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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

This submission reflects the views of
Organisation Name: 
Vegan Australia
Personal Details
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
(For references for this and other questions, please see http://www.veganaustralia.org.au/education_about_vegan_diet_may_improve_indigenous_health) 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 numbers (Refs 1-10,17-20). Whilst the NHRMC recognises vegan diets as healthy and nutritionally adequate, it has yet to investigate the potential for preventing and reversing chronic disease nutritionally (Ref 23). 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 programs (Ref 11).
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
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 dementia (Refs 1-10,12), 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" (Ref 13). This TCR would be a high quality, Targeted Health Activity as part of the Department of Health's Indigenous Australians' Health Programme (Ref 14). 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 disease (Ref 15).
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
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 diabetes (Ref 16), with mortality in this population being primarily heart disease, diabetes, respiratory disease, lung cancer and suicide (Ref 17). As many indigenous Australians' diets consist mostly of refined carbohydrate and animal protein with low amounts of fresh vegetables and fruit (Ref 18), 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" (Ref 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 population (Refs 24,25).
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
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) (Ref 21). As a whole food plant based diet has already been correlated with significantly improved health outcomes in other populations globally (Refs 1-10,12), 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 agriculture (Refs 26,27).
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
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 disease (Ref 1). Whole food plant based diets have demonstrable positive effects on obesity (Ref 2), mental health (Ref 5), arthritis (Ref 9) and dementia (Ref 12). 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. For references for this and other questions, please see http://www.veganaustralia.org.au/education_about_vegan_diet_may_improve_indigenous_health

Page reviewed: 30 August, 2018