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STANDING COMMITTEE ON ABORIGINAL AND TORRES STRAIT ISLANDER AFFAIRS - 19/03/2009 - Community stores in remote Aboriginal and Torres Strait Islander communities

CHAIR —Welcome. Would one of you like to make an opening statement?

Ms Podesta —Thank you very much for the opportunity to appear today. I am going to give a somewhat detailed statement, but I hope that it provides answers to a number of the questions that you indicated you wanted to seek information on. As you can see, we have brought a significant number of officers here today. That is partially to reflect the fact that Aboriginal health is not just the Office of Aboriginal and Torres Strait Islander Health. It is a genuine portfolio commitment, and all of the parts of the department who contribute to this see it as important to be able to provide the evidence to your committee.

We recognise that limited access to affordable healthy food, such as fresh fruit and vegetables, is genuinely an issue for Aboriginal and Torres Strait Islander people in remote areas. There are a number of reasons for reduced access, including lower income levels and the high cost of healthy foods. We have outlined in our submission that the major cause of early death amongst Indigenous people is chronic disease. Much of chronic disease is linked to behavioural factors, including smoking and dietary habits. We also know that research indicates that low fruit and vegetable consumption accounts for approximately 5.1 per cent of the total health gap between Aboriginal and Torres Strait Islander people and non-Indigenous people in this country.

Food security, food access and food supply issues are of particular importance in remote areas, with 20 per cent of Indigenous Australians aged 12 or over reporting no daily fruit intake and 15 per cent no daily vegetable intake. However, I want to make this clear: it is difficult to identify an exact relationship between the limited availability of fresh fruits and vegetables in remote communities and the 17-year life expectancy gap because the supply of fresh food is just one factor in poor nutrition. It is not just about supply. Poor nutrition is one of a combination of factors which contribute to excess mortality.

However, there are a number of pieces of work in action which give us some significant pause for thought and certainly indicate some of the policy directions that we might wish to explore in the future. For example, we have a project working on the Anangu Pitjantjatjara lands which indicates that more than 40 per cent of Aboriginal and Torres Strait Islander people are living below the poverty line. The income of Indigenous people generally declines with increasing geographic remoteness. That is directly from the ABS. So the people who are amongst the poorest people in Australia also tend to have the highest food costs. This has been confirmed by the research that we have undertaken on the Anangu lands, which show that many people do not have sufficient income to cover the costs of a nutritious diet and basic hygiene needs based on the costs of those things within the communities in which they reside.

There is also limited access to affordable healthy foods in particular remote areas. Reasons for this reduced access include both the low income levels, the high cost of fresh foods, a reduced use of traditional foods, a limited family knowledge of nutrition and a lack of well-targeted nutrition information. That is work that is being undertaken by the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan, which we are very happy to elaborate on today.

Many remote Indigenous community stores also stock a relatively limited range of foods relative to rural towns and urban centres. In particular, perishable items, such as fruit and vegetables, are frequently in short supply. They are often of poorer quality and, as you know, they are often higher in cost. Numerous independent studies have shown that the cost of food in such communities is even higher than in other rural and remote communities. The price disparity is even greater for basic healthy food than for unhealthy items, such as takeaway food, soft drinks and tobacco. There is actually a financial reason that people make choices in the communities they live in.

Because of relatively higher levels of unemployment and poverty, combined with high food costs, particularly in very remote areas, many Indigenous people spend a much higher percentage of their income on food. That is reflected in the work that is being undertaken in the strategy plan. In 2001, there was significant work undertaken by health ministers. This is important to note, I think. Approximately 30 per cent of adult Indigenous Australians worried at least occasionally about going without food. In 2004, 5 per cent of Indigenous Australians reported that they did not eat vegetables on a daily basis compared with about one per cent of non-Indigenous Australians. In remote areas, however, this figure rose to 15 per cent for Indigenous Australians. In addition, 13 per cent of Indigenous Australians reported not eating fruit daily compared to 7 per cent of non-Indigenous Australians. This figure climbed to 20 per cent for Indigenous Australians in remote areas.

I want to just briefly talk about the relationship between some of these matters and closing the gap. I know that that is a particular interest of yours. We know that there is a relationship between improved nutrition and closing the 17-year life gap. Addressing low fruit and vegetable intake is an essential part of any strategy to close the gap. As I indicated before, of the total health gap, work that we have undertaken in conjunction with our academic colleagues suggests that about 5.1 per cent can be attributable to low fruit and vegetable intake. To put this in perspective, tobacco and excess alcohol, risk factors that are a very central part of the strategies for intervention, contribute approximately 17 per cent and 6.8 per cent to the health gap. Fruit and vegetables contribute about 5 per cent.

CHAIR —How do you measure that?

Ms Podesta —I will ask my colleague Mr Thomann. It is a technical answer, but we are very happy to give you that. We deliberately commissioned them at the highest level. It is peer evaluated research deliberately because you need to be able to talk science, not rhetoric.

Mr LAMING —What is the second one?

Ms Podesta —Smoking. Smoking is undoubtedly the big killer, no question. Tobacco has clearly received an enormous amount of attention, which is appropriate, as has alcohol. But fruit and vegetable intake is also one that we need to focus on if we are going to make substantial gains.

I want to talk briefly as well about children because, as you know, COAG targets are about not just excess mortality for adults but also the issue of reducing child mortality. I am sure you know that, compared with non-Indigenous babies, Indigenous children are three times more likely to die before their first birthday. They are twice as likely to be of low birth weight, almost three times as likely to suffer from foetal growth restriction and almost twice as likely to be born preterm. Intergenerational malnutrition is a contributing factor in these outcomes. Maternal malnutrition is a predictor of low birth weight, with a fivefold increase in risks documented amongst infants born to underweight mothers. Factors such as malnutrition and poverty affect child development and correlate with susceptibility to infections and the later development of chronic disease, particularly cardiovascular disease, type II diabetes and chronic renal failure and premature death in adults. Essentially, children who are born to parents with poor nutritional status also tend to have a much higher susceptibility to chronic disease.

I am very happy to go in more detail, or my colleagues, today to talk about some of the prevalence rates and some of the contributory factors to certain conditions. I note the time. If you wish, I would be happy to do that.

Mr LAMING —No. We would like to ask some questions.

Ms Podesta —I am happy to stop there. We have specific information on particular conditions and their relationship to nutritional status.

CHAIR —Is that in the submission?

Ms Podesta —Yes. But we also brought additional information today if you wish to talk about it. You indicated to us in the pre-questions that that is what you particularly wanted to focus on.

CHAIR —Yes. It is.

Ms Podesta —We focused on bringing some of that evidence today.

CHAIR —We would like all that information.

Mrs VALE —We would like all this information. This is really important. It is getting to the crux of the terms of reference. Is it possible, and without any inconvenience to the team here, if perhaps we could see them again?

CHAIR —Yes. I think that is fine.

Mrs VALE —Because, to do justice to your research, we have only five minutes and we have to go. I find that what you are saying is exactly what we want to hear. We need to know what you have to tell us. It is just the time constraints are a little too much.

CHAIR —Yes. I agree.

Mrs VALE —If we are going to be here tomorrow, I suppose it is impossible to organise something?

CHAIR —No. It is a bit tough.

Ms Podesta —We have everyone who is an expert here.

CHAIR —We apologise, but that is how the day has turned out. Firstly, I think all the information you have on this we would really appreciate. What Danna said is right; it does go to exactly the issue. I think what we might try and do is schedule you again in the next sitting block, which is May-June.

Mrs VALE —Is it possible, Chair, that we could just have this group without anybody else?

CHAIR —On the day, yes.

Mrs VALE —On the day, because I am sure we will take up your whole time.

CHAIR —Is that all right?

Ms Podesta —We would love that. Thank you. We are very excited.

CHAIR —Are you being sarcastic?

Ms Podesta —Yes, vaguely. No, we are not being sarcastic at all. Of course, we are happy to.

Mr LAMING —And that information would be important. I just want to add in a request for more information on the MSHR work on the electronic monitoring of food sales so we can see where that is at, because that really comes to the nub of what we are trying to do, which is improve community stores. We know that baseline all around the world remote areas have these very same problems. But what is the uniquely Australian solutions to the challenges?

Ms Podesta —We can certainly talk a little about the Mai Wiru project that we have been running very successfully on the Anangu Pitjantjatjara lands.

Mr LAMING —If you could circulate it through the committee.

Ms Podesta —Certainly.

Mr LAMING —And, as I said, the Menzies research.

Ms Podesta —Certainly.

CHAIR —It might be in the information you have given. The questions we were going to ask were about the Mai Wiru and the RIST. In the communities that you have looked at, do you have information about the percentage of food that is consumed coming from the store?

Ms Podesta —That will not be possible. We are investigating, as part of Mai Wiru, a point of sale system to be introduced electronically so that we will be able to monitor actual amounts and types of foods that are sold in the stores on the lands. So we have used Mai Wiru as an example to look at best practice in improving both nutritional outcomes and store management practices, not with complete success but with significant success.

CHAIR —Obviously this is a lot of really important information you are providing us in relation to the nutrition of these communities and the contribution it plays to the gap. I guess the question I am wanting to know is: to what extent does the community store contribute to the question of nutrition? Is half of the food sourced in the community store or is it 90 per cent? We have had a little evidence about that, but it is not that comprehensive. It might have been FaHCSIA who gave us some figures on that.

Ms Podesta —It would be FaHCSIA.

CHAIR —I just wonder whether anything had. Maybe we will leave that as a question on notice if there is anything floating around your department about that.

Ms Podesta —We would certainly be able to give you more detailed information about that with regard to Anangu Pitjantjatjara lands because of our long-term association with the stores and the reforms there. That is a project that is sponsored by the health service, so it has a very high level of research integrity. It is not anecdotal.

CHAIR —That would be good. I am really sorry about the unsatisfactory nature of this. Thank you for taking the time. Thank you very much for coming. We really look forward to seeing you when we are next here. Certainly what you have to say is very important for our inquiry. Thank you, and thank you to Hansard.

Resolved (on motion by Mr Laming):

That this committee authorises publication, including publication on the parliamentary database, of the transcript of the evidence given before it at public hearing this day.

Committee adjourned at 1.55 pm