Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

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Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...
NT Health Nutrition
and Physical Activity
Strategy 2015–2020
Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

       Foreword2                                             Objective 3: optimise feeding practices
       Acronyms5                                             and promote an active lifestyle for
                                                              children aged 0−5 years	                         24
       Who is this strategy for and how
                                                                Background	                                    24
       can it be used?                                  6
                                                                What the data tell us	                         25
                                                                Our challenge                                  26
                                                                Evidence for effective interventions	          26
       Key action areas and target group	               6
                                                                Suggested strategies across settings	          28
       Related policies, strategies and guidelines      7      Indicators	                                    28
       Guiding principles	                              7      Stakeholders*	                                 29
         Working within a health
                                                              Objective 4: promote and support healthy
         promoting framework	                            7
                                                              eating and regular participation in physical
         Targeting the social determinants of health	    7   activity among school aged children	             30
         Gender and diversity	                           7     Background	                                    30
         Providing cultural security	                    8     What the data tell us	                         31
         Sustaining through capacity building	           8     Our challenge	                                 33
         Working in partnership	                         8     Evidence of effective interventions	           33
         Commitment to monitoring and evaluation	        8     Suggested strategies across settings	          34
       Summary of strategies	                           9      Indicators	                                    35
       Objective 1: improve food security,                      Stakeholders*	                                 35
       particularly in remote communities	              14   Objective 5: achieve and maintain a
         Background	                                    14   healthy weight for all adults and older
         What the data tell us	                         14   Territorians	                                    36
         Our challenge	                                 16     Background	                                    36
         Evidence of effective interventions	           16     What the data tell us	                         37
         Suggested strategies	                          16     Our challenge	                                 41
         Indicators	                                    17     Evidence of effective interventions	           41
         Stakeholders*	                                 17     Suggested strategies across settings	          42
       Objective 2: promote and support a                       Indicators	                                    44
       healthy diet and a healthy weight among                  Stakeholders*	                                 44
       women of child bearing age	                      18   Appendix A: Australian Dietary Guidelines        45
         Background	                                    18
                                                              Appendix B: Australia’s physical activity
         What the NT data tell us	                      20   and sedentary behaviour guidelines	              46
         Our challenge	                                 21     National Physical Activity Recommendations
         Evidence of effective interventions	           21     for Children 0−5 years	                        46
         Suggested strategies across settings	          22     Physical Activity and Sedentary Behaviour
                                                                Guidelines for 5−12 and 13−17 year olds9;12	   46
         Indicators	                                    22
                                                                Physical Activity and Sedentary Behaviour
         Stakeholders*	                                 22
                                                                Guidelines for 18−64 year olds1147
                                                                Physical Activity Recommendations for
                                                                Older Australians10	                           47
                                                              References	                                      48

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...
NT Health Nutrition and Physical Activity Strategy 2015–2020

AOD      Alcohol and other Drugs
ABS      Australian Bureau of Statistics
AHP      Aboriginal Health Practitioner
ALPA     Arnhem Lands Progress Aboriginal Corporation
CNW      Community Nutrition Worker
CYH      Child and Youth Health
DET      Department of Education
DLPE     Department of Lands, Planning and the Environment
DSR      Department of Sport and Recreation
GP       General Practitioner
MBS      Market Basket Survey
MSHR     Menzies School of Health Research
NHMRC    National Health and Medical Research Council
OBS      Outback Stores
PHC      Primary Health Care
RMP      Remote Medical Practitioner
RN       Registered Nurse
SWSBSC   Strong Women Strong Baby Strong Culture
SWW      Strong Women Worker
WHSU     Women’s Health Strategy Unit
MHSU     Men’s Health Strategy Unit

                                                                                                          STRATEGY SUMMARY

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...
NT Health Nutrition and Physical Activity Strategy 2015–2020


                                                     “It is no secret that healthy
                                                      nutrition and regular
                                                      physical activity are critical
                                                      to good health.”

It is no secret that healthy nutrition and regular   determinants of a healthy and active lifestyle,
physical activity are critical to good health.       whether these staff work in a policy context
Yet, for most of us, choosing healthier foods        or ‘at the coal face’. It also leaves room for
and drinks and finding time to exercise has          innovative and community driven responses.
never been harder. Not surprisingly rates of
                                                     As most contributing factors to poor nutrition
overweight and obesity are high, and rising,
                                                     or physical inactivity are outside the control
causing an alarming increase in prevalence of
                                                     of the Health sector, many of the proposed
diabetes and chronic diseases.
                                                     solutions will require collaboration with other
These issues present significant public              sectors, within and outside government.
health problems that threaten the gains              The strength of the NT is that in many cases,
made in earlier decades. They also place an          these alliances already exist and are solid;
increasing burden on health budgets and              much good work can therefore be expected
governments in general.                              by capitalising on them.
The Northern Territory (NT) has not been             Finally, this strategy is grounded on health
immune to these developments and is now              promotion principles; it acknowledges the role
facing high rates of chronic diseases. But           that environments play in shaping individuals’
whilst we have an urgent responsibility to act       decisions and aims to develop the conditions
on overweight and obesity, we must also tackle       that will support changes. Only by making it
other nutrition issues, such as underweight          easier for people to make healthy choices in
and anaemia among young children in                  the places they live, work and play, can we
remote communities. As we all know, these            hope to turn the rising tide of chronic diseases.
issues must be addressed in the context
                                                     I thank all of those who gave their time and
of geographic isolation, limited enabling
                                                     attention to the development of this important
                                                                                                                     STRATEGY SUMMARY

infrastructure, and staff turnover.
                                                     document. It is with great pleasure that I
With these challenges in mind, this strategy         commend to you the NT Health Nutrition and
draws on the available evidence to propose           Physical Activity Strategy 2015−2020.
local solutions to NT specific problems.
It contains a comprehensive list of suggestions      Professor Len Notaras AM
for staff who are able to influence the              Chief Executive

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

       Who is this strategy for                                            Key action areas and
       and how can it be used?                                             target group
       The Northern Territory Health (NT Health)                           • Reduce obesogenic environments by
       Nutrition and Physical Activity Strategy                              developing policies and environments
       2015−2020 (‘the strategy’) is intended for                            that support healthy eating and regular
       staff within NT Health who are in a position to                       physical activity.
       influence the determinants of a healthy diet                        • Promote healthy eating by encouraging
       and an active lifestyle.                                              and supporting
       It provides an overview of the key health issues                        - exclusive breastfeeding for the first
       associated with poor nutrition and physical                               6 months of life
       inactivity throughout the life course, brings
       together the available evidence of interventions                        - the introduction of age appropriate
       that have been effective in addressing them,                              solids at around 6 months
       and suggests a range of strategic actions                               - increased consumption of fruit and
       relevant to the NT context.                                               vegetables
       In practice, this strategy can be used as a                             - reduced intake of sugar sweetened
       guide and practical tool for planning and                                 beverages (SSBs)
       evaluation across the spectrum of programs                              - reduced intake of other energy-dense
       that have a remit in nutrition and physical                               nutrient-poor (EDNP) foods and drinks.
       activity. It complements the Northern
       Territory Chronic Conditions Prevention and                         • Promote participation in regular physical
       Management Strategy 2010−2020¹ and                                    activity throughout life.
       supports its implementation.                                        • Promote a reduction in time spent being
                                                                             sedentary or sitting down.
       Aim                                                                 This strategy targets all Territorians, wherever
                                                                           they live. It places however a special emphasis
       This strategy aims to increase the proportion of
                                                                           on Aboriginalª people living in remote
       Territorians who enjoy a balanced diet, lead an
                                                                           communities due to the higher burden of
       active lifestyle and maintain a healthy weight,
                                                                           disease and disadvantage they experience.
       in order to enhance their health and wellbeing,
       and reduce the risk and incidence of chronic
       diseases and premature death.                                       Related policies,
                                                                           strategies and guidelines
       Objectives                                                          • 2014−2017 Strategic Plan, Northern
       Objective 1: improve food security, particularly                      Territory Health²
       in remote communities.                                              • Northern Territory Chronic Conditions
       Objective 2: promote and support a healthy                            Prevention and Management Strategy
       diet and a healthy weight among women of                              2010−2020¹
       child bearing age.                                                  • Northern Territory Work Health and Safety
       Objective 3: optimise feeding practices and                           Act 2011³
       promote an active lifestyle for children aged                       • Australian National Breastfeeding Strategy
       0−5 years.                                                            2010−20154
       Objective 4: promote and support healthy                            • National Women’s Health Policy 20105
       eating and regular participation in physical
       activity among school aged children.                                • National Male Health Policy 20106
       Objective 5: achieve and maintain a healthy                         • Australian Dietary Guidelines7
       weight for all adults and older Territorians.                       • Australian Physical Activity
                                                                             Recommendations and Guidelines.8-¹²

6      a Throughout this document the term Aboriginal should be taken to include Torres Strait Islander people
Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...
NT Health Nutrition and Physical Activity Strategy 2015–2020

Guiding principles                                • review service delivery practices to ensure
                                                    that they do not offend Aboriginal people’s
Working within a health                             culture and values
promoting framework                               • act to modify service delivery practices
                                                    where necessary
Consistent with NT Health’s Health Promotion
Framework13, this strategy promotes a             • monitor service activity to ensure that our
continuum of health promotion practice.             services continue to meet culturally safe
This continuum is reflective of the Ottawa          standards.
Charter14 and relies on a range of approaches,    This approach is extended to the provision
both individual and population-wide, designed     of services to communities of culturally and
to complement one another as they target the      linguistically diverse backgrounds.
determinants of health across the life course.    Sustaining through capacity building
These approaches include:
                                                  A key element to the sustainability of all
• settings and supportive environments            initiatives identified in this strategy is the
• community action                                building of capacity, within the community
• health information and social marketing         or other agencies. Capacity building
                                                  encompasses training and support, sharing
• health education and skills development
                                                  knowledge, assisting with ensuring that the
• screening and individual risk assessment.       infrastructure is in place, addressing the issue
                                                  of sustainability and facilitating the process of
Targeting the social                              problem solving and evaluation.
determinants of health
This strategy acknowledges the need to
                                                  Working in partnership
address the multiple underlying social,           Implementation of this strategy will be a
economic and cultural determinants of health      shared responsibility between a broad range
and aims to reduce health disparities seen in     of stakeholders across the three entities
the NT, by focussing on those who experience      forming the Public Health system in the NT.
the greatest disadvantage and are most at-risk.   Many of the factors that impact on food supply,
Hence its strong focus on Aboriginal people       nutrition or physical activity are however
living in remote communities, and particularly    outside the responsibility of the health system.
on Aboriginal children under the age of two.      For sustained improvements in these domains,
                                                  partnerships must therefore be established
Gender and diversity                              between relevant stakeholders across all levels
This strategy recognises other causal factors     of government, the non-government sector,
of health inequity including: age; ethnic and     research institutions, industry and
linguistic background; gender; incarceration;     the community.
mental health status; physical and or
intellectual disability; and sexuality.
                                                  Commitment to monitoring
                                                  and evaluation
Providing cultural security                       The Nutrition and Physical Activity Strategy
Consistent with NT Health’s Aboriginal Cultural   Unit will monitor performance against the
Security Policy15, this strategy promotes the     objectives at mid-term and five years, and
                                                                                                                  STRATEGY SUMMARY

provision of culturally secure services that      carry out the final evaluation.
• identify those elements of Aboriginal
  culture that affect the delivery of health
  and community services in the Northern

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

       Summary of strategies                                • In partnership with local community
                                                              organisations, the non-government sector
       Objective 1: improve food                              and Aboriginal organisations, support
                                                              community and school gardens, where
       security, particularly in remote                       community capacity and willingness to
       communities                                            support the sustainable implementation of a
                                                              garden project are demonstrated.
       In remote communities
                                                            • Contribute to projects researching
       • Develop community capacity to influence
                                                              options to improve food security in
         availability, variety, quality and affordability
                                                              disadvantaged areas.
         of core foods at the store.
       • Assist store/takeaway management and               Objective 2: promote and
         store committees to develop and implement
                                                            support a healthy diet and a
         food and nutrition policies.
                                                            healthy weight among women
       • Provide advice and learning opportunities
         to store staff to develop and implement            of child bearing age
         initiatives that improve food supply and           Pre-pregnancy
         consumption of healthy food.
                                                            • With adolescent females of child bearing
       • Contribute to store-based activities that            age, emphasise the importance of healthy
         promote and support a healthy diet.                  and balanced nutrition; in particular,
       • Engage with Outback Stores (OBS),                    promote a diet high in iron-rich foods. Refer
         Arnhem Land Progress Aboriginal                      to contraception counselling as required.
         Corporation (ALPA) stores and other key            • Promote folic acid and iodine supplements
         food industry stakeholders to contribute to          for all women planning a pregnancy (see
         their efforts to ensure that the food supply         Figure 3 page 21).
         supports the Australian Dietary Guidelines7
                                                            • Develop and implement weight
         (see Appendix A page 43).
                                                              management programs for women of
       • Support research related to food systems             childbearing age who are overweight
         and factors that influence purchasing and            or obese.
         consumption decisions.
                                                            • Encourage smoking cessation.
       • Build on existing housing initiatives to
         improve community and household food               During the pregnancy and the first
         preparation and storage facilities.                6 weeks post-natal
       • Advocate for initiatives to improve the            • Encourage regular attendance at
         affordability of healthy food and drinks             antenatal clinics.
         (e.g. cross-subsidisation).
                                                            • Incorporate specific weight management
       Across the NT                                          advice as part of regular antenatal care.
                                                              In particular, counsel teenagers on the
       • Work with Community Stores Licensing
                                                              importance of adequate weight gain
         (Australian Government) to ensure
                                                              during pregnancy.
         availability of a range of affordable and
         healthy food in all stores.                        • Promote key nutritional recommendations
                                                              for pregnancy (see Figure 3 page 21).
       • Work with relevant government agencies,
         as well as the agriculture, horticulture           • Encourage regular physical activity to
         and aquaculture industry, to support                 maintain general fitness and for good
         the development of sustainable and                   blood glucose control in those women
         economically viable projects.                        with diabetes.
                                                            • Promote smoking cessation and encourage
                                                              women not to drink alcohol during
                                                              pregnancy and lactation.

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...
NT Health Nutrition and Physical Activity Strategy 2015–2020

Objective 3: optimise feeding                     • Build remote communities’ capacity to
                                                    support and promote the introduction of
practices and promote an                            solids and the development of healthy
active lifestyle for children                       feeding practices.
aged 0−5 years                                    • Work with store managers to ensure
Key focus                                           that displays of infant formula, bottles
                                                    and teats are consistent with the
• Systematic promotion of exclusive                 Marketing in Australia of Infant
  breastfeeding for the first 6 months.             Formulas (MAIF) Agreement.98
• Counselling about the introduction of
  appropriate solids at around 6 months.          In early childhood centres
• Early identification and action on growth       • Provide education and assistance in
  failure, anaemia or overweight.                   developing a nutrition policy and menu
                                                    planning, consistent with the Infant Feeding
• Promotion of regular physical activity and        Guidelines97 and the requirements of the
  limited screen time.                              Australian Children’s Education and Care
Within the health sector                            Quality Authority.
• Implement the National Breastfeeding            Objective 4: promote and
  Strategy4: develop an NT action and
  implementation plan.                            support healthy eating and
• Integrate the systematic promotion of
                                                  regular participation in
  breastfeeding into key messages and             physical activity among school
  practice for all health professionals.          aged children
• Develop and/or enhance systematic               In schools
  data collection and reporting of
  breastfeeding rates.                            • Promote and support the implementation
                                                    of the NT Schools’ Canteen, Nutrition and
• Identify growth failure, overweight, obesity      Healthy Eating Policy.139
  and anaemia early and ensure adequate
  follow up.                                      • Contribute to the development of strategies
                                                    that reduce energy-dense, nutrient-poor
• Contribute to national initiatives seeking        (EDNP) foods and drinks in lunch boxes.
  to reduce exposure to television or screen
  based advertising of energy dense nutrient      • Provide advice, training and support to
  poor foods to children.                           teaching staff to deliver nutrition education
                                                    in schools.
In the home/families/community                    • Provide advice on the development of
• Promote exclusive breastfeeding up to             curriculum related resources that promote
  6 months.                                         nutrition and physical activity and healthy
• Ensure that messages provided to parents          body image.
  about breastfeeding and introduction of         • Advocate for the training of generalist
  solids are consistent with the Infant Feeding     teachers in fundamental movement skills
  Guidelines.97                                     and physical education in general.
• Create supportive community environments        • Advocate for strategies that will
                                                                                                                  STRATEGY SUMMARY

  for the development of healthy eating             increase adolescent girls’ participation
  behaviour, including breastfeeding.               in physical activity.

Strategy 2015-2020 NT Health Nutrition and Physical Activity 2020 ...

        • Advocate for and support active transport        Objective 5: achieve and
          to school.
                                                           maintain a healthy weight for
        • Advocate for active playgrounds and
                                                           all adults and older Territorians
          opportunities for incidental activity
          throughout the day.                              Within the health sector
        • Contribute to the establishment of school        • Create workplace environments where
          based gardens.                                     healthy eating and physical activity are
        • Contribute nutritional advice to Out-of-           easily achievable:
          School Care programs, as required.                  - implement 'Healthy choices made
                                                                easy’, NT Healthy food and drinks
        In other settings                                       provision policy
        • Support local government to develop and
                                                              - develop and implement an
          implement childhood obesity prevention
                                                                Active@work policy
          programs (e.g. COPAL in Palmerston).
                                                              - promote and support active transport to
        • Provide training and support to health
                                                                and from work
          professionals on child nutrition, physical
          activity and healthy body image,                    - promote breaks in sedentary time.
          consistent with current guidelines and           • Strengthen the capacity of health
          recommendations.                                   professionals to address overweight and
        • Promote the Australian Dietary Guidelines          obesity by:
          for Children7 and the Australian                    - promoting awareness of the risks
          recommendations for physical activity for             associated with weight gain and
          children9;12; suggest home-based strategies           the need to address even modest
          to implement them.                                    weight gain
        • Develop partnerships with Good Sports and           - promoting the NHMRC
          key sporting bodies to reduce access to,              recommendations for the management
          and promotion of, EDNP foods and drinks               of overweight and obesity in adults,
          at sporting events.                                   children and adolescents.
        • Promote ‘child friendly by design’               • Ensure that the NTG leads by example,
          approaches to influence the development            by advocating for the adoption of the NT
          of the built environment and public open           Healthy food and drinks provision policy
          spaces so that they incorporate safe active        across all NTG agencies.
          play and transport options.                      • Advocate for, and actively contribute to,
        • Research and implement innovative                  the development of government policies
          strategies to include fathers in nutrition and     that have a positive impact on the
          physical activity promotion.                       determinants of overweight and obesity
        • Contribute to national initiatives seeking to      (e.g. food/active transport policy at national
          reduce exposure to advertising of EDNP             and Territory level).
          foods and drinks to children.                    • Advocate for the integration of Healthy by
                                                             Design principles177 in urban developments.
                                                           • Advocate for the shared use of facilities that
                                                             provide opportunities for physical activity
                                                             (e.g. school grounds).
                                                           • Contribute to national efforts seeking
                                                             the stronger regulation of marketing of
                                                             unhealthy foods and drinks, particularly
                                                             EDNP products.

NT Health Nutrition and Physical Activity Strategy 2015–2020

• Advocate for, and support, Australian           • Promote participation in lifestyle
  Government regulatory initiatives in food         modification programs (such as Eat Better,
  reformulation and labelling to support            Move More).
  healthier eating.                               • Contribute to the development of
In the community                                    community based sustainable sport
                                                    and recreation programs/ policies/
• Increase community awareness of the               infrastructure, which cater for both men
  need to eat well and be active through            and women across all age groups.
  social marketing
                                                  • Contribute to the upskilling of key
   - disseminate and promote the Australian         community stakeholders in physical
     Dietary Guidelines7                            activity and nutrition (e.g. sport and
   - disseminate and promote the Physical           recreation officers).
     Activity Guidelines for adults11             • Develop a culture of ‘choosing water’ over
   - support national or NGO driven                 sugar sweetened beverages (SSBs) through
     campaigns and initiatives, as they are         the ‘Swap soft drinks for water’ initiative.
     developed (e.g Live lighter).
                                                  In commercial and non-commercial
• Build on and support local government/
  regional council/ community initiated           food services
  programs that assist individuals and groups     • Encourage services in commercial, non-
  to embrace a healthy lifestyle (e.g. Healthy      commercial and institutional premises
  Darwin), particularly in low SES areas and        (e.g. hospitals, aged care institutions, jails,
  remote communities.                               hostels) to provide meals in line with the
• Assist local government and community             Australian Dietary Guidelines.7
  based organisations to develop and              • Encourage managers of remote community
  implement healthy eating/catering policies.       takeaways to provide food in line with the
• Advocate for the development of                   Australian Dietary Guidelines.7
  environments that support active                In sports clubs and associations
  living across all ages and for all abilities,
                                                  • Engage in partnership with local sporting
  and include easy and safe access to public
                                                    clubs, as a setting where healthy behaviours
  open spaces, schools or food retail/shopping
                                                    can be role modelled and promoted.
  outlets that promote universal access.
                                                  • Contribute to the development of healthy
In remote communities                               catering/fundraising activities that support
• Facilitate gendered community based               healthy food and drink options and are in
  opportunities for cooking and food                line with the Australian Dietary Guidelines.7
  preparation learning sessions.
• Engage men in targeted nutrition
  interventions that relate to chronic
  disease prevention and management.
• Support and encourage middle aged
  men and women to continue to engage
  in regular physical activity after they stop
                                                                                                                  STRATEGY SUMMARY

  playing sports.

Objective 1:
     Improve food security, particularly
     in remote communities

     Food security has been defined as the ability of individuals, households
     and communities to acquire appropriate and nutritious food on a regular
     and reliable basis, using socially acceptable means.16
     Food security is determined by people’s local food supply and their capacity and resources to
     access and use that food. Food security is strongly associated with a sustainable food system that
     encourages local production and distribution infrastructures.
     In the NT, 30.4% of the population is Aboriginal and three quarters of that group (74%) live in
     remote areas, in low socio-economic circumstances. In remote communities most of the food
     eaten is food purchased from the store and/or the takeaway. Despite noted recent improvements17,
     the availability and the variety of foods available in these communities remain more limited than in
     regional centres, and prices are significantly higher, suggesting the likelihood of food insecurity.
     While healthy food is more readily available in urban centres, it may be equally unaffordable for
     people living on low income or welfare payments, resulting as well in food insecurity or what has
     been labelled ‘food stress’.18
     It has been postulated that people on limited income may opt for low cost energy-dense
     nutrient-poor (EDNP) foods and drinks in order to maximise energy availability per dollar spent.19
     The resulting poor diet is a major risk factor for chronic diseases such as type 2 diabetes,
     gestational diabetes, cardiovascular disease, hypertension and renal disease, all of which have a
     high prevalence in the Aboriginal population.20 Poor diet also contributes to dental caries.
     The impact of improving the supply of healthy food and drinks is greatest when it is coordinated
     with actions that promote healthy eating and increase demand for healthy food and drinks.

NT Health Nutrition and Physical Activity Strategy 2015–2020

What the data tell us
In 2014, data collected as part of the NT                             A 2012 study in Adelaide found that low-
Market basket Survey (MBS)17 showed that a                            income families would have to spend
healthy food basket was 53% more expensive                            approximately 30% of household income
in remote community stores than in a Darwin                           on eating healthily, whereas high-income
supermarket (see Figure 1 page 13).                                   households needed to spend about 10%.18
That same year, the proportion of incomeb                             A review of the literature describing the link
required to purchase the food basket was                              between poverty, food insecurity and obesity,
34% in remote stores, compared with 22% in                            with specific reference to Australia, has shown
a Darwin supermarket. There has been little                           that the risk of obesity is 20 to 40% higher
variation in this difference over the last three                      among people affected by food insecurity.21
years (see Figure 2 page 14).

    900                                                                                            60


    600                                                                                                                        40


    300                                                                                                                        20

                                                                                                                                          OBJECTIVE 1

       0                                                                                                                       0
            2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

                      DARWIN SUPERMARKET                     REMOTE STORES                       PERCENTAGE DIFFERENCE

b Income is calculated annually from the sum of welfare payments that the hypothetical family is entitled to receive. For more details,
  see the Market basket survey at

        Our challenge
        We must                                              • monitoring and providing feedback
                                                               to participants
        • contribute to increased access to a
          healthy and affordable food supply,                • modifying strategies according to need.23
          wherever people live
        • build nutrition knowledge and skills, and
                                                             Suggested strategies
          stimulate demand for a healthy diet.               In remote communities
                                                             • Develop community capacity to influence
        Evidence of effective                                  availability, variety, quality and affordability
        interventions                                          of core foods at the store.
        Research shows that store managers can have          • Assist store/takeaway management and
        considerable influence over the food supply            store committees to develop and implement
        in remote communities, and that working                food and nutrition policies.
        in partnership with them can benefit the             • Provide advice and learning opportunities
        community’s dietary intake.22                          to store staff to develop and implement
        Overall, there is a paucity of well-designed           initiatives that improve food supply and
        and well evaluated food security programs,             consumption of healthy food.
        particularly those targeting remote                  • Contribute to store-based activities that
        communities. The few documented successful             promote and support a healthy diet.
        interventions include the following best practice
                                                             • Engage with Outback Stores (OBS), Arnhem
                                                               Land Progress Aboriginal Corporation
        • community involvement and support at all             (ALPA) stores and other key food industry
          stages of the project                                stakeholders to contribute to their efforts
        • empowering the community rather than                 to ensure that the food supply supports
          imposing priorities                                  the Australian Dietary Guidelines7 (see
                                                               Appendix A page 43).
        • multifaceted interventions addressing both
          supply of and demand for ‘healthy’ food            • Support research related to food systems
                                                               and factors that influence purchasing and
                                                               consumption decisions.










                 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

                                        DARWIN SUPERMARKET             REMOTE STORES

                                                                            Source: 2014 Market basket Survey (MBS)17

NT Health, Nutrition and Physical Activity Strategy 2015–2020

• Build on existing housing initiatives to    Indicators
  improve community and household food
                                              • Trends in availability, variety, quality
  preparation and storage facilities.
                                                and relative costs of food in remote
• Advocate for initiatives to improve the       communities.
  affordability of healthy food and drinks
                                              • Proportion of population consuming
  (e.g. cross-subsidisation).
                                                the recommended serves of fruit and
Across the NT                                   vegetables.
• Work with Community Stores Licensing        • Establishment of community/
  (Australian Government) to ensure             school gardens.
  availability of a range of affordable and   • Establishment of agricultural, horticultural
  healthy food in all stores.                   or aquacultural projects.
• Work with relevant government agencies,
  as well as the agriculture, horticulture
                                              Environmental Health Program; Department of
  and aquaculture industry, to support
                                              Housing; Department of Primary Industry and Fisheries;
  the development of sustainable and          Department of Justice (Consumer and Business Affairs);
  economically viable projects.               Power and Water Corporation; Australian Government
                                              Department of Prime Minister and Cabinet – Community
• In partnership with local community         Stores Licensing team; Australian Government
  organisations, the non-government sector    Department of Social services; MSHR; ALPA; OBS; Food
  and Aboriginal organisations, support       wholesalers and manufacturers; Store committees; Store
  community and school gardens, where         managers and staff; Community Councils; Aboriginal
  community capacity and willingness to       Land Councils; Fred Hollows Foundation and other
                                              agencies involved in food supply in remote communities;
  support the sustainable implementation of   Remote Indigenous Gardens (RIG Network).
  a garden project are demonstrated.
                                              * See Acronyms page 3
• Contribute to projects researching
  options to improve food security in
  disadvantaged areas.
                                                                                                               OBJECTIVE 1

Objective 2:
     Promote and support a healthy diet and a healthy
     weight among women of child bearing age

     ‘The 1,000 days between a woman’s pregnancy and her
     child’s 2nd birthday offer a unique window of opportunity
     to shape healthier and more prosperous futures. The
     right nutrition during this 1,000 day window can have
     a profound impact on a child’s ability to grow, learn, and
     rise out of poverty. It can also shape a society’s long-term
     health, stability and preprosperity.’24 [emphasis added]
     The capacity of a woman to carry out a healthy pregnancy is influenced by
     a number of factors and her own health since birth.25 Her nutritional status
     in particular has a critical impact on the development of the foetus and birth
     outcomes. The focus on maternal nutrition should therefore not be limited to
     the pregnancy period but also include childhood and adolescence, and the
     peri-conceptual period.25
     A number of factors interact with nutrition to impact on intrauterine
     growth and birth outcomes which also require attention. These include
     mothers’ characteristics and behaviours, exposure to infections and the
     socio-economic environment.

NT Health Nutrition and Physical Activity Strategy 2015–2020

Key maternal nutrition or nutrition-related factors
impacting on foetal development and birth outcomes
Anaemia                                                  birthweight (macrosomia), birth injuries
                                                         due to shoulder dystocia or cephalo-
Iron deficiency anaemia is a risk factor for
                                                         pelvic disproportion, respiratory distress
maternal and perinatal mortality, preterm
                                                         and hypoglycaemia.30 In the long term,
delivery and subsequent low birthweight,
                                                         it is associated with increased risk of
delayed mental development and possibly
                                                         obesity, impaired glucose tolerance and
inferior neonatal health.26;27
                                                         type 2 diabetes in early adulthood.30
Diabetes in pregnancy                              • Gestational diabetes mellitus
Whether pre-existing (type 1 or type 2               - For mothers, it is associated with a
diabetes) or developing in pregnancy as                difficult birth, increased chance of
gestational diabetes mellitus (GDM), diabetes          having an induced birth and caesarean
in pregnancy increases the risk of serious short       birth due to the large size of the baby.
and long term complications in both mother             In the long-term, it places mothers
and child.                                             at increased risk of recurrent GDM
• Pre-existing diabetes                                in subsequent pregnancies and of
   - For mothers, it is associated with                progression to type 2 diabetes.
     a higher risk of miscarriage, pre-              - Babies of mothers with GDM are
     eclampsia, giving birth preterm or                at increased risk of stillbirth, high
     by caesarean section, and the first               birthweight, post birth hypoglycaemia,
     appearance or progression of diabetes-            shoulder dystocia, respiratory distress
     related kidney and ophthalmic                     and jaundice. Babies may also be at
     complications.28;29                               increased risk of obesity, impaired
   - For babies, it is associated with                 glucose tolerance and type 2 diabetes
                                                                                                                   OBJECTIVE 2

     congenital malformations of the spine,            in early adulthood.30;31
     heart and kidneys, stillbirth, high


        • Pre-pregnancy overweight or obesity and           Note that more research is needed to
          large gestational weight gain can strongly        determine the suitability of these guidelines for
          increase the risk of having a large baby.32       adolescents or women from different ethnic
          Large for gestational age babies have a           backgrounds.39
          higher risk of birth injury and complications
          of low blood sugar after delivery.32;33           Other modifiable factors
        • Pre-pregnancy underweight is associated           • Maternal smoking is associated with growth
          with intrauterine growth restriction                restriction and low birth weight45 and is
          (IUGR)34 and increased prevalence of                considered the largest known determinant
          some pregnancy complications, such as               of IUGR in developed countries.25 Recent
          preterm birth and low birthweight.35 The            research also suggests that mothers who
          latter may have serious consequences as             smoke during pregnancy have children at
          low birthweight infants, particularly those         higher risk of obesity in later years.46 The
          who experience a rapid weight gain in               likelihood of smoking decreases with higher
          childhood, are at increased risk of obesity,        levels of schooling.
          insulin resistance, the metabolic syndrome,
                                                            • Alcohol consumption during pregnancy
          type 2 diabetes, hypertension, and coronary
                                                              may result in miscarriage and stillbirth. It
          heart disease later in life. 32;36-38
                                                              is also associated with prematurity, brain
        • Low pregnancy weight gain is associated             damage, birth defects, growth restriction,
          with poor foetal growth, low birth weight,          developmental delay and cognitive, social,
          preterm birth and infant death.25;39                emotional and behavioural deficits.47;48
        • Excess weight gain during pregnancy is            • Stress can also have an impact on women’s
          associated with pre-eclampsia, caesarean            nutritional status, and consequently affect
          delivery40, large for gestational age babies        the development of the fetus.25
          and increased risk of overweight for the
                                                            • Young maternal age may impair foetal
          child by the age of 3.41;42
                                                              development, particularly in the case
        • The NHMRC recommends to measure                     of teenage mothers whose growth is
          all women’s weight and height at the first          incomplete, as the nutritional needs of
          antenatal visit and calculate their BMI.43          the mother’s body compete with those of
          Whilst there are no Australian guidelines           the fetus.25
          for weight gain during the pregnancy, the
                                                            • Poverty or low socio-economic
          US Institute of Medicine (IOM) provides
                                                              circumstances, during childhood and
          guidance on weight gain in pregnancy
                                                              throughout the pregnancy, underpin many
          based on prepregnancy BMI 44:
                                                              of the factors described above.

         Pre-pregnancy Body Mass Index (BMI)      Total weight gain (kg)          Rates of weight gain 2nd and
                                                                                  3rd trimester (kg/week)*
         underweight (BMI30)                          5−9                             0.22 (0.17 – 0.27)

                                                            * Calculations assume a 0.5-2kg weight gain in the first trimester

NT Health Nutrition and Physical Activity Strategy 2015–2020

What the NT data tell us
Anaemia                                           Nine percent of all Aboriginal mothers were
                                                  aged less than 18 years, compared with only
In 2012, rates of maternal anaemia were           0.7% of non-Aboriginal mothers. This pattern
around 14%, among Aboriginal mothers.49           of markedly earlier childbearing among
Type 2 diabetes and GDM                           Aboriginal mothers was seen in all health
• In 2010, pre-pregnancy rates of type            districts including urban areas.52
  2 diabetes were six times higher for            Ante-natal care
  Aboriginal women than for non-Aboriginal
  women (3.53% and 0.58% respectively).           In 2010, overall, women in urban areas
                                                  were more likely to attend an antenatal visit
• Rates of GDM were also higher amongst           in the first trimester than those living in
  Aboriginal women than non-Aboriginal            rural or remote areas. This applied to both
  women (8.3% and 5% respectively).50             Aboriginal and non-Aboriginal mothers.
Smoking                                           Aboriginal mothers were more likely to have
                                                  insufficient antenatal care (no antenatal visit
In 2010, smoking prevalence at first visit or
                                                  or attended less than four visits) compared
at under 20 weeks was 37.9% for Aboriginal
                                                  with non-Aboriginal mothers (13% and 1%
women and 11.5% for non-Aboriginal women.
Smoking prevalence at any time during
pregnancy was 38.5% for Aboriginal women
and 11.6% for non-Aboriginal women.51
                                                  Our challenge
Alcohol consumption                               We must
                                                  • continue to reduce rates of
In 2010, at first antenatal visit, 6% of all NT
                                                    maternal anaemia
mothers reported drinking alcohol during
pregnancy. The prevalence of alcohol              • reduce risk factors for diabetes (e.g. rates
consumption was higher among Aboriginal             of pre-pregnancy overweight and obesity)
mothers (13% at the first visit and 7% at 36      • ensure healthy gestational weight gain
weeks gestation) than non-Aboriginal mothers
                                                  • reduce rates of smoking during pregnancy.
(3% and 1%, respectively).52
Overweight/obesity                                Evidence of effective
No data are available for NT women during         interventions
pregnancy. A recent Australian longitudinal
                                                  A review of interventions for preventing
study of measured pregnancy weight gain
                                                  unintended pregnancies among adolescents
showed that 38% of participants gained weight
                                                  reported that all interventions including
in excess of the IOM guidelines (see page
                                                  education, contraception education and
19) during their pregnancy. Fifty-six percent
                                                  promotion, and combinations of education and
of overweight women gained excess weight
                                                  contraception promotion, reduced unintended
compared with 30% of those who started with
                                                  pregnancy over the medium term and long
a healthy weight.53 Of concern was the fact
                                                  term follow up period.55
that at 16 weeks, 47% of participants were
unsure of the weight gain recommendations         Smoking cessation interventions in pregnancy
for them.                                         reduce the proportion of women who continue
                                                  to smoke in late pregnancy, and reduce low
Mothers’ age                                      birthweight and preterm birth.56 There is
In 2010, a fifth (20%) of Aboriginal mothers      evidence that partners play a powerful role
                                                                                                                  OBJECTIVE 2

were less than 20 years of age at the time        in determining whether pregnant women
of giving birth, almost seven times higher        quit smoking and whether they are able to
than the 3% of non-Aboriginal mothers.            maintain abstinence in the postpartum period.


        Compared to pregnant women who live with                Suggested strategies across
        non-smokers, those who live with a partner
        who smokes are less likely to stop smoking              settings
        during pregnancy and more likely to relapse             Pre-pregnancy
        during the postpartum period.57
                                                                • With adolescent females of child bearing
        There is some evidence that health promotion              age, emphasise the importance of healthy
        interventions are associated with some positive           and balanced nutrition; in particular,
        maternal behavioural change, including lower              promote a diet high in iron-rich foods. Refer
        rates of binge drinking.58                                to contraception counselling as required.
        There is insufficient evidence to recommend,            • Promote folic acid and iodine supplements
        or advise against, pregnant women with                    for all women planning a pregnancy (see
        diabetes enrolling in exercise programs                   Figure 3 page 21).
        in order to improve glycaemic control
        and maintain a healthy weight.59 There                  • Develop and implement weight
        is also insufficient evidence to guide                    management programs for women of
        recommendations around physical activity to               childbearing age who are overweight
        prevent gestational diabetes.60                           or obese.
        A meta-analysis showed that antenatal                   • Encourage smoking cessation.
        dietary programs targeting obese women                  During the pregnancy and the first
        were effective in reducing the total gestational
        weight gain, without detrimental effect on
                                                                6 weeks post-natal
        the weight of the baby.61 A systematic review           • Encourage regular attendance at
        has shown that monitored physical activity                antenatal clinics.
        interventions appear to be successful in                • Incorporate specific weight management
        limiting gestational weight gain.62                       advice as part of regular antenatal care.
        Approaches that take into consideration both              In particular, counsel teenagers on the
        the nutritional status of the mother and other            importance of adequate weight gain
        social or environmental factors amenable to               during pregnancy.
        change are likely to be more effective than             • Promote key nutritional recommenda¬tions
        single focus one. A lifecourse approach to                for pregnancy (see Figure 3 page 21).
        maternal health based on multi-disciplinary
                                                                • Encourage regular physical activity to
        collaboration is important to ensure optimum
                                                                  maintain general fitness and for good
        foetal development and birth outcomes.
                                                                  blood glucose control in those women
                                                                  with diabetes.
                                                                • Promote smoking cessation and encourage
          Eat foods high in iron every day                        women not to drink alcohol during
          - best: liver* and kidney, red meat,                    pregnancy and lactation.
            chicken, fish
          - good: iron enriched bread and cereals                  Key messages for women of child
            (wholegrain), green leafy vegetables,                  bearing age
            egg yolk, legumes.                                     • Eat well, be active and maintain
          Have foods high in vitamin C with meals,                   a healthy weight throughout
           to help absorb iron: bush berry, oranges,                 your life
           mandarin, pawpaw, capsicum, broccoli.                   • Eat iron rich foods and
          * Pregnant women should limit their                        continue to be active during the
            intake of liver to 100 g per week due                    pregnancy
            to the high concentration of Vitamin A
                                                                   • Don’t smoke and don’t drink
            in liver.
                                                                     alcohol while pregnant
                    Source : adapted from CARPA STM 6th ed 54

NT Health Nutrition and Physical Activity Strategy 2015–2020

Indicators                                         Stakeholders*
• Rates of smoking during pregnancy.               Alcohol and other Drugs Program; CYH Program;
                                                   Women’s Health Unit; Men’s Health Unit; Community
• Rates of pre-pregnancy overweight                Health Nurses; RNs; AHPs; RMPs; GPs; midwives;
  and obesity.                                     SWSBSC Program; SWWs; CNWs; relevant community
                                                   health groups (e.g. Australian Breastfeeding Association,
• Mean birthweight.                                Childbirth Education Association, Family Planning
• Proportion of low birthweight babies.            Association); training institutions (e.g. Batchelor Institute
                                                   of Indigenous Tertiary Education, Charles Darwin
• Proportion of macrosomic babies.                 University); MSHR; Heart Foundation.
                                                   * See Acronyms page 3


 Pregnant women should                              Pregnant women should
 avoid alcohol.                                     • enjoy a variety of fruits and vegetables of
 Pregnant women are at greater risk of food           different types and colours
 poisoning and should prepare and store food        • increase their grain consumption, mostly
 carefully. They should avoid:                        wholegrain, in preference to discretionary
 • foods which may contain listeria                   choices
   bacteria like soft cheeses (brie, camembert,     • choose foods high in iron, such as lean
   ricotta, feta and blue cheese), sandwich           red meat or tofu, which are important for
   meats, bean sprouts, pre-prepared salads           pregnant women
   and pâté                                         • make a habit of drinking milk, eating hard
 • raw eggs as they may contain salmonella            cheese and yoghurt, or calcium enriched
 • fish that may contain high levels of mercury       alternatives-reduced fat varieties are best
   – Food Standards Australia New Zealand           • enjoy a wide variety of vegetables, legumes,
   recommend consuming no more than                   fruit and wholegrains and drinking plenty of
   one serve* (100g cooked) per fortnight of          water every day can assist with constipation
   shark/flake, marlin or broadbill/ swordfish,       –a common occurrence during pregnancy
   and no other fish that fortnight, or one         • limit discretionary foods and drinks high in
   serve (100g cooked) per week of orange             saturated fat, added sugars and added salt
   roughy (deep sea perch) or catfish and no          such as cakes, biscuits and potato chips.
   other fish that week
                                                    A daily folic acid supplement (0.5 mg/day)
 • foods such as nuts during pregnancy only         is recommended for women planning a
   if they are allergic to the foods themselves     pregnancy and during the first three months of
   – avoiding these foods has no impact             a pregnancy, in addition to eating foods which
   on the infant’s risk of developing allergy       are naturally rich in folate or are fortified with
   symptoms.                                        folic acid.
 Steady weight gain during pregnancy is normal      A daily iodine supplements (150 mcg/day)
 and important for the health of the mother and     is recommended for women planning a
 baby. However, it is also important not to gain    pregnancy, throughout pregnancy and
 too much weight.                                   while breastfeeding.
                                                                                                                     OBJECTIVE 2

                                                       Source: Adapted from Australian Dietary Guidelines brochure
                                                        Healthy eating during your pregnancy63and Minymaku Kutju
                                                                  Tjukurpa – Women's Business Manual, 5th ed 64

Objective 3:
     Optimise feeding practices and promote an active
     lifestyle for children aged 0−5 years

     Adequate nutrition and physical activity are vital for
     optimal health and development in childhood. A child’s
     nutritional status is strongly influenced by food security,
     adequate care and the underpinning socio-economic and
     cultural environment.65
     Undernutrition in infancy results in poorer health and
     social outcomes throughout life.
     It is critical to act early to prevent undernutrition and obesity in children.
     After age two the effects of undernutrition on childhood growth and
     development are largely irreversible.66 Hence the need for interventions
     during the ‘first 1000 days’ (see box page 16) or the window of opportunity
     defined by pregnancy and the first two years of life.67

NT Health Nutrition and Physical Activity Strategy 2015–2020


Health impacts of malnutrition
Undernutrition in early childhood occurs when      Currently, treatment includes giving iron orally
the transition to solids is inadequate both in     or iron by intra muscular injection.73
quantity and/or quality, and/or untimely. This     Low birthweight, combined with rapid
may lead to stunting or wasting, impaired          growth in early life, is associated with a
immunity and increased susceptibility to           number of chronic conditions in adulthood,
infection, which establish a self-perpetuating     such as overweight or obesity, heart disease
cycle of infection-malnutrition.71                 and diabetes.65;75
Children who are wasted, have a higher ri          Overweight and obesity in childhood tracks
sk of death than children of adequate weight       into adulthood, contributing to increased risk
for height.72                                      of chronic disease in adulthood.76 Maternal
A stunted child is likely to remain short in       obesity is the most significant predictor of
stature throughout life, with associated risks     childhood obesity, however other associated
that continue to the next generation.65 Stunting   risk factors include: low birthweight combined
is also associated with delayed mental and         with rapid growth in early life, intrauterine
motor development, which result in long term,      exposure to gestational diabetes and low
irreversible deficits.69                           socioeconomic status. Research also points to
Anaemia is most commonly the result of             both pre-natal and stressful life events during
inadequate dietary iron intake or absorption,      pregnancy as important determinants of later
and frequent intestinal infection. Other           obesity risk, for example death of a family
contributors are low birthweight, low iron         member or exposure to violence.77
stores in the mother before and during             In young children, growth faltering and obesity
pregnancy, specific complementary feeding          may go unrecognised by carers unless the
practices–such as delayed introduction of          child’s growth (length, height and weight) is
solids, inadequate quantity of iron-rich foods,    monitored against child growth standards.
and drinking cow’s milk before 12 months of
age.73 Iron deficiency anaemia is associated
                                                                                                                   OBJECTIVE 3

with poor growth, impaired cognitive and
motor development, increased susceptibility
to infection and reduced aerobic capacity.74


        What the data tell us
        The critical issues for NT children under the     Mild iodine deficiency has been reported in
        age of 5 are:                                     young people the Top End region before the
        • high rates of low birthweight, chronic          introduction of mandatory iodine fortification
          undernutrition (particularly stunting)          of salt in bread, with females (including those
          and anaemia, mostly amongst Aboriginal          who are pregnant and breastfeeding) most
          children living in remote communities           affected.81 The status of other micronutrients
                                                          is unknown. It is reasonable to assume that
        • emerging overweight and obesity in              where undernutrition exists, micronutrient
          urban communities.                              deficiencies may also be present – particularly
        In the NT the proportion of low birthweight       in regards to calcium, zinc and folate.
        babies born to Aboriginal mothers is more than    Overweight and obesity is becoming
        double that born to non-Aboriginal mothers        more prevalent in very young children in
        (13.8% and 5.7% respectively).78                  Australia and recent data suggest that about
        The prevalence of undernutrition is high,         20% of children aged 2−3 are overweight or
        specifically among Aboriginal children,           obese.82 In South Australia, urban Indigenous
        and is attributed to an insufficient intake of    children have been found to be at higher risk
        age-appropriate complementary foods.79 In         of obesity than non-Indigenous children.83 In
        2014, 17% of Aboriginal children under the        the NT, in 2011, 15.1% of urban Aboriginal
        age of 5 and living in remote communities         children aged 4–6 years were overweight or
        were stunted; 7% were underweight and             obese compared to 11.6% of urban non-
        5% wasted.80 The highest prevalence of            Aboriginal children, and 6.3% of remote
        stunting was found in children aged 1−3           Indigenous children.84
        years, where the rate of stunting was as high     Breastfeeding initiation rates in the NT are
        as 24%, compared with 13% for the under           the highest in Australia, at 99%, compared to
        12 months age group and 12% for the 3−5           around 90% elsewhere.85 Rates and length
        years. Rates of anaemia were also highest in      of exclusive breastfeeding are however not
        the under 12 months and 1−3 years, at 31%         available as there are significant gaps in data
        and 24% respectively. Note that caution must      available on breastfeeding rates. Overall,
        be exercised when interpreting these data as      children who live in remote areas are more
        coverage was in some cases as low as 50%.         likely to have been breastfed than those living
                                                          in major cities (85% and 72% respectively).86

        MALNUTRITION                                     illness.69 A child whose height for age Z score
        Malnutrition refers both to undernutrition       is less than -2SD is considered stunted.
        (associated with stunting, wasting, and          Overweight and obesity:
        micronutrient deficiencies) and overweight       - under 2, WHO recommends weight-for-
        and obesity.68                                   height z score of WHZ +2 as overweight,
        Wasting is defined as low body weight in         WHZ +3 as obese.
        relation to height, due to inadequate energy     - 2-18, overweight and obesity can be defined
        intake.68 A child whose weight-for-height Z      according to age and gender-specific BMI cut-
        score is less than −2 SD is considered wasted.   offs*, which match adult BMI of 25 and 30.
        Stunting is defined as low height or length in   * determined by the International Obesity
        relation to age and is predominantly due to      Task Force (IOTF)70
        chronic inadequate food intake and frequent

NT Health Nutrition and Physical Activity Strategy 2015–2020

Our challenge
We must                                                               Ensuring appropriate infant and early
                                                                      childhood feeding practices along with
• reduce rates of low birthweight (this is also                       adequate nutrient intake by pregnant women
  addressed in ‘Section 2: women of child                             and micronutrient supplementation are
  bearing age’)                                                       some of the best preventive measures to
• reduce rates of stunting, wasting and                               reduce the incidence of undernutrition in
  anaemia                                                             children younger than 5 years, in developing
• prevent and address the development of                              countries.72 Feeding practices that encourage
  overweight and obesity.                                             a variety of food tastes and textures and
                                                                      support the infant’s innate appetite regulation
Evidence for effective                                                are known to help develop healthy food
                                                                      behaviours in children.89
Promoting [Exclusive]                                                 Reducing and preventing anaemia
Breastfeeding                                                         Strategies to help prevent iron deficiency in
                                                                      young children72 include routine iron and folate
Compared to a range of preventive                                     supplements to pregnant women, fortification
interventions to improve child health,                                of staple foods with iron, micronutrient
breastfeeding is shown to have the greatest                           supplementation, deworming and delayed
impact on health because it provides nutrition                        cord clamping. Iron-rich foods should be
and immune protection for babies.87 In the first                      the first foods to be introduced at around 6
6 months of life, the risk of diarrhoea and all-                      months to complement breast milk.90
cause mortality is lowest in babies exclusively
breastfedc compared with babies who were                              In developing countries, home fortification
either not breastfed or partially breastfed.69                        of foods with multiple micronutrient powders
                                                                      is recommended by WHO to improve iron
Nearly all women can breastfeed successfully,                         status and reduce anaemia among infants
when given appropriate support. Breastfeeding                         and children 6–23 months of age.91 The
and nutrition counselling delivered by trained                        evaluation92 of the NT Early Childhood
health professionals or community workers is                          Nutrition and Anaemia Prevention Project
an effective intervention to improve exclusive                        (ECNAPP)d stressed the need for routine
breastfeeding rates.72                                                antenatal and child growth and development
The promotion of breastfeeding is an important                        checks, as well as treatment according to
public health strategy, driven at national level                      relevant protocols.
by the Australian National Breastfeeding
Strategy 2010−2015.4
                                                                      Fostering a stimulating
Reducing and preventing
                                                                      In addition to nutrition, a child’s early
undernutrition                                                        environment can also impact on development,
Recommended actions are community based                               as evidenced by a study showing that stunted
counselling and multi-faceted interventions                           children who experienced psycho-social
integrated into the primary health care                               stimulation through play at age 9−24 months,
system.79                                                             sustained benefits at 18 years of age.93
                                                                                                                                          OBJECTIVE 3

c Exclusive breastfeeding means that the infant receives only breast milk. No other liquids or solids are given – not even water – with
  the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicines.88
d The Early Childhood Nutrition and Anaemia Prevention Project (ECNAPP), also called ‘Sprinkles’, was a research project set up
  to determine the feasibility and acceptability of a community nutrition program to prevent anaemia and improve the nutrition of
  Indigenous infants and young children aged 6 - 24 months. The objectives of the project were to:
  • improve knowledge and practices of carers of 0 - 24 month old infants and young children about optimal infant and young child
     feeding and anaemia prevention
  • provide a preventive home micronutrient supplement (‘Sprinkles’) to 6-24 month olds
  • inform future policy and program development to prevent nutritional anaemia and improve infant and young child nutrition.
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