Technical Paper 1:
Obesity in Australia: a need for urgent action
In developed countries, the prevalence of obesity is higher among people of lower socio-economic status. This differential is observed in the Australian population: in 2004-05, Australians aged 18+ years in the most socio-economically disadvantaged fifth of the population had the highest rates of overweight and obesity (50%, compared with 45% of adults in the least disadvantaged fifth of the population). Similarly, Indigenous Australians are almost twice as likely as other Australians to be obese (after adjusting for differences in population age structures), with these differences greatest among women. In the 2004-2005 National Health Survey, Indigenous females were around one and a half times as likely to be overweight or obese as non-Indigenous females, whereas the rates were similar among Indigenous and non-Indigenous males.
These striking differences demand strategies to address the underlying social determinants. For example, the physical activity and eating behaviours of low-income people may be more dependent on the default choice (often the unhealthy choice in an obesity-promoting environment).
There are several National Indigenous Health Equality Targets from the ‘Close the Gap’ report, which, if achieved, would help address Indigenous disadvantage; for example, access to healthy, affordable food choices for over 90% of Aboriginal and Torres Strait Islander families by 2018. An existing initiative supporting this target is the Remote Indigenous Stores and Takeaway (RIST) project, which aims to improve access to healthy food in remote Indigenous community stores and takeaways through the development, implementation and evaluation of a common set of guidelines and resources promoting access to healthy foods; discourage the promotion of energy-dense, nutrient-poor food and drinks; and endorse guidelines and resources by key stakeholders to influence their uptake. Currently, each state and territory has their own implementation strategy; Queensland Health, for example, is funding the state-wide implementation and evaluation of the resources. Project resources include guidelines, marketing ideas and optimal storage tips for healthy food in remote community stores, and a toolkit to improve the freight transport of healthy foods to remote stores. The ‘Buyer’s Guide 2008 for managers of remote Indigenous stores and takeaways’ developed by the Heart Foundation identifies specific brands of foods and beverages that remote stores and takeaways are encouraged to stock in order to improve the available range of healthier items. The ‘Close the Gap’ report recommends this resource to community stores in their commitment to healthy nutrition and financial goals and targets.
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While it is too early to assess the uptake and use of the resources nationally, results are available from a six-month pilot of a selection of the RIST resources in 2007 in seven remote communities across Australia. The best outcomes (such as substantial increases in sales of fruit and vegetables between 2006 and 2007) were observed in communities where strategies consistent with those recommended in the RIST resources were implemented within a supportive environment. The results illustrate the need for community-based initiatives to involve far more than the provision of resources, including broad community engagement and consultation, and relevant infrastructure and funding.
In the participating Kururrungku community in the east Kimberley region of Western Australia, for example, increased sales of fruit, seafood, lean meat and recommended fats and oils were observed, in conjunction with the community participating as a COAG Trial site for a nutrition program supporting major changes being made to the community store. These included structural changes, such as the provision of a nutritionist in the community, the establishment of a weekly freight delivery of perishable items to the store and the provision of 12 commercial display fridges.
Support ongoing research on effective strategies to address social determinants of obesity in Indigenous and low-income communities.
Develop tailored approaches and services to reach Indigenous and low-income groups, particularly through partnerships with local governments that focus on obesity-promoting environments and mobilise programs in schools and other community settings.