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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: 
Charles Perkins Centre, The University of Sydney
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): 
The proposed research priority is to implement and evaluate interventions to improve the diet of Aboriginal and Torres Strait Islander peoples. Applicants would be required to demonstrate that they are building on available evidence, using a rigorous study design, and implementing sustainable programs with a strong community governance model, across diverse settings in remote, rural, regional and urban Australia. There are two recent systematic reviews. One on dietary intake which revealed just one study was conducted in an urban location, highlighting an absence of information on the translation of evidence across settings (i.e. remote to urban). The second review assessed dietary interventions and found that successful multi-strategy (including the food environment), community-directed nutrition programs in remote areas have demonstrated marked and sustained improvements in anthropometrical, biochemical and haematological indicators of diet-related chronic disease. However, few of these studies were evaluated for long term impact or implemented for longer than two years. A TCR would advance our understanding of which type of intervention is effective and best suited to diverse settings, addressing the long called for need to identify nutrition interventions that are effective for reducing diet-related disease in Aboriginal and Torres Strait Islander communities
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 resulting evidence base would inform the design of programs targeting five of the leading dietary contributors to the health gap between Aboriginal and Torres Strait Islander peoples and other Australians: obesity, high blood cholesterol, alcohol, high blood pressure, and low fruit and vegetable intake. The value of the TCR contributes to: 1) NHMRC Road Map II action areas: a) Close the Gap: promote research knowledge transfer, promote understanding of the gap and the factors that cause higher morbidity and mortality; b) Evaluation research for chronic illness, and ‘evaluations of major causes and risk factors’, and ‘meta-analyses of local studies that can be used at the national level’. 2)The Australian Government’s Science and Research Priorities: a) Food – Practical Challenge 2: knowledge of the social, economic and other barriers to achieving access to healthy Australian foods; b) Health – Building healthy and resilient communities – Practical Challenge 3: Better health outcomes for Indigenous people, with strategies for both urban and regional communities. 3) And for the NSW 10 Year Plan for Health and Medical Research's - Theme 3: Maximise the use of research in policy and practice and health service delivery.
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): 
A TCR should address nutrition-related diseases. Compared to other Australians, Aboriginal and Torres Strait Islander peoples suffer higher rates of diet-related chronic conditions: type 2 diabetes, cardiovascular disease, some cancers and kidney disease; obesity and malnutrition; and experience premature mortality due to these preventable conditions at a much earlier age. These conditions occur within a broader policy framework that should be explicitly factored into research designs. For example, evidence should be produced that informs Australia’s food and nutrition system components, for example: resource allocation; policy and strategy development; education and training; and community capacity building. Research shows that successful nutrition programs explicitly included Indigenous communities, thus research methodology should include participatory action design elements. Furthermore, a TCR should contribute to practice-informed research. This would flow into areas that lack such evidence: the Aboriginal and Torres Strait Islander Health Curriculum Framework, the National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework, and the curricula of Australian nutrition and dietetics degrees. The above factors imply that social determinants of health thinking is needed in a TCR as individual diseases, and the food and nutrition system, are influenced by education and employment, to land and the environment, and to legislation and regulations.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
The disease “burden” is reduced through long-term programs that are sustainable and cost-effective. Well-evaluated and cost effective programs are rare. Therefore, we urge that economic analysis components be a part of any TCR. This could occur as part of a program of implementation science, as implementation implies multi-component program design. This should be reflected in complex research methodologies. They would include consideration of the occurrence of co-occurring nutrition related issues: low birth weight, low breastfeeding rates, risk of anaemia, low fruit and vegetable consumption, low levels of household food security, high levels of energy intake from ‘junk’ foods, and over-consumption of sugar-sweetened beverages. This is why improving diet and nutrition is key to both the prevention and the management of these chronic diseases and therefore plays an important role in achieving health equity for Aboriginal and Torres Strait Islander Australians.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
National Aboriginal and Torres Strait Islander Health Plan: 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; Maternal Health and Parenting: improve maternal nutrition; Childhood Health and Development: good nutrition in the early years; and food and nutrition affordability and availability. Implementation Plan: ‘The nutrition framework gap analysis should address issues such as oral health, increasing knowledge and awareness, health literacy of parents, affordability, access, storage capability, the development of a ‘nutritional risk’ scheme and food security.’ AIHW (2012) Australia’s Food and Nutrition states that ‘Diet-related chronic diseases are the major cause of death and disability in Australia and their prevalence is increasing’. NHMRC (2010) The NHMRC Road Map II: A strategic framework for improving the health of Aboriginal and Torres Strait Islander people through research: ‘Statistics on the health of Aboriginal and Torres Strait Islander people show that trans-generational chronic illnesses related to poverty, inadequate nutrition and diabetes have increased.’ Browne, J., et al. (2016). Food and nutrition programs for Aboriginal and Torres Strait Islander Australians: what works to keep people healthy and strong? Deeble Institute Issues Brief no. 17. Canberra.22

Page reviewed: 30 August, 2018