'They've got to do something about the supply': Improving food security is critical to Closing the Gap

Abstract

Poor diet—including high intake of sugar-sweetened beverages and energy-dense foods, and low intake of fruit and vegetables—is a leading contributor to the burden of disease in Australia, particularly through its association with conditions such as cardiovascular disease and diabetes. Poor diet is also a leading contributor to the gap in health between Aboriginal and Torres Strait Islander (hereafter respectfully referred to as Indigenous) people and non-Indigenous Australians.

Although dietary behaviours are often perceived as individual choices, a broad range of factors can constrain food choice. For example, income and household composition can impact on Indigenous families’ food purchasing: '... if you have got to feed a couple of kids … and you have to buy all of this fruit and veg, whereas you can have a couple packages of chips, or takeaway—well, what are you going to do? … Even though they may know it’s [fruit and veg] really good for them.'

Food security exists when there are no physical, social, cultural, or environmental barriers to safe, nutritious, and culturally appropriate food. It is well-established that Indigenous Australians disproportionately experience food insecurity compared to non-Indigenous Australians. This inequity stems from the impacts of colonisation, including displacement and dispossession, the loss of traditional knowledge and food systems, and persisting socioeconomic disadvantage.

Access to healthy foods, such as fruit and vegetables, is an important component of food security. Recent analysis of data from the national Longitudinal Study of Indigenous Children (LSIC) identified that almost one-half of the 1,230 caregivers in the study reported barriers to their children’s fruit and vegetable intake.1 Overall, around 7% of caregivers reported problems accessing fruit and vegetables, including: that fresh produce was too expensive, not readily available, or of poor quality; transportation issues (e.g. shop too far away, no car); and problems with cooking infrastructure (e.g. no food preparation area or storage). These accessibility-related barriers were more commonly reported by families living in remote areas (24% of families) versus urban areas (3% of families). This reflects the high cost, limited availability, and poor quality of fresh food in remote areas. In remote settings, the food environment itself poses a substantial barrier to food security.

These issues were not only faced by families living in remote settings, however. Some families living in urban areas also faced barriers to accessing fruit and vegetables. Urban families were at increased risk of facing these barriers if they were disadvantaged in terms of financial security, health, housing, and community wellbeing.

Where fruit and vegetables were accessible, available, and affordable, children’s dislike (particularly of vegetables) posed a substantial barrier—overall, dislike was the most commonly reported barrier to children’s intake of fruit and vegetables (reported by 33% of caregivers). This dislike was understood to be related to the pervasiveness and accessibility of unhealthy food options.

Improving underlying determinants of food security such as financial security and housing may improve the ability of Indigenous families to access fruit and vegetables. But regardless of individual or household characteristics such as these, the food environment itself can constrain the ability of caregivers to provide their children with a healthy diet. For example, in both remote areas and disadvantaged urban settings, the relative affordability and availability of unhealthy options compared to healthy options makes it difficult for many families to make healthy choices.

Therefore, it will be critical to improve the food environment in order to improve food security and nutrition—as an Indigenous key informant explained, ‘they’ve got to do something about the supply’.

Our findings from LSIC are consistent with findings from the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands,2 where community-led programs and policies contributed to increased availability and affordability of healthy foods—including fruit and vegetables—and some improvement in micronutrient intake. However, despite these improvements, overall diet quality had decreased in the area since 1986. This was driven by the increased supply and intake of sugar-sweetened beverages and energy-dense foods such as takeaway and convenience meals. Taken together, these findings indicate that even when healthy options are available, affordable, and accessible, other barriers to healthy nutrition remain—particularly the competing availability of unhealthy options.

In summary, in order to improve food security and nutrition among Indigenous Australians, and to help Close the Gap, we will need an approach that combines the following:

1. improving the underlying determinants of food security and nutrition (such as financial and housing security) through culturally-relevant programs; and

2. improving the food environment by increasing the accessibility of healthy foods and decreasing the accessibility of unhealthy foods.

This is of particular priority in remote and disadvantaged urban settings, and will require sustained cross-sectoral action and leadership.

Finally, and most importantly, programs and policies to promote food security and nutrition should be conducted in partnership with, and draw on the strengths of, Indigenous families, communities, and organisations.