Improving access to healthy food in urban Aboriginal communities

Gretchen Miller: Hello, this is Prevention Works: conversations all about the prevention of Australia’s increasing burden of lifestyle-related chronic disease, and it comes from the Australian Prevention Partnership Centre. They bring together policy makers, researchers and practitioners to look at what works and what doesn’t to turn the tide and create a healthier population. I’m Gretchen Miller, and today, we’re going to talk about communities in Sydney’s Campbelltown and the New South Wales city of Wagga, and we’re looking at a situation you might not have thought possible in the city. Food insecurity is a live issue for many of the families there, and it has an ongoing impact on physical health. You’ll find all sorts of things are at play, from public transport to urban design to food affordability and mental health. But action-based research from the Prevention Centre and a passionate community centre is changing all that. With us today is Darryl Wright, a Dungari man from Kempsey in the Macleay region and the Chief Executive Officer at Tharawal Aboriginal Corporation in Campbelltown, and he also oversees the local AMS, the Aboriginal Medical Service. And we’re with Sumithra Muthayya, a nutritional epidemiologist researching food insecurity in urban Aboriginal communities, and she also leads a larger project called SEARCH: the Study of Environment on Aboriginal Resilience and Child Health, and that’s Australia’s largest long-term study of the health and wellbeing of urban Aboriginal children. As well, we’ve got Simone Sherriff, project officer with SEARCH and Simone grew up in Wagga, and is a Wotjobaluk woman from the Wimmera region of north-west Victoria. Let’s start with you, Darryl. If you live in Airds, which is a district of Campbelltown, what’s available to you at the moment in terms of local shops?

Darryl Wright: Well there’s nothing really. There’s a tin shed there with things that it, it’s all tins, but there’s no food, you know, and the food is terrible, and the fruit and vegetables is not worth putting on your plate. And then they got the fast takeaway stuff, you know? It’s unbelievable. You have to go about five miles to get food, and if you’re gonna want to go to there you have to go by bus if you haven’t got a car, which is an hour and a half, so it’s all those sort of issues that we’re faced with.

Simone Sherriff: Yeah as Darryl was saying, like the IGA – it is an IGA isn’t it? – down in Airds it’s like really, really bad. I’ve been there, the food’s so expensive, the fruit and vegetables aren’t even fresh. I’ve been there and some of them are rotten and they’re still trying to sell them to the community and, as Darryl was saying, if people, families want to be able to get to the good food shops like Aldi, Woolworths, Coles, it’s like five kilometres, which doesn’t sound far but if you don’t have a car, you have to catch the bus. It’s like a long way on the bus ’cause it’s not direct to go there. So it’s really hard for families if that’s your only shop you can physically get to by walking.

Gretchen Miller: How often does the bus run?

Darryl Wright: I think it’s every hour, if it turns up.

Gretchen Miller: And then I guess you’ve got to get the kids on the bus.

Simone Sherriff: And the bus stop, who knows where the bus stop is relative to your house, so you might have to lug five kids down to the bus stop and then when you come home, you have to walk 500 metres with all your groceries and your five kids back home. It’s just not ideal.

Gretchen Miller: Darryl, paint me a picture of your community and maybe Sumithra, you can jump in here as well. Who are you looking after? What’s the makeup of your community, how old are they, where do they live?

Darryl Wright: Campbelltown, years ago, was classed as a resettlement village where they transferred people from all over the state and they treat them, Aboriginal communities, out of sight, out of mind. It’s sad.

Gretchen Miller: So Campbelltown has a big history with Indigenous people.

Darryl Wright: Oh yeah, it’s the second largest community in Australia outside of Western Sydney, Mt Druitt, Penrith. We have about 150, 200 elders, and you’re talking between 70 and 85, and they’re all active at the Centre. They’re so important to us because they’re like butterflies. They fly in, sit down and talk to staff, laugh, have a joke and fly out again. And that creates the activities and the wellbeing in the atmosphere.

Sumithra Muthayya: So all these issues that Simone and Darryl have mentioned are big deterrents to going and fetching healthy food. You may as well just get what’s around the corner and be done with it.

Simone Sherriff: Getting pizza delivered to your house seems like a better option doesn’t it, than having to you know, lug all your kids out all day and do the groceries.

Gretchen Miller: Simone, let me ask you what the current research is. It’s funded by the Prevention Centre. What’s it all about?

Simone Sherriff: I think we are aware of a lot of the problems that are going on, but there’s been no evidence to kind of support being able to get funding or services to help improve this and so, yeah SEARCH and the Partnership Centre, along with the AMS, has said we needed to be able to talk to some of the families, Aboriginal health workers, elders and other stakeholders in the community to find out exactly what’s going on in the community and kind of map out a picture of what services are currently available, what the barriers are for getting healthy food and having it available. And then the next step was to try and bring some of the families, some of the health workers, elders and stakeholders together in a room and brainstorm some ideas of what we could do to help improve it for the communities.

Sumithra Muthayya: What really surprised me was that a large proportion of Aboriginal families reported that they run out of food before every payday, which is a fortnight, and so they can’t afford to buy every few days in a month.

Gretchen Miller: So you weren’t expecting to find that level of disadvantage?

Sumithra Muthayya: Almost every family we interviewed described some level of food insecurity.

Simone Sherriff: I think the problems that we found in Campbelltown and in Wagga have been quite similar in terms of the accessibility to be able to get to the shops and the kind of shops that are available in the area, that’s been quite similar, I think. It was surprising to hear now that some of the local fast food takeaway shops are doing free delivery of hot chips, you can just ring up and order like $2 worth of hot chips and they’ll deliver it to your house for free. And so that was kind of surprising that those kind of things are available now.

Gretchen Miller: So there is a long list of pressures impacting on healthy eating in this community, of interrelated pressures. Could you run some of that by me?

Sumithra Muthayya: I think the central issue is the cost of food. It’s probably going to be more than 50 percent of the problem, and as I mentioned before, the cost of food relative to disposable income is a big problem. Whether it’s healthy, unhealthy food, food is expensive, that’s the number one problem. The second issue is that food is available, but you can’t get to it. You know, you can have all the best fresh vegetables, fruit, meat, all the nice food available five kilometres away, but getting to it becomes a problem because of no car, having a large family, having to lug them on a bus. That is the second big issue. And there are other issues around cultural practices where children are not willing to eat healthy food because of the way it is cooked or how it tastes. So parents are not motivated to cook when the kids won’t eat it. And I think another very important issue is the fact that our environment is unhealthy, we surround ourselves with unhealthy food outlets. The worst kind of food you can feed our kids: high in fat, sugar, salt, and then we ask them to eat healthy. There is a responsibility that we as a society should take to make sure that we make our environment healthy because if constantly we are faced with an easy option of a KFC or McDonald’s just a five-minute walk from our house, why would I take the trouble to go to the market, buy the food, prepare it and cook it? You know? We should think about that.

Simone Sherriff: There seems to be some kind of breakdown, they don’t how to cook really cheap, healthy foods. Like growing up, your grandma and stuff used to cook healthy stews and soups and everything that probably costs hardly anything to make.

Darryl Wright: And the other thing is that we’re trying to encourage our community to be aware of what you can do at home. Little garden for your own vegetables in particular, which grows better than fruit. And we do that at work, we got a community garden there and we teach them, and even with the kids, bring the kids to clean up the garden, do the weeding and put a seed in. That’s your seed to watch it grow, and they’re quite surprised when they see after a couple of days it comes up. So it’s educating the kids at early age. It’s so important.

Gretchen Miller: This is the Prevention Works podcast. Stay with us as we discuss the ongoing health impacts of something as simple as not having a good shop nearby or basic public transport. Sumithra Muthayya, nutritional epidemiologist and research leader.

Sumithra Muthayya: It would surprise many to hear that 75 percent of the Aboriginal population lives in non-remote areas and 60 percent of the disease gap between Aboriginal and non-Aboriginal people is attributed to this population.

Gretchen Miller: What do you mean by disease gap?

Sumithra Muthayya: So there is a life expectancy gap of 10 years between Aboriginal and non-Aboriginal people, Aboriginal people have higher mortality morbidity, all of which link to poorer health outcomes, and all of this encompasses the disease gap. And there is data to show that, 20 percent of Aboriginal people in non-remote areas is food insecure.

Gretchen Miller: 20 percent. Okay, so that’s one-fifth of Aboriginal families are dealing with a shortage of food regularly. What’s the medical and health impact of knowing that you’re going to be short of food?

Sumithra Muthayya: There is a large body of evidence highlighting the negative impact of mild to moderate food insecurity, and it really links to diet-sensitive chronic diseases. So it starts with obesity and goes anywhere to cardiovascular disease, renal disease. There’s a clear pathway that’s showing up as we look at more and more data, and that is where our project comes in. We want to address food insecurity and thereby improve the health of our children and their families. Children exposed to food and security experience more acute health consequences compared to adults. And we have also found in SEARCH that children as young as two to 10 years of age already are overweight and obese, about 30 percent of them. The problem begins very early in life and that is why SEARCH is focusing on improving the health of children, and one of the areas we are addressing is obesity through improved food security.

Gretchen Miller: So, if you improve food security, you’re less likely to be obese. Why is that Simone?

Simone Sherriff: You know when families, they don’t have as much money and things, you’re often buying things that are gonna fill up your family, you know, as they’re saying: like clog up your family, so lots of white bread and chips and potatoes that you know are going to be really filling and cheap and affordable. And so then obviously it leads to not having as good health ’cause you’re not getting the right fruit and vegetables and lean meats and everything.

Sumithra Muthayya: Data from SEARCH has shown that emotionally distressed children eat far fewer vegetables. It’s not surprising, but we actually have found the link between emotional distress and poor eating. But what makes the Aboriginal kids more unhealthy is the fact that they’re more obese than overweight proportionally when compared to non-Aboriginal kids. So the proportion of children with obesity keeps increasing relative to non-Aboriginal kids at the age. So that is a clear indication to us that it’s a problem that is getting more acute in early life and continues into adolescence, and by then their food habits are set, their activity levels are set, they’re in a vicious cycle and we want to break that cycle as early in life as possible.

Gretchen Miller: I can imagine that if you don’t always have money for food, if you know that you’re going to run out, that would surely lead to sort of a state of mental health, makes it very difficult to make the choice to go and actually cook something.

Sumithra Muthayya: So, Aboriginal adults and families who can’t afford to eat healthy food over a long period of time end up feeling unwell, both physically and mentally, and that can actually over a period of time can make you feel really down. Even if we know that if we don’t eat well over a period of time, we feel really mentally and physically unwell. On the other hand, being depressed and having to face all the difficulties around unemployment, other challenges in the family, can make you demotivated, you don’t want to go out and get yourself fresh, healthy food to make yourself well. It’s just a cycle that makes it worse and worse.

Darryl Wright: And that’s again what we’re trying to do at Tharawal is to encourage people to come, ’cause we’ve got a nutritionist that works with us, and that’s growing all the time, the class. And a little research out of that is saying that they’re cooking healthy for the kids and they’re losing weight and they’re enjoying it, and I think that’s an important part of it. That we continue that, not only with mums and dads, everyone.

Simone Sherriff: I think it’s been really great, as Darryl was talking about before, those healthy fruit and veg boxes that they’ve set up at Tharawal now. They don’t just give out the healthy fruit and vegetables, you know, people pay $20 and they get it delivered but they also give them recipes and things and they can come in and learn how to cook them. So I think as Darryl was saying it’s been really successful, like not just giving people the fruit and vegetables and say, “Here go do whatever with it”, but actually teaching them how to actually use them and cook them. And yeah, it’s been really successful, and yeah.

Darryl Wright: I mean, the important thing that we needed to do is make an individual strong, and make them feel about good about themself before they can explore other things, and even with their family. You can’t… my grandmother always said to me she said you get the mum’s head right, you know that the family is on track. So that’s why it’s important that we deal with the mums, make the mum strong, because you know when the mum comes for medical services, she doesn’t just bring herself, she brings all her grandchildren with her… and that’s important for us.

Gretchen Miller: What are some of the other pressures that happen for Indigenous families?

Simone Sherriff: I think as well, like a lot of people don’t understand that sometimes I talk about the amount of money or food you have for your household, but in Aboriginal families, you’re not just feeding the people who are literally living in your house, you’re often providing for extended family and friends and things as well. So it puts more financial pressure on that person as well. And also, like people have funerals and things and unexpected things come up where suddenly you have all these people staying at your house that you didn’t expect and that’s another reason why people sometimes will run out of food and money. When we’ve been doing these interviews, talking to families as well, like there’s a lot of people who are saying that they’re working, but they feel like they’re working poor kind of people, because they were saying like they can’t get access to some of the services, like food vouchers or charity, things like that, because they work, they don’t have a healthcare card, and they feel like yeah they’re struggling just the same as the people who aren’t working. So that’s been quite challenging as well. Like what do we do for these kind of people because they can’t access some of the charities and things, ‘cause they don’t have healthcare cards, so yeah, they feel quite even more disadvantaged sometimes.

Gretchen Miller: You’re with Prevention Works, and shortly the Australian Prevention Partnership Centre researchers talk about how to do it better. It is possible to improve things even as you’re doing the research and making a long-term commitment to the communities you work with.

Darryl Wright: It’s true, and we’ve always had that issue in the back of our minds, Aboriginal people in particularly in AMS where we, we don’t have control of the data, so the university or the agency work… do what they wanted to do with us and go and do their PhDs and all that sort of stuff. But the other thing that we’re concerned about too is no money comes with research. So if there’s any change of direction with the medical service in terms of all the stuff and all the data coming out, we have to carry that load.

Simone Sherriff: I think it’s so nice to be able to see this change that’s happened where, still there’s so many people that want to do the research, but the communities have the power now to you know, say no if there’s not going to be any benefits for them. Like it’s nice to be able to see that change.

Sumithra Muthayya: I think SEARCH has been unique in that, right from the very beginning, there has been a clear understanding that the data belongs to the community. They own it. And from the very beginning, data has been collected by Aboriginal researchers in SEARCH, and it is shared with the entire partnership, and data is constantly fed back and interpreted by the community, and we make our decisions based on that.

Gretchen Miller: Sumi, what are you finding that you think are realistic and great solutions coming out of the community?

Sumithra Muthayya: Since there are problems with both the availability and accessibility of healthy food, I think the suggestion to have a pop-up grocer or a mobile shop which comes around to your suburb bringing subsidised vegetables and fruit and other healthy food might be a great solution in the interim before the neighbourhood gets better shops that supply healthy food. I think that addresses both the availability and accessibility issue. In terms of cost, I think the subsidy is the way to go. Tharawal for instance supplies vegetable and fruit boxes for $15, and takes it to the family homes. But if we have a truck that comes around, it can benefit more families.

Gretchen Miller: What about other transport options?

Simone Sherriff: At the AMSs in terms of other services as well, like that was one of the big barriers, like in a lot of the communities, like if you want to be able to get to different specialists and things, if you don’t have transport, you can’t get there. So the AMSs now, like Tharawal, they have their own transport and they’ll bring you, pick you up from your house, bring you there. And so it’d be really good as well if you could have some kind of transport available to be able to get families to go to the supermarket and then bring them home again so they don’t have to rely on the bus service that you know could take nearly two hours one way just to get there to do their shopping. So yeah, a lot of families have said that if there was some kind of shuttle bus, they could pay a couple of dollars, or if it was free, to be able to take them to do their grocery shopping, and it could just be that it leaves even once a day or something at a certain time, but at least people know that that option is there for them. Yeah, I think that would be really good.

Sumithra Muthayya: One of the Aboriginal elders mentioned that often families take the trolley to the shops and just fill it. They don’t even think about what will I eat for the next four days and can I plan and buy the required food and then use them. And contrary to that, a lot of families when they get their pay, they fill their trolleys with just about anything. And a few days later, food starts to go off. And that’s also why they often run out of food. So a lot of help around how to budget, how to plan, how to get the right food, and how to store would be very helpful.

Gretchen Miller: How realistic is it that some of those solutions are going to come to bear out of your research?

Sumithra Muthayya: We are looking at a range of potential solutions, which is why we started talking to the community first because there’s so little information about what are the real issues the community is facing. We can go in and do a whole lot of things and come to nothing. So we’ve now received critical information around the key areas where the communities are struggling and we’re also talking to people who are stakeholders in this whole food security business. So you’re talking about people in transport, people in education, people in health, people in Aboriginal organisations who cater to this community, and we’re bringing all of them together to map out a framework that’ll give us critical points of intervention that will most likely give us some headway in this space. There is no single solution to this, which is why we have taken the trouble to talk to such a vast number of stakeholders in this food security pathway. So you’re talking about availability, accessibility, affordability, acceptability, of healthy food. And we’ve actually gone and spoken to different people in this path, and we expect that, once we have gone through it together and come to an agreement that these are the set of things we do in order to improve food security, we will then take the next step.

Darryl Wright: I think that it’s now my responsibility to run with some of this stuff, and I think that what we need to do now is talk about this to our elders, to our community because we’ve got to get them on side. And if they don’t follow what we’re doing, we’re just… our head up against a brick wall. I think that now, they’re in a position, they’re making decisions about themselves, about their health, they’re interested, they know all the difficulties, they’re turning their life around, and I think this is just the next step in how we can bring them in with us. So we need to grab the data, what’s coming out of this research and run with it and spread it because the grandmother always said, “You don’t own it, you give it out…”

Gretchen Miller: You don’t own it?

Darryl Wright: Yeah, you gotta share it, you know?

Gretchen Miller: Thank you to all for joining us on Prevention Works. It’s been really a fascinating conversation, thank you.

Simone Sherriff: Thank you!

Sumithra Muthayya: Thanks Gretchen.

Darryl Wright: Thank you very much for having us.

Gretchen Miller: Thanks to Darryl Wright from the Tharawal Aboriginal Corporation in Campbelltown, Sumithra Muthayya and Simone Sherriff, both from the SEARCH Project, and at preventioncentre.org.au, you’ll find more information into our guests and their work. You might also want to listen to renowned nutritionist Amanda Lee about who of us eats healthy and who doesn’t. The answer might surprise you. I’m Gretchen Miller, and I hope to catch you next time.