Health & Nutrition Strategy
- Improve health & nutrition of the elderly and children
- Assist in prevention and management of diabetes, heart disease and kidney disease
- Action to break down dependency
- Develop a range of Yol?u traditional foods
- Create non-subsidised employment
Chronic Disease in Indigenous populations
Aboriginal and Torres Strait Islander peoples are one of the most disadvantaged population groups in Australia as indicated by their poor health status (1). In comparison to the general population of Australia, Indigenous Australians have higher rates of premature mortality from preventable chronic diseases (2) as well as significantly lower life expectancy (3).
Literature has shown that modifiable risk factors such as nutrition can prevent much of the burden of disease caused by chronic disease if focused on (2). There is sufficient evidence suggesting that dietary change can appreciably reduce the risk of developing chronic diseases and eating a healthy, balanced diet can reduce mortality (4). For healthy nutrition and chronic disease prevention, consumption of fruits and vegetables is essential (5-6).
Fruit And Vegetable Promotion
ALPA has long since recognised the importance of promoting fruit and vegetable consumption in our communities. Strong evidence suggests that an adequate intake of fruit and vegetables is protective against chronic diseases such as Type Two Diabetes, hypertension, coronary heart disease and some cancers. Unfortunately, surveys have indicated that Australians are not consuming the recommended amounts of fruit and vegetables, with the rate of those not meeting recommendations highest amongst Indigenous people (3). The 2008 report into Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples reported that 1 in 5 (20%) of Indigenous people living in remote areas reported no usual daily fruit intake, with 15% reporting no usual daily intake of vegetables, as compared to their non-remote Indigenous counterparts of 12% and 2% respectively (3).
Pollard et al (7) argue that in order to encourage changes in dietary behaviour, the determinants of food choice need to be explored and understood. Access, cost and availability of fruit and vegetables are likely to strongly influence fruit and vegetable consumption (8). Fruit and vegetable promotion is hence, one of the key focuses of ALPA's Health and Nutrition Strategy. ALPA is the first to admit we are at the end of a very long food transport chain, thus prices are not always as cheap as the major capitals. We do however have fruit and vegetable prices similar to Darwin supermarkets due to our 100% freight subsidy on fresh fruit and vegetables. ALPA has been independently subsidizing (no government funding) these vital food groups for over 30 years and will continue to do so in an effort to increase consumption of fruit and vegetables and hence work towards preventing chronic diseases. In addition, we now also subsidise all freight on frozen, tinned and dried vegetables. These subsidies help make prices more comparable to Darwin prices.
ALPA also has a core range of fruit and vegetables that our stores are expected stock at all times (within reasonable circumstances) to promote range and variety. When possible, fruit and vegetables are flown in once a week at Galiwinku and Milingimbi, increasing the range and quality of our produce on display. Activities and fruit donations from ALPA also help to promote these food groups through cultural, sporting and health events within the communities.
Healthy Takeaway Options
Takeaway food in some instances forms a large part of individual food consumption in remote indigenous communities. We are in most cases the only provider of both supermarket and takeaway foods in such communities. For this reason it is important that there are always healthy choices available. Current range includes healthy hot meals, corn cobs, boiled eggs, roasted sweet potatoes, cassava/taro, salads (when ingredients available) and sandwiches.
Product placement within the takeaway is such that healthy options are prominently displayed to encourage their purchase over a product of lower nutritional rating. Bottled water, diet drinks and 100% fruit juice are available in the takeaway areas.
Cooking equipment within takeaways is also being modified to increase both nutrition and yield of product. ALPA member stores now all have "Combi-steam ovens". These ovens cook large volumes of food, but have the added advantage of moisture control. Where machines have been installed, deep fryers have been removed, so all chips, chicken, fish etc. are oven baked.
ALPA takeaways work closely with the Departments of Environmental Health and the Department of Health and Physical Activity Division to ensure that occupational health and safety, food safety and nutrition standards are at all times meeting the Australian standards.
General Store Nutrition
Simple sugars such as those obtained through granulated sugar, confectionery and sugar based carbonated beverages can often make up a large component of the Indigenous diet (9). As a consequence, ALPA aims to promote alternatives over the standard confectionery range such as nuts and dried fruits, sugar-free gum and snack pack style fruit tubs. Water and diet drinks are given adequate amounts of shelf space and promotional activities designed to drive sales (and hence consumption) are undertaken. Sugar free product varieties, including artificial sweeteners and diet cordial will be available, and we endeavour to have product lines with low fat varieties such as milk, yoghurt and meats available at all times.
Store & Community Education
The health and nutrition strategy encompasses education and training of both staff and the external community. This education occurs both at the store level and in the greater community through community groups and events. This education is delivered is through practical exercises (i.e. cooking demonstrations or work activity demonstrations), and through written or verbal materials such as posters, "shelf-talkers" and educational DVD's. Close collaboration with ALPA, the Northern Territory Government Public Health Nutritionists and other health professionals/community health workers are a regular occurrence. Our community based Nutritionist also works extensively with ALPA's training department to develop appropriate resources for our staff members on the ground.
Under ALPA's Health and Nutrition Strategy, the position of a 'Good Food Person' is identified in each of the 5 ALPA member community stores and is encouraged in client stores. Through this role, the ALPA Indigenous store workers are encouraged to develop knowledge of health and nutrition and then pass this onto the community. This position involves participation in community health groups and community events and advising and referring products and services relating to health and nutrition. They are also involved in supporting in-house store audits for health and nutrition, as well as food safety.
At ALPA we believe that in order to promote healthy eating practices, it is important to build strong community partnerships. Each partnership brings different jigsaw pieces to the table, in order to complete the jigsaw; we all need to work together. Through these effective partnerships in communities, as well as agencies that service these communities lessons can be learnt for positive impacts on Indigenous health.
ALPA has formed solid partnerships with a number of organizations both within and outside our communities. Some examples of community organizations include community clinics, schools, and shires. Other external organizations include Red Cross, Menzies School of Health, CDU and Jimmy Little Foundation.
ALPA's Health and Nutrition Strategy has grown in many of its focus areas, and will continue to grow. Current concern about Indigenous Healthy by Communities, Governments and other aligned organisations continue to reinforce the importance of ALPA's Health and Nutrition Strategy.
Short to medium term focuses:
- Strong emphasis on chronic diseases such as diabetes and suitable foods for those with these diseases.
- Project on in-store health promotion strategies (joint project with Menzies School of Health)
- Increasing fruit and vegetable, water and diet drink sales (and hence consumption)
- Healthy communities through healthy takeaway and store options
- Increasing the awareness of the dangers of smoking
- Working on and developing community partnerships
For more information on ALPA's Health and Nutrition Strategy and corresponding activities please contact ALPA's Nutritionist, at firstname.lastname@example.org
- National Aboriginal and Torres Strait Islander Nutrition Working Party. National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan: a summary 2000-2010. 2001.
- Northern Territory Government. Revision of the Preventable Chronic Disease Strategy. Department of Health and Families Families Darwin, NT, 2009:1-62.
- Australian Bureau of Statistics. Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples cat. no. 4704.0 2008.
- Cade J, Upmeier H, Calvert C, Greenwood D. Costs of a healthy diet: analysis from the UK Women's Cohort Study. Public Health Nutrition 1999;2:505-512.
- Dietary Guidelines for Australian Adults. National Health and Medical Research Council, Commonwealth of Australia. 2003
- Baghurst P, Beaumont-Smith N, Baghurst K, Cox D. The relationship between the consumption of fruits and vegetables and health status: Report to Department of Health and Aged Care and the Strategic Intergovernmental Nutrition Alliance. In: Nutrition CHSa, ed., 1999:1-84
- Pollard J, Greenwood D, Kirk S, Cade J. Lifestyle factors affecting fruit and vegetable consumption in the UK Women's Cohort Study. Appetite 2001;71-79.
- Brimblecombe J. Enough for rations and a little bit extra: Challenges of nutrition improvement in an Aboriginal community in North-East Arnhem Land. Menzies School of Health Research. Darwin: Charles Darwin University, 2007.
- Lee AJ, O'Dea K, Mathews JD. Apparent dietary intake in remote Aboriginal Communities. Australian Journal of Public Health 1994;18:190-197.