2.19 Dietary behaviours
Why is it important?
Many of the principal causes of ill-health among Aboriginal and Torres Strait Islander peoples are nutrition-related diseases, such as heart disease, Type 2 diabetes and renal disease. While a diet high in saturated fats and refined carbohydrates increases the likelihood of developing these diseases, regular exercise and intake of fibre-rich foods, such as fruit and vegetables, can have a protective effect against disease (Wang et al. 2014). The National Health and Medical Research Council revised their Australian Dietary Guidelines in 2013. The guidelines specify recommendations for adequate minimum daily intake of fruit and vegetables according to age and sex (NHMRC 2013; ABS 2014d).
The Burden of Disease and Injury in Aboriginal and Torres Strait Islander peoples 2003 (Vos et al. 2007) attributed 3.5% of the total burden of disease in the Aboriginal and Torres Strait Islander population to low fruit and vegetable consumption. Its impact is largely as a risk factor for ischaemic heart disease (Voset al. 2007). Diet-related diseases are caused by combinations and interactions of environmental, behavioural, biological, social and hereditary factors. There is a substantial quantity of evidence that associates dietary excesses and imbalances with chronic disease. Of particular relevance in Indigenous communities are factors such as socio-economic status and other risk factors including insulin resistance, glucose intolerance, obesity (especially central fat deposition), hypertension, high blood triglycerides, perinatal and postnatal nutrition and childhood nutrition (NHMRC 2000; Longstreet et al. 2008). Good maternal nutrition and healthy infant and childhood growth are fundamental to the achievement and maintenance of health throughout the life cycle. Inadequate nutrition during pregnancy is associated with low birthweight in babies (see measure 1.01). Growth retardation among Indigenous infants after the age of 4 to 6 months has consistently been noted (Bar-Zeev et al. 2013). Australian obesity rates have also increased from 19% of the adult population in 1995 to 28% in 2011–12 (ABS 2013h).
The latest data on dietary behaviours for Aboriginal and Torres Strait Islander peoples comes from the 2012–13 Health Survey. In 2012–13, 15% of Indigenous Australians aged 2–14 years and 3% of those aged 15 years and over reported adequate daily fruit and vegetable intake. For those aged 15 years and over, 42% were eating the recommended daily intake of fruit (2 serves) and 5% the recommended daily intake of vegetables (5–6 serves). The recommendations for minimum serves of fruit and vegetables were lower for children (around half of the adult recommendations). In 2012–13, 78% of Indigenous children aged 2–14 years met the recommended fruit intake and 16% the recommended vegetable intake.
The majority of Indigenous Australians aged 15 years and over reported eating at least one serve of vegetables daily (91%) and also at least one serve of fruit (72%). Since 2004–05 (in non-remote areas), there has been a decline in the proportion of Indigenous Australians aged 15 years and over meeting the required vegetable intake (8.3% to 5.3%).
In 2012–13, the age group least likely to be consuming adequate serves of fruit and vegetables were those aged 18–24 years. Adequate daily intake of fruit was higher for Indigenous Australians aged 15 years and over in remote areas (46%) compared with non-remote (41%) while this pattern was reversed for adequate daily intake of vegetables (3.1% in remote and 5.3% in non-remote areas). A higher proportion of Indigenous females aged 15 years and over reported adequate daily fruit and vegetable intake (45% and 7%) compared with Indigenous males (40% adequate fruit intake and 3% adequate vegetable intake).
After adjusting for differences in the age structure of the two populations, Indigenous Australians aged 12 years and over were 1.4 times more likely than non-Indigenous Australians to report less than one serve of fruit daily and 1.9 times as likely to report less than one serve of vegetables. Rates of recommended levels of daily fruit and vegetable intake were lower for Indigenous Australians than for non-Indigenous Australians (ratio of 0.9 for fruit and 0.8 for vegetables).
The 2012–13 Health Survey showed an association between dietary behaviour and income, educational attainment and self-assessed health status. For example, Indigenous Australians aged 18 years and over in the lowest quintile of income were more likely than Indigenous Australians in the two highest quintiles of household income to report less than one serve of fruit daily (30% compared with 27%) and less than one serve of vegetables daily (10% compared with 6%). Those who were unemployed were less likely to eat the recommended serves of fruit (39%) than those who were employed (43%). Low fruit and vegetable intake was also associated with low levels of physical activity and risky/high risk alcohol consumption.
Findings from the biomedical component of the 2012–13 Health Survey show that 8% of Indigenous Australian adults had haemoglobin levels indicating a risk of anaemia, with women more likely to be at risk than men (10% compared with 5%). After adjusting for differences in the age structure of the two populations Indigenous Australians were almost twice as likely (rate ratio of 1.9) as non-Indigenous Australians to be at risk.
Evidence suggests that people living in poverty tend to maximise calories per dollar spent on food. Energy-dense foods rich in fats, refined starches and sugars represent the lowest-cost options, while healthy diets based on lean meats, whole grains and fresh vegetables and fruits are more costly (Drewnowski et al. 2004). People in vulnerable groups may therefore simultaneously be overweight or obese and experience food insecurity (AIHW 2012a).
In 2012–13, 10% of Indigenous Australians aged 15 years and over went without food when they could not afford to buy more. Indigenous Australians were 7 times as likely as non-Indigenous Australians to go without food due to financial constraints in the previous 12 months. A person's access to a healthy diet can be influenced by a range of socio-economic, geographical and environmental factors. Food security, food access and food supply issues are of particular importance in rural and remote areas. Remote stores often have a limited range of foods, particularly perishable foods such as fresh fruit, vegetables and dairy foods, and purchase prices are usually higher (Pratt et al. 2014; Scelza 2012; DAA 2013). Low income combined with high food costs result in many Indigenous Australians spending a large proportion of their income on food and contributes to concerns among Indigenous Australians of going without food (Brimblecombe et al. 2009). Australians in the most disadvantaged groups tend to spend 40% of their income on food while those in the highest income quintile spend 15%.
In 2009–10, the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP) was evaluated to determine how effectively it was implemented and how it could be more effective and responsive to the current environment. The evaluation identified that the key achievements of NATSINSAP were in three of the seven priority action areas: food supply in remote and rural communities; disseminating and communicating good practice; and Aboriginal and Torres Strait Islander nutrition workforce. Some specific examples within these priority action areas include: the launch of the Remote Indigenous stores and takeaways resources; the development of nationally accredited nutrition training materials for Indigenous health workers; the revival of the National Nutrition Networks conference and development of an Indigenous nutrition web directory on the Australian Indigenous Health InfoNet. The outcome of the evaluation is currently informing the development of a National Nutrition Framework to identify and drive nutrition-related activities. The nutritional needs of Indigenous populations are expected to be a key area of focus in the framework.
The revised Australian Dietary Guidelines ('the Guidelines') incorporating the Australian Guide to Healthy Eating (AGTHE) was released in 2013 under the banner of the Eat for Health Programme. The programme provides a suite of evidence-based guidelines as well as educator and consumer nutrition resources. The Guidelines apply to all population groups, including adults, children and adolescents, pregnant and breastfeeding women, older Australians, Aboriginal and Torres Strait Islander peoples and culturally and linguistically diverse groups. Currently there is a range of consumer and professional healthy eating resources available, including posters for Indigenous populations and a new AGTHE plate that shows the proportion of the diet that should come from each of the five food groups each day. Further adaptations of these resources for specific sub-groups of the population are planned, including adapting the AGTHE plate for Aboriginal and Torres Strait Islander peoples in 2014–15.
Under the Tackling Indigenous Smoking programme, a component of the Australian Government's Indigenous Australians' Health Programme, a national Regional Tackling Smoking and Healthy Lifestyle workforce has been deployed in 57 regions across the country to raise awareness of the health impacts of tobacco smoking and chronic disease in Indigenous communities, to actively promote positive lifestyle changes and to assist in timely access to appropriate health services as needed. The teams facilitate culturally secure community education, health promotion, and social marketing activities to promote quitting, smoke-free environments and encourage healthy lifestyle choices, including physical activity and nutrition. A review is being undertaken to ensure programmes are based on the most up-to-date evidence.
In 2014, the Australian Government launched the Healthy Bodies Need Healthy Drinks resource package. This suite of culturally appropriate promotional materials encourages school-aged children, their families and communities to choose water instead of high-sugar drinks in an effort to prevent obesity, chronic disease and dental caries.
Figure 2.19-1 shows the proportion of Indigenous Australians who met the guidelines for adequate intake of fruit and vegetables by age in 2012–13. In 2012–13, the age group least likely to be consuming adequate serves of fruit and vegetables were those aged 18–24 years.
(a) Based on one serve of fruit for children aged 2–8 years and two serves for persons aged 9 years and over.
(b) Based on two serves of vegetables for children aged 2–3 years, four serves for ages 4–8 years and five for persons aged 9 years and over with the exception of 18–49 year old males to eat six serves.
Source: 2012–13 AATSIHS (ABS 2014b)
Figure 2.19-2 shows the age-standardised proportion of Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians aged 15 years and over who ran out of food and couldn't afford to buy more at some time over the last year in 2012–13. Data is presented separately for non-remote and remote areas. Data is presented separately for those who went without food when they couldn't afford to buy any more; and those who ran out of food but did not go without food. Refer to the findings section of this measure for a description of key results found in this figure.
Source: ABS & AIHW analysis of 2012–13 AATSIHS