Food security in Aboriginal and Torres Strait Islander communities in remote Australia during the COVID-19 pandemic: An analysis of print news media and press releases.

OBJECTIVE: This article aims to examine the framing of the issue of food security in very remote Aboriginal and Torres Strait Islander communities in print media and press releases during the beginning of the COVID-19 pandemic in 2020. METHODS: Newspaper articles were identified following a systematic search of the Factiva database, and press releases were identified from manual search of key stakeholder websites from January to June 2020 and analysed using a combined adapted framework of the Bacchi's What's the Problem Represented to be? Framework and the Narrative Policy Framework. RESULTS: A food delivery "problem" dominated representations in press releases, and food supply at store level had prominence in print media. Both presented the cause of food insecurity as a singular, identifiable point in time, framed the issue as one of helplessness and lack of control, and proposed policy action. CONCLUSIONS: The issue of food security was represented in the media as a simple issue requiring an immediate fix, as opposed to a complex issue requiring a systems-level and sustained policy response. IMPLICATIONS FOR PUBLIC HEALTH: This study will help to guide future media dialogue to impact on both immediate and longer-term solutions to food insecurity in very remote Aboriginal and Torres Strait Islander communities in Australia.

Exploring the impacts of a fresh produce market program: a realist economic evaluation.

OBJECTIVE: To determine the contexts under which a fresh food market program is cost-effective in improving dignified access to nutritious food for food-insecure individuals. METHODS: A realist economic evaluation was employed. Purported cost related theories about how the program may function, known as context-mechanism-outcome configurations were developed. In-depth interviews with key stakeholders (program developers, funder, local food relief agencies, volunteers) involved in the program (n=19) as well Photovoice with focus groups with market attendees (n=8) were conducted and coded for contexts, mechanisms and outcomes. A cost-effectiveness analysis of the program was calculated whereby the cost inputs associated with operating the program were compared to the quantity and value of produce distributed. Alternative cost scenarios were evaluated in a sensitivity analysis. The cost-effectiveness analysis was used together with qualitative data to refine theory. RESULTS: Food insecure individuals attending a partnership fresh food market with a small fee, experienced improved, yet infrequent access to nutritious food through community connections and support a more dignified, viable access to fresh nutritious food. CONCLUSIONS: Food relief should consider alternative models. IMPLICATIONS FOR PUBLIC HEALTH: More dignified food relief programs that support local connections may be part of the solution to addressing food insecurity.

Traditional Food Energy Intake among Indigenous Populations in Select High-Income Settler-Colonized Countries: A Systematic Literature Review.

The traditional diets of Indigenous Peoples globally have undergone a major transition due to settler colonialism. This systematic review aims to provide a perspective of traditional food intake of Indigenous populations in high-income settler-colonized countries. For inclusion, studies reported the primary outcome of interest-traditional food contribution to total energy intake (% of energy)-and occurred in Canada, the United States (including Hawaii and Alaska), New Zealand, Australia, and/or Scandinavian countries. Primary outcome data were reported and organized by date of data collection by country. Forty-nine articles published between 1987 and 2019 were identified. Wide variation in contribution of traditional food to energy was reported. A trend for decreasing traditional food energy intake over time was apparent; however, heterogeneity in study populations and dietary assessment methods limited conclusive evaluation of this. This review may inform cross-sectoral policy to protect the sustainable utilization of traditional food for Indigenous Peoples.

A Qualitative Analysis of the Accessibility and Connection to Traditional Food for Aboriginal Chronic Maintenance Hemodialysis Patients.

BACKGROUND: Due to the lack of resources in remote Aboriginal communities within the Northern Territory of Australia, Aboriginal people requiring chronic maintenance hemodialysis often must relocate from their home communities to Darwin city permanently to receive ongoing care. This phenomenon can cause distressing isolation from important traditional food, land, and family. OBJECTIVE: The aim was to identify the relation to traditional food from an Aboriginal perspective and the enablers and barriers to accessing traditional food post-relocation from remote regions of the Northern Territory, Australia, to the urban city of Darwin. METHODS: This was a qualitative study design with a total of 12 Aboriginal participants (4 males, 8 females) receiving ongoing hemodialysis at the Nightcliff Renal Unit. Participants had all relocated from a remote region to Darwin. Interviews were conducted between July and September 2018 in Darwin, Australia. Data interpretation was conducted by an Aboriginal researcher and co-authors with a combined 30 y of experience conducting research with Aboriginal people in a health context. Data analysis comprised an inductive thematic analysis approach with an indigenist knowledge interpretation lens to construct, reaffirm, and protect Indigenous views. RESULTS: Traditional food was an important part of participants' identity and strongly connected to social, emotional, spiritual and physical health, and well-being. Access to traditional food post-relocation is associated with enablers and barriers including mobility, local knowledge, social support networks, commercial access, and economics. CONCLUSIONS: Dialysis patients who are dislocated from remote Aboriginal communities to Darwin experience clear disruption to traditional food access, consumption, availability, and knowledge dissemination to the younger generations.

The impact of social enterprise on food insecurity - An Australian case study.

Like many high-income countries, in Australia there are a range of programmes in place, from social security to food banks, to help address food insecurity. So far, they have been unable to adequately alleviate and prevent this growing nutrition challenge. This paper presents an evaluation of a new type of intervention in the food security landscape, the social enterprise. The Community Grocer is a social enterprise that operates weekly fresh fruit and vegetable markets in Melbourne, Australia. The aim of the study was to examine the market's ability to increase access, use and availability of nutritious food in a socially acceptable way, for low socioeconomic status urban-dwelling individuals. The mixed-method evaluation included: comparative price audits (n = 27) at local (<1 km) stores; analysis of operational data from sample markets (n = 3); customer surveys (n = 91) and customer interviews (n = 12), collected in two phases (Autumn 2017, Summer 2018). The results found common (n = 10) fruit and vegetables cost, on average, approximately 40% less at the social enterprise, than local stores. Over twenty per cent of customers were food insecure and 80% of households were low income. Thirty-four different nationalities shopped at the market, and just over half (54%) shopped there weekly. More than 50 types of vegetables and fruit were available to purchase, varying for cultural preferences and seasonality, which supported variety and choice. Overall, this enterprise promotes food security in a localised area through low-cost, convenient, dignified and nutritious offerings.

Using unfolding case studies to better prepare the public health nutrition workforce to address the social determinants of health.

OBJECTIVE: The public health nutrition workforce has been reported to be underprepared for practice. The present study aimed to test the ability of an unfolding case study approach to support the public health nutrition workforce for the workplace, with a focus on improved access to nutritious food. DESIGN: Two unfolding case studies were trialled with undergraduate students in two-hour workshops to enhance their capability to address access to nutritious food as a social determinant of health. The approach provided information about the case using a staged approach that supported learners to review and reply to information and then continue this process as the case became increasingly complex. SETTING: Melbourne, Australia.ParticipantsThirty-eight undergraduate nutrition and dietetics students. RESULTS: The analysis revealed that the unfolding case study approach provided a place to challenge and deepen knowledge and think about the application of theory. As the cases developed and became more challenging, students were supported to consider appropriate approaches and recognised the constant evolution and dynamic nature of practice. CONCLUSIONS: This learning activity challenged students and supported deep learning about possible solutions. It may also be useful at a graduate level and for continuous education of nutritionists and/or dietitians to empower the workforce to address the social determinants of health, rather than just acknowledging them as a set of barriers that prevent people and communities from achieving optimal health. Further work is required to investigate how unfolding case studies in curricula shape preparedness for practice of public health nutrition.

Engaging a disadvantaged community with a fruit and vegetable box scheme.

ISSUE ADDRESSED: Interventions which target the determinants of unhealthy diets are required to promote healthy eating and reduce the burdens of diet-related diseases such as cardiovascular disease, diabetes and some cancers. METHODS: Qualitative interviews (n = 12) were conducted to explore the perspectives and experiences of local stakeholders regarding the implementation and uptake of a healthy eating initiative (a fruit and vegetable box scheme) in a disadvantaged, regional community. RESULTS: Factors affecting the community's engagement included marketing strategies, customer experiences, a community-centred approach, partnerships and logistics. CONCLUSIONS: Community engagement is often essential for an intervention to be effective. The factors which influence community engagement should be considered during planning, especially when targeting disadvantaged groups. SO WHAT?: Behavioural change interventions may continue to be met with limited success if community engagement and the overarching structural barriers to healthy eating are not addressed.

The role of a food policy coalition in influencing a local food environment: an Australian case study.

OBJECTIVE: To explore how an Australian rural food policy coalition acts to influence a local food environment, focusing specifically on its composition, functions and processes as well as its food-related strategies and policy outputs. DESIGN: A qualitative case study approach was undertaken. Three sources were used to triangulate data: eleven semi-structured in-depth interviews with coalition members, analysis of thirty-seven documents relating to the coalition and observation at one coalition meeting. Data were analysed using a thematic and constant comparison approach. Community Coalition Action Theory provided a theoretical framework from which to interpret findings. SETTING: Two rural local government areas on the south-eastern coast of Victoria, Australia. SUBJECTS: Eleven members of the food policy coalition. RESULTS: Five themes emerged from the data analysis. The themes described the coalition's leadership processes, membership structure, function to pool resources for food system advocacy, focus on collaborative cross-jurisdictional strategies and ability to influence policy change. CONCLUSIONS: This Australian case study demonstrates that with strong leadership, a small-sized core membership and focus on collaborative strategies, food policy coalitions may be a mechanism to positively influence local food environments.

A longitudinal study of the cost of food in Victoria influenced by geography and nutritional quality.

OBJECTIVE: To monitor the cost and affordability of a nutritious diet and to assess the influence of distance from the capital city and socioeconomic status on the cost of nutritious food in Victoria. METHODS: Twenty-six of Victoria's 79 local government areas (33%) were randomly chosen for inclusion in the study. A random sample of stores was selected for inclusion from each local government area. The cost of the 44 'healthy' and 10 'discretionary' food and drinks in the healthy food basket for a family of four for a fortnight was collected during the winter and summer of 2012, 2013 and 2014. RESULTS: The mean cost of the basket increased from $424.06 ± 38.22 in winter 2012 to $451.19 ± 33.83 in summer 2014 (p<0.001), representing about 31% of government benefit household income. Fruit and vegetables prices were the most varied over time. Distance of the store from state capital city centre predicted difference in food cost. CONCLUSIONS: These findings show that a healthy diet may be unaffordable for some Victorians. IMPLICATIONS: The cost of food is a key factor influencing intake. Public health strategies may need to consider strategies to make healthy food more affordable for some.