We can’t close the gap on health unless we talk about nutrition

The 2016 Closing the Gap report, released today, makes little mention of Australia’s biggest failure in closing the gap in health outcomes for Aboriginal and Torres Strait Islander Australians: food and nutrition issues.

The latest figures from the Australian Bureau of Statistics reveal the alarming prevalence of food insecurity among Australia’s Indigenous people.

One in five adults have signs of chronic kidney disease – twice that of non-Indigenous Australians. The Lancet has reported on the case of a five-year-old girl diagnosed with type 2 diabetes. Malnutrition persists in remote communities with unacceptably high rates of anaemia among pregnant women, infants and young children.

Diet is the single most important factor in the chronic disease epidemic facing Aboriginal communities. However, the role of diet is not widely acknowledged.

While smoking and alcohol have become the public faces of the crisis, their effects pale in comparison to the impact of diet and nutrition. Yet there are no references to food, nutrition or diet anywhere in COAG’s Closing the Gap health strategy. Smoking, by contrast, is mentioned 25 times.

Aboriginal and Torres Strait Islander communities, particularly in remote and regional areas, face significant challenges to food quality and access. 

Food staples are highly refined and of poor nutritional quality, with a proliferation of cheap, highly processed unhealthy foods. There are infrequent deliveries of fresh foods, which are extremely expensive, and their high cost is amplified by low employment rates and low income.

The terrible irony is that Australia’s First Peoples lived for tens of thousands of years in good health before European settlement, supported by highly sophisticated and sustainable systems of food production, agriculture, estate management and trade.

Archaeologists can date the age of an Aboriginal skull as before or after colonisation by the state of its teeth – signs of plaque and decay appear only after European settlement.

Successive governments have pledged their commitment to closing the health gap between Aboriginal and non-Aboriginal Australians, leaving a trail of abandoned policies and half-implemented plans in their wake.

The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 was launched with great fanfare, but it was three years before a project officer was appointed to co-ordinate the implementation.

An evaluation report on the strategy – made public this year following a freedom of information request – showed that at its highest level of funding, the strategy had only enough funding to employ 1.2 full-time equivalent project staff.

Queensland and the Northern Territory have both had considerable success with the development of an Aboriginal and Torres Strait Islander health and nutrition workforce to operate within communities.

However, their early gains have been reversed. In Queensland, the jobs of more than 140 primary prevention experts, 30 per cent of whom were improving Indigenous community food supply and diet, were slashed to just 14 workers by the Newman government.

Food and nutrition policy and plans are palpably absent at the Commonwealth level.

The 2016 Closing the Gap report, released this morning by Prime Minister Malcolm Turnbull, includes just one short paragraph addressing nutrition.

The National Aboriginal and Torres Strait Islander Health Plan 2013-2023 appeared to have a renewed focus on nutrition, with three recommendations that acknowledge the issue of food insecurity and the importance of nutrition early in life, and a key goal to develop a national nutrition policy.

However, the federal government changed soon after the health plan was released, and only recently released the implementation plan, a year overdue.

The plan does not include the recommended national nutrition policy, and references to nutrition are scant and vague.

There is a very real risk that nutrition will continue to be invisible unless strong co-ordination is prioritised.

The three goals in the plan related to diabetes all refer to management, with no mention of prevention, which is delayed until the 2018 revision of the plan. It’s as if the government would rather pay for dialysis carts than improve the food supply.

Australia must commit to system-level change processes that draw on Aboriginal communities as partners with a range of stakeholders. Though many solutions are complex, long-term and whole of life, our world-class health system can do better.

In the meantime, encouragingly, there are ways to improve Aboriginal and Torres Strait Islander nutrition that we already know will work.

We have evidence for the success of community-based and led programs to improve food supply and cost, promote healthy food options and improve food storage facilities.

Solutions can be as simple as providing refrigerators for fresh food, offering healthy takeaway choices, subsidising freight on fresh fruit and vegetables and increasing the variety of healthy foods available.

It’s time for governments to develop a national Indigenous health strategy that is implemented, resourced and governed properly – without falling prey to frequently changing governments and administrations.

It should be a multi-sector strategy, with the acceptance and engagement of community leaders. And it should include meaningful ways to improve diet and nutrition.

We know the scale of the problem, we know that governments have failed to deliver, and we know what works. Let’s seize the opportunity to work together to close the nutrition gap to extend the basic right of good health to all Australians – to all our benefits.

Professor Stephen Simpson is academic director of the University of Sydney’s Charles Perkins Centre and executive director of Obesity Australia.