Diseases Among Aboriginal and Torres Strait Islander Populations - Term Paper Example

High Fibre Intake Program for Aboriginal and Torres Strait Islander People Introduction In Australia, the Aboriginal and Torres Straight Islander people are being classified as being vulnerable, due to the disadvantages of income, socio-economic status, employment, and education. The people of Aboriginal and Torres Strait Islander have changed their lifestyles and the patterns of their food consumption, gradually moving from a hunter-gatherer lifestyle to a settled Western-style existence since European colonists began to settle in Australia (Lee et al 1994). The Aboriginal diet has been changed from a nutrient-dense diet, which is high in fibre and low in fat and refined carbohydrate, to an energy-dense diet, which is high in fat and in refined sugars. These factors have greatly influenced the incidence of diet-related diseases, such as cardiovascular disease, hypertension, and type II diabetes. These diseases are now prevalent among Aboriginal and Torres Strait Islander populations. Lee et al (1994) investigated apparent per capita food and nutrient intake in six remote Australian Aboriginal communities. It was found that, in comparison to the rest of the Australian community, the intake of sugars and sweetened soft drinks were greater, and the intake of whole grains, fruits, and vegetables were much lower. Moreover, they found that white flour, white sugar, bread, and meat provided over half of the apparent total energy intake for the people of the Aboriginal communities. The high intake of refined carbohydrates and the high percentage of energy intake from meat with excessive visible fat may help to explain the prevalence of obesity, diabetes, and cardiovascular disease. There is a real need for a program in these communities that will help people change their patterns of food consumption. A high fibre intake program is proposed to promote consumption of vegetables, fruits, and whole grains in Aboriginal population, in order to reduce diet-related diseases. To improve nutrition and public health for all Australians, the Eat Well Australia (EWA) program has been developed by the Strategic Inter-Governmental Nutrition Alliance (SIGNAL) (National Public Health Partnership 2001). This action plan has been developed for all Australians, and the promotion of Indigenous health is also included; the companion document to the EWA program is the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan (NATSINSAP). The proposed high fibre intake program is intended to reinforce the importance of a diet rich in fruits, vegetables and whole grain products as outlined by the EWA program, and to improve the accessibility of these foods in remote and rural communities to meet the dietary needs of Aboriginal and Torres Strait Islander people. Program Aim The high fibre intake program aims to increase the intake of dietary fibre in Aboriginal communities by promoting consumption of whole grain products, fresh vegetables and fruit in order to reduce and eventually eliminate the health gap between Aboriginal and Torres Strait Islander people and the rest of the Australian population. It is hoped that modifying consumption patterns in this way will reduce the incidence of diet-related diseases in these populations. Program Objectives Increase the availability of whole grain products in remote and rural food retail sectors. Increase the availability in remote food retail sectors of fresh fruits and vegetables, as well as increasing the proportion of canned fruits and vegetables, or dry fruits and vegetables, and juices without added sugar. Spread the concept of high fibre intake among those of the Aboriginal and Torres Strait Islander communities. Promote a dietary shift from high fat and refined carbohydrates to high fibre, low fat, and low refined carbohydrates in the Aboriginal and Torres Strait Islander populations. Rationale A large amount of scientific detail has been dedicated to the study of the relationship between dietary fibre and diabetes or coronary heart disease. Not only does diet influence body weight, but it is also recognized as a modifiable risk factor for type II diabetes (Manson and Spelsberg, 1994). A study that was conducted by Meyer et al (2000) supports the idea that consumption of grains (particularly whole grains), cereal fibre, and dietary magnesium (present in grains) play a role in delaying or completely preventing the development of diabetes in older women. Dietary fibre improves glycemic response and insulin release by slowing the absorption and digestion of food and by regulating several of the metabolic hormones (Anderson and Akanji 1991). Numerous studies show a correlation between fibre intake and the risk of heart disease and high levels of cholesterol. A study done by Kushi et al (1999) suggested that a high fibre diet reduced the risk of coronary heart disease, and a second study done by Erkkila et al (1999) also found that dietary fibre intake was inversely correlated with total cholesterol concentration and serum triglycerides. In addition, Kleemola et al (1999) demonstrated that regular consumption of ready-to-eat breakfast cereals was related to a reduction in intake of total and saturated fats, and a reduction in serum cholesterol levels. These scientific studies have proven that consumption of dietary fibre is beneficial for the regulation of both the blood sugar and the serum cholesterol levels. These results show that fibre can reduce the risks of some diet-related diseases, including coronary heart disease and type II diabetes. Statistical studies carried out by the Australian Bureau of Statistics (ABS) show that the proposed program has the potential to produce positive results for Australia’s Indigenous populations; this is of course dependent upon those populations accepting the program and modifying their dietary patterns based upon its recommendations. In recent years, the ABS carried out two studies: A National Health Survey (NHS) in 2001, and the National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) in 2004-05. These studies shows similar results, with 11-12% of Indigenous Australians reporting a long-term health condition associated with the circulatory system. Additionally, in both studies Indigenous Australians were over three times more likely to report diabetes than non-Indigenous Australians. The 2001 NHS did not collect diet data from Indigenous Australians living in remote areas. However, the 2004-05 NHS found that 20% of Indigenous people in remote areas did not eat at least one serving of fruit daily, compared to 12% in non-remote areas. For vegetables, 15% of Indigenous Australians living in remote areas did not eat at least one serving daily, compared to just 2% in non-remote areas. Even in non-remote areas, only 42% of the surveyed population met the recommended daily fruit intake, and just 10% met the recommended daily vegetable intake. Overall, the data indicate that Indigenous Australians do not include enough vegetables and fruits in their daily diets, and as a consequence, the incidence of diet-related diseases has not declined in this population. Although the Health and Welfare of Australia’s Aboriginal and Torres Strait Islander People 2005 reported that education, employment and mortality statistics had improved between 1994 and 2002, a significant gap still existed between the Indigenous and non-Indigenous populations. For example, the mean gross household income for Indigenous people was equal to just 59% of that for non-Indigenous people in 2002. The mortality rate of endocrine, nutritional and metabolic diseases for Indigenous males and females were approximately 7 and 11 times, respectively, higher than those for non-Indigenous male and females. Furthermore, the life expectancy of the Indigenous population was approximately 17 years less than the non-Indigenous Australian population. For these reasons, disseminating information on the importance of a high fibre diet to the Aboriginal and Torres Strait Islander people is an important undertaking. In addition, the factors of influence on the food consumption pattern for the Aboriginal and Torres Strait Islander communities are not only social, economic, and cultural, but also include knowledge of and attitudes to food and nutrition. Thus, for reducing the incidence of diet-related diseases and improving the health of the Indigenous population, a high fibre intake program should concentrates not only on increasing fibre intake, but also on understanding the reasons for doing so. Program Action In remote food sectors, stores, and takeaway outlets Provide financial support so that remote food sectors can sell affordable healthy food. Develop an incentive system to encourage the sale of whole grain products, fruits, and vegetables. Reduce the availability of sweetened soft drinks and increase the availability of juice without added sugar in remote stores. Encourage food stores and takeaway outlets in remote and rural areas to supply or to use whole grain products, such as wholemeal flour, bread, toast, sandwiches, and traditional foods. Develop food and nutrition guidelines for remote stores and takeaway outlets to effectively manage food supply and storage. Advertise the benefits of whole grains, fruits, and vegetables in stores, community centres, and local newspapers and media. In Aboriginal and Torres Strait Islander Communities Establish a partnership between the government and communities to support the high fibre intake program. Target Indigenous family networks, as families have a strong influence in Aboriginal society. Set up communications channels to disseminate the concept of the benefits of fibre and other health issues, and get feedback or useful information from Indigenous communities. Organize and implement a system to review progress and assess the health of Aboriginal communities to determine the efficacy of the program, and to make any changes needed to meet the Aboriginal population’s current. Select and train Aboriginal people to assist the program and communicate with Aboriginal and Torres Strait Islander communities and population. Key Partners for Promoting Consumption of Whole Grains, Fruits, and Vegetables Supplier sectors: Department of Agriculture Regional Officers, growers and grower associations, producers of canned, frozen, and other fruit and vegetable products. Transport sectors: Goods delivery associations, freight transportation companies. Distribution sectors: Local fruit and vegetable shops, remote supermarket or fruits and vegetables markets. Food service sectors: Local restaurants, takeaway outlets, cafeterias, and school canteens. Promotion sectors: Local government and non-government organizations, local food promotion groups, community representatives, health workers, area health services, and Aboriginal medical services. Media: Local media, including TV, radio, newspapers, and magazines. Cooperation With Health Policies and Strategies Eat Well Australia and NATSINSAP (2000-2010) Aboriginal Health and Well-being Strategic Plan (2000-2010) National Indigenous Health Information Plan (1997) National Advisory Group on Aboriginal and Torres Strait Islander Health Information and Data (1997) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples (2003) National Aboriginal and Torres Strait Islander Health Survey (2004-05) for Australia, New South Wales, Victoria, Queensland, South Australia, Tasmania, Northern Territory and Australian Capital Territory The Australian Guide to Healthy Eating (1998) New Dietary Guidelines for Australian Adults (2003) New Dietary Guidelines for Children and Adolescents in Australia (2003) National Diabetes Strategy (1999) (Online information accessed 30 April 2007 at http://www.abs.gov.au) Conclusion The rate of diet-related diseases in Aboriginal and Torres Strait populations is significantly higher than in non-Indigenous Australian populations, and life expectancy is significantly reduced in Indigenous populations compared to the non-Indigenous populations. Many causes include social, economic, and cultural factors. Furthermore, knowledge of and attitude towards food and nutrition also have a strong impact on food choice and consumption. The pattern of food intake in Aboriginal population has already begun to change from traditional bush food to settled Western food, resulting in a higher intake of fat and refined carbohydrates, and an decrease in fibre intake. A combination of these factors has caused an increase in the incidence of diet-related diseases, such as coronary heart disease, hypertension, and type II diabetes in Indigenous populations. Wolever et al (1997) surveyed the North American Aboriginal population and came to the conclusion that the high prevalence of diabetes in this population was due to the adoption of a high fat, low fibre diet, which, in turn, was due to recent changes in lifestyle. According to this and other evidence, dietary modifications are an essential step in reducing the incidence of dietary diseases in Indigenous populations. There is a great amount of data that indicates the existence of a strong need for a high fibre intake program targeted to Aboriginal and Torres Strait Islander people. Implementing such a program will require extensive cooperation with other policies and strategies, government and non-government organizations, aboriginal communities, and food sectors including growers, producers, transporters and distributors. Price (2004) indicates that community stores in Aboriginal communities are key sources of nutrition for communities, and should be viewed as essential services. Community stores, therefore, are key players in providing a variety of affordable, accessible high fibre products. Nevertheless, providing healthy foods, including whole grain products, fresh fruits, and vegetables, is not enough. It is also vitally important to change the attitudes towards and the knowledge of food and nutrition. This will require working with communities and family networks to ensure that they feel comfortable with the program and with making significant dietary changes. Due to this reason, training people within the Aboriginal communities will be an effective and sustainable way of disseminating dietary information. The future of this program involves the program being seen in other countries. Diet-related health problems are being seen throughout the world, and each country should be tended to. Eating a healthy and sensible diet can become very expensive, as fresh fruit and vegetables are high on the market, but this program can make it so that those who could not afford healthy food before can do so now. This program will grow, spreading to the many countries, and decreasing the cases of diet-related diseases. In conclusion, the implementation of a program promoting high fibre intake is suggested to improve health and decrease the incidence of diet-related diseases among Indigenous Australian populations. It is to also help decrease the health gap between Aboriginal and Torres Strait Islander people and non-Indigenous Australians. Once in effect, this program must be continually reviewed to determine how effective each aspect of the program is, and whether future changes should be made to meet the needs of Indigenous populations. This program is designed with the health of others in mind. It is an affordable and effective way to become healthy, remain healthy, and avoid diet-related diseases. It helps others plan proper meals, and allows people to begin thinking seriously about the food and fats and carbohydrates that they are taking in. Aboriginal and Torres Strait Islander people have changed to an energy-dense diet, which contains foods that are high in fats and in refined sugars. These unhealthy diets are influencing numerous diet-related diseases, including type II diabetes, obesity, and coronary heart disease. The program is designed to help Aboriginal and Torres Strait Islander people, as well as the rest of Australia, to become more serious about their diet and their health. The high fibre program is to promote the consumption of vegetables, fruits, and whole grains. Eat Well Australia was developed to help with the task of increasing the intake of dietary fibre by increasing the amounts of fruits, vegetables, and whole grains in stores and takeaway outlets. The program is to help stores sell affordable fresh and healthy foods, and to encourage the sales of these foods. Other key partners are being sought for the promotion of the consumption of healthier foods, including distribution centers, food services, and the media. Studies show a correlation between fibre intake and the risk of heart diseases and high levels of cholesterol. Other statistics show that the program should have positive results, changing the diets and lives of Aboriginal and Torres Strait Islander people, and the rest of Australia. References Anderson JW and Akanji AO. 1991 Dietary fibre- an overview. Diabetes Care, 14:1126–1131. Australian Bureau of Statistics 2006 National Aboriginal and Torres Strait Islander Health Survey, 2004-05 (online accessed 25 April 2006) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12004-05?OpenDocument Australian Bureau of Statistics 2002 National Health Survey: Aboriginal and Torres Strait Islander Results, Australia, 2001 (online accessed 25 April 2006) http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4715.0Main+Features12001?OpenDocument Erkkila AT, Sarkkinen ES, Lehto S, Pyorala K & Uusitupa MI.1999 Dietary associates of serum total, LDL, and HDL cholesterol and triglycerides in patients with coronary heart disease. Prev Med 28: 558–565. Kleemola P, Puska P, Vartiainen E, Roos E, Luoto R, & Ehnholm C 1999 The effect of breakfast cereal on diet and serum cholesterol: a randomized trial in North Karelia, Finland. Eur. J Clin. Nutr. 53: 716-721 Kushi LH, Meyer KA and Jacobs DR.1999 Cereals, legumes, and chronic disease risk reduction: evidence from epidemiological studies. Am J Clin Nutr., 70: 451S–458S. Lee AJ, O’Dea K and Mathews JD 1994 Apparent dietary intake Aboriginal communities Australian Journal of Public Health 18:190-197 Manson JE and Spelsberg A. 1994 Primary prevention of non-insulin-dependent diabetes mellitus. Am J Prev Med; 10:172–84. Meyer KA, Kushi LH, Jacobs DR, Slavin J, Sellers TA & Folsom AR 2000 Carbohydrates, dietary fibre, and incident type 2 diabetes in older women Am J Clin Nutr, 71:921-930 National Health and Medical Research Council. 2000 Nutrition in Aboriginal and Torres Strait Islander peoples: an information paper. Canberra: National Health and Medical Research Council, Canberra. (Online, accessed 28 April 2006) http://www.nhmrc.gov.au/publications/synopses/n26syn.htm National Public Health Partnership 2001 Eat Well Australia: An Agenda for Action for Public Health Nutrition 2000-2010 Strategic Inter-Governmental Nutrition Alliance of the National Public Health Partnership (online accessed 23 April 2006) http://www.dhs.vic.gov.au/nphp/publications/signal/eatwell1.pdf National Public Health Partnership 2001 National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan: a summary the National Aboriginal and Torres Strait Islander Nutrition Working Party (online accessed 23 April 2006) http://www.nphp.gov.au/publications/signal/natsinsa2.pdf Price R 2004 Food Alliance for Remote Australia: a voice for food security issues in remote Australia The National SARRAH Conference, Alice Springs, Central Australia (online accessed 1 May 2006) http://www.ghwatch.org/english/casestudies/remote_aus.pdf Wolever TMS, Hamad S, Gittelsohn J, Gao J, Hanley AJG, Harris SB & Zinman B 1997 Low dietary fibre and high protein intakes associated with newly diagnosed diabetes in a remote aboriginal community Am J Clin Nutr, 66: 1470-1474 Read More