peoples’ food security experiences and coping strategies used when food insecurity occurs is limited. Such evidence is important to inform policies that can reduce the consequences of food insecurity. This study investigated factors perceived by Aboriginal and Torres Strait Islander families with young children to influence household food security, and coping strategies used, in an urban setting. A qualitative research inductive approach was used. Data were collected through an iterative process of inquiry through initial interviews with 30 primary care-givers, followed by in-depth interviews with six participants to further explore emerging themes. Major topics explored were: influencing factors, food insecurity experiences, impact on food selection, and coping strategies. Food affordability relating to income and living expenses was a major barrier to a healthy diet with large household bills impacting food choice and meal quality. Access to family support was the main reported coping strategy. Food insecurity is experienced by Aboriginal and Torres Strait Islander families, it is largely intermittent occurring especially when large household bills are due for payment. Family support provides an essential safety net and the implications of this are important to consider in public policy to address food insecurity.

The Association between Stressful Events and Food Insecurity: Cross-Sectional Evidence from Australia

A considerable body of empirical evidence exists on the demographic and socio-economic correlates of food insecurity in Australia. An important omission from recent studies, however, is an understanding of the role of stressful life events, or stressors in explaining exposure to food insecurity. Using nationally representative data from the 2014 General Social Survey and multivariable logistic regression, this paper reports on the association between 18 discrete stressors and the likelihood of reporting food insecurity in Australia. The results, adjusted for known correlates of food insecurity and complex survey design, show that exposure to stressors significantly increased the likelihood of experiencing food insecurity. Importantly, stressors related to employment and health approximately doubled the odds of experiencing food insecurity. The results underscore the complex correlates of food insecurity and indicates that conceptually it interacts with many important social and economic problems in contemporary Australia. There is no simple fix to food insecurity and solutions require co-ordination across a range of social and economic policies.