The Chronicle Volume 29, Issue 2, may 2017 PublIcatIon of the chronIc DIseases networkIN THIS ISSUE...

• From the CDN Team ..................p1• 13th Annual ADMA and 21st Annual

CDN conference.........................p1• Evaluation of the Strong Baby Tuck-

er Project: Summary Report........p2• Community Stores Licensing in the

Northenr Territory........................p6• Promoting Healthy Food in Remote

Indigenous Comminities .............p8• Healthy Training in ALPA stor

es...............................................p10• Merne Murde (‘Good Food’) Pro-

ject.............................................p11• Housing for Health ....................p12• Media Release: Northern Territory

Government...............................p14• Media Release: Menzies...........p15• Media Release: Australian Indige-

nous HealthinfoNet....................p16 • Chronic Condition Journal Articles

of Interest..................................p17

The Chronic Diseases Network was set up in 1997 in response to the rising impact of chronic conditions in the NT. The Network is made up of organisations and individuals who have an interest in chronic conditions. These include:• Aboriginal Medical Services of the

NT• Arthritis & Osteoporosis

Foundation of the NT• Asthma Foundation of the NT• Cancer Council of the NT• Healthy Living NT• Heart Foundation - NT Division• Medicare Local NT• Menzies School of Health

Research• NT Health

The Chronic Diseases Network

nt Department of health www.health.nt.gov.au/professionals/chronic-conditions-health-professionals

The Chronicle

CDN Editorial Committee

Chronic Diseases NetworkT: 08 8985 8174

E: ChronicDiseasesNetwork.THS@nt.gov.au

Contributions appearing in The Chronicle do not necessarilyreflecttheviewsoftheeditororDepartmentof Health.Contributions are consistent with the aims of the Chronic Diseases Network and are intended to:• Inform and stimulate thought and action• Encourage discussion and comment• Promote communication, collaboration, coordination

and collective memory

From the CDN TeamWe are excited to bring you the second edition of The Chronicle for 2017. Thank you to all who have provided articles for this edition.

If you would like to submit an article to feature in upcoming ‘The Chronicle’ or the ‘e-CDNews’, please contact the CDN Team.

Want to become a member of the Chronic Diseases Network? You will re-ceive monthly e-CDNews publications, quarterly The Chronicle publications and regular updates on the CDN conference. Simply complete the membership form attached and send to ChronicDiseas-esNetowrk.THS@nt.gov.au to subscribe. It’s Free!

13th Annual ADMA and 21st CDN Conference: Integrated Chronic Care - From Healthy Child to Healthy Adult.Monday 11 to Tuesday 12 September 2017 at the Darwin Convention Centre

Register before 31 July 2017 to receive an early bird discount!

Poster abstracts can be submitted for consideration. Please email your poster abstracts to l.demos@alfred.org.au by 5pm AUST EST on 30 August 2017.

Support is offered for NT Aboriginal Health Professionals who are presenting forthefirsttime.Thiscanincludeassistanceindraftingtheabstractaswellasco-presentingtheabstract.PleasecontactourMemberServicesOfficeron ChronicDiseasesNetwork.THS@nt.gov.au with your email marked for attention of “The Aboriginal Reference Group.”

Thepreliminaryconferenceflyer,abstractguidelinesandregistrationformscan be found at http://www.adma.org.au/past-conferences.html

For Further Information Contact: The Australian Disease Management Association (ADMA)E-mail: info@adma.org.au Website: www.adma.org.au Tel: +61 3 9076 4125

May 2017

Evaluation of the Strong Baby Tucker Project:Summary Report

By Top End West Primary Health Care Team

1. IntroductionThe Strong Baby Tucker Project was evaluated by the Top End West Primary Health Care Outreach Team in November 2016. The purpose of the evaluation was to measure the effectiveness and impact of the project in Wadeye. The evaluation was carried out by conducting surveys with community members and stakeholders, and an interview with the Mi Patha Takeaway. The health outcomes of the children in Wadeye were also reviewed.

2. Summary of Results

2.1 Community:• 59 surveys were completed• 68% were aware of the pots• 69% had seen the pots• 28% had purchased the pots. Reasons for not purchasing them included no small children, wasn’t aware of the pots,

makes own food, wrong texture, not available/stocked, taste, look of pots/packaging• 31% purchased them sometimes, 6% purchased a lot, 6% purchased once a week and 6% purchased 3 times a

week• 82% had seen the posters in the Takeaway, Women’s Centre and the Shop• 95% knew who the pots were for and responses included babies, little kids and kids• 80% knew why the pots were important and answers included healthy tucker, strong blood, make strong, kids get a

feed, good for children and keep healthy• 94% thought the pots were good for the community

2.2 Stakeholders:• 9 stakeholders completed the survey• 89% had some involvement in the project• 67% had received some feedback from the community including: kids like the pots, price too high, not always

available at the Takeaway, people don’t like to ask for it, suspicion that pots are too old and people don’t understand that Take Away staff will reheat a new pot for them

• 78% believe the community knows about the pots due to the parents who attend FaFT and First Bites, one regular customer and Child Health Nurses are good at making sure mums know about the pots.

• 44% think that the community residents buy the pots• 89% had seen the posters• 100% thought pots were good for the community• 89% think strategies can be put in place to increase sales

Left: Picture shows the Strong Baby Tucker Pots packaging.

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Topic of discussion Comments/ FeedbackResources/Guidelines currently being used to facilitate implementation of the SBT project

On commencement the current managers were provided with a hard copy folder with resources relevant to the Baby Pots Project containing the following; • Recipe• A Baby Pots Plan for 2016 (devised by previous PHN)• Advertising posters• Sales monitoring tool• Mi Patha Nutrition Policy (draft form)• Strong Baby Tucker Action Plan• Nutrient comparison (devised by previous PHN)• BRACS script• Previous meeting minutes between PHN and Take Away managers.

Barriers to producing, promoting and selling baby pots

• Nomajorbarriersidentifiedbytakeawaymanagersindicatingtheyhadtheappropriate resources, equipment and skills to implement the project

• Smallamountofdifficultlyinachievingcorrecttexture(basedononebatchmade)

• Suggestion made by managers to produce 2x age appropriate textures (eg. Smooth pureed and soft lumpy)

• Suggestion made by managers of CDN/ PHN providing up skilling on the context of the pots to take away staff

Adherence to Nutrition Policy • Initially displaying 2 pots in bain-marie daily. Due to less customers and poor sales on Mondays and Tuesday adjusted to 1 on these days

• Wednesday - Friday are busier days so they generally put two pots out on these days

• Return to displaying 1 pot on weekends• A poster is displayed in the main area of the Take Away to promote the

availability of the pots• Managers are working on developing a slide show including Baby Pots poster

to display on the TV screen in store• Managers indicated they are happy to work with relevant stakeholders to better

promote the Strong Baby Tucker projectSales Data • No documented sales data available for the pots prior since taking over in July

2016• Estimated sales based on initial batch made in July (approximately 150-200

pots), of which 60 had been sold to the Health Centre (First Bites) and 80 sold through Takeaway, exhausted by the end of October 2016 indicating the sale of 150-200 pots in 4 months

• Anecdotally the sale of the pots to community members was reported to be poor

• Previous sales record from the end of 2012- to early 2013 was located which indicated the sales of 5-21 pots per week

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2.4 Child Health Outcomes

• There was decline in anaemia and underweight children aged 6-24 months in Wadeye from 2013-2015.

2.5 Enablers, Barriers and Suggestions for Improvement

Community and Stakeholders Mi Patha Takeaway Enablers Enablers• Community thinks it’s a good initiative• Understanding of the importance of the pots• Promotion through FaFT and First Bites• Support from the Child Health Nurses• Sighting of posters

• Provision of folder with resources• Pots promoted using poster in main

area of takeaway

Barriers Barriers• Lack of awareness• Texture• Availability in the takeaway/displaying of pots• Some parents make their own baby food• Misunderstanding that the pots are old and won’t be

reheated fresh

• Smallamountofdifficultyachievingcorrect texture

• No document sales data available

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Community and Stakeholders Mi Patha Takeaway Suggestions for Improvement Suggestions for Improvement• Improve promotion through more posters and signage

at the Creche, Save the Children and FaFt and other methods

• Increase education to parents• Increase availability of pots on the shelf• Improve the texture so it’s age appropriate or consider

having two textures • More discussion of the pots in the community• Change the ingredients regularly and include kangaroo

meat, potato and more sauces• Make pots fresh and hot• Review label on pots to include a list of ingredients and

wording in local language • Revamp and re-brand• Wider distribution of pots ie: Sell at T-house• More focus on Dads (lots of Dad’s at the Youth Centre)• Take-away staff help to improve it• Involve the local women who will be running the Early

Childhood Development and Learning Program• Use pots during Bush Wok sessions and at playgroup• Promote it during Kid’s Kitchen, School Holiday program

and at Women’s Bush Camp• Talk to Save the Children • Make it more appealing at point of sale

• Place two age appropriate textures • Upskilling by the Child Health Nurse

or Public Health • Promote the pots using a slide show

on the TV at the shop• Work with stakeholders to improve

promotion • Improve monitoring of sales

Conclusion

This evaluation has outlined that the community support the idea of the pots and recognise the importance. Therefore, the initiative should be continued in Wadeye. In order to generate more sales of the product, it appears that there must be a number of improvements made including changes to the product, more education and more promotion.

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6 May 2017

Community Stores Licensing in the Northern Territory

Supplied by Sonya Boersig, Department of Prime Minister and Cabinet

Community stores are the backbones of remote Aboriginal communities with locals depending on them to supply their family’s nutritional needs. While many community stores are well-run and offer a good range of reasonably priced, healthy food, some stores lack these essentials.

Because good nutrition is essential to good health and a strong future, the Australian Government is working to ensure community stores properly serve their community, by helping locals to run and manage their stores. In the Northern Territory, we are tackling these issues through community store licensing.

The licensing of community stores began in 2007 and there are currently 103 stores licensed in the Northern Territory. Store licensing means the Australian Government sets standards that stores need to meet to help make sure they have affordable fresh and healthy food available and can stay operating for a long time. For a community store to get a licence, they need to: • Have good quality, healthy food available, including fresh fruit and vegetables, lean meats and healthy takeaway

options (where takeaway food is sold);• Have nutrition policies in place. Some stores for example sell bottled water much cheaper than soft drinks.• Be a safe, clean place for people to shop; and• Meet standards for how the store should run and how things should be sold.If a store does not meet these standards the Australian Government may apply conditions to the store’s licence requiring it to make improvements or undertake particular actions.

Once a store has been licensed, the Australian Government monitors and works with the store to ensure it meets the licensing requirements, including any conditions that may be placed on a store’s licence. The Australian Government can work with the store if it needs to make changes to meet the standards required.

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Licensing applies to all of the Northern Territory except for Darwin and Palmerston, Katherine, Tennant Creek, Alice Springs and Nhulunbuy. This area is called the Food Security Area.Licensing is not needed in larger towns and cities because there is enough variety of food, drink and grocery outlets that people can choose where they shop.

A community store may have to be licensed if it is in the food security area and is an important source of food, drink or grocery items for an Aboriginal community. The Australian Government will consult with the local community before deciding whether a store must be licensed. This consultationprocessinvolvestalkingtocommunitymembers,storecustomersandlocalserviceproviderstofindoutif the store is an important source of food, drink or grocery items to the community. If the store is not important to the community (because people mostly shop elsewhere for example) then the store is not required to be licensed.

So,whenastore is licensed itmeanspeoplecanbeconfident that itprovidesarangeofhealthy foodfor the localcommunity, and that it is a safe place with appropriate standards in place. It also means that the Australian Government works with the store’s managers to prevent poor practices, such as book-up (a kind of informal credit) which is prohibited under licensing. This helps minimise debt for customers and address community concerns about PIN security, differential pricing, fees and charges, and poor book keeping practices that often arose prior to the introduction of licensing.

Therearemanyreportssuggestingstoreslicensinghascontributedtoasignificantimprovementintheaccessibilityoffood, including healthier food, in the Northern Territory. In particular, the Northern Territory Market Basket Survey 2015 shows in 2015 remote NT stores had on average 28 varieties of fresh fruit and vegetables for sale, which is an increase of 27 per cent on 2007 before licensing was introduced when stores had on average only 22 varieties.

Licensed stores are also encouraged to develop and implement policies relating to nutrition, pricing and employment. At some stores these policies may be helping make nutritious food more affordable, including through lower prices on healthy products, allowing locals to feed their family healthy meals for less.

Licensing does not change everything, though. Licensing does not allow the Australian Government to set or control the prices community stores charge for products. However, improvements in the operations of stores and other Australian Government support provided (such as governance training, funding to support capital improvements and professional store management services by Outback Stores) can help set the store up to be managed well and therefore have better long term access to good quality, affordable food. Well-run communities stores help to ensure families have access to healthy food choices so they can work and study to the best of their abilities.

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Promoting Healthy Food in Remote Indigenous Communities

Written by Jen Savenake, Health and Nutrition Manager at Outback Stores

Outback Stores mission is to make a positive difference in the health, employment and economy of remote Indigenous communities by supporting quality and sustainable retail stores. Outback Stores was set up in 2006 to help remote communities to access healthy food. It is an Australian Government owned company with an independent board of directors.

Outback Stores manages 36 stores on behalf of communities in WA, NT and SA. Outback Stores provides a fee for service management, working with communities to:• Promote improved health and nutrition outcomes• Support remote communities who require food security • Deliver positive social outcomes whilst maintaining strong commercial principles • Returnanyprofitstothecommunity• Support stores to stay open with Australian Government funding• Increase Indigenous jobs, employing more than 300 Indigenous staff • Provide training and business development• Provide strong governance with a support team of 60 in Darwin.

Outback Stores Nutrition Strategy is embedded in the operation of the organisation using the retail and marketing expertise to promote healthier choices. The Outback Stores range of products considers nutrition, quality, price, availability and individual community needs.

Outback Stores Nutrition Strategy:

Ensure a wide range of nutritious, safe, quality, affordable food, drink and groceries are available:

• The pricing structure makes healthy foods more affordable. For example, there is no freight on fresh fruit and vegetables and healthier takeaway food has a lower margin than less healthy options. Outback Stores do not promote or discount confectionary, pies or sugary drinks through any type of marketing or promotion.

• Some Outback Stores are very remote and getting refrigerated food into communities can be a challenge, when the produce travels over a week by truck (or barge). Some of these communities receive deliveries every fortnight and can be cut off by road for months during the wet season. Stores can pre-order dry goods for up to 3 months. Essential freshproduceneedstobeflownin.Comparethisto the average regional centre supermarket which has 3 days food in stock.

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Make healthy food and drink choices easier, while still maintaining choice:

• Reducing sugary drinks for example, 600ml water is $1.00 in all stores and sugary drinks are at least 25% more expensive than diet varieties.

• Increasingfruitandvegetablesforexample,thefirstthingyouseeinOutbackStoresarethefruitandvegetables• Increasing healthy takeaway options for example, at least 50% of takeaway foods will be healthier options.• Best practice to support and encourage healthy choices for example, the layout of the stores is designed to give

healthy options prime position. Water is located at the front of the store and sugary drinks towards the back, fruit is located on the front counter rather than confectionery.

Increase awareness and understanding of healthy food, among customers, store staff and Store Boards.

• Training staff to support best practice and encourage healthy choices. • Healthier cooking methods are used where possible. In most Outback Stores takeaways, there are no deep fryers.

Pictured Left is Natalie Brown from the Nguru-Walalja, Yuendumu store.

What brings the nutrition strategy to life is store managers, store staff, store committees, communities and the relationships we have with them:

• Increased the volume of fruit and vegetable sales (5% in 2016 over the previous 12 months).• Reduced sugary drink sales (from 68.3% to 67.8% in 2016 of all drinks sales) • Increased sales of water (from 16.2% to 18.3% in 2016 of all drink sales) • Increased healthy takeaway options.

For more information, please contact Jen Savenake, Health and Nutrition Manager Jen.Savenake@outbackstores.com.au

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Healthy Training in ALPA stores

Written by Tracey Fitzgibbon - Nutritionist at ALPA

Staff at ALPA’s Arnhem Land stores are training to be Good Food People so they can pass on their knowledge to com-munity members in a bid to reduce diabetes and heart disease. ALPA nutritionist Tracey Fitzgibbon is teaching at least onepersonfromeverystoretoknowthefivefoodgroups,readnutritionlabels,andunderstandthesugarcontentofsoft drink. Meredith Garrawurra from Buthan Store is one of six staff members to complete the workbook and, like her colleagues on Elcho Island, Milingimbi, at Ramingining and Gapuwiyak, was surprised to learn juice was not always a healthy drink option. Golden Circle UHT Orange Juice has 7.6g of sugar per 100ml, not much less than Coca Cola with 10.6g sugar per 100ml.

ALPA’s Good Food People do cook ups in store using a simple recipe from the ALPA Community Cookbook. Customers get to taste the dish and receive a free recipe card so they can recreate the healthy meal when they are at home. Once staff have completed their recognised training, ALPA will offer shopping tours to their customers where they will do their weekly grocery shop with the assistance of a Good Food People graduate. The Good Food Person will show customers how to read nutrition labels while they shop to assist them in choosing healthier products within the store.

The training has a strong focus on preventing diabetes and heart disease which are the leading causes of death for Aboriginal and Torres Strait Islanders1. While some people may be at higher risk of developing diabetes through genetic factors, many cases may be delayed or prevented through healthy diet, weight loss, physical activity and not smoking. These healthy lifestyle factors can also lower the risk of heart disease. Through training their staff, ALPA is hoping to spread the message throughout the remote communities where it operates that healthy eating is important and can positively impact people’s lives.

For further information, please contact Tracey Fitzgibbon:ALPA – Arnhem Land Progress Aboriginal Corporation T: 0402 564 439 E: nutrition@alpa.asn.auA: PMB 175 via Winnelle,,NT,0822 W: www.alpa.asn.au

Reference:1. Australian Bureau of Statistics, 2016, 3303.0 - Causes of Death, Australia, 2014, http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/3303.0~2014~Main%20Features~Leading%20Causes%20of%20Aboriginal%20and%20Torres%20Strait%20Islander%20Deaths~10015

May 2017

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The Merne Murde (‘Good Food’) Project

Written by Alex McClean - Manager, Arid Edge Environmental Services

“We better plant more kale next year” says Ankawenyerre Homeland resident Lucky Morton looking at the vegetable garden nestled between the 4 houses on her tiny homeland. “We ate it all up too quick this year”.

Ankawenyerre (also known as Rocket Range) is one of 16 outstations that make up the Utopia Homelands, 250km north east of Alice Springs in Central Australia. Like many remote Aboriginal communities, food insecurity is a key contributing factor to the chronic disease burden currently experienced by residents living in the Utopia Homelands.

Groceries are available through the 4 community stores on or near the homelands – businesses that play an important role in improving the social, economic and health outcomes of people in these communities. But in Utopia these stores can be up to 50km from people’s homes, prices are high and freshness is low compared to regional centres such as Alice Springs, and the availability of cash to purchase food is highly variable in this highly welfare dependent community.

By any measure, remote Aboriginal communities like the Utopia Homelands are some of the most food insecure communities in Australia, and as a result bear a disproportionately high burden of chronic disease, in particular anemia, obesity, diabetes and kidney disease.

Could food producing gardens like the garden at Ankawenyerre play a role in addressing these issues of food insecurity and chronic disease?

The Merne Murde (‘Good Food’) Project has been showing that they can. Since establishment by GPPNT (now NT Primary Health Network) in 2009, the project is supporting over 100 gardeners at 13 gardens across 10 homelands within the Utopia Homelands. Now managed by Arid Edge Environmental Services (AEES), with support from My Pathway and NT PHN, the project uses a combination of preventative health, horticulture and community development approaches to work with keen gardeners to establish food producing gardens in their homes.

AEES’ horticulturalist works with gardeners to build fencing, shade and self watering ‘wicking beds’ to produce a range of fruit and vegetables - kale, spinach, sweet peas, cabbage and oranges over winter, and tomatoes, corn, kale, lettuce, melons and mulberries over summer. Regular cookups run by AEES’ nutrition worker and dietician harvest produce from the gardens to teach simple healthy meals, with a particular focus on engaging women and children. These recipes, including beef and vegetable stew or chow mein, are selected to address key nutrition related anemia and obesity.

As the popularity of the project grows, more families are cooking the projects recipes and requesting gardens. Lucky’s assessment of the situation seems to be right – we’d better plant more kale next year!

For more information: P: (08) 8953 8835E: alex@aridedge.com.auW: http://aridedge.com.au/

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12 May 2017

Improving Nutrition - The Ability to Store, Prepare and Cook Food

WrittenbyLeanneDrury,CDNMembershipServicesOfficer,NTDepartmentofHealth

In Australia, Aboriginal and Torres Strait Isalnder people experience the highest burden of chronic disease such as diabetes, cardiovascular disease and renal disease contributing to one third of the gap in life expectancy between Indigenous and non-Indigenous people. One of the greatest contributing factors is poor diet and physical inactivity. Social determinants of health such as low household income, cost of food, ability to store, prepare and cook meals and local store management practices can make it challenging to establish a healthy diet, particularly for those in remote communities. A safe and reliable water supply is also essential to improving nutrition, not only for drinking but also for preparing food and cleaning cooking utensils.

Housing for Health has developed a guide based on nine different safety healthy living practices that link health to the place in which people live.

One of the healthy living practices critical to health is Improving Nutrition. In the Housing for Health Guide, Improving Nutrition isbrokenupintofivedifferentcategories:

1. Quality of drinking water2. Food storage3. Preparing food – sinks and benches4. Cooking 5. General issues for kitchen design

These guideliens were developed using Australian national survey data collected between 1999 and 2013 from 7,500 households (representing 50 000 people).The guide is particularly useful for people who work or study in health, design, architecture, engineering, government and non-government organisations, community development, advocacy and construction.

For more information about the Housing for Health guide, visit the website

Quality of drinking water:

People living in rural and remote communities may not always have access to clean, safe drinking water and as a result can negatively impact their health. In some circumstances, even when water may be considered safe to drink, people may think the water has a bad taste. This can have a negative impact on health as people may swap water for soft drink or add cordial to water to disguise bad tasting water, adding high levels of avoidable sugar to their daily intake. Furthermore, the money spent on soft drinks or cordial can mean less money available to spend on nutritionally dense foods and drink less water than required to maintain a healthy diet.

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Food Storage:

Storing food in a safe and hygienic manner within a house is essential for maintaining a healthy diet and can improve the household’s nutrition through lowering overall household costs as a result of reduced waste and having more money available for groceries1. In order for people to store food safely, residents require space that is well ventilated, cool, dry, and protect from rodents, pest, insects as well as pets. Materials used for cupboards are required to be water resistant, resilient to rust, rot, and insect infestation. Another essential health hardware item important for household nutrition is a properly functioning refrigerator as this allows the safe storage of dairy products, fruit and vegetables, meats and fish.Arefrigeratorthatfunctionspoorlycannotonlycausefoodtospoilbutisalsonotveryenergyefficient,reducingtheoverallhouseholdbudget.Studieshavehighlightedthatenergyefficientrefrigeratorscansaveupto$1.20perdaytoruncomparedtoinefficientrefrigerators.Bothfoodstoragecupboardsandrefrigeratorsshouldbeaccessibletoallhousehold members, including those with disabilities.

Preparing food – sinks and benches:

Preparing food in a hygienic matter depends on the availability, design and construction of benches, easy to clean splash backs, and a sink that has running water and adequate draining. Preparation areas can become unhygienic whentheybecomedifficulttocleanor/andbecomesinfestedwithvermin.Commonissuesthatariseasaresultorpoordesign and maintenance include: • Benches and cupboards rotting due to the use of materials which are not waterproof • Wall structure decay behind bench and sink • The use of bench materials not tolerable to hot items• Single drainer sinks resulting in a lack of space for clean or dirty dishes or sinks that are not large enough to clean

large kitchen items used to prepare food such as frying pans or pots. • Poor bench designs that are too small/narrow to allow for kitchen utensils to be stored or used to prepare food safely.

Cooking:

Cookingpreferencesvaryfromhouseholdtohousehold.SomefamiliesprefertocookoutsideusingafireorBBQwhileothers would prefer to have a complete outdoor kitchen. Cooking needs also vary with some families using basic kitchen appliances to cook, and others using multiple appliances including toaster, electric kettle, oven, stove and microwave. Regardless of the appliances used, cooking food requires functioning health hardware. It is important to have other ways to cook and may become essential if the main cooking appliances are not functioning or the house is crowded.

When selecting a stove it is important for the residents and housing managers to consider the following: • Stoves previously used; success or failures of the design• Benefitsofgasversuselectricstoves: -Abilitytorefillgasbottles -Availabilityofgasfittersorelectricianforrepairsandmaintenance - Cooking preference - Running cost• Easy to clean and maintain• Easy to remove for repairs; availability of spare parts• Upright stoves versus wall ovens and cooktops; ensure ovens can be accessed by people with disabilities. General issues for kitchen design:

Houses that are overcrowded may require a number of different options to prepare, store and cook food which may include different places around the house, outside in the yard or even on the veranda. Storage, preparation, and cooking should improve nutrition of all household members through all of the kitchen components regardless of where they are located.

References: 1. The Healthy Living Practices 2017, Health Habitat, accessed 2/05/2017, http://healthabitat.com/housing-for-health/the-healthy-living-practices2. Housing for Health: the guide 2013, Health Habitat, accessed 2/05/2017, http://www.housingforhealth.com/the-guide/health-housing/improving-nutrition-the-ability-to-store-prepare-and-cook-food/

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Room to Breathe: First Remote Housing Contracts to Create Jobs for Territorians

1 May 2017

LocaljobsforTerritorianslivinginremoteIndigenouscommunitieswillbecreatedwiththefirstcontractsawardedlastweekforRoomtoBreathe,partoftheTerritoryLaborGovernment’sflagshipremotehousingprogram.

TheMinisterforHousingandCommunityDevelopmentGerryMcCarthysaidtheTerritoryLaborGovernmenthasfulfilledanother election commitment by awarding four Room to Breathe contracts to Indigenous businesses, to build additional living spaces onto existing houses to ease overcrowding, with work expected to start in the coming weeks.

“All Territorians are entitled to control over their life and access to high quality services - when our remote communities and regions are strong, the Territory is strong,” Mr McCarthy said.

“We promised to restore trust in Government by creating jobs and empowering people in the bush, which is why this announcement is so important.”

MrMcCarthysaidthefirstRoomtoBreatheworkworth$2.7millionhasbeenawardedtofourIndigenousbusinesseswhich will create local jobs and employment opportunities and build local capacity.

“TheNThassignificanthousingproblemsthathaveseverelyimpactedmanyTerritoriansfortoolong,whichiswhywefast-tracked $10 million to start Room to Breathe before Budget 17,” he said.

“Building additional living spaces under Room to Breathe will improve liveability of remote housing – a good home is an important factor in a good education, good health and good community outcomes.”

Mr McCarthy said today’s announcement was in stark contrast to the chaos of the CLP Government over the last four years of government.

ThefirstfourtendershavebeenawardedtothebelowIndigenousbusinessesforthefollowingcommunities: Hermannsburg - Tangentyere Constructions (T/A Sonwane Pty Ltd) Maningrida - Bawinanga Aboriginal Corp Milikapiti - Tiwi Contractors Pty Ltd Ramingining - Bukmak Constructions (ALPA)TheremainingtendershavebeenreleasedandwillbeawardedinthefirstthreeweeksofMay.

“More jobs will be created when the remaining $7.3 million is awarded to Indigenous businesses,” Mr McCarthy said. “Local decision making has guided the roll out of the program - local people have worked closely with the Department of Housing and Community Development to decide what additional living spaces they need for their families.

“We want our remote housing program to be delivered in true partnership with Indigenous communities, because local people make the best decisions about their future and issues that impact them.”

Room to Breathe is part of the Territory Government’s record 10-year $1.1 billion remote housing program which will create local jobs, joint venture opportunities and increase the demand for the supply of steel and other building materials.“This will build the local economy and improve outcomes in remote Indigenous communities,” Mr McCarthy said.

Media contact: Emmanuelle Clarke 0428 497 154

The Chronicle

14 May 2017

15 May 2017

Traditional food trends in remote Northern Territory communities

Media Release: Menzies of School and Health Research

Wednesday, 29 March

The majority of Aboriginal people living in remote Northern Territory communities are regularly using traditional foods in their diets according to research from Menzies School of Health Research published in the Australian and New Zealand Journal of Public Health on March 29 2017.

The paper, Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory reports that a nutritious diet including the consumption of traditional foods plays a key role in protecting against chronic disease for Aboriginal and Torres Strait Islander people living in remote communities.MenziesresearcherandleadauthorMeganFergusonsaidthatinadditiontodemonstratingsignificanthealthbenefits,traditional foods remained an integral part of identity, culture and country for Aboriginal and Torres Strait Islander people, while also alleviating food insecurity in remote communities.‘Surveys conducted in remote Northern Territory (NT) communities revealed almost 90% of people consumed a variety of traditional foods each fortnight’.

‘We have long understood that native animal and plant foods are highly nutritious. There is no evidence that Aboriginal and Torres Strait Islander people had diabetes or cardiovascular disease whilst maintaining a diet of traditional foods, and it has been shown that reverting to a traditional diet can improve health.

‘In relation to food insecurity we also found that 40% of people obtained traditional food when they would otherwise go withoutfoodduetofinancialhardshiporlimitedaccesstostores,’MsFergusonsaid.The list of traditional food reported during the research is extensive and includes a range of native animal foods including echidna, goanna, mud mussel, long-neck turtle and witchetty grubs and native plant foods including green plum, yam and bush onion.

The 20 remote NT communities surveyed reported that traditional foods were available year round.‘There is still much to be learnt about the important contribution traditional foods makes to nutrition and health outcomes. We need to work with Aboriginal and Torres Strait Islander leaders to understand more about contemporary traditional food consumption. This is crucial to informing broader policy that affects where people live, how they are educated, employment and other livelihood opportunities,’ Ms Ferguson said.

The article will be available at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1753-6405This study was funded by the National Health and Medical Research Council (NHMRC). The contents of the published materialaresolelytheresponsibilityof theindividualauthorsanddonotreflecttheviewsoftheNHMRC.AssociateProfessor Julie Brimblecombe is supported through a National Heart Foundation Fellowship- ENDS -

Media contact:Paul Dale, senior communications manager

Phone: 0439 108 754 or (08) 8946 8658 | Email: communications@menzies.edu.au

Menzies School of Health ResearchMenzies School of Health Research is one of Australia’s leading medical research institutes dedicated to improving Indigenous,globalandtropicalhealth.Menzieshasahistoryofover30yearsofscientificdiscoveryandpublichealthachievement. Menzies works at the frontline, joining with partners across the Asia-Pacific as well as Indigenouscommunities across northern and central Australia. Menzies collaborates to create new knowledge, grow local skills and findenduringsolutionstoproblemsthatmatter.

New publication confirms important improvements in the health of Aboriginal and Torres Strait Islander people

Media Release by the Australian Indigenous HealthInfoNet

16 March 2017

The Overview of Aboriginal and Torres Strait Islander health status 2016 provides a comprehensive summary of the most recent indicators of the health of Aboriginal and Torres Strait Islander people. The Overview shows that that the health of Aboriginal and Torres Strait Islander people continues to improve slowly and there have been a decline in the death ratesforAboriginalandTorresStraitIslanderpeopleandalsoasignificantclosing of the gap in death rates between Aboriginal and Torres Strait Islander and non-Indigenous people.

Theinfantmortalityratehasdeclinedsignificantly.Therehavealsobeenimprovements in a number of areas contributing to health status such as the proportion of Aboriginal and Torres Strait Islander mothers who smoked during pregnancy has decreased. There has been a slight decrease in the proportion of low birth weight babies born to Aboriginal and Torres Strait Islander mothers between 2004 and 2014. Age-standardised death rates for respiratory disease in NSW, Qld, WA, SA and NT declined by 26% over the period 1998-2012 for Aboriginal and Torres Strait Islander people.

The Overview, which draws on the most up-to-date, authoritative sources and undertakes some special analyses, is freely available on the HealthInfoNet web resource, along with downloadable PowerPoint presentationsofkeyfacts,tables,andfigures.ItisanimportantpartoftheHealthInfoNet’s commitment to collaborative knowledge exchange, which contributes to closing the gap in health between Aboriginal and Torres Strait Islander people and other Australians by making research and other knowledge available in a form that is easily understood and readily accessible to both practitioners and policy makers. HealthInfoNet Director, Professor Neil Drewsays‘TheOverviewisourflagshippublicationandhas proved to be a valuable resource for a very wide range of health professionals, policy makers and others working in the Aboriginal and Torres Strait Islander health sector. The Overview provides an accurate, evidence based summary of many health conditions in a form that makes it easy for time poor professionals to keep up to date with the current health status of Aboriginal and Torres Strait Islander people throughout Australia. We have a greater focus on strengths based approaches which you will see in our introduction.’

Spokesperson: Professor Neil Drew - HealthInfoNet Director Tel: 08 9370 6155 Mob: 0418 901 468 Email: n.drew@ecu.edu.au

Media contact: Tara Hoyne – Tel: 08 9370 6109 Email: t.hoyne@ecu.edu.au

About the HealthInfoNet: Now in its 20th year, this is a massive Internet resource that informs practice and policy in Aboriginal and Torres Strait Islander health by making up to date research and other knowledge readily accessible via any platform. In this way, the HealthInfoNet contributes to closing the gap in health between Aboriginal and Torres Strait Islander peoples and other Australians. Working in the area of translational research with a population health focus, the HealthInfoNet makes research and other information freely available in a form that has immediate, practical utility for practitioners and policy-makers in the area of Aboriginal and Torres Strait Islander health, enabling them to make decisions based on the best available evidence www.healthinfonet.ecu.edu.au

May 2017 16

Pictured L-R Associate Professor Ted Wilkes and HealthInfoNet Senior Research

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Chronic Condition Journal Articles of Interest

A Focus on Food Security

Hospital Setting:

‘The Indigenous Australian Malnutrition Project: the burden and impact of malnutrition in Aboriginal Australian and Torres Strait Islander hospital inpatient, and validation of a malnutrition screening tool for use in hospitals-study rational and protocol’Authors: Morris et al.

Background:Malnutrition isassociatedwithadverseoutcomesforhospital inpatientsand isasignificanteconomicburden on hospitals. Malnutrition is frequently under-recognised in this setting and valid screening and early diagnosis are important for timely nutritional management. Aboriginal Australian and/or Torres Strait Islander peoples (Indigenous Australians) are likely to be at increased risk of malnutrition due to their disproportionate burden, pattern and age-distribution of chronic diseases. Despite this increased risk, the burden and impact of malnutrition in Indigenous Australians is poorly understood. Furthermore, a suitable screening tool has not been validated for this vulnerable patient group. The aim of this study is to determine the burden of malnutrition, understand its impact, and validate a malnutrition screening tool for Indigenous Australian inpatients. Methods: This project involves cross-sectional, prospective cohort and diagnostic validation methodologies to assess the burden and impact of malnutrition and to validate a malnutrition screening tool. A target of 752 adult Indigenous and non-Indigenous Australian inpatients will be recruited across three different public hospitals in the Northern Territory and far north Queensland of Australia. Cross-sectional data collection will be used to determine the prevalence of malnutrition using the Subjective Global Assessment and to stratify participants based on the International Consensus Guideline Committee malnutrition aetiology-diagnostic framework. Subjects will then be followed prospectively to measure short and long-term health outcomes such as length of hospital stay, in-hospital mortality, 30-day and 6-month readmission rates. Finally, the utility of a new screening tool, the Australian Nutrition Tool, will be assessed against an existing screening tool, the malnutrition screening tool, used in these settings and the malnutrition reference standard, the Subjective Global Assessment. Discussion: Indigenous Australians continue to experience poorer levels of health than non-Indigenous Australians and issues such as food insecurity, poor diet, and a disproportionate burden of chronic disease play a key contributing role for malnutrition in Indigenous Australians. To improve the health and hospital outcomes of Indigenous and non-Indigenous Australians, it is important that patients are routinely screened using a validated screening tool. It is also imperative that the burden and impact of malnutrition is properly understood, and fully appreciated, so that early and appropriate nutritional management can be provided to this group of hospital patients.

Springer Plus. 2016. Doi 10.1186/s40064-016-2943-5

Community Setting:

‘Traditional food availability and consumption in remote Aboriginal communities in the Northern Territory, Australia’Authors: Ferguson, M et al.

Objective: To explore availability, variety and frequency consumption of traditional foods and their role in alleviating food insecurity in remote Aboriginal Australia. Methods: Availability was assessed through repeated semi-structured interviewsandconsumptionviaasurvey.Quantitativedataweredescribedandqualitativedataclassified.Results: Aboriginal and non-Indigenous key informants (n=30 in 2013; n=19 in 2014) from 20 Northern Territory (NT communities participatedininterviews.Aboriginalprimaryhouseholdshoppers(n=73in2014)infiveofthesecommunitiesparticipatedin a survey. Traditional foods were reported to be available year-round in all 20 communities. Most participants (89%) reported consuming a variety of traditional foods at least fortnightly and 71% at least weekly. Seventy-six per cent reported being food insecure, with 40% obtaining traditional food during these times. Conclusions: Traditional food is consumed frequently by Aboriginal people living in remote NT. Implications for public health: Quantifying dietary contribution of traditional food would complement estimated population dietary intake. It would contribute evidence of nutrition transition and differences in intakes across age groups and inform dietary, environmental and social interventions and policy. Designing and conducting assessment of traditional food intake in conjunction with Aboriginal leaders warrants consideration.

Australian and New Zealand Journal of Public Health. 2017. Doi 10.1111/1753-6405.12664

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‘Insights into nutritionists’ practices and experience in remote Australian Aboriginal communities’Authors: Colles SL, et al.

Objective: To explore and describe methods of communication, education practices, perceived challenges and the potential role of nutritionists working in remote Australian Aboriginal communities in order to inform future public health efforts. Methods: Nutritionists who work or have worked in remote Aboriginal communities in Australia’s Northern Territorywithinthepastdecadewereidentifiedviapurposiveandsnowballsampling,andrespondedtoasemi-structuredsurvey in 2012. Content and interpretive thematic analysis was used to generate themes. Results: Working approaches of 33 nutritionists are presented, representing 110 years of working experience in the Northern Territory. Emerging themes included: ‘Community consultation is challenging’, ‘Partnering with local people is vital’, ‘Information is not behaviour’, ‘Localisation of nutrition education is important’ and ‘Evaluation is tricky’. Available time, training background and workforce structure were said to constrain practice and those nutritionists with longer experience described a more culturally competent practice. Conclusions: Modificationsinstructure,trainingandsupportofthepublichealthnutritionworkforce, facilitation of professional and cultural partnerships, outcome evaluation and localisation and evaluation of health messages may promote more meaningful nutrition communication in remote communities. Implications: Findings can inform further investigation into the structures needed to improve public health skills for nutritionists transitioning from mainstream practice into the challenging cross-cultural context of Aboriginal health settings.

Australian and New Zealand Journal of Public Health. 2016. Doi 10.1111/1753-6405.12351

‘Detection of 12.5% and 25% Salt Reduction in bread in a Remote Indigenous Australian Community’Author: McMahon E, et al.

Abstract: Food reformulation is an important strategy to reduce the excess salt intake observed in remote Indigenous Australia. We aimed to examine whether 12.5% and 25% salt reduction in bread is detectable, and, if so, whether acceptability is changed, in a sample of adults living in a remote Indigenous community in the Northern Territory of Australia. Convenience samples were recruited for testing of reduced-salt (300 and 350 mg Na/100 g) versus Standard (~400 mg Na/100 g) white and wholemeal breads (n = 62 for white; n = 72 for wholemeal). Triangle testing was used to examine whether participants could detect a difference between the breads. Liking of each bread was also measured; standardconsumeracceptabilityquestionnairesweremodifiedtomaximiseculturalappropriatenessandunderstanding.Participants were unable to detect a difference between Standard and reduced-salt breads (all p values > 0.05 when analysed using binomial probability). Further, as expected, liking of the breads was not changed with salt reduction (all p values > 0.05 when analysed using ANOVA). Reducing salt in products commonly purchased in remote Indigenous communities has potential as an equitable, cost-effective and sustainable strategy to reduce population salt intake and reduce risk of chronic disease, without the barriers associated with strategies that require individual behaviour change.

Nutrients. 2016. Doi 10.3390/nu8030169

‘Nutrition in remote Aboriginal communities: lessons from Mai Wiru and the Anangu Pitjantjatjara Yankunytjatjara Lands’.Authors: Lee, A et al.

Objective: To examine the impact of efforts to improve nutrition on the Anangu PitjantjatjaraYankunytjatjara (APY) Lands from 1986, especially in Mai Wiru (good food) stores. Methods: Multiple methods were employed. Literature wassearchedsystematically.In2012,thestore-turnovermethodquantifieddietaryintakeofthefiveAPYcommunitiesthat have a Mai Wiru store. The price of a standard market basket of basic foods, implementation of store nutrition policy requirements and healthy food checklists were also assessed in all seven APY community stores at intervals from 2012.Results were compared with available data from 1986. Results: Despite concerted efforts and marked achievements, including decreased intake of sugar, increased availability and affordability of healthy foods (particularly fruit and vegetables) and consequent improvement in some nutrient intakes, the overall effect has been a decrease in total diet quality since 1986. This is characterised by increased supply and intake of discretionary foods high in saturated fat, added sugar and salt, particularly sugar sweetened beverages, convenience meals and take-away foods. Conclusions: ThedocumentedimprovementsconfirmthatresidinginthesecommunitiescanhelpAboriginalresidentsexert control over key aspects of their food supply.

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19 May 2017

‘However,theoverallfindingsreflectbroaderchangestothegeneralAustralianfoodsupply,andreinforcethenotionthat, in the absence of supportive regulation and market intervention, adequate and sustained resources are required to improve nutrition and prevent diet-related chronic disease on the APY Lands. Implications: This study also provides insights into food supply/security issues affecting other remote communities and wider Australia.

Australian and New Zealand Journal of Public Health. 2016. Doi. 10.1111/1753-6405.12419

Child Health

Participatory systems approach to health improvement in Australian Aboriginal children’Authors: McDonald EL et al.

Abstract: The factors underlying poor child health in remote Australian Indigenous (Aboriginal and Torres Strait Islander) communitiesare complex.There is a lackof consistent and reliable information that allows: (i) the identificationofpriorities or areas of particular need at household and community levels; (ii) monitoring progress over time; and (iii) the assessment of the impact of interventions. This paper describes the process and methods used to identify the factors that underlie high rates of poor child health in remote Aboriginal communities in the Northern Territory (NT). This work has led to the development of indicators and tools suitable for use within a continuous quality improvement programme.Indigenous and non-Indigenous individuals from a range of disciplines and backgrounds participated in study activities. Thisallowed fora rangeofperspectives, includingscientific, layandAboriginalperspectives, tobeaccommodatedandreflectedinstudyoutcomesandoutputs.Studyparticipantsidentifiedawiderangeofphysicalandsocialfactorsthat they believe underlies poor child health in remote Aboriginal community contexts in the NT. The approach taken inthisstudyprovidessomeconfidencethattheindicatorsdevelopedwillbeseenasmeaningfulandappropriatebythe residents of remote communities and key stakeholders. Two tools have been developed and are now in use in the practice setting. One assesses social determinants of health at the community level, for example water supply, food supply. The second applies to individual households and assesses the social and environmental indicators that are recognized as placing children at greater risk of poor health and development outcomes.

Health Promotion International. 2017. Doi 10.1093/heapro/dau003

‘Understanding Barriers to fruit and vegetable intake in the Australian Longitudinal Study of Indigenous Children: a mixed-methods approach’Authors: Thurber KA, et al.

To identify barriers to fruit and vegetable intake for Indigenous Australian children and quantify factors related to these barriers, to help understand why children do not meet recommendations for fruit and vegetable intake. We examined factors related to carer-reported barriers using multilevel Poisson models (robust variance); a key informant focus group guidedour interpretationof findings.ElevendiversesitesacrossAustralia.Australian Indigenouschildrenand theircarers (N 1230) participating in the Longitudinal Study of Indigenous Children. Almost half (45 %; n 555/1230) of carers reported barriers to their children’s fruit and vegetable intake. Dislike of fruit and vegetables was the most common barrier,reportedby32·9%ofcarers;however,weidentifiedfewfactorsassociatedwithdislike.Carersweremorethanten times less likely to report barriers to accessing fruit and vegetables if they lived large cities v. very remote areas. Withinurbanandinnerregionalareas,childandcarerwell-being,financialsecurity,suitablehousingandcommunitycohesion promoted access to fruit and vegetables. In this national Indigenous Australian sample, almost half of carers faced barriers to providing their children with a healthy diet. Both remote/outer regional carers and disadvantaged urban/inner regional carers faced problems accessing fruit and vegetables for their children. Where vegetables were accessible, children’s dislike was a substantial barrier. Nutrition promotion must address the broader family, community, environmental and cultural contexts that impact nutrition, and should draw on the strengths of Indigenous families and communities.

Public Health Nutrition. 2017. DOI 10.1017/S1368980016003013C

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Economic Factors:

‘The economic feasibility of price discounts to improve diet in Australian Aboriginal remote communities’Authors: Magnus A, et al.

Objective: Toestimatethecost-effectivenessoffiscalmeasuresappliedinremotecommunityfoodstoresforAboriginalAustralians. Methods: Six price discount strategies on fruit, vegetables, diet drinks and water were modelled. Baseline diet was measured as 12 months’ actual food sales data in three remote Aboriginal communities. Discount-induced changes in food purchases were based on published price elasticity data while the weight of the daily diet was assumed constant. Dietary change was converted to change in sodium and energy intake, and body mass index (BMI) over a 12-month period. Improved lifetime health outcomes, modelled for the remote population of Aboriginal and Torres Strait Islanders, were converted to disability adjusted life years (DALYs) saved using a proportional multistate lifetable model populated with diet-related disease risks and Aboriginal and Torres Strait Islander rates of disease. Results: While dietarychangewassmall,fiveofthesixpricediscountstrategieswereestimatedascost-effective,belowa$50,000/DALY threshold. Conclusion:Stakeholdersarecommittedtofindingwaystoreduceimportant inequalities inhealthstatus between Aboriginal and Torres Strait Islanders and non-Indigenous Australians. Price discounts offer potential to improveAboriginalandTorresStraitIslanderhealth.Verificationoftheseresultsbytrial-basedresearchcoupledwithconsideration of factors important to all stakeholders is needed.

Australian and New Zealand Journal of Public Health. 2016. Doi 10.1111/1753-6405.12391

‘Effect of a price discount and consumer education strategy on food and beverage purchases in remote Indigenous Australia: a stepped-wedge randomised controlled trial’Authors: Brimblecombe J, et al.

Background: Evidence is mounting that price discounts can be effective in improving diet. This study examined the effectiveness of a 20% price discount on food and drink purchases with and without consumer education in remote Indigenous Australia. Methods:A20%discountonfruit,vegetables,water,andartificiallysweetenedsoftdrinkswasapplied for 24 weeks in 20 communities in remote Indigenous Australia where the community store was managed by the Arnhem Land Progress Aboriginal Corporation (ALPA) or Outback Stores (OBS) in a stepped-wedge randomised trial. Communitieswererandomlyallocatedtoafixedframeworkoffivesetsoffourstratifiedbystoreassociation;tenstores(two in each set) were randomly assigned to receive consumer education. A store from each of the ALPA and OBS store groups (contained in separate opaque envelopes) was selected, and stores in turn continued to be consecutively allocatedtothefixedstoresetframework,startingwiththefirststoreslotinthefirststoreset,untilallstoreshadbeenallocated. The effect of the discount on the weight of fruit and vegetables purchased (the primary endpoint) was assessed using weekly store sales data and mixed models per protocol. We did sensitivity analyses by repeating the analyses with the outliers included and repeating the analyses for the primary outcome measure removing each store one at a time. This trial was registered with Australian New Zealand Clinical Trials Registry, number ACTRN12613000694718. Findings: Weekly store sales data on all food and drink products sold in 20 stores were collected from July 1, 2012, to Dec 28, 2014. Price discount alone was associated with a 12·7% (95% CI 4·1–22·1) increase in purchases in grams of fruit and vegetables combined (primary outcome), and a 19·8% (6·2–35·1) increase post discount (after vs before); aneff ect of 12 g and 18 g per capita per day. Sensitivity analyses did not modify the results for the primary outcome measure. Interpretation: A 20% discount can only increase fruit and vegetable purchases to help protect against obesity and diet related disease to a certain extent. Large discounts might have a greater impact than small discounts. Creative merchandisingapproachestoconsumereducationcouldalsobeconsideredalongsidefiscalinterventionstoachievemarked improvements in diet.

Lancet Public Health. 2017. Doi 10.1016/S2468-2667(16)30043-3

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The Chronic Diseases Network acknowledges the participation and support of the CDN Steering Committee members from the following organisations:

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