The failure of successive governments to act on improving food and nutrition for Aboriginal and Torres Strait Islander peoples is a “shame and disgrace”, according to University of Newcastle researcher Dr Mark Lock.

In an exhaustive investigation of the fate of the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010, he identifies a litany of government failures, including unheeded recommendations, poor stewardship, inadequate resources, lack of information, lack of community engagement, lack of political will, and secrecy in public administration.  

In the Croakey Longread below, he calls for sweeping reforms and bold leadership to address this critical public health issue.

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By @MarkJLock

Governance is a concept referring to how a State is organised by elected citizens in order to achieve goals of common interest to the development of the Nation.

Access to quality and nutritious food is one of those ‘givens’ in our Nation, except for Aboriginal and Torres Strait Islander peoples. The issues have been known for over 100 years and continue to be noted in various articles published in The Conversation (see articles with content from Jennifer Brown, Amanda Lee, Danae Bosler, Carley Tonoli, Karen Soldatic, and Julie Brimblecombe for example).

The effects of poor food access and poor nutrition were addressed in the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010 (referred to as NATSINSAP, for an overview see HealthInfoNet, and for the original strategy go to here). The NATSINSAP was badged as ‘whole-of-government’ and…yes you know how the rest of the policy rhetoric goes!

The company Urbis Pty Ltd was contracted to review the NATSINAP and produced a review report which I could only gain access to through Freedom of Information application. My analysis – from a governance angle – reveals a small insight into how ineffective governance processes of the Australian State perpetuate social inequality for disadvantaged Australian citizens. 

The following summary points show what was necessary to do in order to get a simple ‘review’ of a public strategy. On 17th June 2015 @MarkJLock received the Urbis Report ‘Review of the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000 – 2010, Final Report’ – communications are covered in the Appendices (B to F).

The Urbis Review cost $109,000 to taxpayers, and the FOI application resulted in a cost to my account of $315.

The FOI application was necessary as an email to Australian health ministers (Appendix C) – which received several responses (Appendix G to M) – did not result in the public release of the Urbis Review.

The 2015 email followed-on from my original letter from 2003 was written as Mark Lutschini as Convenor of the ATSISIG of PHAA (Appendix A).

On the topic of citizen advocacy in relation to NATSINSAP I wrote a publication for Nutridate (1) and the Croakey blog (1).

Recommendation unheeded for revision and update of NATSINSAP

The Urbis review process consisted of a focussed literature review, review of Commonwealth Department of Health and Ageing documents, and interviews with 18 stakeholders (including ten of the 11 members of the NATSINSAP Steering Committee). The Urbis review refers to the NATSINSAP as a ‘Strategy and Action Plan’, evident in the following quotes.

‘This review recommends that the Strategy and Action Plan be revised and updated through a consultative process, and that it be adequately funded and embedded in emerging policy frameworks with clear accountability and reporting requirements’ (p. ii, Executive Summary).

‘A future Indigenous nutrition strategy will be effective only if it is adequately funded and supported by Commonwealth, state and territory governments’ (p.38)

‘This review…also identified considerable assets which have been generated. It would be desirable to build on those assets to continue to improve Indigenous nutrition’ (p.ii, Executive Summary).

‘The broad thrust of the Strategy and Action Plan remains relevant, and it should be revised to update and clarify its focus, and align it with other reforms in Indigenous policy and health. This is particularly important as there is insufficient attention to Indigenous nutrition as a contributor to chronic disease in recent policy initiatives, particularly the NPA on Closing the Gap on Indigenous Health Outcomes. (p.40, Summary and Recommendations).

Note that the Urbis review was completed in 2010 and yet five years lapsed to 2015 before there could be public accountability of this implementation failure. The political leaders from all jurisdictions demonstrate poor leadership in not owning-up to the failure to effectively implement NATSINSAP.

Poor stewardship

Notice that the response from Senator the Hon Fiona Nash is carefully worded so as NOT to include the words ‘National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan’. The response also refers to ‘National Nutrition Policy’ that ‘the Government is considering its way forward with this work’. However, a quick visit to the Government’s nutrition website shows that the page was last updated 24 April 2013 which is marked as ‘current’. I had written to the Population Health Division in 2014 to ask about the status of national nutrition policy and the response provided little clarity beyond the website. What I wanted to know was who the members of national nutrition committee were, what were its ‘terms of reference’, what were its timelines for consultation and where there any documents publicly available? No big secret, one would think!

Good stewardship is necessary for engendering consistent performance, however the NATSINSAP ‘was based on assumptions about governance, intergovernmental collaboration and ongoing evaluation that were not realised’ (p.40, Summary and Recommendations).’ Furthermore, that ‘The operational capacity necessary to drive implementation of the Strategy and Action Plan was significantly compromised by its governance arrangements, particularly after 2006, by lack of consistent levels of commitment by government’ (p. 40, Summary and Recommendations).

In the decade from 2000-2010 there were 28 Federal, State and Territory elections. Clearly, new leaders change policy implementation plans according to party policy which points to the failure of the Council of Australian Governments (COAG) in providing a stable administrative implementation structure which could buffer against changing political priorities.

Inadequate resources

The Urbis review shows that the NATSINSAP Strategy was endorsed by the Australian Health Ministers’ Conference (AHMC) in 2001, but dedicated project officer funding was not achieved until 2003 with a person employed in 2004. ‘The Strategy and Action Plan was poorly resourced, with its highest level of funding sufficient to employ 1.2 EFT project staff’ (p. i, Executive Summary).

This inadequate resource base contrasts with the importance of good nutrition as ‘Critically, the Strategy and Action Plan was inadequately funded. Adequate funding of programs to promote good nutrition is essential to address Indigenous nutrition issues that impact on chronic disease’ (p.40, Summary and Recommendations).

When a strategic opportunity did arise to fund the NATSINSAP, it was not even considered in budget allocations as ‘Upon the release of the National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes (NPA) committed to close the gap on health outcomes in five priority initiatives (tackling smoking, healthy transition to adulthood, making Indigenous health everyone’s business, delivering effective primary health care services; and improving coordination of the patient journey). The NPA committed $1.58 billion to these initiatives, with no allocation specifically to address Indigenous nutrition issues. (p.29).’

Lack of information and research

Inadequate resourcing for research was also a factor as ‘The potential for the Implementation Group to disseminate and communicate information about ‘good practice’ continues to be constrained by limited research evidence of what is effective in improving Indigenous nutrition.

This is recognised in the report of the National Health Preventative Taskforce, which noted the paucity of evidence about what interventions are most effective’ (p. 16). In fact, even the National Health and Medical Research Council, which apparently is an expert body for health and medical research and developing health advice for the Australian community, published ‘Nutrition in Aboriginal and Torres Strait Islander Peoples: An Information Paper’ in 2000 but is now rescinded.

This adds insult to injury as not only is the Urbis review now long past – completed in 2010 – but there is no ongoing strategic mechanism for gathering evidence in relation to practices that improve better food and nutrition practice for Australia’s First Peoples.

Limited Aboriginal community controlled engagement

One important knowledge gathering process is to have an ongoing dialogue with the very people affected by the NATSINSAP – Aboriginal and Torres Strait Islander peoples. Whilst ‘The Strategy and Action Plan was developed through a consultative process and there was a high degree of ownership among Indigenous organisations, health workers and public health officials at the time it was developed and endorsed. The ‘ground up’ consultative process was considered to be an important achievement’ (p.28). However, as one interviewee noted:

“it did not deliver on the promise of more resources, better funding. People on the ground did not get what they needed to achieve targets in the action areas” (p.28).

The ground-up ownership was disrespected in the poor implementation process, which do not include Aboriginal community controlled perspective as ‘It was noted that community controlled Aboriginal health services had not been closely involved in implementation of the Strategy and Action Plan’ (p.28).

In fact, the ‘NATSINSAP Steering Committee was comprised primarily of health department officials’ (p.37). However, ‘Much of the success of activities under the Strategy and Action Plan can be attributed to the high level of commitment, energy and professionalism of members of the Steering Committee and the project staff’ (p.40, Summary and Recommendations).

Clearly, reliance solely on the energy and commitment of dedicated people is a poor strategy for successful implementation of a national initiative. Good governance also needs to include strategic oversight, planning and management.

Low Political Priority

Underpinning the governance failures was a lack of political will, as ‘The Strategy and Action Plan was designed to facilitate changes considered to be of public value. However, it did not attract the necessary financial and political support, nor was it operationally and administratively feasible to fully implement the Strategy and Action Plan with current arrangements’ (p.36).

My research showed that the ‘whole of government’ approach was undermined by 28 elections in the period 2000-2010 (Federal, State and Territory). During the decade 2000-2010, the Federal Ministers for Health changed from Michael Wooldridge, Kay Patterson, Tony Abbott, and Nicola Roxon (from Liberal and Labor governments).

Furthermore, in the decade from 2000-2010 we had the “Federal level” Abolition of the Aboriginal and Torres Strait Islander Commission, the New Arrangements in Indigenous Affairs, then Close the Gap and now the Indigenous Advancement Strategy. Professor Marcia Langton has written how machinery of government changes creates inertia in Aboriginal affairs. In this case, this signals a failure in the governance of the Federation of Australia to protect its First Peoples.

Secrecy of public administration

Politicians come and go; however, citizens also have a right to expect national priorities to be implemented through stable public administration processes.

However, the senior public servants of the Australian Health Ministers’ Advisory Council, who were emailed along with Australian health ministers, did not respond. With their high salaries and thousands of staff, they remain unaccountable in the failure to implement NATSINSAP. They follow their Ministers in this regard as deliberately not publishing the Urbis review; clearly they made decisions to bury the Urbis review, as well as making decisions affecting the effective implementation of NATSINSAP.

As a former public servant, I am acutely aware of the process of developing a Ministerial, of how emails and letters are carefully responded to, and how bureaucratic ‘advice’ is built into supporting political decisions.

What needs to be done?

A review of governance processes

There were failures on many fronts in the implementation of the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan 2000-2010. Constant political changes, shifts in political priorities and machinery of government changes mean that leaving Indigenous food and nutrition reforms in the hands of Governments is an unpalatable recipe. There is a clear case for the Australian National Audit Office to conduct an investigation into this whole-of-governance failure. Furthermore, the Productivity Commission could oversee the development of a national roundtable on food and nutrition policy governance.

Independent strategic oversight

Furthermore, Australian governments cannot be trusted to drive a new reform agenda. Therefore, I recommend that an independent organisation, such as the Charles Perkins Centre at the University of Sydney, be given national strategic oversight of Indigenous food and nutrition. Also, whatever is done should occur with substantial funding so that the current piecemeal state-by-state approach can be brought under better planning and coordination processes.

Develop an ongoing evidence-gathering process

There needs to be substantial commitment to an evidence-based process for updating current food and nutrition evidence (research, policies, strategies and practice) to underpin new policy. This falls within the remit of the National Health and Medical Research Council however, this body of experts has failed to recognise the need to improve the evidence base in this regard. Therefore, a national tender process – open and transparent – should be commissioned.

Bring together the experience of practitioners

And finally, the food and nutrition community should be supported to come together in a national forum to discuss the broad range of experience-based activities which they have seen lead to better food and nutrition for outcomes in their local communities.

Dietitians, nutritionists and Aboriginal health workers need to come together to share their stories of success in order to renew the hope that all Australian’s should receive high quality and affordable food and nutrition.

Concluding remarks

The shame and disgrace in the failure to develop a better food and nutrition future for Australia’s first peoples is evident in the unheeded recommendations, poor stewardship, inadequate resources, lack of information, lack of community engagement, low political priority, and secrecy in public administration.

Achieving better food and nutrition for Australia’s First Peoples requires these issues to be addressed through bold leadership of a renewed policy and strategic development approach.

References

Mark Lock 2015 – Freedom of Tweets- a social media advocacy campaign to unlock the secrets of nutrition governance. Available at http://blogs.crikey.com.au/croakey/2015/05/21/freedom-of-tweets-%E2%80%93-a-social-media-advocacy-campaign-to-unlock-the-secrets-of-nutrition-governance/?wpmp_switcher=mobile

Lock, Mark J. Promoting better food and nutrition for Australia’s first peoples [online]. Nutridate, Vol. 26, No. 2, May 2015: 2-5. Availability:<http://search.informit.com.au/documentSummary;dn=209830019754321;res=IELHEA> ISSN: 1835-5080. [cited 19 Jun 15].

Better Food and Nutrition for Australia’s First Peoples at https://www.facebook.com/betterfoodnutrionforfirstpeoples?ref=hl

Appendices

These are available from Mark upon request (email [email protected])

Appendix –A –Letter from 2003             

Appendix B – Email to Population Health Division ‘Front Desk’ – 11 June 2014              

Appendix C – Email 26 Feb 2015 to Australian Health Ministers             

Appendix D – Submission to Senate Select on Health’s Inquiry into Health Policy, Administration and Expenditure – 6th March 2015          

Appendix E – Australian National Audit Office email – 17th March 2015            

Appendix F – FOI Notice of Decision – 12 May 2015     

Appendix G – Sharon Claydon MP – 11 March 2015      

Appendix H – Dr Kim Hames MLA – Response 20 March 2015 

Appendix I – The Hon Jillian Skinner MP – Response 27 March 2015     

Appendix J – The Hon Jill Hennessy MP – Response 30 March 2015      

Appendix K – Simon Corbell MLA – Response 7 April 2015        

Appendix L – Cameron Dick MP – Response 7 April 2015

Appendix M – Senator the Hon Fiona Nash – Response 13 May 2015     

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