SHIFTING THE FOCUS ON ABORIGINAL NUTRITION

Institutes & Centres

Flinders Health and Medical Research Institute

Article published on 13 November 2020

Denial of access to traditional foods, rationing and using food as social control. Recognising the impact of colonisation on Aboriginal peoples' nutrition is a step we need to take to change the narrative.

As a young dietitian, Dr Annabelle Wilson was thrown in the deep end when she was sent to work with Port Augusta, Oodnadatta and Coober Pedy Aboriginal communities, but her experiences there have led to revolutionary changes in the way non-Aboriginal health workers engage with Indigenous patients.

“I just felt totally ill-equipped to work with Aboriginal people,” Dr Wilson says of her first experiences there. “And I felt like the health service had a set of different priorities to those of the Aboriginal people I was working with.”

So strongly did she feel about how the health services were not meeting the needs of Aboriginal people that she did her PhD investigating how health professionals could work more effectively with Aboriginal communities, in order to contribute to better health outcomes for Aboriginal people.

Now as an Advanced Accredited Practising Dietitian and a Senior Research Fellow, Dr Wilson is working to make those outcomes a reality.

As part of her effort to support healthcare providers, with colleagues Dr Wilson established a peer-mentoring scheme for dietitians working with Aboriginal people.

The dietitians, who came from all over Australia, came together for an initial face-to-face meeting and then, over a year, had six-weekly catch-up sessions to talk about people, challenges and enablers, and just to provide peer-to-peer support.

Now, with seed funding from the Flinders Foundation, she is working with a team to scale that up to a national intervention study, bringing Aboriginal voices into the mentoring process as a first step.

“We’re using the Knowledge Interface Approach, designed by Maori Elder and Scholar Sir Mason Durie, which is about bringing together Aboriginal and non-Aboriginal knowledges – not privileging one type of knowledge over the other, but saying that both are valid and both are important, and we need to include them both,” Wilson says.

The other part of the seeding grant is to use something called “critical realist evaluation”.

Dr Annabelle Wilson

“We know that peer mentoring has a benefit to the practice of dietitians working in Aboriginal health, but we don't know the exact pathway or mechanisms that lead to that benefit. So a critical realist evaluation allows you to actually work out what works for whom and under what conditions," Dr Wilson says.

Her ultimate goal is to change the current narrative in Australian Aboriginal and Torres Strait Islander nutrition research, and peer mentoring, along with changing the way we speak about Aboriginal food and nutrition, is one way in which that can be achieved.

“Currently the discourse around Aboriginal people's nutrition is very deficit based – it’s focused on what people perceive is wrong. It doesn't recognise the impact of colonisation on nutrition,” Dr Wilson says.

“It never takes into account the denial of access to traditional foods, the way food has been used as a form of social control, rationing, even genocide, where food and water have been used to poison Aboriginal people.”

Then there are the more contemporary challenges such as lack of availability of fresh, affordable food in remote communities. So that ongoing colonial impact on food is not recognised widely.

“So we argue in our work that we need to shift that narrative, that it needs to be strengths-based,” says Dr Wilson.

Dr Wilson points to the understanding that before colonisation, Aboriginal people were not living a simplistic ‘hunter-gatherer’ existence as often portrayed, but a very complex ecological lifestyle involving sophisticated agricultural practices.

“That is just not acknowledged when we consider food and nutrition in the context of Aboriginal people.”

Dr Wilson says she knows of no other program like it in Australia, but given the nature of the topic, which is not widely understood, there are challenges in obtaining funding.

“Often in public health, we have this set idea of what we see as the problem, but I am advocating that we need to shift the lens or see the issue from another perspective,” Dr Wilson says.

“And in relation to this work, instead of always focusing on problematising Aboriginal people's health, it's about shifting the lens back onto the white health professional and their own attitudes, biases and values, and how that affects how they work.”

Dr Wilson's earlier work involved interviewing many non-Aboriginal health professionals working in Aboriginal health. As a result, she developed a continuum based on how effectively they were practising.

“This continuum started with those who felt totally at a loss to those who were really scared of, for example, being perceived as being racist,” Dr Wilson says.

“There were those who thought it was too hard and just disengaged, but there were those who I called barrier-breakers who, regardless of all of those challenges, just went ahead and did it anyway. They had the most effective practice and were most aware of their own position as non-Aboriginal people.”

Dr Wilson admits that the changes in approach and attitude she is proposing can be hard for some people.

“It requires a whole lot of skills that people don't necessarily have intuitively. And that's things like valuing multiple perspectives and knowledge, being able to be reflexive, having a willingness to sit with discomfort and being okay in feeling uncomfortable and then having the courage to challenge and change that.”