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.
Although health is core business for hospitals, junk food and soft drinks have long dominated kiosks and vending machines that line hospital foyers and corridors.
But now Queensland is leading the way with a long overdue move to ban these items, which are driving contributors to obesity, poor health and chronic disease.
The ban is motivated by a call to reduce junk food advertising and availability to children. But other hospital goers will also benefit from moves to promote healthy food.
Making these changes is not easy. The food and drink industry, which has long enjoyed binding contracts with hospitals, has complained that it was not consulted in the decision.
Australian Beverages Council spokesperson, Geoff Parker, called the move “an insult to people’s intelligence,” arguing that “People don’t want governments snooping around in vending machines or hospital cafeterias.”
But the world’s leading obesity researchers say making unhealthy foods less available is needed to address the global health crisis. The ubiquity of food that is energy dense and nutritionally poor is a clear contributor to its overconsumption.
The executive summary of The Lancet’s 2015 obesity series argues that “Today’s food environments exploit people’s biological, psychological, social, and economic vulnerabilities, making it easier for them to eat unhealthy foods.
“This reinforces preferences and demands for foods of poor nutritional quality, furthering the unhealthy food environments.
“Regulatory actions from governments and increased efforts from industry and civil society will be necessary to break these vicious cycles.”
Targeting individual behaviours does not work, the researchers contend. They say a broad environmental focus on ‘denormalising’ unhealthy food consumption is needed – much like campaigns to reduce smoking.
That means changing social norms by creating an environment in which consuming unhealthy food and drinks becomes less attractive, less conventional and less accessible.
When trialled, healthier vending machine food and drink options have produced successful outcomes in schools, workplaces, hospitals and health services.
Evaluations of these initiatives not only reported that people bought healthier food items, but also that sales increased.
Behavioural economics tells us that people don’t necessarily make decisions based on careful weighing of risks and benefits. Behaviours are influenced by emotions, identity and environment – including the options available to us.
Based on this, contemporary research is considering how to ‘nudge’ people towards healthier behaviours and improve population health. When it comes to food, a grouped analysis of 42 trials in developed countries found that, on average, nudging strategies produced a 15.3% increase in healthier choices.
Healthier options in hospital vending machines and kiosks may not benefit the processed food and sugary drink industry, but people’s health and wellbeing could surely profit.