Nutrition & Society – Case of Aboriginal Communities

Introduction

Sugar-sweetened beverages (SSBs) have increasingly become a global concern due to its adverse impact on human health. In Australia, particularly amongst the Aboriginal and Torres Strait Islander people, the consumption of SSBs is at higher rates (Avery, et al., 2017). The Indigenous Australians face unacceptable health inequalities as compared to other Australians due to several social and cultural factors that contribute to poor health. Due to higher SSBs consumption, the type-2 diabetes is also higher amongst Indigenous Australians (Bartone, 2019). SSBs have been identified as main contributor to bad health due to its loaded empty kilojules that give rise to metabolic diseases and dental caries.

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Statistics

Aboriginal Communities consumes 75 grams (18 teaspoons) of free sugar on average as compared to the 15 grams (4 teaspoons) consumed by non-Indigenous people per day (Rethink Sugary Drink, 2019). Two thirds (41%) of all the free sugar consumed by Aboriginals comes from beverages (especially from soft drinks, energy drinks and sports drinks) (Fehring, et al., 2019). About 14% of total energy amongst Aboriginals is consumed as free sugars. Due to the high consumption, about two thirds (66%) of the Aboriginals aged 5 and over are reported to be overweight or obese. Out of all, only 7% of the Indigenous Australians met their daily recommended serves of vegetables in 2018 (Australian Government Department of Health, 2020).

The free sugar intake was much higher in Aboriginal older children and young adults. Moreover, the males in the Aboriginal communities consumed more sugary drinks as compared to the females. According to report by Australian Government Department of Health (2020), 24% of Aboriginals were reported to consume SSBs daily while 1.5% consumed diet drinks daily. 63% of the Aboriginals consumed SSBs or diet drinks once a week. The consumption rates were lower for the people aged 45-54 years (63%) and 55 years and over (49%) as compared to the consumption rate of people aged below 45 years (80%).  According to survey by ABS (2016), Indigenous community consumed 67% of their total energy from sugary drinks as compared to 51% of non-indigenous community (Rethink Sugary Drink, 2019).

Social Determinants of Health

Social determinants of health include the conditions within which the people are live, communicate, work, age and grow (Tasevska, et al., 2014). The factors include education, employment, social support, physical environment and the socio economic status.

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Housing Conditions

People living in rural and remote areas were reported to have higher intakes of energy, fat and sugar. Aboriginals living in very remote areas were likely to smoke and drink sugary beverages at risky levels (Lee, et al., 2016). They face higher costs of healthy food choices due to which they are likely to consume more unhealthy foods. According to Fehring et al. (2019), 31.1% of Aboriginal adults living in the outer regional and remote Australia consumed sugary drinks daily as compared to 8.3% of Aboriginal adults living in major cities. According to Thurber et al. (2019), the prevalence of SSB consumption was 36.3% amongst Aboriginal children living in major cities as compared to 62.8% of Aboriginal children living in remote areas who consumed sugary drinks on daily basis (Coopes, 2018). The higher consumption in remote Aboriginal settings reflects the affordability, accessibility and prices of healthy food with limited food outlets.

Employment, Education & FInancial Strain

Caregivers’ education and financial strain were also identified as key contributors of high SSB consumption amongst Aboriginal community in Australia. The 59.2% of children with education of primary carer below 10 year consumed SSB higher than the 44.9% of children who consumed SSB with primary carer’s education of more than 10 years (Thurber, et al., 2020). Similarly, the employment status of primary carer also affected consumption of SSB in Aboriginal communities. 54.1% of carer with no jobs had children consuming higher SSB as compared to SSB consumption of 45.6% of children with employed care givers in 2018 (Thurber, et al., 2020).

Gender/Age

SSB consumption is affected by gender and age factors in Aboriginal communities. According to Thurber et al. (2014), children’s SSB consumption was higher for ages between 5-7 years as compared to the children less than 4 years age. Moreover, 47% of the children between 2-18 years consumed more sugary drinks as compared to 31% of older adults in Aboriginal community of Australia. Also the survey from ABS (2016) showed that teenage boys aged 14-18 years derived 18% of the dietary energy from consuming free sugars (25 teaspoons) per day that was highest as compared to girls (Rethink Sugary Drink, 2019). Moreover, women aged 19-30 consumed sugar of 17% to their total energy intake. Evidence also suggests that the males are more likely to consume the SSB than females in Aboriginal communities (Rethink Sugary Drink, 2019). Also, the reports suggest that the SSB consumption is highest in the age group of 18-39 years. Sweet drinks were reported to be more popular with kids as compared to older Aboriginal Aussies (Diabetes Australia, 2018).

Health Outcomes

SSB intake is strongly and significantly associated with long-term health issues like weight gain, obesity and diseases like type-2 diabetes (Bleich & Vercammen, 2018). The short term effects are on the psychological health and dental issues causing cavities.

Body Weight & Obesity

More ounces of SSB intake mean more calories that do not provide energy to body. SSBs heighten the obesity risk amongst the children and adolescents. This is evident from high obesity rates in Aboriginal communities in Australia as 66% of adults and 29.7% of children were overweight or obese due to higher consumption of sugar as compared to non-indigenous Australians (Avery et al., 2017). A child’s risk of becoming obese increases by 60% with each added SSB consumption daily. Drinking 20 ounce bottle of SSB daily can add 25 pounds per year. According to report by Diabetes Australia (2018), SSB is associated with weight gain, obesity, type 2-diabetes, heart diseases, stroke, cancer and kidney diseases.

Diseases

Drinking large amount of SSB can increase the risk of developing type 2 diabetes, gout and heart diseases. Women who drink one to two SSB per day have twice the risk of developing type 2 diabetes as compared to those that drink less than one SSB daily. According to Malik et al. (2014), SSB consumption leads to insulin resistance and inflammation due to high-fructose corn syrup. Type 2 diabetes was highest amongst aboriginals with prevalence of 11.1% and additional 4.7% at risk (Wright et al., 2019). The SSB consumption and risk of type 2 diabetes are positively correlated (see figure 2 below).

Conclusion

SSB lies at the bottom of healthy beverages list due to high calories and absence of nutrients. The above short report indicates a clear and consistent association between obesity rates, diabetes risk and other bad health outcomes in Aboriginal communities and the high consumption of SSBs. The further analysis on this topic will provide understanding on past and current efforts by Australian Government to reduce SSB consumption amongst Aboriginal and Torres Islander communities in Australia to close the gap between health conditions.

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References

AIHW, 2020. Social determinants and Indigenous health. [Online] Available at: https://www.aihw.gov.au/reports/australias-health/social-determinants-and-indigenous-health
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Australian Government Department of Health, 2020. Summary of nutrition among Aboriginal and Torres Strait Islander people. [Online] Available at: https://apo.org.au/sites/default/files/resource-files/2020-05/apo-nid305130.pdf
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Avery, J. C. et al., 2017. Sugar-sweetened beverage consumption, correlates and interventions among Australian Aboriginal and Torres Strait Islander communities: a scoping review protocol. BMJ Open, 7(7), p. e016431..

Bartone, T., 2019. Ama Report Card on Indigenous Health. [Online] Available at: https://nacchocommunique.files.wordpress.com/2019/11/2019-ama-report-card-on-indigenous-health.pdf
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Bleich, S. N. & Vercammen, K. A., 2018. The negative impact of sugar-sweetened beverages on children’s health: an update of the literature. BMC Obesity, 5(6).

Coopes, A., 2018. The cost of eating well in Australia’s remote Indigenous communities. [Online] Available at: https://www.croakey.org/the-cost-of-eating-well-in-australias-remote-indigenous-communities/
[Accessed 6 November 2020].

Diabetes Australia, 2018. Health levy on sugar-sweetened beverages. [Online] Available at: https://www.diabetesaustralia.com.au/wp-content/uploads/Sugary-drinks-Position-statement-2018.pdf
[Accessed 6 November 2020].

Fehring, E. et al., 2019. Supporting healthy drink choices in remote Aboriginal and Torres Strait Islander communities: a community‐led supportive environment approach. Australian and New Zealand Journal of Public Health, 43(6), pp. 551-557.

Harvard T.H Chan, 2020. Sugary Drinks. [Online] Available at: https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/
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Lee, A., Rainow, S. & Tregenza, J., 2016. Nutrition in remote Aboriginal communities: lessons from Mai Wiru and the Anangu Pitjantjatjara Yankunytjatjara Lands. Australian and New Zealand Journal of Public Health, 40(1), pp. S81-S88.

Malik, V. S., Popkin, B. M., Bray, G. A. & Després, J.-P., 2014. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care, Volume 33, p. 2477–83.

Naccho Community, 2020. Why we need to rethink Aboriginal childhood. [Online] Available at: https://nacchocommunique.files.wordpress.com/2018/06/aaauntitled.png
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Rethink Sugary Drink, 2019. Consumption data. [Online] Available at: https://www.rethinksugarydrink.org.au/for-professionals/consumption-data.html
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Tasevska, N. D. D., Lorts, C. & Yedidia, M., 2014. Determinants of sugar-sweetened beverage consumption among low-income children: are there differences by race/ethnicity, age, and gender?. Journal of the Academy of Nutrition and Dietetics, 117(12), pp. 1900-1920.

Thurber, K. A., Bagheri, N. & Banwell, C., 2019. Social determinants of sugar-sweetened beverage consumption in the Longitudinal Study of Indigenous Children. Family Matters, Volume 95, p. 51.

Thurber, K. A. et al., 2020. Sugar-sweetened beverage consumption among Indigenous Australian children aged 0–3 years and association with sociodemographic, life circumstances and health factors. Public Health Nutition, 23(2), pp. 295-308.