Chapter 3 Healthy stores, healthy communities
Stores which promote and stock healthy food alternatives are an
essential contributor to building healthy Indigenous communities in remote
areas. This chapter provides an overview of the health status of Indigenous
people living in remote areas, noting the links between health outcomes and nutrition.
The chapter then considers how store managers, health workers,
governments and communities themselves may contribute to developing the
necessary policies, initiatives and incentives to promote healthy food
preferences in remote Indigenous communities.
Health status of Indigenous people living in remote communities
Indigenous people suffer disproportionately high levels of chronic
diseases compared to the non-Indigenous population. Once rare, lifestyle
diseases such as diabetes, heart disease, kidney failure and overweight
problems now feature in many remote communities.
In 2005–06, Indigenous people were hospitalised at 14 times the rate of
non-Indigenous people for care involving dialysis, and at three times the rate
for endocrine, nutritional and metabolic diseases (which includes diabetes). 
The Department of Health and Ageing reported that:
n approximately three
times as many Indigenous Australians reported diabetes or high sugar levels as
n Indigenous Australian
adults were twice as likely to be obese as non-Indigenous Australian adults,
n the incidence of
end-stage renal disease in remote areas of Indigenous Australians is 20 times
as high as for other Australians —
In some parts of Australia we almost have a diaspora of
people who cannot live in community any more. In some communities nearly
everyone over the age of 50 who is alive is either in town or with their
partner in town on dialysis,
n of Aboriginal and
Torres Strait Island people living in remote communities 14 per cent reported
heart and circulatory conditions, compared to 11 per cent of those living in
non-remote areas, and
n cases of
self-reported diabetes and high sugar levels are nine per cent for Indigenous
Australians living in remote areas, compared to five per cent living in
non-remote areas. 
Figures on mortality rates in the ABS report, The Health and Welfare
of Australia's Aboriginal and Torres Strait Islander Peoples, 2008 include:
n life expectancy for
Indigenous Australians was 59 years for males and 65 years for females,
compared with 77 years for all males and 82 years for all females, a difference
of around 17 years, and
n the mortality rate
for Indigenous infants and Indigenous children aged one to 14 years in the
period 2001–2005 was around three times that for non-Indigenous infants and
The Australian Medical Association reported that compared with their
non-Indigenous Australian counterparts, Indigenous children are:
n two to three times
more likely to die in the first 12 months of life, and 11 times more likely to
die from respiratory causes,
n more likely to be
stillborn, to be born pre-term, to have low birth weight, or to die in the
first month of life,
n nearly 30 times more
likely to suffer from nutritional anaemia and malnutrition up to four years of
n at a much higher risk
of suffering from infectious and parasitic diseases, diseases of the
respiratory and circulatory system, hearing loss, rheumatic fever, dental
caries, injuries, and clinically significant emotional and behavioural
n cared for by
significantly fewer adults, who are also at higher risk of premature death,
serious illness, substance abuse, imprisonment, major social and emotional
stress, lower household income, lower educational attainment, lower employment,
and lower access to appropriate sanitary and household conditions, than other
The Committee notes that changes to the health profile of Indigenous
people will not be seen in the short term; there are no quick-fix solutions. Long
term health improvements are reliant on improvements to nutrition, diet and
lifestyle. As John Tregenza, Mai Wiru Health Policy Coordinator suggested, ‘We
cannot now change the health profile of anyone from five on.’
Dietary change and current food preferences
Indigenous people are relying more on the community store for food
supply compared with the past. John Tregenza, who has been working in the
Anangu Pitjantjatjara Yankunytjatjara (APY) lands for 35 years, told the
Committee that in 1974, 90 per cent of diet was locally sourced from the bush
and 10 per cent from store. Now the store is the primary place for people to
get their sustenance.
Indigenous people across Australia do still regularly go hunting for
foods for ceremonial purposes and as a healthy supplement to diet.
However, there has been a reduction in reliance on traditional hunting for a
number reasons, including:
n community gardens,
fruit orchards and animal husbandry conducted in many communities disappeared
with the missions and diet became largely based on non-perishable foods like
tinned corned beef, tea, white flour and sugar, which are nutrient poor,
n the impact of
environmental degradation and feral animals. For example, quandong trees, very
high in Vitamin C, have been destroyed by the numbers of camels in the desert,
regulations have affected the potential to grow and trade traditional foods and
goods, for example, between Cape York, Papua New Guinea and between the Torres
Strait Islands, and
n the high cost of fuel
and management plans to sustain fishing resources have impeded the opportunity
for people living in the Torres Strait to hunt dugong, turtle and fish.
The Committee notes that dugong and turtles are threatened and traditional
hunting needs to be undertaken in a traditional way under a sustainable
management plan. The Committee encourages the development of these plans where
they are not currently in place.
Sedentary lifestyle with increased access to attractive low nutrition
foods has, in some circumstances, removed incentive and energy needed for
traditional food gathering and hunting. The reliance on the community store in
remote Indigenous communities has resulted in high consumption of nutrient poor
and energy dense foods, a change from the traditional food systems which were
largely nutrient dense but relatively low in energy and fat, sugar and salt.
Link between poor nutrition and health
Poor nutrition is a major contributor to the poor health outcomes and
early death in remote Indigenous communities. The National Health and Hospitals
Reform Commission reported in June 2009 that ‘Poor nutrition —particularly low
fruit and vegetable intake—is an important determinant of the health gap among
Aboriginal and Torres Strait Islander people’.
Research indicates that low fruit and vegetable consumption accounts for
five per cent of the life expectancy gap between Indigenous and non‑Indigenous
people in Australia. Tobacco contributes 17 per cent. The burden of disease for
Aboriginal and Torres Strait Islander people from low fruit and vegetable
consumption is 1.6 times higher in remote areas than in non-remote areas.
The National Aboriginal and Torres Strait Islander Health
Survey 2004– 05 found that in remote areas, 20 per cent of Indigenous
people aged 12 years and over reported no usual daily fruit intake and 15 per
cent reported no usual daily intake of vegetables.
Research points to maternal and early nutrition as important in a
person’s health over their lifespan. The Department of Health and Ageing stated
that health disparities between Indigenous and non-Indigenous Australians have
their origins in early childhood development and continue to exert impact
across the life course, leading to increased morbidity from chronic and preventable
diseases with reduced life expectancy. The young mothers who are conceiving
have poor nutritional status, the uterine environment for their children is
poor and this contributes to an ongoing cycle of health problems.
Nutritionists have discussed the importance of targeting child and
maternal health because it allows good eating and exercise patterns to be
established early. The Prime Minister’s
Science, Engineering and Innovation Council (PMSEIC) Working Group’s report
into maternal and foetal health in Aboriginal and Torres Strait Islander
Populations recommended ensuring access to healthy food at affordable prices in
Indigenous communities as a critical step to close the gap in infant and
maternal mortality and low birth weight in Aboriginal and Torres Strait
Government initiatives on closing the gap in health
Two of the targets agreed to by the Council of Australian Governments (COAG)
in October 2008 to close the gap were related to health:
n close the gap on life
expectancy within a generation, and
n halve the gap on
mortality rates for Indigenous children under five within a decade.
Commonwealth Government initiatives to promote good nutrition and
healthy eating among remote Aboriginal and Torres Strait Islander communities
n The National
Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan
(NATSINSAP) was endorsed by the Australian Health Ministers Conference in
August 2001. NATSINSAP was designed to build on existing efforts to make
healthy food choices easier choices for Aboriginal and Torres Strait Islander
peoples, irrespective of where they live. In 2004 a national project officer
was appointed to provide coordination for the implementation for key components
of the NATSINSAP. This position was funded by the Commonwealth Department of
Health and Ageing.
A key achievement of the NATSINSAP
was the collaboration between five state and territory jurisdictions and the
completion in 2008 of the Remote Indigenous Stores and Takeaways Project (RIST).
Nine resources have been developed, intended to establish and improve standards
for ‘healthy’ remote stores. The RIST package includes:
Guidelines for stocking healthy food in remote community stores
Fruit and vegetable quantity spreadsheet
Marketing ideas for healthy food in remote community stores
Healthy Fast Food: A resource for remote stores and takeaways
Freight Improvement Toolkit
Checklists for the Store and Takeaway
Heart Foundation Buyers Guide for managers of remote Indigenous
stores and takeaways
Guidelines for maximising the shelf life of fruit and vegetables
Keeping Track of Healthy Food—a monitoring and reporting tool (in
Microsoft Access software format) that uses scanned sales data to assess a
community’s consumption of key foods and nutrients. This information is
indicative of a remote community’s food purchasing habits and nutritional
n The licensing of
stores and income management in the Northern Territory were introduced as
government interventions intended to improve the quality, quantity and range of
groceries, including healthy foods and drinks in stores, and to increase
healthy purchases. Store licensing and income management is discussed further
in Chapter 7,
n Outback Stores was
established in 2006 as a non-government enterprise to improve the commercial
viability of remote community stores, provide a better range of affordable
healthy foods, provide consistency in delivering and supplying quality
products, increase local employment opportunities for Indigenous workers, and
establish more efficient and reliable stores. An assessment of the Outback
Stores model is in Chapter 7, and
n The Mai Wiru Regional
Stores Policy (Mai Wiru), auspiced by the Nganampa Health Council, aims to
improve the health and well-being of Aboriginal people living on the Anangu
Pitjantjatjara Lands. It helps to ensure continuous access to safe, nutritious,
affordable food through the stores. The Department of Health and Ageing funded
the Nganampa Health Council to develop and implement Mai Wiru.
Stores—balancing the economic and health benefits
Health experts advise that the disproportionate amount spent on cigarettes,
sweets and sugared drinks compared with water and fresh fruit and vegetables is
having an impact on the health of remote Indigenous communities. Strategies
must focus on increasing consumption of healthier products as well as
discouraging the consumption of unhealthy products, such as sugared drinks.
Community stores in the past have had a poor record on health promotion,
with sales of sweets and nicotine products sustaining profits. The sale of
cigarettes is of great concern. In 1995 a community with a population of 50
spent $5 824 on cigarettes in one month, whereas only $920 was spent on fresh
fruit and vegetables. At one store in Maningrida
the monthly turnover was $600 000, with purchases of fruit and vegetables
at $13 000 and cigarettes at $130 000. This was despite no advertising and the
cigarettes not being on display.
Several witnesses argued that remote community stores must operate as
viable businesses before they can consider promoting healthy options. From a
business point of view, selling nutritious foods carries a higher risk. High
profit items, such as chocolate and lollies, can capitalise on some of the loss
experienced through the loss of perishable fruit and vegetables. As accountant Craig
Spicer, Remote Community Management Services, stated:
We like to try to get as much money on those [TVs] as we can.
Obviously the lollies and all the sweets are high profit. We get flak from
teachers and nurses about that, but the fact is that we cannot sustain these
places without making money. Our vision is to have a commercial investment
where we thrive without any grants or anything else. It goes to show that it
can be done, but it is hard work.
Joseph Elu, Mayor of the Northern Peninsula Area Regional Council (NPARC)
and former Chairman of Indigenous Business Australia (IBA), agreed that every
store should be run as a commercial enterprise and retail works when you supply
what the community wants:
Retail is about people walking through the door because they
know what they want and that is why they go to your store. If you are going to
just sell them what you think they should be eating or what you think they
should be buying they will quickly look for another place where they know the
things they want are sold.
Mr Elu believed the most important aspect of a viable store is that
communities feel engaged and involved. Therefore the store becomes a focal
point where people gather; it is not just about where they go to buy things. He
stated that the original concept of Outback Stores was to, firstly, be
commercially viable and secondly, supply quality healthy foods.
Outback Stores contended that, as a group, it needs to be viable to deliver
services. According to Outback Stores, the approximate population size required
is 200 for a store to be viable. Other factors which impact on viability
include remoteness, access to transport and transient populations.
The Northern Territory Government’s strategy with its ‘Working Futures Package’
is that all store models must be viable businesses into the future.
The Committee received counter arguments that community stores in remote
communities provide a primary and essential service which should be subsidised.
Subsidies are further discussed in Chapter 5.
The Nganampa Health Council (NHC) sees the supply of affordable healthy
food as an essential service: ‘a health issue, not a fiscal or an economic
issue, in the sense of those stores’. The NHC, the APY Council
and the Ngaanyatjarra Pitjantjatjara Yankunytjatjara (NPY) Women’s Council
together developed the Mai Wiru stores policy which applies to all stores in
the APY lands and works to deliver affordable healthy foods. The NYP Women’s
Council maintained that stores should be considered ‘essential services’ and
receive government funding or subsidies in the same way a clinic or a school
Free fruit and vegetables, particularly to children and young pregnant
women, was advocated by FoodBank Western Australia.
Encouragingly, several witnesses detailed approaches which delivered
positive health as well as viable business outcomes. Darryl Pearce, Chief
Executive Officer, Lhere Artepe Aboriginal Corporation stated that the health
economy must be considered in conjunction with the cash economy of a community.
For example in 1986, a store gave away fresh fruit and vegetables while still
returning a profit of $45 000 to the community.
The Arnhem Land Progress Aboriginal Corporation (ALPA)’s position is
that a community’s store must be potentially commercially viable before it will
consider managing it. ALPA’s consultancy service manages 11 stores owned by
other community organisations. All are profitable and viable commercial
enterprises, however they do operate with an emphasis on local employment and
training, nutrition and range with best possible prices.
Some communities have opted to operate at no profit or low profit in
order to keep the margins on food as low as possible.
Influence of store managers
Store managers can hold a very powerful position in determining the food
supply, quality, pricing, freshness and promotion of goods, and this in turn
impacts on the health outcomes of a community. Attitudes can influence the
quality of the food supply and the turnover of healthy foods. In some
circumstances, the success of a store is judged on profit or the amount of
money the store can return to the community.
The tenure of managers can also be an issue: a health policy implemented
by one manager may be discontinued by another manager.
The NPY Women’s Council stated that health outcomes have depended on whether
store managers adhere to Mai Wiru: if a store manager is compliant the policy
works, but if a store manager ignores the policy there are terrible health
Many witnesses asserted that the promotion of healthier purchases should
not be the responsibility of the store. Store managers can spend long hours
managing the store as a viable business and therefore are time and resource
poor when it comes to considering health policies.
Dr Bruce Walker, Chief Executive, Centre for Appropriate Technology (CAT)
stated that stores can make tactical responses but alone cannot create the
demand for higher consumption of healthy food.
Store managers are generally very conservative when it comes to stocking
fruit and vegetables because once outside the cold-chain these have to be sold
quickly or be thrown out, therefore creating a loss. ALPA links the sales of
fruit and vegetables to the store manager’s performance targets and provides bonuses
to encourage them to step out of their comfort zone and try increasing orders
of fresh produce.
Health and nutrition education
As discussed above health outcomes in the community do not, and should
not, rely on store managers alone. Health units, nutritionists and community
leaders need to work collaboratively with communities and store managers to
develop health strategies for the store. Nabeel Rasheed, Store
Manager in Jilkminggan, noted that there was a doubling of fruit and vegetable
sales after the Sunrise Health Service had nutrition demonstrations in the
The Committee received other accounts of positive health outcomes in
communities where nutritionists work. Ian McDowell, who had managed stores in
remote communities in the Northern Territory and Queensland, surmised the high
turnover of fruit and vegetables in Kowanyama was due to the nutritional
education work of the health centre.
The Queensland Government funds nutritionists to work with the stores in
Cape York and the Committee observed the benefits of this first-hand during its
visits to Bamaga, Aurukun and Kowanyama. Lesley Podesta, Department of Health
and Ageing, referred to the benefits of nutritionists working in communities:
At the best, nutritionists that have been working in
communities have made a big difference about being able to show people that
substitution by nutrient-rich food of nutrient-poor food does not change taste…
I know this will sound crazy, but a really good example is that a pie is a very
popular item and one of the nutritionists had spent a lot of time identifying
the best pies in terms of lower fat, high-protein content that was able to be
shipped, had a longer shelf life …
Nutritionists offer all sorts of advice to managers and community
members to promote healthy choices, such as:
n choosing nutrition
enhanced foods, including intakes of key nutrients such as folate, iron and
calcium during pregnancy,
n preparing healthier
n marketing and
education programs combined can be effective in promoting healthy eating
n labelling for health
– identifying what is good food choice and what is poor food choice,
n reducing or removing
the sale of unhealthy items,
n in store promotions
and promotions in local media,
n educating about brand
or product attraction, and
n appropriate placement
on products on shelves and in fridges.
Armed with evidence based data, a nutritionist can help communities and
managers understand what products are being bought from the store and the
potential health effects. A key component of Mai
Wiru has been the monitoring of sales, whereby nutritionists demonstrate to
community leaders the impact of sales on the health of the community. This has
some influence on store committee decisions about what to stock in their store,
and store managers must comply with these decisions. For instance, in Amata the
nutritionist presented information about how much money was being spent on Coke
and the community decided to remove it from the store.
The benefit of the point-of-sale monitoring tool is discussed below.
In many remote communities health units, charities, and businesses are
collaborating with stores on health programs. Many stores support nutrition
programs and supply fresh fruit and vegetables to schools and to other programs,
such as meals on wheels.
Under Queensland Health’s ‘Eat Well Be Active—Healthy Kids for Life’
project nutritionists work with schools to deliver a whole‑of‑community
approach to improve child nutrition. The project is being trialled over three
years in three locations and targets four key areas: mothers and babies, junk
food reduction and healthy food consumption, improving family budgeting, and
promoting activity. Tagai State College on Badu Island is the lead agency for
the project in the Torres Strait. Project Coordinator Rita Kebisu told the
Committee that baseline data for the project is gathered by routine screening
and monitoring of all babies and children to 12 years. Funding for the project ends
in late 2009.
The Australian Red Cross and the Fred Hollows Foundation are delivering
food nutrition and supply programs to remote Indigenous communities with the
help of nutritionists and the stores. The Red Cross has
developed a national partnership with Outback Stores and has signed a
Memorandum of Understanding to guide the partnership. The collaboration aims to
‘work towards making a positive impact on the health of remote Aboriginal people
by partnering with Indigenous communities to deliver long term sustainable
health outcomes’. Strategies include ensuring fruit is continually available
for breakfast clubs, developing in-store nutrition promotion, and sharing sales
data to inform ongoing development of food security policies.
Oral health is another health area of great concern in remote Indigenous
communities. Outback Stores is also working with Oral Health Services NT to
provide oral hygiene products.
Other health initiatives in communities aim to improve the capacity to
store, cook and prepare food at home in remote Indigenous communities. There
are programs operating out of health clinics about healthy food preparation and
there was support for these programs from both women and men.
Cooking lessons in remote Indigenous communities is discussed further in
The Committee notes there were many good examples of programs which
provided services and education around food and nutrition, cooking classes and
homemaker skills that were phased out by Government in the late 1990s.
Witnesses in Maningrida advised that funding for a nutritionist had been cut
after six months. The need for staff was urgent as the clinic did not have the
capacity to run nutrition programs in addition to seeing the 600 people on the
chronic disease list every three to six months.
Following the Committee’s visit, Maningrida received funding for a
nutritionist for two days a month. Witnesses in Maningrida called for longer
term funding for anti-smoking and nutrition education.
Indigenous health workers
Indigenous people represent one per cent of people working in
health-related occupations in Australia. In the Northern
Territory Department of Health and Families there is one Indigenous
nutritionist. Dr Julie Brimblecombe from the Menzies School of Health Research
asserted the importance of Indigenous people conveying health messages to other
Indigenous people and the need to train community people who can sit down with,
empathise with, and understand their situation.
The National Health and Hospitals Reform Commission recommended the
government provide support for training for an Indigenous health workforce:
We must also strengthen the vital role of Community
Controlled Health Services, train and recognise an Indigenous health workforce
and a workforce for Indigenous health, and up-skill our health workforce to
provide culturally appropriate services.
NATSINSAP recognised that cross-cultural communication and awareness is
essential to the development of effective health programs.
Dr Amanda Lee, member of the NATSINSAP Steering Committee, commented that the
main factors for success in health interventions are engagement with the
community and community control over the interventions that are trialled. This
means a qualified nutritionist does not need to be in the community all the
time. Rather, it is important that someone from the community with an understanding
of nutrition communicates with the community:
A mother, a health worker, a community change agent, anyone
in that community that has the respect of the community but is able to respond
to community wishes and knowledge and build on that past understanding to
enable them to influence the store, and the uptake of the food.
The importance of a local person educating a community is well
illustrated by the Jaywon land owners, east of Katherine, who have ten
principal language groups but low English literacy levels with few people having
an above primary school education. Family and kin obligations are paramount in
the lives of residents; traditional systems of social and economic organisation
prevail, as do traditional knowledge and beliefs. The Sunrise Health Service
stated that the understanding, attitudes and practise about illness and health
are often very different to those in non‑Indigenous health systems.
The Dieticians Association of Australia (DAA) and the Public Health
Association of Australia (PHAA) stated that a ‘well supported, funded and
educated Aboriginal and Torres Strait Islander nutrition workforce is essential
to attaining food security’. They were advocates of a cultural respect
framework to ensure Aboriginal and Torres Strait Islander health workers are
valued for local nutrition knowledge in conjunction with cultural processes and
Developing healthy store policies
NATSINSAP regards the development, monitoring and reporting of nutrition
policies for all remote stores as essential. NATSINSAP believes nutrition
policies must include measurable targets on the sales of key indicator foods,
such as fruit and vegetables and sugared drinks.
The Central Land Council argued that all stores should adopt health
All stores should have positive community health and
nutrition principles included in their rules, so that the committee of the
store is bound by those principles in its management role. Stores committees should
be given assistance to review the current rules.
The Committee was told that community generated health agreements are
fundamental and attempts to merely impose health foods will fail. Rather, there
needs to be choice and education is required so community members can make
informed choices about the purchase of healthy foods and takeaways. Mai Wiru in
APY lands demonstrates that supporting the stores and the communities, through
knowledge and education, has resulted in the communities demanding and
purchasing healthier food. Lesley Podesta from the Department of Health and
Ageing recognised that Mai Wiru store is a ‘fantastic project’ which could be
rolled out across other areas.
There has been a range of health policies adopted by remote Indigenous
communities across Australia. Health policies are briefly described below:
n Outback Stores—The
Outback Stores Nutrition Strategy focuses on improving nutritional outcomes,
and improving sales of healthy food, through in-store promotion of fruit and
vegetables, preferential pricing of key nutritional lines and basic foods,
inclusion of nutritional options in takeaway menus, and selective sourcing of
nutritional lines. Outback Stores employs nutritionists who help to develop the
capacity of store managers and staff to focus on the health needs of the
communities as part of their day-to-day work. They do this by spending time
with the managers in the store and providing training. Nutrition strategies on
store presentation include not selling confectionary at point-of-sale counters,
bowls of fruit on counters, and not displaying tobacco.
Outback Stores set targets on the
sale of fruit and vegetables at seven and a half per cent this year and 10 per
cent in the future. (In most communities Outback Stores had entered fruit
and vegetable sales were at two per cent, whereas in April 2009 fruit and
vegetable sales were seven per cent across the organisation.) Outback Stores
has set a target to reduce tobacco sales to 10 per cent.
Outback Stores used the RIST resources to inform them on developing their core
NATSINSAP advocated the need for
Outback Stores to have a nutritionist on its governing board.
n Mai Wiru—The
Mai Wiru (good food) policy, introduced in 2002, was developed jointly by the
Nganampa Health Council, the NPY Women’s Council and the APY council as a
result of work done in 1998 showing that people’s income was insufficient to
allow them to access affordable healthy food.
All eight communities under Mai
Wiru have signed an MOU with the Mai Wiru Stores Policy Unit to implement the
Mai Wiru policy. A steering committee, which is made up of the Chairs of each
community governing body, signs off on strategies within the policy. The Unit
has been funded by the Commonwealth Department of Health and Ageing and carries
out necessary functions that stores do not have resources to do: organise
preferred suppliers, training, staff recruitment and nutritional expertise. A
public health nutritionist was recruited in April 2006 who helped with
implementation and improvements to the diet of the community. In 2007 the Mai
Wiru stores policy received the National Heart Foundation Award for community
The Nganampa Health Council was
investigating a future governance model on the APY lands, which would ensure
that the Mai Wiru policy is enforced, yet managed by another management group.
Consideration is being given to transitioning to management with Outback
Stores. Under the Anangu Pitjantjatjara Yankunytjatjara Land Rights Act 1981,
whereby traditional owners have the power to introduce by-laws, it would be
possible to stipulate that the future manager of the stores would be governed
by the Mai Wiru policy.
n ALPA Yolngu
community owned and Australian Retail Consultancy (ARC) stores—In 1985 ALPA
implemented its own nutrition policy and self-funded freight subsidy on fruit
and vegetables in its stores to drive consumption.
The major objectives of ALPA’s 2004 Health and Nutrition Strategy include
improving the health and nutrition of Arnhem Land communities, specifically
targeting diabetes, kidney disease, heart disease, aged care and children’s
health. ALPA employs a nutritionist and good food staff members in every store.
n Other community
owned stores—In many instances managers and store committees welcome
collaboration with health clinics about what to stock or how to present stock in
the store. For example, the two stores in Maningrida have received advice from
the health clinic and nutritionists about stocking different products.
The Finke River Mission store manager works with a Northern Territory
government funded nutritionist to develop strategies to encourage the
consumption of healthier products. A Healthy Store Policy
was drawn up with managers, community members and the NPY Women’s Council in
Tjukurla. A list of policy items includes stocking a minimum amount of healthy
fresh food, stocking sugared drinks in small bottles only, and encouraging the
sale of healthy foods by displaying good food posters and so on.
n Private owned and
run: station stores and roadhouses—Health polices in these stores can be dependent
on the priorities set by the manager.
Department of Communities—the Nutrition Policy for Remote Retail Stores
and Take-Aways (2007) includes strategies to consistently stock a wide
range of healthy and affordable foods including takeaways. Nutrition promotion,
education and training of store staff are objectives with store participation
in nutrition programs at least twice a year. The Retail Stores Unit seeks
agreement to the policy from the local Aboriginal shire council. The
implementation of the policy is monitored, reviewed and evaluated annually.
n Islanders Board
of Industry and Service (IBIS) stores—the IBIS Healthy Food Policy includes
a pricing policy that specials only healthy food and subsidises the provision
of health foods. Integral to the policy is the ongoing availability of fresh
fruit and vegetables. IBIS stores identify and highlight healthy food choices
through signage, publication of recipes, advertising, and marketing. A
nutritionist is employed by IBIS to promote healthy food choices in
communities. The IBIS store on Thursday Island has a bakery which is selling
low GI index, wholegrain, rye and multi-grain bread.
Store committees and community representatives have self imposed a
variety of mechanisms to improve health of their community. Some models are
innovative and the Committee recognises that different communities require
different approaches. Some examples of different community healthy store
n Removal of the sale
of Coke, Passiona, Gatorade and Disney poppers
— by the community of Amata. Diet Coke and Sprite was not removed. Data a year
later showed there was an increase in orange juice and water sales,
n Displays of foods—stores
managed by Ninti Corporate Services have lower mark ups on fruit and vegetables
and display healthy foods near the checkout at eye and hand level. A basket of
fruit is at the checkout and individual pieces are sold at 50 cents each,
recommendation from the Indigenous women of Gapuwiyak, ALPA developed the
FOODcard to assist people with budgeting for healthy food throughout a pay
cycle. The card was voluntary and was for food and essentials only, so articles
like lollies, toys, takeaway fatty foods and soft drinks were excluded. A de facto
labelling (green ticket) system also introduced indicated the products that
could be purchased with the FOODcard,
n Encouraging hunting
of nutritious foods—the people of Mapuru in north-east Arnhem Land made an
active decision to go hunting and traditional food sourcing because it was
impossible for them to get delivery of frozen produce. In the co-op the
community could buy healthy foods and general household necessities. The co-op
won the National Heart Foundation award for Small Rural and Remote Initiatives
in 2004, and
n Cross subsidisation —Queensland
Department of Communities stores subsidise the prices of healthy foods at the
expense of less healthy items, including tobacco and high sugared drinks.
NATSINSAP outlined in its submission the goals and objectives of the Remote
Indigenous Stores and Takeaways (RIST) project. The goal of the project was to
improve access to healthy food in remote Indigenous community stores and
takeaways. Objectives of the project were to:
n develop a common set
of guidelines and resources that promote access to healthy foods, and
discourage the promotion of energy-dense/nutrient poor food and drinks, and
n implement and
evaluate guidelines and resources across a number of remote community store and
takeaway trial sites.
The core outcome of the RIST project was the development of a package of
nine resources to assist remote stores and takeaways to stock, promote and
monitor the sales of healthy foods. The RIST resources, referred to in
paragraph 3.17, are a result of comprehensive research and development by
NATSINSAP—a collaboration of five state and territory jurisdictions.
Queensland Health is currently leading a twelve month project to
promote, distribute and train people in the use of the RIST resources and to
design, conduct and report on an evaluation of these resources in Aboriginal
and Torres Strait Islander communities across Queensland and the APY lands in
South Australia. While this work is still ongoing, preliminary work in piloting
these resources has demonstrated improvements in the sale of healthy foods when
local level nutritionists worked in partnership with stores and communities to
support their implementation.
The NATSINSAP provided the Committee with a comprehensive submission and
gave evidence at a public hearing in Canberra. The Committee was impressed with
the work undertaken by NATSINSAP from a national perspective. During the public
hearing NATSINSAP told the Committee:
The engagement of nutrition experts within store groups are a
real[ly] important catalyst for change and influencing the supply and demand of
healthy food. We would also like to see the promotion of these RIST resources
in all remote stores across Australia. 
The Committee believes that NATSINSAP has carried out valuable work in
the field of health and nutrition. The Committee also believes that the
Queensland Government project to promote, distribute and train people in the
use of RIST resources should be carried out by other jurisdictions such as the Northern
Territory, Western Australia and South Australia.
The Committee strongly supports the distribution and use of the RIST
resources with the support of nutritionists.
The Committee recommends the Australian
Government fund the rollout of the Remote
Indigenous Stores and Takeaways (RIST) resources to all remote Indigenous
communities across Australia, in conjunction with the support required by a
Monitoring and evaluating health initiatives
With any intervention to improve health in remote Indigenous
communities, testing must be done on whether these interventions work. There is
currently no national mechanism for monitoring sales of food, and therefore the
consumption of healthy or non-healthy food, in remote communities.
The RIST point-of-sale monitoring tool Keeping Track of Healthy Food can
be modified to monitor any types of foods which stores or nutritionists may be
Outback Stores is using the RIST point-of-sale monitoring tool to
measure the sale of key indicator foods. The Queensland Health
pilot project to report on and evaluate the RIST resources in Queensland and
the APY lands was due to be completed in October 2009. 
Robyn Bowcock, a Public Health Nutritionist working in Western Australia,
stated that the RIST point-of-sale monitoring tool is a ‘very strong tool to
feed back and make change in the community store’ to the benefit of the health
of the community.
However, the RIST point-of-sale monitoring tool is only as effective as its
operators. Store employees must be trained in the use of the tool and
nutritionists are required to go onsite to check the point-of-sale system is
working correctly. Also, each store must have the appropriate infrastructure
setup to operate the monitoring tool.
The Committee has heard that tensions between health and business are
not incommensurable in remote community stores. In many instances, a profitable
store is the main source of income to a remote Indigenous community. That
income is often put back into the community via a health policy in the store,
such as subsidised fruit and vegetables.
Given the important contribution the store makes to the nutrition and
health outcomes of a community, there should be the aim of ensuring that every
store in a remote Indigenous community has a well-developed health policy and
is able to deliver healthy foods regularly, reliably, in quantity and at a good
The Committee acknowledges that store managers often have very demanding
workloads. They can be under pressure to produce a profit so may be reluctant
to make changes which might threaten that profit. Incentives to change the
practices of store managers and increase the stock of healthy foods must be
matched with programs that aim to increase demand from communities for healthy
Incentives, such as increases in pay or bonuses, may be a method of motivating
store managers to attempt to stock and sell healthy produce, such as fresh
fruit and vegetables.
The Committee recommends the Australian Government consider
the development of an incentive scheme to influence store managers to sell
The Committee observed stores where nutritionists and health experts
have had a positive influence on strategies to promote the consumption of
healthy products. It is important that nutritionists working with communities
and store managers in developing health policies are adequately resourced.
Short term programs will only achieve short term results and longer term
strategies are required to effect lasting lifestyle changes.
The Committee considers that the Outback Stores Board should include a
nutritionist, as suggest by NATSINSAP. The Committee also strongly urges other
Boards that oversee stores in remote Indigenous communities to include a
nutritionist in their membership to assist in developing healthy community
stores and so build healthy communities.
The Committee recommends that the Australian Government require
that membership of the Outback Stores board include a nutritionist.
The Committee recommends that the Australian Government work
collaboratively with state and territory governments, health services and
remote store operators to ensure that nutrition education programs are
available to all remote Indigenous communities.
The Committee stresses the importance of stores and people in remote
communities having access to nutritionists and community health workers to
inform their food choices and to provide skills for budgeting and food
preparation that are compatible with the cultural, material and financial
circumstances they live with.
In many instances there are advantages to health information being
delivered by local Indigenous community members. The Committee urges federal, state
and territory governments to increase their efforts to provide opportunities
for Indigenous people to train as local health workers and assist in the
delivery of local health care programs.
Ideally the Committee would wish to see every remote Indigenous
community store with a healthy store policy in place. However given the
diversity of store ownership and management structures, this can only be
mandated for Government supported Outback Stores. Instead, the Committee
recommends that assistance be provided to every remote Indigenous community and
store to develop a healthy store policy, if they wish. The following chapter
discusses access to other supply chain coordination assistance and the
Committee recommends that this assistance be contingent on having a healthy
The Committee also encourages state and territory governments to require
that a healthy store policy is established in consultation with each community
for the stores it owns or operates.
Many communities have developed successful healthy store policies and
interventions. These should be commended and in particular the Committee notes
the success of Mai Wiru healthy store policy as an outstanding model.
The Committee also notes the importance of a healthy store policy being
developed in consultation with the community and adapted to be appropriate to
the traditions, preferences and needs of that community.
The Committee recommends that the Australian Government
require all Outback Stores to develop, in consultation with local
communities, a specific healthy store policy.
The Committee recommends that the Australian Government work
collaboratively with all remote Indigenous community store owners, operators
and communities to assist in the development and ongoing management of a
healthy store policy.
To evaluate the impact of healthy store policies, the Committee considers
a coordinated national system of monitoring food sales in remote communities is
required. It should be mandated for Outback Stores, and funded and made
available for use by other remote community stores. This monitoring system would
provide data for policy development, coordination and review, program planning
and evaluation and reporting against targets on a healthy store policy.
The Committee notes that the RIST monitoring and reporting tool Keeping
Track of Healthy Food, which has been developed by the Menzies School of
Health Research, is able to provide this data and may be able to be used or
adapted for use to provide the appropriate point-of-sale monitoring.
Training should be provided on the operation of any monitoring tool and,
once data is available, feedback should be provided to health workers,
government programs and communities about the sale of products and the dietary
and health implications.
The Committee recommends that the Australian Government work
collaboratively with state and territory governments to fund and make
available to all remote Indigenous community stores:
Remote Indigenous Stores and Takeaways (RIST) or similar point-of-sale
for store employees on the operation of the tool, and
to provide feedback to communities and governments about the sale of products
from the store.
The Committee was impressed by ALPA’s FOODcard system—a voluntary
budgeting tool to assist with healthy purchases—and considers a system similar
to this could be offered for use across other communities. The Committee recommends
that a similar healthy food card system be offered in all Outback Stores and
that the Government consult with all other remote store operators to facilitate
its introduction where desired. For this to be effective, the Committee
recognises that delays in transferral of funds from the Basics Card to the ALPA
card, recorded in evidence, should be addressed.
The Committee recommends the Australian Government make
available in all Outback Stores a system similar to the FOODcard established
by the Arnhem Land Progress Aboriginal Corporation. The Committee also
recommends that the Australian Government consult with other remote community
store operators to facilitate more widespread introduction of this system for
communities who are interested.
The Committee recognises the importance of a healthy diet for pregnant
women and breast-feeding women as this has a significant impact not only the
health of the mother and newborn but also on the infant mortality rate.
Consequently the Committee recommends that consideration is given to a similar
healthy food card system and be made available through local health services to
all pregnant and breast feeding mothers in remote Indigenous communities.
The Committee recommends the Australian Government consider
the optional introduction of a healthy food card system to pregnant and
breast-feeding mothers in remote Indigenous communities.
To ensure that the nutrition needs of the growing child in remote
Indigenous communities are met the Committee strongly supports the continuation
of school nutrition programs, such as Queensland’s ‘Eat Well Be Active’
Project, funded by state and territory governments.
In view of the urgent need to foster Indigenous child health, the
Committee also recommends that the Australian Government should support these
programs under a national Primary Health Care initiative to provide healthy
lunches and drinks at pre-schools and schools in remote Indigenous communities as
The Committee recommends that the Australian Government
establish a national Primary Health Care program to fund and coordinate
supply of healthy lunches and drinks to children at pre-schools and schools
in remote Indigenous communities where this need is identified.
Employment and training opportunities
Stores are one of the biggest employers of Indigenous people in remote
communities. The Committee found that the majority of employees in remote
community stores across the country were local Indigenous people.
The Northern Territory Government asserted that local jobs should be a
condition of government support for store management models.
One of Outback Stores’ four goals is to increase Indigenous employment
opportunity through local recruitment and training. ALPA is one of the largest
independent employers of Aboriginal people in Australia with over 300
non-subsidised staff. IBIS is employing about 134 Indigenous people across the
region of Torres Strait.
Store managers were usually employed from outside the community. The
intention of some groups, however, was to train local Indigenous staff up to a
level where they can manage their own store. Outback Stores has trained three
Indigenous store managers and one is managing their own store. Two of the
Island and Cape stores in the Torres Strait are managed by local Indigenous
people. IBIS employs 14 store managers who are Indigenous Australians.
As far as training is concerned, most stores offer on-the-job training
in retail up to a basic level. However to become managers, people need to go
away to major centres which generally they do not want to do.
At Outback Stores there is a 12 day induction course which covers areas
such as the company’s values, policies and procedures, safety, four-wheel
driving, cross-cultural training, point-of-sale systems and dealing with
customers. Employee training and store manager training is run in the store
under the Australian apprenticeship training program. An accredited trainer
goes to the stores to monitor progress of employees and managers.
ALPA’s employees are trained locally in the store and at ALPA’s own
registered training facility. ALPA is currently focusing on providing training
in the participants’ first language. Alastair King, General Manager, ALPA,
referred to the benefits of Aboriginal to Aboriginal training of staff:
One thing we have learnt over the years is that the Yolngu to
Yolngu training—Aboriginal to Aboriginal training—is so much better than
non-Indigenous to Indigenous training. It works so much better and you get the
underpinning knowledge there rather than just the mechanics of what to do. They
understand why they are doing it.
Reverend Dr Gondarra, Chairman ALPA, referred to the company’s emphasis
on self-sufficiency and self-management: their people are being paid for their
work and are being educated to be able to run businesses.
The Maningrida Progress Association was also using the ALPA training course and
on-the-job training for its employees.
Island and Cape, operating in Queensland, is training local Indigenous
people at the store about food security and is in negotiations with authorities
in Cairns to get this type of training certified.
Irene Fisher, Chief Executive Officer, Sunrise Health Services, called for more
varied training, such as in marketing, health promotion and management in the
store for the Indigenous employees.
The Committee was told that the changes to Community Development
Employment Projects (CDEP) Program would result in lower levels of employment
and the loss of community sustainability.
It was claimed that in Djarindjin changes to CDEP have compromised the
running of its community store. Djarindjin Aboriginal Corporation had run the
store on a minimum profit basis to meet community needs. The Corporation had
also managed the CDEP, which supported part-time jobs in the store. The store
in turn funded a range of community run micro-businesses, foods, beauty
products and bush medicines. Through the CDEP the
Jarlmadangah community built a shed, lined it and put in a fridge, freezer and
cool room and it became the store.
A number of stores employed part-time staff members through top-up under
CDEP. This allowed on-the-job training and for people to participate in cultural
There were, however, limits on CDEP top-up. Stephan Rainow, Nganampa
Health Council, explained:
It also appears that there are restrictions placed on people
on CDEP working more than 28 hours per week, which limits their capacity to
earn money. And for people on Centrelink payments there is no WorkCover, which
limits their capacity to earn extra income. These are major disincentives for
people seeking to increase their income earnings capacity and as a consequence
limit the cash turnover in the stores. There are limited or no checks and
balances that regulate the remote economy on the APY lands within which people
spend their income on a daily basis.
At public hearings, FaHCSIA stated that CDEP would remain in remote
Indigenous communities with some adjustments. Dianne Hawgood, Manager, Indigenous
Remote Service Delivery Group, FaHCSIA, explained the changes:
There will be some new components to it, though, much more of
a focus on CDEP being used as work experience, looking for opportunities for
CDEP participants to get additional training so that they are ready for job
opportunities that may come into the communities, for example through some of
the new COAG investment in housing and other areas.
Lynne Curran, Group Manager, Office of Indigenous Policy Coordination, FaHCSIA,
also stated that, as commercial businesses, there is scope for stores in remote
Indigenous communities to convert to market wage positions. There are a range
of other employment reforms happening, including the Indigenous Employment
Program, aimed to deliver better employment and training opportunities to
On the job training and employment in stores contributes to the economic
sustainability and health of remote communities. The Committee commends stores
which have high levels of training and employment of Indigenous staff.
There are difficulties in attracting and keeping external managers,
therefore it is logical that supporting the training of local people would
benefit the community and the management of the store.
All stores should have a policy to employ local Indigenous staff
wherever possible in the store. Training and development should be offered by
the store to increase capacity of Indigenous store employees. Wherever possible,
local Indigenous employees should be encouraged to step up to management roles.
The Committee recommends the Australian Government, in
collaboration with educational institutions, investigate and develop:
facilitation of training of Indigenous staff living in remote communities to
store management levels, and
certification of in-store training of skills such as health promotion and
food supply and storage.
Remote communities that had managed themselves and their stores very
well under the CDEP were concerned at the loss of the measure of self‑governance
they had worked to achieve.
The Committee considers an assessment of the impacts the CDEP reforms
will have on the viability and employment opportunities in remote Indigenous
community stores is warranted.
The Committee recommends the Australian Government assess
the impact that Community Development Employment Projects reform will have on
the viability and employment opportunities in stores in remote Indigenous
Improvements to the employment and health of Indigenous people in remote
communities will go a long way to closing the gap in life expectancy.
However, Indigenous people living in remote areas require a more
consistent and regular supply of quality nutritious food in order to maintain
and enhance their health and well-being. The following chapter discusses challenges
of providing fresh food to remote communities.