The economics of food choice in remote Indigenous communities Kerin O’Dea Sansom Institute for...
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Transcript of The economics of food choice in remote Indigenous communities Kerin O’Dea Sansom Institute for...
The economics of food choice in remote Indigenous communities
Kerin O’DeaSansom Institute for Health Research
University of South Australia
Consistent pattern of food intake over many decades
• Very high intakes of refined carbohydrates, soft drinks, fatty meats
• Very low intakes of fresh fruits and vegetables and lean meats and fish
Why have these patterns persisted for over 20 years?
• Ignorance or poverty??• Widely held assumption that food preferences
are conservative: “flour, sugar, tea”• Our observations are very different
– People appreciate high quality food– Keen to taste new dishes– Understand quite well the qualities of healthy
western foods
Julie Brimblecombe, PhD thesis, 2007
Interventions to improve diet quality in remote community stores
• The Minjilang Project: Amanda Lee et al, 20 years ago
• Looma Healthy Lifestyle:15 years ago– Both interventions showed that the quality of the
food supply could be improved• Increased consumption of fresh fruit and vegetables• Reductions in fat and sugar
– This translated into reduction in CVD risk factors• BUT the dietary quality changes were still below
ideal
The economics of food choice
• Maximising calories• Reducing food spending by changing quality
before reducing quantity• Over eating when food is available• Women restricting their own intake to protect
children
Drewnowski and Darmon, AJCN, 2005
Fats and oils
Sugarflour
Fresh fruit, vegetablesLean meat, fish
Energy density MJ/kg
$ per MJ
Confectionary
Poverty and the food supply
Drewnowski and Darmon, AJCN, 2005
Cost of dietary improvement
Food item Actual quantity (g) per capita per day
Modelled quantity (g) per capita per day
Fruit 41 245
Vegetables 76 285
Milk powder 30 50
Wholegrain bread 9 21
Table sugar 96 48
Aerated added sugar drinks 248 132
Water 13 130
Canned corned beef 15 8
Hot chips 25 12
Pies 15 7
Salt 1 0.3
x 5.9
x 3.8
x 1.7 x 2.4
Additional Expenditure – at least $200 perfortnight for a family of 6
Brimblecombe, PhDThesisMed J Aust, May 2009
Improving nutrition at Looma School canteen
• An integrated program of improved diet, health education, regular exercise– Food supply
• first lunch, then breakfast– Sport– Health education in curriculum
• Diet• Exercise• Smoking• Alcohol and other drugs
Nutrient intakes provided by breakfast plus lunch, 1996 vs 1998
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1996
1998
Inta
ke (
prop
ortio
n of
RD
I)In
take
(pr
opor
tion
of R
DI)
Impact of healthy breakfast and lunch at the Looma School
• These two meals provided the Recommended Daily Intake for most of the key nutrients (vitamins, minerals)
• Schools and child care centres provide an ideal setting for such interventions– Post weaning period critical
• Cost-effective: well-targeted• Must be supported by community• Should be viewed as an investment in the future
health of the next generation
Many different types of nutrition interventions
• School breakfast and lunch programs abound– No control or evaluation of quality– Need simple guidelines– Should be evaluated over the long term using
simple standardised data collection• Impact on school attendance and performance• Impact on health
• Food supply interventions are less common
Key references• O'Dea K. Marked improvement in carbohydrate and lipid metabolism in diabetic
Australian Aborigines after temporary reversion to traditional lifestyle. Diabetes 33:596-603, 1984.
• Lee AJ, O'Dea, K, Mathews JD. Apparent dietary intake in remote Aboriginal communities. Aust J Publ Health 18: 190-197, 1994.
• Lee AJ, Bailey APV, Yarmirr D, O'Dea K, Mathews JD. Survival tucker: improved diet and health indicators in an Aboriginal community. Aust J Publ Health 18: 277-285, 1994.
• Rowley KG, Su Q, Cincotta M, Skinner M, Skinner K, Pindan B, White GA, O’Dea K. Improvements in circulating cholesterol, antioxidants, and homocysteine after dietary intervention in an Australian Aboriginal community. Am J Clin Nutr 74:442-8, 2001.
• Brimblecombe J, O’Dea K. Role of energy cost in food choices for an Aboriginal community in Northern Australia. Med J Aust 190:549-551, 2009.