Sugar and water: Diet and structural inequality in remote communities

Reliable drinking water.
 
At a glance, it is something most people in Australia likely wouldn’t even think twice about.
 
For people in remote Aboriginal and Torres Strait Islander communities, however, that can be very different.
 
When Dr Katie Thurber, researcher at the Australian National University (ANU) Research School of Public Health, wanted to take a deeper look into figures showing a higher rate of sugar consumption among Aboriginal and Torres Strait Islander peoples, especially young children, she found lack of lack of access to reliable drinking water to be a genuine concern.
 
‘It aligns with a lot of conversations we’ve been having with Aboriginal and Torres Strait Islander communities. In other work, this concern about water quality just keeps coming up organically,’ she told newsGP.
 
Dr Thurber and her research team were specifically interested in how such issues affect very young Aboriginal children when it comes to the consumption of sugary drinks.
 
‘There’s a particularly high prevalence of cordial and other sugary drinks consumed by Aboriginal kids at two to three years of age in ABS [Australia Bureau of Statistics] data,  but we don’t have any data before that, on those first two years of life,’ she said.
 
‘The longitudinal study of indigenous children [LSIC] collects data starting with kids less than a year old, so we thought it would be good to look at this data in terms of what drinks kids are consuming, but also what might be underlying this.
 
‘Our main questions were why is this going on and what might we want to do about it?’
 
In pursuit of the answers, the researchers used a mix of quantitative and qualitative research, analysing the statistics from the LSIC, while also holding a focus group with families from Aboriginal and Torres Strait Islander communities and run by members of the same communities.
 
The results have been recently published in Public health nutrition.
 
The focus group enabled researchers to access information that may not have otherwise been available to them, such as limited access to water.
 
‘That’s not something we have quantitative data on, so that came strictly from the focus group,’ Dr Thurber said.
 
The focus groups revealed that many families had drinking water that did not look or taste good, or was simply unsafe to drink, which limited their healthy options.
 
‘If it’s a matter that it doesn’t taste good, families … would add some cordial or sugary drink to the water just to make it palatable,’ Dr Thurber said.
 
‘In terms of where it’s not safe to drink, if you can’t drink the tap water, then the options are to buy something. And, particularly in remote settings, if there’s only one community store, we know the prices are really high, and that often, bottled water is not the cheapest option.
 
‘If you then bring in things like socioeconomic disadvantage, if you’re experiencing financial insecurity, and there’s an option that your kids are actually really going to enjoy that’s cheaper than water, you can see why then you end up in a situation where families are doing this.’


Dr Katie Thurber and her research team wanted to take a deeper look at the statistics behind sugary drink consumption in Aboriginal and Torres Strait Islander communities.

Socioeconomic disadvantage and the presence of multiple stressors in family life had other impacts on this issue.
 
‘Parents are aware of what they would ideally like their children to drink, but there might be other, bigger things impacting the family. And, at the end of the day, what the child is drinking, as long as the child is healthy, is not number-one priority for that day,’ Dr Thurber said.
 
The inverse also proved to be true, when researchers looked into the lives of the 50% of Aboriginal and Torres Strait Islander children under two years who had never had any sugary drinks at all.
 
‘We found that children were less likely to have ever had sugary drinks if their families were doing well; so if the families had socioeconomic advantage, good social support, and weren’t experiencing a lot of different stressors in their day to day life,’ Dr Thurber explained.
 
The impact of racism was discussed in the focus group, which, to Dr Thurber, illustrates the importance of a holistic approach to public health.
 
‘Racism as a factor linked to sugary drinks is not necessarily something that would be front of mind,’ she said.
 
‘But we know that racism is a really key determinant of health, and it’s come up in other papers that have found people talk about how decreasing racism might improve health behaviours, which includes nutrition.’
 
Dr Thurber believes the results of the study identify key barriers that families and health professionals can face in trying to tackle sugary-drink consumption in remote Aboriginal and Torres Strait Islander communities.
 
‘The quantitative findings clearly show us that the complex life circumstances of competing priorities can make it really difficult for parents to give their child the optimum nutrition they want,’ she said.
 
‘So when giving advice, if it’s cut-and-dried, black-and-white advice that isn’t applicable in the setting, or the families are facing barriers that get in the way of that, how can we make it more flexible and fit to the context? And how can we actually support health providers to give this sort of more contextually relevant messaging?’
 
Dr Thurber also suggested implementation of more holistic health programs providing wraparound support and integrated team delivery among professionals, including GPs, nurses and caseworkers.
 
However, she believes solutions also need to come from higher up.
 
‘This is a structural problem, so we need system-level solutions,’ she said.
 
‘What sort of policies can we implement that are going to support things like financial security and reduce racism from the top down? Rather than saying it’s programs that need to build this up, when we have structural inequality that is maintaining and entrenching these inequalities.’
 
Dr Thurber believes that the study proves the value of consulting with the communities themselves.
 
‘If you don’t ask, if the focus group hadn’t happened and the interviewers hadn’t passed on these issues, they would have been completely missing from our paper,’ she said.
 
‘I think it really speaks to the importance of working with these key informants to explain what is underlying the quantitative findings.’

Aboriginal and Torres Strait Islander health children's health nutrition sugar