In 2008 the Australian government released its Closing the Gap Strategy, which laid out plans to achieve health equality for Aboriginal and Torres Strait Islander people by 2030.
How is it tracking?
Not well, according to a 10-year review by the Australian Human Rights Commission – if anything, the gap has grown.
Of all Australian population groups, Aboriginal and Torres Strait Islander people still suffer the worst health outcomes, and their lives are about 10 years shorter than the rest of the populace.
According to Robert Tickner from the Australian Red Cross, “It is a national disgrace that, despite our reputation as one of the world’s most bountiful food producers, so many Australians cannot get adequate, nutritious and affordable food.”
Poor nutrition is a key contributor to the overburden of health issues faced by Indigenous Australians, which include overweight and obesity, malnutrition, heart disease, type 2 diabetes, chronic kidney disease and tooth decay.
These diseases contribute to at least three-quarters of their mortality gap.
Food insecurity is a big part of the problem. Much of this is due to poverty. Many Indigenous Australians also live in remote communities where healthy food is hard to come by. What is available is expensive because of transport costs.
As a result, fresh fruit and vegetable intake is very low, and “discretionary foods” make up 41 percent of their daily energy intake. Sugar consumption – largely from sweetened drinks – is nearly 50 percent more than the World Health Organisation’s recommendations.
Combined with easy access to unhealthy food and drinks, poor education and nutrition literacy is also part of the problem.
Many community-based programs have helped, the most successful being those with multi-level strategies that encourage community involvement at every stage of their development and implementation to make sure they are culturally appropriate and address local needs.
Some programs have focussed on improving the food supply through local retail outlets, school and community gardens, food provision by community organisations, and community store nutrition policies.
Nutrition education can also help, if delivered in conjunction with making healthy food accessible through cooking education, budgeting advice, and group-based lifestyle programs.
But these are band aid solutions to the overarching problem: there have been no nationally coordinated nutrition ventures since the National Aboriginal and Torres Strait Islander nutrition strategy and action plan expired in 2010.
The situation can be traced to many historical factors; indeed, all the evidence suggests that before European settlement Indigenous Australians enjoyed good health and a varied diet of nutritious fresh plant and animal foods.
Now they suffer socioeconomic disadvantage with low income and unemployment, institutional racism, low access to primary health care and poor quality, overcrowded housing, all of which contribute to ill-health and mortality.
Health equality is a basic human right. Treating diseases and improving nutrition and food security are important, but the review argues that underlying structural factors also need to be tackled before Australia can close the gap.
While Mediterranean regions are fighting it out for top healthy nation ranking, Australia is slipping.
Spain has overtaken Italy as the world’s healthiest country, according to Bloomberg’s 2019 Healthiest Country Index, while Australia has dropped two places to number seven.
Despite Australia’s escalating rates of obesity and heart disease, our nation is still well ahead of the US, which has slipped one place to rank 35.
For the Bloomberg index, countries are ranked on elements such as life expectancy and penalised for tobacco use, obesity and other health risks. Environmental considerations like hygiene and access to clean water are also factored in.
In the US, life expectancy has slipped as a result of premature death from drug overdoses and suicides, while the Mediterranean diet, with well-established health benefits, could help explain Spain’s and Italy’s superior rankings.
A different analysis by LetterOne, the Global Wellness Index, is also searching beyond economic data in their quest to identify a healthy society.
The latter index uses metrics including blood pressure, tobacco and alcohol use, obesity, government healthcare spending, rates of depression, happiness and exercise.
According to their breakdown, Canada ranks as number one out of 151 countries. The US doesn’t fare well on this one either, coming in at number 37, while Australia just scrapes into the top 25 healthiest countries at 23.
Overall, what stands out from both lists is that many smaller nations are outperforming countries considered financially well off, reflecting increased awareness that strong economies do not equate to better health.
Even though Australia is doing moderately well in the overall scheme of things, several facts can’t be ignored. For instance, we endure, on average, 11 years of poor health – topping other OECD countries.
Health equality has a long way to go, with a 10-year gap in life expectancy between indigenous and non-indigenous Australians.
More than half of Australia adults have poor health literacy and less than four percent of people consume recommended serves of vegetables and legumes while most Australians don’t follow guidelines for any of the five core food groups.
We are also the second highest meat consumers in the world, eating on average 95 kilograms per person each year (260 grams per day) compared to a world average of 35 kilograms annually.
This is a major concern, given that red meat is classified as a carcinogen by the World Health Organisation.
A recent Lancet report by 37 experts worldwide recommends a dramatic reduction in meat consumption – no more than 28 grams per day – and 100 percent increase in legume, nut, fruit and vegetable consumption globally.
The CSIRO recommends that Australians also need to invest resources to support aging, address increased rates of chronic disease and improve equity in health care access.
The link between type 2 diabetes and obesity is so strong that the condition, also known as obesity-dependent diabetes, is now referred to as “diabesity”.
Diabesity has reached epidemic proportions globally, prompting researchers to name this century “the unprecedented diabetogenic era in human history”.
Over time, diabetes causes serious health complications, including heart disease, kidney disease and stroke. It impacts peripheral blood vessels, eyes, gums, and even the brain, with Alzheimer’s disease now dubbed “type 3 diabetes”.
Obesity is also linked to heart disease and stroke, and other conditions including colon cancer, depression, liver diseases and gastroesophageal reflux disease. Both conditions result in poorer quality of life and premature death.
Various lines of evidence have revealed how obesity escalates diabetes risk.
When fat cells grow, particularly by 30 percent or more, they get “angry” and release inflammatory markers, causing chronic inflammation. These cytokines impact insulin receptors that prompt cells to let glucose in. The pancreas tries to release more insulin and eventually becomes exhausted.
Abdominal fat cells also produce hormones that further decrease the effectiveness of insulin receptors.
In the pancreas, fat cells directly reduce its ability to release insulin. All these factors lead to insulin resistance and high blood sugar levels – resulting in diabetes.
In turn, diabetes can reinforce weight gain. For instance, when it’s not controlled and glucose can’t enter cells for energy and important metabolic processes, the cells send out hunger signals.
Anti-diabetic medications including insulin can also increase weight gain.
Essentially, once set in, the condition can spiral out of control and has therefore been described as a slow poison.
Apart from a genetic vulnerability, most factors contributing to diabesity can be addressed before it becomes unmanageable.
The primary candidates are diet and physical activity, so warding off diabesity means taking charge of lifestyle habits.
A varied diet that decreases meat, processed foods and refined carbohydrates while increasing fresh plant foods such as fruit, vegetables, legumes, nuts, seeds and wholegrains is a primary defence.
Apart from reducing caloric intake and weight gain, this dietary approach avoids blood sugar spikes by reducing refined sugars and increasing fibre, putting less strain on the pancreas to release insulin.
Research suggests the antioxidant compounds and magnesium in plant foods help cells become more sensitive to insulin. Antioxidant polyphenols may also prevent diabetes in other ways, including their ability to stimulate insulin secretion and improve glucose uptake.
Plant fibre not only slows the release of glucose into the blood stream, it promotes intestinal bacteria that can improve the body’s glucose response, insulin signalling and insulin sensitivity.
Plant-based diets are also low in saturated fat, advanced glycation end-products (AGEs – oxidant compounds that are particularly high in cooked meat) and other dietary elements associated with insulin resistance.
Exercise can not only help deter weight gain; its numerous health benefits include improved insulin sensitivity. Experts recommend a combination of regular aerobic and resistance or strength training for optimal results.
Other lifestyle factors that can help maintain healthy weight and blood glucose levels include lowering stress and sleeping well.
This month saw the launch of the Healthy Ageing APAC Summit in Singapore on 12-13 June, covering a smorgasbord of topics related to nutrition and healthy ageing throughout the Asia-Pacific region.
Currently more than half of the world’s over-60s live in the Asia-Pacific. And the region’s number of older adults is expected to double from 547 million in 2016 to nearly 1.3 billion by 2050.
The summit was launched to explore how the nutrition and food industry “can meet the needs of the rapidly ageing populations of today, and more crucially, tomorrow.”
Nikki attended the summit. “There was just so much information and networking, it really was a fabulous couple of days! I’m very lucky to have been able to attend and learn a lot.” Here are some highlights.
Presenter Chin Juen Seow from Euromonitor pointed out that healthy living has become a major trend – and not just in ageing.
He suggests this is driven by an array of social and cultural influences spanning economics, population change, technological advancement, concerns about the environment and sustainability, and changing values: “Health is the new wealth.”
As a result, 37 percent of packaged food sales in Asia are presented with a health focus, and this is predicted to increase.
Dr Lesley Braun from Blackmores presented new research suggesting that omega-3s may benefit sarcopenia. Bolstered by animal studies that show increased stimulation of muscle protein synthesis, human trials provide some evidence of improved muscle-related biomarkers in older adults after taking omega-3 supplements.
Dementia is now the second highest cause of Australian deaths. It is risky and expensive for pharmaceutical companies to develop drugs for Alzheimer’s disease – the most common form of dementia – according to Dr Shawn Watson from Senescence Life Science, with a 99.6% failure rate of clinical trials. Their focus on amyloids could be the limiting factor.
Increasing research shows that nutrition and sleep can support healthy brain function with ageing, preventing risk of Alzheimer’s via several biological mechanisms including reduced inflammation and oxidative stress. Watson reported positive results from supplementation with turmeric and ginseng.
Alzheimer’s disease has also been nicknamed “diabetes type 3.” When people eat too much sugar, cells are bombarded with insulin, which tells them to take in the glucose for energy. Over time the cells become insulin resistant, leading to diabetes and a host of related health problems. Research has linked a lack of insulin to the formation of plaques associated with Alzheimer’s – one more reason to avoid excess sugar and refined carbohydrates.
Accordingly, the glycemic index (GI) was developed to rank foods by how quickly sugar is released into the blood stream. Kathy Usic from the Glycaemic Index Foundation told the audience about an impending global roll-out of the Low GI Symbol on food packaging to help address the soaring epidemic of chronic disease.
Amidst a wave of related research on low carbohydrate/high protein diets, a study is currently underway to investigate the effects of a low-GI high-protein diet on pre-diabetes/type 2 diabetes prevention. Watch this space!