‘I believe there are profound obligations for those who commit themselves to helping their fellow human beings in the pursuit of a better quality of life…. There are of course daunting and at times seemingly insurmountable obstacles, yet the challenges can be stimulating and enticing.’ – Rob Riley, Aboriginal leader and activist.
Through my travels in Aboriginal health I have come to the realisation that the challenges in Aboriginal health only “seems insurmountable”. It is not really. It does take time, lots of it. It needs to be tackled slowly, with the people who own their health and wellbeing and who ultimately are in control of their individual and collective futures. The first lesson that one must learn is this, “Aboriginal health does not mean the physical wellbeing of an individual, but refers to the social, emotional, and cultural wellbeing of the whole community.” And with this well-known Aboriginal concept I reflected on one aspect of Lifestyle Medicine, nutritional considerations in Aboriginal health and wellbeing.
Nutritional status is influenced by many social and environmental factors. Over- and under-nutrition and malnutrition are great contributors to chronic disease, cancers, child and maternal health issues and many other immune related diseases. This contemporary nutrition status of many Aboriginal and Torres Strait islander communities was not the norm prior to European contact and settlement when the diet was low in energy and rich in nutrients.
Sometime ago I found myself in a remote Aboriginal community and in my first staff meeting. By the end of the meeting where I probed the team what concerns their community had about their health. We noted these nutritional issues that needed addressing:
- Why are young adults dying from the same diseases as the older people at the same time? Diseases like heart attacks, strokes, heart failure, emphysema, kidney disease and diabetes;
- Why are our kids failing to thrive from the age of 8-12 months? Why is the under-fives anaemia rates so high after all that we have done? We have a good de-worming protocol but their growth and development is still not optimal.
These are big questions. We made a commitment to address the nutritional needs of kids under 5 years.
Good maternal and child nutrition are fundamental to the achievement and maintenance of health throughout life. Maternal nutrition prior to conception, during pregnancy and the postnatal period is important for the health of the mother, the baby and the infant. Adequate nutrition in early childhood affects growth and development, reduces the risks for childhood (recurrent and chronic) infections and chronic diseases later in life.
In the remote community children under five had regular growth and development checks. These were mapped on charts and on a black board for the community to see. Anaemia rates were recorded. In some communities the anaemia rates can be as high as 90% where the national average is 8%. De-worming and iron supplements were the mainstay of medical management. The community were not satisfied with the medical approach as the rates of anaemia has not changed for their community. We turned to an approach that may be seen by some as harder to do than tablets and injections to “cure” childhood anaemia. We turned to nutritional education and life skills training.
Nutrition education alone will not improve food security or dietary intake. Our greens, for example, usually come off the barge after 2-3 day’s journey and we received them having flowered bright yellow. Nevertheless, nutritional education is an essential component of a holistic approach to a nutrition problem. It empowers the individual and the community to direct the futures of their children health and that of the community. The aim of a community wide nutritional education program is to increase food and nutritional knowledge, skills and capacity within an environmental and cultural context with all it resources and challenges.
In the remote community:
- the monthly visiting nutritionist agreed to refocus her agenda and integrate her service delivery to that of the women’s center services and agenda;
- nutritional education was not only the domain of the health service, but it travelled to all sections of the community – homeland services, school, aged and respite center and Council. It is important to acknowledge that different families or clan groups control different sections of the community. By taking the nutritional education away from the clinic and deliver it to all the other services we can be more inclusive and reach the whole community with a message that is directly delivered from a trusted source.
- The school started their own curriculum (art, music, sports and recreation as well as learning about nutrition and their bodies); and the women’s centre started their own program around nutrition (cooking classes, shopping excursions, weaning practices) with the help of health care workers. The women conveyed that western vegetables and other foods are still strange to Aboriginal communities and can be intimidating, leading people to avoid using some fresh and packaged foods.
- Female Aboriginal health workers through a peer education strategy delivered nutritional activities to young women, mothers and aunties (grandmothers).
- The health service negotiated with the general store, with the Council’s backing, to rearrange the aisle displays (fruit and veggies at the front not the back and sweets were moved to the back away from the cash register; cans of veggies are arranged at eye level; labelling of iron rich “strong blood” foods direct shoppers gaze.)
- even the local band were tasked to come up with a catchy song about anaemia.
By the end of 6 months when the next under-five health screening report was due. We found to our surprise that we halved our anaemia rates by 50%. The lower rate of 30% remained for at least 3 years. We celebrated of course with an all-of-community celebration consisting of fun runs (Barge to Store), traditional ground oven cook-up of seafood, damper making (with fortified flour), spear throwing, line fishing, school sports and my favourite the Battle of the Moieties Tug-of-War. The band closed the celebrations in the evening with the anaemia song (reggae style) to the kids, young adults and some die-hard old people dancing to ensure the party did not stop.
So why could we not move further downwards with our anaemia rate? Food security is when people have “physical and economic access to sufficient, safe and nutritious foods to meet their dietary needs and food preferences for an active and healthy life.” The factors at play in food security in Aboriginal and Torres Strait Islander communities include income and employment, housing and overcrowding, transport and food costs, cultural food values and access as well as food and nutritional literacy, knowledge and skills. People in remote areas are more likely to experience food insecurity than those in non-remote areas. This does not mean Aboriginal and Torres Strait Islander people in urban settings don’t experience food insecurity. The highlight factor in the urban context’s food insecurity is lack of transport.
There are many more opportunities to address nutrition-related Aboriginal health and wellbeing which are not amenable to quick fixes and Band-Aids. We should take them.
Skin can be different,
but blood same.
Blood and bone…
all same.
Man can’t split himself.
– Bill Neidjie, Kakadu Man.
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.