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.
Posted by ProPortion Foods Blog on Jun 28, 2019 in Nutrition
If you visit a psychiatrist one day in the not-too-distant future, you may be surprised to find that you are given dietary advice.
That doesn’t mean you won’t be given counselling, and medication where necessary, but it reflects a growing awareness about the importance of nutrition for good mental health.
In fact, some psychiatrists are already doing this, like Dr Drew Ramsey in the US, who regularly prescribes his clients a diet high in fresh, nutritious food and low in highly processed food.
Research on links between diet or nutrition and mental health has steadily grown over the past decade or so. This comes from a combination of studies investigating single nutrients and whole diets.
A whole array of nutrients is essential for brain function. Accordingly, research has found that supplementing with nutrients such as vitamins B and D, omega-3, zinc, and magnesium can improve symptoms of depression and anxiety.
Vitamin B and omega-3 may also help alleviate cognitive decline and dementia with aging.
But, although nutritional supplements may be necessary at times, we don’t eat nutrients, we eat whole food. Importantly, interactions between nutrients play important roles in brain function.
Fibre is also critical as it helps to facilitate healthy gut bacteria. This is increasingly recognised as being critical for reducing systemic inflammation and maintaining healthy brain function.
Population studies have consistently shown links between unhealthy diets and higher levels of depression and anxiety, and conversely between healthy diets and better mental health.
It might be said that people who are anxious or depressed eat more poorly, but longitudinal studies also found that people who ate poorly were more likely to develop mental health problems over time.
Other research has shown that people who have higher inflammatory markers in their blood – which underlie a range of chronic diseases – are more likely to become mentally ill.
And diet is a key contributor to low-lying inflammation.
More recently, two randomised controlled trials have confirmed what population research has found. Both were conducted in Australia independently finding that diet substantially reduced depressive symptoms in people suffering major depression.
The quick answer: a diet high in fresh food and low in processed food. Like Michael Pollan famously said: “Eat food. Not too much. Mostly plants.”
The traditional Mediterranean diet is high in plant foods – including fruit, vegetables, legumes, nuts, seeds, and whole grains, and includes generous amounts of extra virgin olive oil for salads and cooking (it has a high smoke point so is safe for cooking over moderate heat).
It contains moderate amounts of fish, dairy, and red wine with meals, and little or no meat, highly processed foods and confectionary.
There is endless scope to experiment with this type of diet, which is deceptively simple, tasty, and cheap.
And you never know, healthy food prescriptions might be subsidised by Medicare one day – US researchers have predicted that subsidising 30% of the cost of healthy foods could prevent nearly two million heart attacks, prevent 350,000 deaths and save $100 billion in health care costs.
Given that physical health and mental wellbeing are intimately related, this remedy be just what the psychiatrist ordered.
While multitudes of people around the world face food insecurity, a whopping third of food is lost or wasted. This equates to more than a billion tonnes of food valued at nearly $940 billion every year.
Australia is a part of the problem: five million tonnes of food reach landfill annually, which would fill 9,000 Olympic sized swimming pools, according to OzHarvest. This comes at no small cost – wasted food costs the Australian economy around $20 billion a year.
Apart from the financial cost, food waste impacts the environment. Precious resources such as water and energy are used to grow, transport and sell food. And every tonne of food that ends up in landfill results in 750kg of carbon dioxide being released into an already overloaded atmosphere.
Every business, school and household needs to pull their weight to address the problem. But health care facilities face unique challenges in dealing with their contribution.
Food surplus accounts for half of all waste generated by the health system, squandering resources, labour and finances.
In 2015, an Australian audit found that 200 grams of food was wasted, on average, per bed each day in hospitals and aged care facilities. Most of this came from uneaten food on patient trays. Other sources are hospital kitchens and cafeterias, according to a US survey.
In hospitals, food service revolves around health care procedures, generating several different routes for food waste. These include bulk cooking, long delays between ordering and serving, and missed meals due to hospital procedures, fasting, test scheduling, and patients being checked out.
Patients and older adults are more likely to have poor appetite and treatments and conditions that limit eating through symptoms like pain and nausea.
Palatability of hospital food is a key issue, as well as packaged food that is unopened and thrown away or half-eaten – which also contributes to plastic pollution.
These issues not only have implications for food waste, but also for patients’ nutrition intake.
Methods for serving patient meals have not changed in 30 years. Improved technologies offer several ways in which the issue of food waste – and associated problems like surplus food costs and malnutrition – can be addressed.
A study by HealthShare NSW reformed hospital food delivery using improved workflow processes and menus, staff training and technology. The project aimed to decrease the time lag between ordering and getting meals to four hours or less, improve food quality and nutrition and increase patient choice.
As a result, improvements were made at various stages of the process, reducing patient food waste by half. Patients’ food intake also increased considerably.
Other health care facilities have switched to a room service model for feeding patients. This personalised approach results in better patient satisfaction, in turn improving nutrition intake and reducing food waste.
Melbourne’s health department joined other organisations to trial recycling organics, finding it a viable way to divert wasted food from landfill.
In all, combining streamlined technologies and procedures for storing, ordering, delivering and disposing of food with improved patient choice, food quality and dining environments can improve nutrition intake and reduce food waste – a win-win on all counts.
Recognition of links between diet and mental health has snowballed in recent years. This includes the impact of nutrition on risk of dementia and Alzheimer’s disease.
Some individual nutrients have been singled out, such as vitamin B6 and omega-3. While these are important, by themselves they are no replacement for healthy dietary patterns.
In particular, the Mediterranean diet has been showered with accolades for its physical and mental health benefits.
Most people won’t argue with the fact that a healthy diet can ward off heart disease, diabetes, obesity and other chronic lifestyle ailments.
Not so many connect diet with mental health. But the brain is an organ, just like the heart, the liver and the pancreas.
It’s not just any organ. Although the brain accounts for only 2-2.7% of the body’s weight, it uses up 25% of the body’s glucose supply at rest – and this increases to 50% when it’s active.
As such, the brain is highly dependent on a regular supply of energy and nutrients from food. This fuels its structure and function, keeping us sharp and happy.
Not only does the brain need nutrients to work properly and create the neurotransmitters that keep it ticking over, it is directly influenced by signals from the gut through pathways known as the ‘gut-brain axis’.
These pathways are hormonal, neuronal and immunological. And there are trillions of little workers that help or hinder gut-brain messages: microscopic bacteria that dwell in the intestines.
These microbial communities are impacted by several factors including antibiotics, stress and excessive hygiene. They are also influenced by the food we eat.
Specifically, a diet high in sugar and processed food breeds less healthy bacteria while the beneficial microbes munch and proliferate on a whole food, high fibre diet.
There isn’t just one Mediterranean diet. Likewise, populations that live long healthy lives – with miniscule risk of dementia – have variations in their diets.
But there is no need for confusion; some basic underlying dietary principles are simple to follow.
The driving tenet is eating plenty of plant foods: fruit, vegetables, legumes, nuts, seeds and wholegrains. These are teeming with nutrients, antioxidants and fibre that promote a healthy gut and brain.
Fats are also important. In particular, extra virgin olive oil – a healthy monounsaturated fat – has numerous benefits attributed to its antioxidant properties. This oil has a high smoke point so can be used liberally for cooking as well as salads.
The diet typically includes moderate intakes of fish, which is associated with reduced risk of dementia, fermented dairy and red wine with meals. Importantly, it is low in sugar, processed foods and meat.
Nurturing a healthy lifestyle not only includes following these dietary principles; engaging in regular physical activity is also robustly linked to better physical and cognitive outcomes with aging.