Overweight and obesity among Indigenous children: individual and social determinants

Abstract

What is the problem? Obesity rates are higher among Indigenous, compared to non-Indigenous, Australians, and this problem begins in early childhood. If this trend of increasing obesity among Indigenous children continues, there will be a corresponding negative impact on health, and the gap in life expectancy will widen, not close. Childhood is a critical life stage, and early intervention strategies can reap a lifetime of rewards. Childhood obesity prevention programs have predominantly targeted individual behaviours (such as physical inactivity and unhealthy diet) and have been unsuccessful to date. The approach needs to shift to addressing social and economic factors, rather than individual behaviours in isolation. Why is it relevant to policymakers? In February 2014, Prime Minister Tony Abbott acknowledged that progress against the Closing the Gap targets was disappointing and that a change of direction was needed. This should encompass a shift in focus away from individual factors and onto social and economic factors. As an example of relevance to state and territory policymakers, the ACT Chief Minister and Minister for Health Katy Gallagher has called for obesity prevention efforts to move beyond the health portfolio, towards a coordinated effort across all arms of government. This requires action on the food environment, schools, workplaces, urban planning and social inclusion. As part of her plan, Gallagher recently announced a ban on soft drinks in public schools in the ACT. What does the evidence say? To date, there has been a limited evidence base to guide the development of programs and policies for obesity prevention among Indigenous children. It has been recognised that social and economic factors are important, but empirical evidence is required to quantify the relative contribution of these factors and to work out which factors are the most important ones to target first. Data from the Longitudinal Study of Indigenous Children (LSIC), a national study managed by the Australian Government Department of Social Services, show that individual choices are strongly influenced by the broader context. In 2011, Indigenous children experiencing disadvantage at both the individual and the neighbourhood level consumed significantly more soft drink than more advantaged Indigenous children in the survey. Maternal education, housing stability, urbanisation and neighbourhood disadvantage are important factors affecting Indigenous children’s soft drink consumption, and therefore risk of obesity. What should policymakers do? If programs are to change the health behaviours and health outcomes of Indigenous children successfully, they must address social and economic factors—the context in which individual choices are made. Factors influencing obesity are not confined to the health portfolio; policy development should occur across portfolios including housing, education, employment, social welfare and community development. The broader benefits of such programs should be considered when weighing the cost. Research conducted at the National Centre for Social and Economic Modelling, University of Canberra, estimated that if Australia were to adopt the recommendations of the WHO Commission on Social Determinants of Health report "Closing the gap within a generation", half a million Australians could avoid suffering a chronic disease; 170,000 more Australians could enter the workforce (generating earnings of $8 billion); and $4 billion in redundant welfare support payments would be saved. The implications for the wellbeing of Indigenous Australians, and for health equity, have not been calculated, but are undoubtedly considerable.