Improving the supply of food in communities is a high priority. Health staff can contribute to improved food supply in their community by participating in the strategies outlined in this section.
The local store plays a central role in the nutritional status of an Aboriginal community. People buy most of their food from the store. Stores are also a place for social interaction. It is important for health staff to be involved in the store. Stores have a major role to play in educating about food and nutrition issues and promoting general physical well-being (McMillan 1991; Lee et al 1996 ).
Poster by Theda Puruntatameri
The benefits gained from encouraging discussion about the role of the store can flow both ways - to the community and to health staff
|Get to know the store manager. Consider the store manager as a partner in improving and maintaining the community's health. Management and staff may be keen to work with you and the community on store issues|
|Let people know about the Guidelines in 'The Store Book'. Find out how their store or their community already supports the Guidelines|
|Talk to others in the health team. Find out what kind of nutrition activities happened previously in the store; what people thought of the activities; what worked; what did not work and why|
|Read the chapter 'Sharing Health Information' in Volume 1 for more details about feeding back information|
Store committees have enormous potential for providing direction and support to store managers.
The role of a store committee varies with each community. Some store committees will be a sub-committee of the Community Council. Other store committees will be independent and have members representing the wider community. The amount of work involved in being on a committee will depend on the extent of the committee's role. A store committee will be more effective in its role if it has a store policy that it has developed itself.
What health staff can do:
|if people want help or advice with food policy or implementing the store food guidelines, contact the THS Nutrition team|
|make sure that the information you give the community is consistent and suited to local conditions. Use the resources of the THS Community Nutritionists|
|provide any support you can without affecting the independence of the committee|
Having a well thought out, community supported, store policy can give a community more control over all aspects of the store. Community residents decide what the policy will contain. A process of local policy development, as outlined in 'The Store Book', will support :
The policy may include:
In order to develop a local store policy people will need to explore a range of issues such as:
The Nutrition Team can provide training for people who want to help their community to develop a store food policy. They use 'The Store Book' as a facilitator's guide.
|See 'Useful resources' at the end of Section 2|
The store committee could consider different ways of reducing the cost of goods sold through the store, for example:
If health staff have the consent of community leaders to help improve community nutrition, then it will be useful to first do some kind of assessment of the store.
A community market basket survey (CMBS) is a way of getting an idea of the price, variety and quality of the food which is available at the community store. This local information is then compared with information about the same foods in the nearest regional centre. This survey can be done a number of times to provide a picture over time.
This type of survey can also be used to find out what it costs a 'typical' family of six people to purchase a healthy diet (foods within the basket) over a fortnightly pay period.
Market basket surveys can be used to:
A story about the power of a Market Basket Survey
When working in the Barkly, I used to do store surveys every year. I'd go back to a community and tell people what this meant - prices in their community compared to Tennant Creek. It generates a lot of interest. In one community the people were already working on making changes with alcohol - how many take away cans people could buy. People were saying "the prices in the store had been put up to make more money as they are selling less alcohol", but they couldn't prove it so they couldn't do anything about it. They also felt the store keepers were treating them unfairly. I was able to say "Look, I've got the prices before the changes were made and I can check them again now". One of the stores used to be 10% higher than town and now it's 30% higher. The other one used to be 30% higher and now it's 55% higher. The evidence of the change in prices was able to be used as part of the evaluation of liquor licensing changes in that community.
Having information about the stores has also meant that we were able to talk more about what was happening in the store and what people wanted from the store. That lead on to people saying "what can we do about the unfair things that are happening?" and "can someone help us?" We got Consumer Affairs involved and community members came forward with stories to write down and take back to Consumer Affairs. The stories were about unfair things that were happening in the store like people getting ripped off with the bookup system and not being able to spend their own money on what they wanted.
Increased awareness in the store about prices and consumer rights meant that people knew that if they wanted some unfair things to stop they could do something about it. Another good store opened up in that community shortly after and people used their feet to show how they wanted to be treated and that they wouldn't keep paying the very high prices.
Monica Kelly, former Community Nutritionist, Tennant Creek
Nutritionists have standard forms which you should use to do an CMBS. The form has two parts - a price section and a choice section.
|Contact your nearest Community Nutritionist about getting forms, information and assistance with the survey|
|Meet with the store manager. Let him or her know you intend to do a survey and explain the reasons why. Gain his or her cooperation. Arrange for a time that is convenient. Allow about an hour for each survey|
|Note: Consumer Affairs advise that the store manager does not have the legal right to refuse anyone from conducting a store survey|
The Community Nutritionists in town have a computer software package which can easily analyse the results. They can provide you with a range of feedback reports including easy to read graphics.
Here are some examples of a community report which has been prepared by Nutritionists. Names of specific places are not mentioned. To promote discussion about the results of a survey you can enlarge the reports or use them to prepare colourful posters with photographs of the store, foods and people.
Figure 1 shows how much money a family of 6 (2 adults, 2 children, a 14 year old male and a grandmother) needs to buy enough healthy food for 14 days from the community store compared to buying the same foods in town.
Figure 2 below reports on the cost differences of items between the community store and town. The question might be asked, "Why is tobacco the same price as it is in town when healthy foods and 'healthware' is more expensive?"
Figure 3 shows the percentage of a fortnightly paycheck that the same family would need to spend on healthy foods in the community store versus a store in town.
Figure 3: relationship between cost of family basket
and income in Darwin and NT Aboriginal Community
Figure 4 shows how many $20 notes are required to buy enough healthy foods from the community store compared to buying the same foods from the town store.
Instead of assessing individual dietary intake you can use the turnover of the store as a method to work out what people eat from the store.
The store turnover method has been validated against blood test results. From these results, we know that an increase in fruit and vegetable consumption does lead to an increase in nutrient levels in the blood. Therefore, this method can be used to replace more invasive methods such as testing an individuals blood for nutrient levels.
Results of a store turnover study can be expressed in three ways:
The store turnover method is complex and requires specialist computer programs and specially trained nutritionists.
|If the health team and/or community is interested in doing a store turnover study, contact your Community Nutritionist for information and support|
A story of change: the Minjilang Store
The Minjilang store is making money out of offering the community a high quality, health promoting diet!
Minjilang is a small remote island community off the coast of Arnhem Land. The Community Health Centre is run by local Aboriginal Health Workers who became concerned about diabetes and heart disease in their community. They asked Nutritionist, Amanda Lee, to examine the adults' blood to find out the extent of the problem.
What they discovered was:
- 41% were overweight and 34% were underweight;
- 64% had low folic acid levels (one of the B vitamins). Blood levels are a good indicator of fresh food intake, particularly of fruit and vegetables;
- 14% had diabetes.
- At the same time stock turnover in Minjilang store was studied.
People were eating:
- 30 teaspoons of sugar in tea and 14 teaspoons of sugar in cool drinks per person per day;
- too much fat in fatty meat, pies and cooking oil;
- 83g per person per day of fruit and vegetables;
- very little wholemeal bread.
At Minjilang's request the Aboriginal Health Workers, Mandy and Annie Bonson, an Aboriginal Nutrition Worker worked for a year in the store and with family groups, talking about good store foods and checking weight, blood levels and store turnover every three months for signs of improvement.
After twelve months this was the picture at Minjilang:
- overweight dropped to 34% and underweight to 25%;
- many people achieved normal cholesterol levels - 52% of the community compared to only 36% before;
- most people (90%) achieved normal folate levels;
- fruit and vegetable intakes more than doubled;
- sugar sales decreased by 13%;
- saturated fat intake dropped by about 25%;
- wholemeal bread sales more than doubled;
- to reduce cholesterol, people changed to mono unsaturated oil (like canola) for cooking.
It is interesting that at one point in the year, fruit and vegetable sales dropped back to their old low level and that coincided with the appointment of a new manager in the store. He believed that Aboriginal people didn't like fruit and vegetables and didn't want to over order for fear of wastage. The community solved that problem by chartering a plane from the mainland to transport weekly fruit and vegetable supplies, independently of the store! After a little while the manager bowed to consumer demand and greatly increased the fruit/vegetable order.
Another point of great interest to the business-minded is that whilst all these positive health and nutrition changes were taking place, profits actually increased!
Northern Territory Department of Health and
Community Services, Food for Thought in Rural Aboriginal Communities:
An Information Booklet for Remote Northern Territory Store Managers 1995:27-28
Bush foods, like any fresh foods, are preferable to foods that have been processed, stored for long periods or transported long distances.
|See the section on "Bush and wild foods" in Section 1 of this chapter|
Traditional Aboriginal foods, when they were available, provided the range of nutrients which are necessary for growth and survival. For example, there are many nutrient similarities between the varieties of local yams (which grow under the ground), and root vegetables which grow elsewhere in the world. All are starchy and have varying amounts of vitamin C and carotene.
Native leaves and fruits are often juicy, enjoyable foods to consume. They have varying levels of vitamins and minerals. A notable exception is the 'kakadu plum' (Terminalia ferdinandiana) or 'Billy Goat Plum' which has the highest recorded levels of vitamin C at between 1 000-5 300mg of vitamin C per 100 grams (Brand Miller et al 1993:186-188)
The meats from native animals, like other wild game meats are strong in flavour and generally low in fat content when compared to other meat sources.
The nutritional worth of bush foods is not their most important feature in contemporary Aboriginal society in the Northern Territory. Bush foods are recognised as part of the healing and spiritual practices of many Aboriginal people.
Hunting and collecting bush foods also provide a means of getting enjoyable exercise.
Ways to support the use of local foods:
|support the collection of bush tucker|
|talk to the old people about traditional ways, about what they used to eat and what they used to feed their babies and children|
|include bush foods in any nutrition activities or projects you may be involved with|
|include bush foods in any training resources you may be preparing|
|combine hunting/gathering days with education and information sharing about health issues, for example, have a 'day out' for people with diabetes|
|include bush tucker in health education in schools by working with the elders and school staff. Involve the elders in teaching about bush tucker|
|talk with relevant people about the possibility of including some types of bush tucker in the store|
|develop an understanding of what is stopping people from being able to collect bush tucker|
Getting bush tucker into Royal Darwin Hospital
The bush tucker program started because many sick Aborigines are sad during hospital stays because they wish to be with their family and eat familiar food. Many leave early because they wouldn't eat western food. A lot of the benefit of serving bush tucker to Aboriginal patients in the hospital is in the minds as well as nutritional. Usually people are a long way from home with no family, and bush tucker is something familiar, a natural salty taste they're used to.
I had the idea to get bush food to help reduce conflict between staff and patients over hospital food. I work full-time. I talk to patients about the hospital menu, talk nutrition two-ways - old ways and new ways, healing prayers with patients, adults and children, translating for patients in 8 languages, teaching hospital and community health staff about bush tucker and culture. I also talk to people about diabetes, kidney problems, talk to pregnant mums, post natal, and mothers with malnourished children; and adults, male and female.
I collect bush tucker like mud crabs, periwinkles, mud mussel, mangrove worms, long bums, bush berries, plums, yams, inland and salt water foods, with staff. I check with the doctors, sisters who can eat bush tucker check about any allergies. After ward rounds I go to catering to prepare and serve the bush tucker for up to 60 patients - adults and children.
Lots of people have been involved in the program. The military gave us access to hunting areas. Kitchen staff at hospital gave us access to do cooking. Hospital admin staff - including security for firewood. Bagot was supportive. Northern Land Council for permits.
My story about Bush Tucker teacher has been recorded on radio, television, video and newspaper. I have talked to students at Batchelor College, BBC, at conferences in Alice Springs, Katherine, Broome, Darwin and Maningrida.
Bamal Pat Gamanangga, Nutrition Worker,
Aboriginal Nutrition Bush Tucker Teacher, Royal Darwin Hospital
The most common kinds of local food production are:
These initiatives can provide:
For these local food production initiatives to work there needs to be:
'Mai Palya': A story about the Titjikala Healthy Food Project
Mai Palya is our project to keep children in Titjikala strong and healthy and help prevent sickness. We see this as a way to strengthen our culture by strengthening the family, keeping people at home caring for the family so that the community is closer together with all of us keeping an eye on the health of our children. Mai Palya is the name of the food program because it is about keeping families strong and healthy, about bush foods and about store foods.
The painting of 'Mai Palya' ... shows three 'outsiders' (the health promotion officer, the nutritionist from town and the Women's Centre Coordinator) sitting down with women from Tijikala all of us sharing our knowledge of health, families and food.
Mai Playa has developed slowly fitting into the changing needs of the Titjikala community. The women who come to the Women's Centre working with Mai Palya do not see food business as something by itself, as a separate 'nutrition program', but as part of the whole picture of daily living and healthy families. Food business is part of the Women's Centre which is itself part of the pattern of daily living at Titjikala.
Mai Palya has been making healthy sandwiches for the kids in school with the ASPA [Aboriginal Students And Parents Association] program. The school teacher did not have time to always make the sandwiches so she asked Mai Palya to help with the work. Now the kids have a fruit juice, a piece of fruit and sandwiches with meat, cheese, salad or baked beans everyday. They really enjoy them.
Mai Palya cooks for the old people. Some women do the cooking and two women take the meals to the old people in the Women's Centre vehicle. This way the women can see if the old people are cared for. The old people say "palya", they are happy with the food.
With Mai Palya the women have learnt different ways of cooking like using less fat and salt and more vegetables as well as using less sugar. The women are trying these new ways at home but sometimes this is hard to do when some houses do not have electric stoves. To learn new ways we need to be able to buy the foods in our community store and use the equipment we have at home to cook the food.
The Titjikala Store
The community store has also seen some changes..... We looked at the store orders for fresh fruit and vegetables for September 1993 and September 1994 to see if there had been any changes. We saw that while there was more variety of fruit and vegetables being ordered in 1994 the quantity was about the same.
The store in Titjikala has had many temporary managers over the past two years. By looking at the store invoices we could see that what was ordered depended on the manager. If the manager liked fresh fruit and vegetables they ordered more variety and more in quantity. So what was available to the community to buy from the community store depended on the store manager.
One idea was for the community to make a list of fruit and vegetables, and other foods we need to keep healthy, foods that the store manager needs to order every week. That way the community decides what kind of food is in the store, not the manager.
People in Titjikala are happy with the store now. It sells fresh fruit and vegetables, wholemeal bread, diet cool drinks and spring water, fruit juice, low fat milk, artificial sweeteners like 'Equal', fresh meat that is not too fatty, frozen fish and not too many sweet things for the young kids.
The store always tries to make healthy sandwiches to sell as take-aways. These sell very quickly, better than the pies and pasties. Hard boiled eggs and cheese sticks are sold as snacks as well. But more people are needed to work in the store so we can keep doing this work.
Extracts from Mai Palya:Titjikala Healthy Food Project Report, October 1994
Strong Food Poster by Donna Burak, Worry Food Poster by Maryann Tungatalum