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.