Health-Promoting Food Pricing Policies and Decision-Making in Very Remote Aboriginal and Torres Strait Islander Community Stores in Australia.

Megan Ferguson,Julie Brimblecombe,Marjory Moodie,Jon Altman,Kerin O'Dea

doi:10.3390/ijerph15122908

Abstract

Aboriginal and Torres Strait Islander people living in remote communities in Australia experience a disproportionate burden of diet-related chronic disease. This occurs in an environment where the cost of store-purchased food is high and cash incomes are low, factors that affect both food insecurity and health outcomes. Aboriginal and Torres Strait Islander storeowners and the retailers who work with them implement local policies with the aim of improving food affordability and health outcomes. This paper describes health-promoting food pricing policies, their alignment with evidence, and the decision-making processes entailed in their development in community stores across very remote Australia. Semi-structured interviews were conducted with a purposive sample of retailers and health professionals identified through the snowball method, September 2015 to October 2016. Data were complemented through review of documents describing food pricing policies. A content analysis of the types and design of policies was undertaken, while the decision-making process was considered through a deductive, thematic analysis. Fifteen retailers and 32 health professionals providing services to stores participated. Subsidies and subsidy/price increase combinations dominated. Magnitude of price changes ranged from 5% to 25% on fruit, vegetables, bottled water, artificially sweetened and sugar sweetened carbonated beverages, and broadly used ‘healthy/essential’ and ‘unhealthy’ food classifications. Feasibility and sustainability were considered during policy development. Greater consideration of acceptability, importance, effectiveness and unintended consequences of policies guided by evidence were deemed important, as were increased involvement of Aboriginal and Torres Strait Islander storeowners and nutritionists in policy development. A range of locally developed health-promoting food pricing policies exist and partially align with research-evidence. The decision-making processes identified offer an opportunity to incorporate evidence, based on consideration of the local context.

Highlights

Aboriginal and Torres Strait Islander people living in remote areas generally experience the poorest health outcomes and hold the worst economic position in Australia [1,2]
This paper describes health-promoting food pricing policies including their alignment with evidence, and the decision-making processes in their development in very remote Aboriginal and Torres Strait Islander community stores in Australia
Forty-two more people were invited to participate by Megan Ferguson; two delegated the interview invitation to staff under their supervision, 21 did not respond to the email invitation and 19 declined, with the most common response being that they did not have sufficient knowledge relevant to the study objectives

Summary

Introduction

Aboriginal and Torres Strait Islander people living in remote areas generally experience the poorest health outcomes and hold the worst economic position in Australia [1,2]. Aboriginal and Torres Strait Islander people experience unemployment at 4.2 times, and have an average disposable income 70% of, non-Indigenous Australians [3]. The life expectancy of Aboriginal and Torres Strait Islander people is approximately 10 years less than non-Indigenous Australians. The majority of this gap is due to chronic disease, especially cardiovascular disease and cancer, and injury for the 35–74 years age group [4]. The gap is largest in remote areas where Aboriginal and Torres

Methods

Results

Discussion

Conclusion