First Nations Peoples’ Participation in the Development of Population-Wide Food and Nutrition Policy in Australia: A Political Economy and Cultural Safety Analysis

Document Type : Original Article

Authors

1 Global Obesity Centre, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia

2 School of Health and Social Development, Deakin University, Geelong, VIC, Australia

3 Committix Pty Ltd., Newcastle, NSW, Australia

Abstract

Background
Healthy and sustainable food systems underpin the well-being of Indigenous peoples. Increasingly governments are taking action to improve diets via population-wide policies. The United Nations Declaration on the Rights of Indigenous People states that Indigenous peoples have the right to participate in all decisions that affect them. We analysed Australian national food and nutrition policy processes to determine: (i) the participation of Aboriginal organisations, (ii) the issues raised in Aboriginal organisations’ policy submissions, and (iii) the extent to which Aboriginal organisations’ recommendations were addressed in final policy documents.
 
Methods
Political economy and cultural safety lenses informed the study design. We analysed publicly-available documents for Australian population-wide food and nutrition policy consultations occurring 2008-2018. Data sources were policy documents, committee reports, terms of reference and consultation submissions. The submissions made by Aboriginal organisations were thematically analysed and key policy recommendations extracted. We examined the extent to which key recommendations made by Aboriginal organisations were included in the subsequent policy documents.
 
Results
Five food and nutrition policy processes received submissions from Aboriginal organisations. Key themes centred on self-determination, culturally-appropriate approaches to health, and the need to address food insecurity and social determinants of health. These messages were underrepresented in final policy documents, and Aboriginal people were not included in any committees overseeing policy development processes.
 
Conclusion
This analysis suggests that very few Aboriginal organisations have participated in Australian population-wide food and nutrition policy processes and that these policy development processes are culturally unsafe. In order to operationalise First Nations peoples’ right to self-determination, alternative mechanisms are required to redress the power imbalances preventing the full participation of Aboriginal and Torres Strait Islander peoples in population-wide food and nutrition policy decisions. This means reflecting on deeply embedded institutional structures and the normative assumptions upon which they rest.

Keywords


  1. Kuhnlein HV. Food system sustainability for health and well-being of Indigenous Peoples. Public Health Nutr. 2015;18(13):2415-2424. doi:10.1017/s1368980014002961
  2. Levkoe C, Ray L, Mclaughlin J. The Indigenous Food Circle: reconciliation and resurgence through food in Northwestern Ontario. J Agric Food Syst Community Dev. 2019;9(B):1-14. doi:10.5304/jafscd.2019.09B.008
  3. Sebastian T, Donelly M. Policy influences affecting the food practices of Indigenous Australians since colonisation. Aust Aborig Stud. 2013(2):59-75.
  4. Kuhnlein H, Erasmus B, Creed-Kanashiro H, et al. Indigenous peoples' food systems for health: finding interventions that work. Public Health Nutr. 2006;9(8):1013-1019.
  5. King U, Furgal C. Is hunting still healthy? Understanding the interrelationships between indigenous participation in land-based practices and human-environmental health. Int J Environ Res Public Health. 2014;11(6):5751-5782. doi:10.3390/ijerph110605751
  6. Rasmussen M, Guo X, Wang Y, et al. An Aboriginal Australian genome reveals separate human dispersals into Asia. Science. 2011;334(6052):94-98. doi:10.1126/science.1211177
  7. Clarkson C, Jacobs Z, Marwick B, et al. Human occupation of northern Australia by 65,000 years ago. Nature. 2017;547(7663):306-310. doi:10.1038/nature22968
  8. Florin SA, Fairbairn AS, Nango M, et al. The first Australian plant foods at Madjedbebe, 65,000-53,000 years ago. Nat Commun. 2020;11(1):924. doi:10.1038/s41467-020-14723-0
  9. Pascoe B. Dark Emu: Aboriginal Australia and the Birth of Agriculture. Broome: Magabala Books; 2018.
  10. Gracey M. Historical, cultural, political, and social influences on dietary patterns and nutrition in Australian Aboriginal children. Am J Clin Nutr. 2000;72(5 Suppl):1361S-1367S. doi:10.1093/ajcn/72.5.1361s
  11. O'Dea K. Preventable chronic diseases among indigenous australians: the need for a comprehensive national approach. Heart Lung Circ. 2005;14(3):167-171. doi:10.1016/j.hlc.2005.06.004
  12. Shannon C. Acculturation: Aboriginal and Torres Strait Islander nutrition. Asia Pac J Clin Nutr. 2002;11 Suppl 3:S576-578. doi:10.1046/j.0964-7058.2002.00352.x
  13. Damman S, Eide WB, Kuhnlein HV. Indigenous peoples’ nutrition transition in a right to food perspective. Food Policy. 2008;33(2):135-155. doi:10.1016/j.foodpol.2007.08.002
  14. Australian Institute of Health and Welfare (AIHW). Australian Burden of Disease Study: Impact and Causes of Illness and Death in Aboriginal and Torres Strait Islander People 2011. Canberra: AIHW; 2016. Australian Burden of Disease Study Series no. 6.
  15. Australian Bureau of Statistics (ABS). Australian Aboriginal and Torres Strait Islander Health Survey: Nutrition Results – Food and Nutrients 2012-2013. Canberra: ABS; 2015.
  16. Marmot M. Social determinants and the health of Indigenous Australians. Med J Aust. 2011;194(10):512-513.
  17. Carson B, Dunbar T, Chenhall RD, Bailie R. Social Determinants of Indigenous Health. New South Wales: Allen & Unwin; 2007.
  18. Sherwood J. Colonisation - it's bad for your health: the context of Aboriginal health. Contemp Nurse. 2013;46(1):28-40. doi:10.5172/conu.2013.46.1.28
  19. O’Sullivan D. Justice, culture and the political determinants of indigenous Australian health. Ethnicities. 2012;12(6):687-705. doi:10.1177/1468796811432697
  20. Anderson I. The truth about Indigenous health policy. Arena Magazine. 2002(56):32-37.
  21. Lee VS. Political determinants and Aboriginal and Torres Strait Islander women: don't leave your integrity at the political gate. J Public Health Policy. 2017;38(3):387-393. doi:10.1057/s41271-017-0075-y
  22. United Nations. United Nations Declaration on the Rights of Indigenous Peoples. 2007. http://www.un.org/esa/socdev/unpfii/documents/DRIPS_en.pdf.  Accessed June 10, 2015.
  23. Panaretto KS, Wenitong M, Button S, Ring IT. Aboriginal community controlled health services: leading the way in primary care. Med J Aust. 2014;200(11):649-652. doi:10.5694/mja13.00005
  24. Anderson I, Sanders W. Aboriginal Health and Institutional Reform within Australian Federalism. Canberra: Centre for Aboriginal Economic Policy Research; 1996.
  25. Cunningham J, Baeza J. An 'experiment' in Indigenous social policy: the rise and fall of Australia's Aboriginal and Torres Strait Islander Commission (ATSIC). Policy Polit. 2005;33(3):461-473. doi:10.1332/0305573054325684
  26. Anderson IP. Mutual obligation, shared responsibility agreements & indigenous health strategy. Aust New Zealand Health Policy. 2006;3:10. doi:10.1186/1743-8462-3-10
  27. Strategic Inter‐Governmental Nutrition Alliance. National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010. Canberra: National Public Health Partnership; 2001.
  28. Pholi K, Black D, Richards C. Is 'Close the Gap'a useful approach to improving the health and wellbeing of Indigenous Australians? Australian Review of Public Affairs. 2009;9(2):1-13.
  29. Hunter B, Jordan K. Explaining social exclusion: towards social inclusion for Indigenous Australians. Aust J Soc Issues. 2010;45(2):243-265.
  30. Browne J, Hayes R, Gleeson D. Aboriginal health policy: is nutrition the 'gap' in 'Closing the Gap'? Aust N Z J Public Health. 2014;38(4):362-369. doi:10.1111/1753-6405.12223
  31. Fisher M, Battams S, McDermott D, Baum F, Macdougall C. How the social determinants of Indigenous health became policy reality for Australia's National Aboriginal and Torres Strait Islander Health Plan. J Soc Policy. 2019;48(1):169-189. doi:10.1017/s0047279418000338
  32. Browne J, de Leeuw E, Gleeson D, Adams K, Atkinson P, Hayes R. A network approach to policy framing: a case study of the National Aboriginal and Torres Strait Islander Health Plan. Soc Sci Med. 2017;172:10-18. doi:10.1016/j.socscimed.2016.11.011
  33. Coalition of Aboriginal and Torres Strait Islander Peak Organisations. Partnership Agreement on Closing the Gap. Canberra: National Aboriginal Community Controlled Health Organisation; 2019.
  34. Joint Council on Closing the Gap. National Agreement on Closing the Gap. Joint Council on Closing the Gap; 2020. https://www.closingthegap.gov.au/sites/default/files/files/national-agreement-ctg.pdf.  Accessed August 3, 2020.
  35. Backholer K, Beauchamp A, Ball K, et al. A framework for evaluating the impact of obesity prevention strategies on socioeconomic inequalities in weight. Am J Public Health. 2014;104(10):e43-50. doi:10.2105/ajph.2014.302066
  36. Browne J, Lock M, Walker T, Backholer K. The Effects of Food Policy Actions on First Nations Peoples’ Nutrition-Related Outcomes: A Systematic Review. Melbourne: Report for the Victorian Health Promotion Foundation; 2019.
  37. Browne J, Gleeson D, Adams K, Minniecon D, Hayes R. Strengthening Aboriginal and Torres Strait Islander health policy: lessons from a case study of food and nutrition. Public Health Nutr. 2019;22(15):2868-2878. doi:10.1017/s1368980019001198
  38. Productivity Commission. Indigenous Evaluation Strategy: Issues Paper. https://www.pc.gov.au/inquiries/current/indigenous-evaluation/issues.  Accessed  February 3, 2020. Published 2019.
  39. Durie M. Indigenous knowledge within a global knowledge system. High Educ Policy. 2005;18(3):301-312. doi:10.1057/palgrave.hep.8300092
  40. Reich MR, Balarajan Y. Political economy analysis for nutrition policy. Lancet Glob Health. 2014;2(12):e681-682. doi:10.1016/s2214-109x(14)70350-x
  41. Friel S, Schram A, Townsend B. The nexus between international trade, food systems, malnutrition and climate change. Nat Food. 2020;1(1):51-58. doi:10.1038/s43016-019-0014-0
  42. Reich MR, Balarajan Y. Political Economy Analysis for Food and Nutrition Security. Washington, DC: World Bank; 2012.
  43. Giddens A. The Constitution of Society: Outline of the Theory of Structuration. Berkeley: University of California Press; 1984.
  44. Hall PA. The role of interests, institutions, and ideas in the comparative political economy of the industrialized nations. Comparative politics: Rationality, culture, and structure. 1997:174-207.
  45. Department of Health and Ageing. National Aboriginal and Torres Strait Islander Health Plan 2013-2023. Canberra: Australian Government; 2013.
  46. Australian Health Ministers Advisory Council. Cultural respect framework 2016-2026 for Aboriginal and Torres Strait Islander Health: A National Approach to Building A Culturally Respectful Health System. Canberra: Australian Government Department of Health; 2016.
  47. Lock M, Burmeister O, McMillan F, Whiteford G. Absence of rigorous evidence undermines cultural safety reforms. Aust J Rural Health. 2020;28(1):4-5. doi:10.1111/ajr.12606
  48. Ramsden I. Cultural Safety and Nursing Education in Aotearoa and Te Waipounamu: A Thesis Submitted to the Victoria University of Wellington in Fulfilment of the Requirements for the Degree of Doctor of Philosophy in Nursing [dissertation]. Wellington: Victoria University of Wellington; 2002.
  49. Laverty M, McDermott D, Calma T. Embedding cultural safety in Australia's main health care standards. Med J Aust. 2017;207(1):15-16. doi:10.5694/mja17.00328
  50. Australian Health Practitioner Regulation Agency. Aboriginal and Torres Strait Islander Cultural Health and Safety Strategy 2020-2025. https://www.ahpra.gov.au/News/Consultations/Past-Consultations.aspx.  Accessed  March 28,2020.
  51. Mackean T, Fisher M, Friel S, Baum F. A framework to assess cultural safety in Australian public policy. Health Promot Int. 2020;35(2):340-351. doi:10.1093/heapro/daz011
  52. Came H. Sites of institutional racism in public health policy making in New Zealand. Soc Sci Med. 2014;106:214-220. doi:10.1016/j.socscimed.2014.01.055
  53. Thompson L, Duthie D. Towards culturally safe social policy processes for Aboriginal Australians. Int J Interdiscip Soc Community Stud. 2016;11(4):47-62. doi:10.18848/2324-7576/CGP/v11i04/47-62
  54. Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Aust Health Rev. 2019;43(6):611-618. doi:10.1071/ah18062
  55. Howse G, Dwyer J. Legally invisible: stewardship for Aboriginal and Torres Strait Islander health. Aust N Z J Public Health. 2016;40(Suppl 1):S14-20. doi:10.1111/1753-6405.12358
  56. Browne J, Coffey B, Cook K, Meiklejohn S, Palermo C. A guide to policy analysis as a research method. Health Promot Int. 2019;34(5):1032-1044. doi:10.1093/heapro/day052
  57. Mackean T, Adams M, Goold S, Bourke C, Calma T. Partnerships in action: addressing the health challenge for Aboriginal and Torres Strait Islander peoples. Med J Aust. 2008;188(10):554-555.
  58. Referendum Council. Uluru Statement from the Heart. https://ulurustatement.org/the-statement.  Accessed May 26, 2017.
  59. Sabatier PA. The need for better theories. Theories of the Policy Process. 1999;2:3-17.
  60. Lee A, Baker P, Stanton R, Friel S, O'Dea K, Weightman A. Scoping Study to Inform Development of the National Nutrition Policy for Australia. Canberra: Australian Government Department of Health; 2013.
  61. Australian Indigenous Governance Institute. Governance in Indigenous Organisations https://toolkit.aigi.com.au/toolkit/1-3-governance-in-indigenous-organisations.  Accessed January 22, 2020.
  62. Braun V, Clarke V, Cooper H. Thematic analysis. APA Handbook of Research Methods in psychology. Vol. 2. Research Design. American Psychological Association; 2012.
  63. Krippendorff K. Content Analysis: An Introduction to Its Methodology. 4th ed. Los Angeles: Sage Publications; 2019.
  64. Grbich C. Qualitative Data Analysis: An Introduction. 2nd ed. London: Sage; 2012.
  65. Australian Bureau of Statistics. Census of Population and Housing: Australia Revealed, 2016. https://www.abs.gov.au/ausstats/abs@.nsf/mf/2024.0>.  Accessed February 8, 2020. 
  66. Dwyer JM, Lavoie J, O’Donnell K, Marlina U, Sullivan P. Contracting for Indigenous health care: towards mutual accountability. Aust J Public Adm. 2011;70(1):34-46. doi:10.1111/j.1467-8500.2011.00715.x
  67. Department of Health. Consultation Hub. https://consultations.health.gov.au/.  Accessed  February 6, 2020. Published 2020.
  68. Baker P, Hawkes C, Wingrove K, et al. What drives political commitment for nutrition? A review and framework synthesis to inform the United Nations Decade of Action on Nutrition. BMJ Glob Health. 2018;3(1):e000485. doi:10.1136/bmjgh-2017-000485
  69. Jenkin G, Signal L, Thomson G. Nutrition policy in whose interests? a New Zealand case study. Public Health Nutr. 2012;15(8):1483-1488. doi:10.1017/s1368980011003028
  70. Carey R, Caraher M, Lawrence M, Friel S. Opportunities and challenges in developing a whole-of-government national food and nutrition policy: lessons from Australia's National Food Plan. Public Health Nutr. 2016;19(1):3-14. doi:10.1017/s1368980015001834
  71. Cullerton K, Donnet T, Lee A, Gallegos D. Using political science to progress public health nutrition: a systematic review. Public Health Nutr. 2016;19(11):2070-2078. doi:10.1017/s1368980015002712
  72. Shiffman J, Smith S. Generation of political priority for global health initiatives: a framework and case study of maternal mortality. Lancet. 2007;370(9595):1370-1379. doi:10.1016/s0140-6736(07)61579-7
  73. Fogarty W, Bulloch H, McDonnell S, Davis M. Deficit Discourse and Indigenous Health: How Narrative Framings of Indigenous People are Reproduced in Policy. Melbourne: The Lowitja Institute; 2018.
  74. Askew DA, Brady K, Mukandi B, et al. Closing the gap between rhetoric and practice in strengths-based approaches to Indigenous public health: a qualitative study. Aust N Z J Public Health. 2020;44(2):102-105. doi:10.1111/1753-6405.12953
  75. Thompson LJ, Duthie D. Towards culturally safe social policy processes for Aboriginal Australians. Int J Interdiscip Soc Community Stud. 2016;11(4):47-62.
  76. Baker P, Gill T, Friel S, Carey G, Kay A. Generating political priority for regulatory interventions targeting obesity prevention: an Australian case study. Soc Sci Med. 2017;177:141-149. doi:10.1016/j.socscimed.2017.01.047
  77. Baum F, Fisher M. Why behavioural health promotion endures despite its failure to reduce health inequities. Sociol Health Illn. 2014;36(2):213-225. doi:10.1111/1467-9566.12112
  78. Sacks G. Policies for tackling obesity and creating healthier food environments: 2019 progress update for Australian governments. www.foodpolicyindex.org.au.  Accessed  August  4, 2020. Published 2019.
  79. Lutschini M. Engaging with holism in Australian Aboriginal health policy--a review. Aust New Zealand Health Policy. 2005;2:15. doi:10.1186/1743-8462-2-15
  80. Lock M. Australian Open Disclosure Governance-Closed to Cultural Voice. Critique of Australian Open Disclosure Governance and the Cultural Voice of Australia's First Peoples. 2019; https://committix.com/projects/cultural-voice-and-open-disclosure/.  Accessed February 13, 2020.
  81. National Health and Medical Research Council. Engaging Indigenous people in guideline development. https://nhmrc.govcms.gov.au/guidelinesforguidelines/plan/engaging-aboriginal-and-torres-strait-islander-people-guideline-development.  Accessed January 7 2020. Published 2019.
  82. Came H, O’Sullivan D, McCreanor T. Introducing critical Tiriti policy analysis through a retrospective review of the New Zealand Primary Health Care Strategy. Ethnicities. 2020;20(3):434-456. doi:10.1177/1468796819896466
  83. O’Sullivan D. Indigenous Health: Power, Politics and Citizenship. Melbourne: Australian Scholarly Publishing; 2015.
  84. Gobbett H. Indigenous Parliamentarians, Federal and State: A Quick Guide. https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/rp1718/Quick_Guides/IndigenousParliamentarians.  Published 2017.
  85. Came H, McCreanor T, Haenga-Collins M, Cornes R. Māori and Pasifika leaders’ experiences of government health advisory groups in New Zealand. Kōtuitui: New Zealand Journal of Social Sciences Online. 2019;14(1):126-135. doi:10.1080/1177083X.2018.1561477
  86. Nursing Council of New Zealand. Guidelines for cultural safety, the Treaty of Waitangi, and Māori health in nursing education and practice. http://www.nursingcouncil.org.nz/Publications/Standards-and-guidelines-for-nurses.  Accessed March 28, 2020. Published 2011.
  87. Lock MJ, Thomas DP, Anderson IP, Pattison P. Indigenous participation in an informal national indigenous health policy network. Aust Health Rev. 2011;35(3):309-315. doi:10.1071/ah09812

Articles in Press, Accepted Manuscript
Available Online from 26 September 2020
  • Receive Date: 20 April 2020
  • Revise Date: 26 August 2020
  • Accept Date: 08 September 2020