Fred Hollows Foundation

Submission from The Fred Hollows Foundation

September, 2011

From: Joy McLaughlin

Manager, Indigenous Australia Program
The Fred Hollows Foundation

Preamble

The Fred Hollows Foundation welcomes the initiative of the Department of Agriculture, Fisheries and Forestry in planning to “integrate food policy from paddock to plate and protect Australia’s food security” and appreciates the opportunity to contribute to this discussion.

Our submission seeks to contribute to your deliberations and decision making to ensure that particular attention is paid to a group of Australians particularly vulnerable to food security matters—Aboriginal and Torres Strait Islander peoples who live in remote and isolated communities and locations.

The Foundations concerns about poor access to fresh, affordable and nutritious foods in remote areas continues and we are particularly disappointed that the Commonwealth Government have yet to respond, at the time of writing, to the Everybody’s Business, Remote Aboriginal and Torres Strait Community Stores report, that was tabled in the House of Representatives in November 2009.

The Foundation supports key recommendations of that report, especially in relation to:

  • Reducing the cost of and improving the availability of healthy foods in remote communities by introducing freight subsidies to all remote areas - we note that the report recommend subsidies for the Torres Strait. TFHF supports subsidies for all remote communities.
  • Improving the fresh food supply chain (using ARIA category or other tools) by establishing a national Indigenous food coordination office
  • Building healthy store policies and supporting the Remote Indigenous Stores Takeaways scheme, including enhanced training, resources and assistance provided to community stores
  • Promoting and enabling self-sufficiency in food and the production, processing and consumption of fresh foods at a local level, with an emphasis on local gardens and farms.

Furthermore, we encourage the National Food Plan to recognise, acknowledge and act upon the self-evident fact that food security, food access, food costs and food quality are central issues for all people in remote areas, and that an inadequate diet continues to be a major contributor to the poor health outcomes of Aboriginal and Torres Strait Islander peoples.

Our submission, hereafter, outlines a variety of options  to contribute to development of workable and sustainable solutions and offers recommendations to deliver fresh, affordable and nutritious food to people in remote areas.

Introduction

Indigenous Australians experience higher rates of morbidity and mortality than the wider Australian population, primarily due to preventable chronic conditions including diabetes, circulatory disease, kidney disease, respiratory disease and cancer (1). This disparity in health and wellbeing is attributable to the relative social and economic disadvantage of Indigenous Australians.

Inadequate diet is a major contributor to poor health status, particularly in the case of people living in remote parts of Australia. In remote areas, Indigenous people report significantly lower daily fruit and vegetable intake than people living in non-remote areas.  

The factors contributing to the poor nutritional health of Indigenous Australians in remote areas include poor food security; limited access to healthy foods; high cost of food coupled with low income; poor facilities for the safe storage and preparation of food. 

Article 25 of the Universal Declaration of Human Rights states that “everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food”(3). To effectively ‘close the gap’ between the health of Indigenous and other Australians, the human rights of Indigenous peoples must be realised(4), which includes equal access to a safe and healthy food supply.

About The Fred Hollows Foundation

The Fred Hollows Foundation (The Foundation) is an independent, non-profit, secular development agency that works both internationally and in Australia.

The Foundation’s vision is for a world where no one is needlessly blind and where Indigenous Australians enjoy the same health and life expectancy as other Australians.

The Foundation aims to achieve four key goals:

1. End avoidable blindness

2. Improve Indigenous health

3. Build a strong organisation

4. Create an international structure.

The Foundation’s Indigenous Australia Program supports a wide range of programs and projects in the Northern Territory, Queensland, South Australia, Western Australia and  New South Wales that focuses on; nutrition and food security, primary health care innovation and capacity, health promotion, individual and organisational capacity, women’s development, aural health,  advocacy,  governance , community engagement and eye health.

Our programs are developed and implemented in collaboration with Indigenous and non indigenous partners and stakeholders that include; Aboriginal Medical Services Alliance Northern Territory (AMSANT), Aboriginal community controlled health services, the Aboriginal Peak Organisation NT (APO), women’s groups, store committees, research institutions and local, territory/state and federal government.

Access to healthy food supply and food security is one of the key determinants of health that The Foundation seeks to address through its Indigenous Australia Program.

The Fred Hollows Foundation’s food and nutrition initiatives
The Foundation has been working with the Jawoyn communities since 1998 to address food supply and nutrition in the Katherine east region, also known as the Nyirrunggulung region. The partnership started with commissioning the Centre for Aboriginal Economic Policy Research (CAEPR) to conduct a scoping study into structural elements impeding better nutrition and the capacity to measure and monitor health impacts that would arise as a result of intervention(5).

The scoping document formed The Foundation’s involvement addressing the issue of in food supply and nutrition in the Nyirrunggulung region.

Current food and nutrition initiatives supported by The Foundation include:

  • Stores Nutrition Promotion and Education Project in partnership with the Menzies School of Health Research aims to trial food labeling along with the development and piloting of information materials and processes about fat, sugar, and sodium.
  • Nutrition and Food Security Short Course in conjunction with Menzies School of Health Research working towards development and implementation of a short course on evidenced based nutrition approaches to food security to improve particularly women’s and children’s health. 
  • Early Childhood Anaemia Project, a collaborative interagency, 5 year strategic nutrition supplement and education program that is currently being piloted in 9 remote locations spread throughout northern Australia.
    The project attempts to address the persistent unacceptably high rates of anaemia and poor nutrition amongst 6-24 month old infants and young children.  Further to improve evidence to assist in addressing the issues more broadly. 
  • Women’s Development Project now in its 6th year is a community capacity and development program which aims to increase self determination of women in the Nyirranuggulung region.  In 2010 The Fred Hollows Foundation worked to develop a healthy cookbook specifically for community groups to cater meals for between 10 – 100 people.
  • Roper Gulf Shire Landcare and Horticulture Project now in its 4th year aims to increase land care and horticultural activities in remote areas for the benefit of local Aboriginal people.  The key themes are in exploring opportunities to increase local food production, increase employment training options and improve pathways to increased food security.  In practical terms, this support has seen the development of community-based horticultural projects and the further roll-out of school-based horticulture and nutrition programs in conjunction with the Sunrise Health Service Nutritionist.

The Foundation suggests that the National Food Plan widely investigates programs such as this and incorporates horticulture, market gardens, nutritional training etc in its final document.



Question 1: What is the most important thing (you think) a national food plan should try to achieve?

Access to fresh, affordable and nutritious food is clearly impeded in remote areas and continues to negatively affect the health and wellbeing of Indigenous Australians.

The National Food Plan needs to address the inherent inequities of access and cost of foods to all people outside major metropolitan centers, in the interests of social justice and good health outcomes.

Regard for Aboriginal and Torres Strait Islander peoples who suffer the poorest health outcomes of any Australians and remain vulnerable to pricing and availability.

The National Food Plan must take into account and consider the findings of pre-existing ‘food reviews’  conducted in the public sector in recent years—Everybody’s Business, FoodNorth, the Remote Indigenous Stores and Takeaway Project and NATSINSAP, to name a few.

These reviews recommend (i) a “whole of government’ approach to resolve food supply issues; (ii) the establishment of a monitoring and evaluation system and (iii) the improvement of infrastructure and freight systems, including freight subsidies for food. 

The Foundation fully endorses these recommendations and tactics to address the inequities of access, quality and price of food for Indigenous people.
Furthermore, The Foundation supports the work of the Remote Indigenous Gardens network, to enable people to grow their own food and increase their independence.  The development and growth of horticulture skills for local people must be valued.  Productive market gardens would be a vital component of any ‘national plan’ to boost food security, quality and affordability, to supplement and enhance other means of readily available food supply.

Question 2: What do you think the vision and objectives for a National Food Plan should be?

The National Food Plan must deliver food security for all people regardless of how much money they have or where they live.
As stated above inadequate diet is major contributor to poor health status, particularly in the case of people living in remote parts of Australia.  In remote areas, Indigenous people report significantly lower daily fruit and vegetable intake than people living in non-remote areas.

The factors contributing to the poor nutritional health of Indigenous Australians in remote areas include poor food security; limited access to healthy foods; high cost of food coupled with low income; poor facilities for the safe storage and preparation of food; and limited control over community store management.

The National Food Plan should promote and practice equity in its vision and give special consideration to Indigenous people in remote areas (because of their isolation, poverty and limited access to nutritious foods) when deliberating on effective policies and activities to tackle the issues of food security, availability and cost.

The National Food Plan should focus on equity,  it should take a whole of government approach, it should develop a national monitoring and evaluation system and it should introduce and institute freight subsidies for food and the promotion of self-sufficiency initiatives.
 
Question 4:  What does food security mean to you?  How would this be achieved?  How would we know if/when we are food secure?

Food security only occurs when people have on-going access to safe, adequate, affordable and nutritious food to meet their dietary and metabolic needs (and their own food preferences) to enable a healthy life with regular social, intellectual and physical activities.

The evidence that many Indigenous communities and individuals are not ‘food secure’ is indisputable.  The National Food Plan could achieve ‘food security for all’ by reconsidering the myriad recommendations from the reviews conducted in the public sector in recent years —Everybody’s Business, FoodNorth, the Remote Indigenous Stores and Takeaway Project, NATSINSAP etc.

These reviews recommend (i) a “whole of government’ approach to resolve food supply issues; (ii) the establishment of a monitoring and evaluation system and (iii) the improvement of infrastructure and freight systems, including freight subsidies for food. 

While the vast majority of Australians are ‘food secure’ already and enjoy regular access to fresh, affordable and nutritious foods,  food security for most Indigenous people in remote areas has been marginal, or non-existent.   

Food security for all will only be achieved when all Australians have the same access to fresh, affordable and varied foods, irrespective of where they live.
But there is no ‘quick fix’ and indicators of food security and access—good birth weights, thriving infants, improved chronic disease management, increased life expectancy etc—will not improve swiftly, even if the NFP adopts a whole-of-government approach, sets up evaluation systems and introduces freight subsidies for food.

The NFP’s objectives must be long-term and should be guided by on-going consultation with Indigenous groups and individuals in remote areas.  The ‘community control’ of stores and shops, with genuine, well resourced, culturally appropriate support,  will further improve food security as those most affected by poor food access will make decisions to the benefit of their own communities.

Only then will improvements to Indigenous health outcomes, quality of life and lifestyle options be evident and quantifiable.

Question 6: What two or three actions by the government would most benefit food consumers?

1: Establish a high level ‘whole of government’ approach to resolve the issues of food security. 
The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 (NATSINSAP) provides a national framework for action but has been largely ignored.  Funding for the implementation of the strategy, particularly in the area of food supply and food security should be urgently addressed.

The 2003 report ‘FoodNorth: Food for Health in North Australia’ provides a comprehensive summary of the key issues around food supply to remote communities.  It also identifies a number of strategies that have the potential to be developed and applied nationally to improve food supply and nutrition for Aboriginal and Torres Strait Islander people in remote communities, most of whom live in the north of the country.

Only with a whole of government approach can the enormous distances, logistical challenges and impediments to food supply be tackled in a coordinated and collaborative way, across state boundaries and with shared objectives and processes.

2: Establish a national monitoring and evaluation system to properly assess food supply and food security in remote Indigenous communities.  Currently, there are no standard indicators or benchmarks for food security at the community and household level and no system to link this with health and wellbeing indicators.

The Remote Indigenous Stores and Takeaway Project (2008) is an example of the cross-jurisdictional collaboration that is required to address the omnipresent—and dangerous—food supply issues that bedevil remote Australia. 

The project developed a suite of tools to assist community stores with their stocking, marketing and monitoring of healthy foods.  It emphasised the need for better strategies to improve both the supply and demand sides in remote Indigenous communities and a stronger focus on monitoring and evaluation requirements.

In April 2006, Nexus Management Consulting provided a framework for food and nutrition surveillance in Australia that is worth close consideration and review.  Their report is titled ‘National food and nutrition monitoring and surveillance system: a framework and business case’, available from website.

3: Improve infrastructure and freight systems, including subsidies for freight.
The quality, affordability and variety of healthy foods in Indigenous communities remain poor.  Very poor.  Freight costs—the tyranny of distance—bad economies-of-scale at a community level and low personal incomes of many Indigenous people further impede and discourage the food supply chain to the bush.

Everybody’s Business, FoodNorth, the Remote Indigenous Stores and Takeaways Project and NATSINSAP, and other reports, all contend that government subsidies for freight costs would improve infrastructure and freight systems and, critically, deliver fresh, nutritious and affordable foods to people in remote areas. 

The West Australian Department of Health also recognises the inequalities of food access and price for Indigenous people in remote areas in its ‘Food Unit Communiqué’ of January 2010.  It advocates for a national food access and pricing survey to support policy initiatives to promote food security.  Further, it recommends formalising partnerships between government agencies, the food industry and appropriate academic institutions to explore the influence of food access and pricing on health, and to improve infrastructure and freight systems.

The Foundation urges the National Food Plan to consider the introduction of freight subsidies to improve food supply to remote areas.

4: Promote and enable self-sufficiency in the production, processing and consumption of fresh foods at a local level, with an emphasis on local gardens and farms.
The Foundation agrees with the Remote Indigenous Gardens (RIG) network that the development of ‘self sufficiency’ initiatives in remote Indigenous communities will take much time and considerable initial investment but will ultimately provide long-term solutions to some of the food security problems that impede good health outcomes for people.

Modern solutions, such as trucking and shipping fresh food over vast distances, will need to be augmented with ‘home grown’ food to ensure fresh foods are made available to people throughout the year.  Extreme weather events, rising fuel costs and carbon charges mean the modern solutions will not work alone and other solutions are needed as extreme weather events—cyclones and tropical storms causing flooding and isolation of townships—regularly impact communities in the north during the wet season.

The Foundation believes these ‘other solutions’ include investment in long-term capacity building to support remote communities in producing, processing and consuming more fresh food at a local level.  This capacity building includes the support for different types of gardens and farms, the development of economic enterprise initiatives and the recognition of different market types (ie initial subsistence farming would, ideally, evolve into viable commercial operations over time).

‘Succession planning’ is also crucial to the development of self-sufficiency in food production, as the skills and motivations need to be handed on to keep the knowledge (and the gardens) alive. Support is also needed for the creation of infrastructure for the production, storage, marketing, distribution and consumption of fresh foods.

As the Public Health Association notes in its submission to the National Food Plan: “Australia will need to produce twice as much food in half the time, under changing climate and economic conditions, using less resources (ie land, fertilizers, water, replacing fossil fuels etc).” 

Clearly, we need to get started on developing food self-sufficiency in remote Indigenous communities in an effort to prevent continuing food shortages in these areas and to contribute more fully to feeding the nation in general.


Further background


1. Food supply, quality, cost and competition issues

The inequality in food access, food availability and food use experienced by Indigenous Australians living in remote areas has been well documented (6). The common issues are:

High cost of food compared to cities and regional centers and a high proportion of income utilised to purchase foods.

Limited variety of foods, particularly fresh fruits and vegetables.

Poor quality of fresh fruits and vegetables.

Infrequent and unreliable transport and freight systems, particularly during the wet season.

Inadequate housing and facilities for safe storage and preparation of foods in the home.

Lack of competition as there is often only one food retail outlet.

Substandard infrastructure for stores.

In 2008 the Dietitians Association of Australia and Public Health Association of Australia released a joint policy statement on Food Security for Aboriginal and Torres Strait Islander Peoples(7) which provides an overview of the disparities experienced by Aboriginal and Torres Strait Islander communities in relation to access, availability and use of healthy foods.

Since 1995, the Northern Territory government has published results of the annual Market Basket Survey that monitors food cost, availability, variety and quality in remote community stores. There has been some improvement in the disparity of food costs between Darwin and remote stores. In 1998 the average cost of a basket of food was 41% more expensive in remote stores than in a Darwin supermarket. By 2006 the differential was 29%.

However the proportion of income required to purchase the same basket of foods has continued to increase in remote communities, with 36% of family income required to purchase the food basket compared to 28% of family income in Darwin.(8)
The National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 (NATSINSAP) provides a national framework for action (9).

2. models for community stores

The store has a special place in the life of a remote community. It fulfills a range of social and economic functions and plays a key role in strengthening the social fabric of the community. It is not only a source of food and drinks and other household goods but also a banking and credit facility, a source of employment and training and a social gathering/meeting place.

The effectiveness of a community store can therefore be judged in a number of ways but, for the purposes of this submission, The Foundation will consider effectiveness primarily in relation to community control and access to a safe and healthy food supply.

Community stores are operating under a range of financing, governance and management arrangements. The Australian Indigenous population is made up of many culturally diverse groups living in diverse and unique communities. Therefore a “one size fits all” approach to store models cannot be applied across all Indigenous communities. The models must reflect and adapt to the needs, aspirations and capacities of individual communities. FoodNorth poses two questions when considering governance of community stores: ‘Who owns the store?’ and ‘What is the purpose of the store?’ By answering these questions, the community can determine the most appropriate model for their store.

The Foundation believes that the underpinning principle of all models should be the right of Indigenous communities to have real control and real participation in decision making about matters that affect their community, including the type of store model. This reflects the direction The Foundation is taking with regards to food supply, where our focus has been on the development and governance of store committees to empower them to fully participate in decision making processes about their community food supply.

As already noted, there is no national food and nutrition monitoring framework and in the absence of consistent benchmarks the effectiveness of the various store models cannot be measured.

The licensing of community stores in the NT under the Australian Government Northern Territory Emergency Response (NTER) has provided a framework to ensure that good practices are in place in stores, regardless of the store model. A recent report by FAHCSIA found that licensing has had a favorable impact on the availability of healthy foods (9).

References

1 Australian Bureau of Statistics and Australian Institute of Health and Welfare. The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples 2008. Canberra: ABS and AIHW; 2008. ABS cat no 4704.0., AIHW cat no IHW 21.

2 Leonard D. FoodNorth: food for health in north Australia. Perth: North Australia Nutrition Group, Department of Health Western Australia; 2003.

3 General Assembly of United Nations. Universal Declaration of Human Rights. 1948. Available from: website 

4 Human Rights and Equal Opportunity Commission. Social justice report 2005. Sydney: HREOC. 2005.

5 Taylor J and Westbury N. Aboriginal nutrition and the Nyirrunggulung health strategy in Jawoyn country. Canberra: Centre for Aboriginal Economic Policy Research. 2000.

6 National Health and Medical Research Council. Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: NHMRC. 2000.

7 Dietitians Association of Australia and Public Health Association of Australia. Food security for Aboriginal and Torres Strait Islander peoples policy [document on the internet]. PHAA and DAA; 2008 Available from: website

8 Department of Health and Community Services. Northern Territory market basket survey 2006. Darwin: Northern Territory Government; 2007.

9 Families Housing Community and Indigenous Affairs. Stores post licensing monitoring report. 2008. Available from: website
 

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