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Draft Road Map 3: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research submission

This submission reflects the views of
Organisation Name: 
Vegan Australia
Personal Details
Specific Questions
Question 1A: Is the proposed objective of Road Map 3 relevant?: 
Question 2A: Are the three priority areas of Road Map 3 accurate?: 
Question 3A: Are there any further priority areas to add? Please provide further details: 
The Road Map should explicitly prioritise research into advocating a whole food plant based diet to improve Aboriginal and Torres Strait Islander health. The significance of chronic diseases, including cancer, diabetes, kidney health and respiratory and cardiovascular diseases, is mentioned in the Road Map, but diet, one of the major causes of these diseases, is not. While research into improving access to healthy food could be covered in other areas such as public health, preventative health programs, intervention and risk studies, we believe that it is crucial that the health benefits of a whole food plant based diet be explicitly included in the Road Map. Please see our earlier submission to the NHMRC on this matter copied to Question 5 below. Also see our submission to the Australian Department of Health on how whole food plant based diets can prevent and manage chronic conditions here: http://www.veganaustralia.org.au/a_way_forward_for_chronic_disease
Question 5: Are there any other comments you would like to make regarding Road Map 3? Please provide details: 
Below is a copy of a previous submission on this matter by Vegan Australia. This can be found here: http://www.veganaustralia.org.au/education_about_vegan_diet_may_improve_indigenous_health Proposed research priority A culturally-sensitive, integrated program of education into the adoption of a whole food plant based (vegan) diet represents an excellent research opportunity into further understanding the significant health benefits that such a diet affords. Whole food plant based diets have been strongly correlated with protection against cardiovascular disease, some cancers, obesity, hypertension, type 2 diabetes, depression and anxiety, all of which conditions impact the Aboriginal and Torres Strait Islander (ATSI) community in alarming numbers1-10,17-20. Whilst the NHRMC recognises vegan diets as healthy and nutritionally adequate, it has yet to investigate the potential for preventing and reversing chronic disease nutritionally23. The North Karelia Project in Finland could serve as a program model. In this approach to reducing chronic disease, coronary heart disease mortality was reduced by 73% among 30-64 year old males, cancer and all-cause mortality were reduced, and general population health was improved through a portfolio of interventions that encouraged movement toward a more plant-based diet, with reduced salt and sugar consumption; smoking cessation; and increased physical activity. Individual measures included working with food manufacturers to reduce the amount of fat, salt and sugar in processed foods; and developing innovative school- and community-based nutrition education programs11. Relevant government health research priorities Eight of the nine National Health Priority Areas (NHPA) agreed upon by Commonwealth and State and Territory governments, non-government organisations, health experts, clinicians and consumers would be addressed with a TCR into whole food plant based nutrition interventions for indigenous people. With already strong scientific support suggesting amelioration of some cancers, cardiovascular disease, mental health, diabetes mellitus, asthma, arthritis, obesity and dementia1-10,12, this TCR would be pursuing the agenda of the NHPA initiative by "targeting specific areas that impose high social and financial costs on Australian society"13. This TCR would be a high quality, Targeted Health Activity as part of the Department of Health's Indigenous Australians' Health Programme14. Furthermore, this TCR is an evidence-based strategy that would enable policy makers and health workers to fulfil the goals of four of the National Service Improvement Frameworks in reducing risk, managing acute conditions, long term care and care in the advanced stages of disease15. Contribution to Aboriginal and Torres Strait Islander health The Australian Aboriginal and Torres Strait Islander Health Survey in 2012-13 found that Indigenous Australians were at higher risk of asthma, heart disease, diseases of the ear, hearing loss and diabetes16, with mortality in this population being primarily heart disease, diabetes, respiratory disease, lung cancer and suicide17. As many indigenous Australians' diets consist mostly of refined carbohydrate and animal protein with low amounts of fresh vegetables and fruit18, studying the impact of eating a nutritious vegan diet could offer hope in managing and/or reversing debilitating and expensive health conditions. Such an intervention would be in step with WHO and European Union policies which aim to "be consistent with the protection and promotion of public health"21. In the Marshall Islands, the Diabetes Wellness Program, a study launched in March 2006, yielded reductions in fasting blood sugars, cholesterol and triglycerides via a 100% plant based, high nutrient diet, with lifestyle and nutritional education, and exercise. Participants reported pain reduction, greater ease of movement, improved bowel health, increased energy and weight loss. As the Marshallese face comparable health challenges to Australia's indigenous community, such a study further indicates the benefits that might also accrue in this population24,25. Reducing burden of disease on health system and Australian economy The Australian Institute of Health and Welfare (AIHW) estimated that the health expenditure for Aboriginal and Torres Strait Islander people in 2010-11 was $4.6 billion (3.7% of Australia's total recurrent health expenditure)21. As a whole food plant based diet has already been correlated with significantly improved health outcomes in other populations globally1-10,12, a culturally appropriate nutritional program for the ATSI community is likely to dramatically improve outcomes for the health system and economy as a whole. Some plant-based nutritionists estimate that a switch to a healthy vegan diet has the potential to lower healthcare costs upwards of 70-80%, because of decreased medication use, services, and procedures in people eating whole plant-based food. Additionally, eating plants is sustainable environmentally. The impact of the environment on health is often overlooked, yet this dietary intervention also addresses this important factor through the reduction of a significant cause of greenhouse gases and deforestation, ie animal agriculture26,27. Support for this research priority Numerous studies support the use of whole food plant based nutritional programmes in improving health. A comparison of 96,000 participants found that vegans had 75% risk reduction for hypertension, 47% - 78% for type-2 diabetes, and 14% for all cancers, with vegan males experiencing a 42% reduced risk from cardiovascular diseases and 55% from ischemic heart disease1. Whole food plant based diets have demonstrable positive effects on obesity2, mental health5, arthritis9 and dementia12. A joint report of the WHO and the UNFAO stated, "Households should select predominantly plant-based diets rich in a variety of vegetables and fruits, pulses or legumes, and minimally processed starchy staple foods. The evidence that such diets will prevent or delay a significant proportion of non-communicable chronic diseases is consistent. A predominantly plant-based diet has a low energy density, which may protect against obesity." A TCR which supports ATSI populations adopting a whole food plant based diet would be a tremendously valuable allocation of the NHMRC's Medical Research Endowment Account. References •1. Beyond Meatless, the Health Effects of Vegan Diets: Findings from the Adventist CohortsLe, LT & Sabate, J •2. Comparative effectiveness of plan-based diets for weight loss: a randomized controlled trial of five different diets Turner-McGrievy, GM, Davidson, CR, Wingard, EE, Wilcox, S & Frongillo EA •3. A Low-Fat Vegan Diet Improves Glycemic Control and Cardiovascular Risk Factors in a Randomized Clinical Trial in Individuals with Type 2 Diabetes Barnard, ND, Cohen, J, Jenkins, DJA, Turner-McGrievy, GM, Gloede, L, Jaster, B, Seidl, K, Green, AA, Talpers, S •4. Vegetarian diets and blood pressure: a meta-analysis Yokoyama, Y. Nishimura, K, Barnard, ND, Takegami, M, Watanabe, M, Sekikawa, A, Okamura, T, Miyamoto, Y •5. A multicentre randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study Agarwal, U, Mishra, S, Xu, J, Levin, S, Gonzales, J, Barnard, ND •6. Usefulness of vegetarian and vegan diets for treating type 2 diabetes Trapp, CB, Barnard, ND •7. A way to reverse CAD? Esselstyn, CB Jr, Gendy, G, Doyle, J, Golubic, M, Roizen, MF •8. A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial Barnard, ND, Cohen, J, Jenkins, DJA, Turner-McGrievy, G, Gloede, L, Green, A, Ferdowsian, H •9. Fasting followed by vegetarian diet in patients with rheumatoid arthritis: a systematic review Muller, H. de Toledo, FW, Resch, KL •10. Medically supervised water-only fasting in the treatment of hypertension Goldhamer, A, Lisle, D, Parpia, B, Anderson, SV, Campbell, TC •11. Successful prevention of non-communicable diseases: 25 year experiences with North Karelia Project in Finland, Public Health Medicine, Vol 4, Pages 5-7 Puska, P •12. Diet and Alzheimer's disease Physicians Committee for Responsible Medicine •13. National Health Priority areas Australian Institute of Health and Welfare •14. Indigenous Australians' Health Programme Australian Government Department of Health •15. National Chronic Disease Strategy Australian Health Ministers' Conference •16. Australian Aboriginal and Torres Strait Islander Health Survey: First Results, Australia, 2012-13 Australian Bureau of Statistics (ABS) •17. Mortality Australian Indigenous HealthInfoNet •18. Australian Aboriginal and Torres Strait Islander Health Survey: Nutrition Results - Food and Nutrients, 2012-13 Australian Bureau of Statistics (ABS) •19. Summary of Aboriginal and Torres Strait Islander Health Australian Indigenous HealthInfoNet •20. Expenditure on health for Aboriginal and Torres Strait Islander people 2010-11 Australian Institute of Health and Welfare (AIHW) •21. Global Strategy on Diet, Physical Activity and Health World Health Organization •22. Human Vitamin and Mineral Requirements WHO/FAO •23. Eat for Health. Australian Dietary Guidelines (p. 35) National Health and Medical Research Council •24. Defeating Diabetes: Lessons From the Marshall Islands Brenda Davis, RD •25. Defeating Diabetes: A story of hope from the Marshall Islands Brenda Davis, RD •26. 6 Reasons Plant-Based Nutrition Is The Solution to The Healthcare Crisis Julieanna Hever •27. Impact of a vegan agricultural system on land use Greg McFarlane

Page reviewed: 31 July, 2018