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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: 
The George Institute for Global Health
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): 
A program of implementation science research to understand how to maximise and sustain the impact of interventions to tackle diet-related diseases in Aboriginal and Torres Strait Islander Population Groups would yield significant and sustained health benefits for Australia. Whilst poor nutrition is the leading preventable risk factor for poor health in Australia generally,1 rates of diet-related chronic conditions, including type 2 diabetes, obesity, cardiovascular disease, some cancers and kidney disease are even higher in Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islanders are twice as likely to be born with low birth weight, suffer from anaemia and be eating less than one serve of vegetables a day and three times more likely to have diabetes than non-Indigenous Australians. The factors influencing diets vary within and between communities but consist of a combination of economical, geographical (access to shops selling healthy affordable food options and/or transport), educational and psycho-social (motivation) factors. Recent systematic reviews have identified a range of interventions that can be implemented to improve diets. Further research is needed to support local community health practitioners to implement and evaluate effective interventions and to ensure research learning is effectively translated at community level.
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): 
The Australian Government has made a political commitment to reducing the impact of exposure to healthy diets for different population groups through the 2011 UN Resolution on the Prevention and Control of NCDs (resolution A/RES/66/2) and through its pledge to “end hunger, achieve food security and improve nutrition” as part of its contribution to the advancing the Sustainable Development Goals. The Australian Government’s Science and Research Priorities include 1) Food – Practical Challenge 2: knowledge of the social, economic and other barriers to achieving access to healthy Australian foods and: 2) Health – Building healthy and resilient communities – Practical Challenge 3: Better health outcomes for Indigenous people, with strategies for both urban and regional communities. The NHMRC’s (2000), information paper on Aboriginal and Torres Strait Islander Communities highlighted the lack of research into nutrition interventions that are effective, as well as concern that there was more than enough research describing the problems, when the need was to conduct research that solved the problems already identified by the community.
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): 
Improving access to and consumption of healthier foods would contribute to reductions in chronic diet related diseases. A TCR to support and evaluate community-led interventions to improve diet would therefore have direct health outcomes in terms of improved nutrition in the intervention sites as well as helping us to understand which interventions work best in which settings. A 2009 MJA editorial on "Improving Aboriginal and Torres Strait Islander nutrition and health” outlines the evidence base and “best-buy” economic interventions to improve indigenous nutrition and health. Potential nutrition interventions that have already proven to be successful in some settings include nutrition interventions in primary care, school based programs, and improvement of remote store management practices. The objective of the new TCR should be to trial intervention programs using scientifically sound, practical, culturally acceptable study designs. The implementation trials should be conducted in a variety of settings to establish what works best for different population groups. By collating all the lessons to date to inform interventions to improve food access and testing these through a program of intervention research projects in different real world settings, and translating this learning into improved interventions, we would be considerably enhancing the knowledge base in terms of effective sustained interventions to improve nutrition.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Poor diet is one of the biggest contributors to ill health in Australia and costing the country and rates of diet-related diseases are even higher in Aboriginal and Torres Strait Islander groups. Interventions to improve diet will improve health outcomes with the potential to save millions of dollars in healthcare costs.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
The 2015 National Aboriginal and Torres Strait Islander Health Implementation Plan recognises that chronic diseases, including diabetes, are the major causes of morbidity and mortality and, as part of identifying interventions to address chronic diseases, recommends a Nutrition Framework Gap Analysis which should address, amongst other things, knowledge and awareness, access and food security. A review of the impact of nutrition interventions is just being completed and shows that successful multi-strategy (including the food environment), community-directed nutrition programs in remote areas have demonstrated marked and sustained improvements in indicators of diet-related chronic disease. The National Aboriginal and Torres Strait Islander Health Plan identifies the need for effective nutrition interventions in two priority areas: (1) Priority for Whole of Life: low fruit and vegetable intake is one of the top seven risk factors contributing to the health gap; improved access to nutritious foods (2) Maternal Health and Parenting: improve maternal nutrition; Childhood Health and Development: good nutrition in the early years; and food and nutrition affordability and availability.

Page reviewed: 30 August, 2018