1

2

3

FOOD POLICY ACTION WORKSHOP13-15 October 2003

Alice Springs

Facilitators:

Dr John Coveney Dr Mark LawrenceSenior Lecturer Senior LecturerPublic Health School of Health SciencesFlinders University Deakin UniversityAdelaide Melbourne

4

Prepared by:Julie Brimblecombe, Trine Vangsgaard, Joseph Fitz

Menzies School of Health Research

Artwork & graphics by Joseph Fitz, Menzies School of Health Research

This document contains an edited transcript of the presentations and workshop discussionsas well as group activities presented at the workshop on “butcher’s paper”. Presentationswere typed directly into a Microsoft word document. Only minor edits have been made toenable ease of reading and/or to protect a person’s identity. Comments made by thefacilitators and workshop participants have been included in the transcript and areidentified by an “F” for facilitator and a “P” for participant. Statements and information inthis report do not necessarily reflect the views of Menzies School of Health Research,Northern Territory Department of Health and Community Services, Central AustralianDivision of Primary Health Care, Flinders University or Deakin University.

Abbreviations:

ACCC Australian Competition and Consumer CommissionALPA Arnhem Land Progress AssociationANZFA Australian and New Zealand Food AuthorityAS Alice SpringsATSIC Aboriginal and Torres Strait Islander CommissionCA Central AustraliaCADPHC Central Australian Division of Primary Health CareDAA Dietitians Association of AustraliaDHCS Department of Health and Community ServicesFARA Food Alliance for Remote AustraliaMSHR Menzies School of Health ResearchNGO Non Government OrganisationNHF National Heart FoundationNATSINSAP National Aboriginal and Torres Strait Islander Nutrition Strategic

Action PlanNT Northern TerritoryPHAA Public Health Association of AustraliaSA South AustraliaSIGNAL Strategic Inter-Governmental Nutrition AllianceSWSBSC Strong Women, Strong Babies, Strong CultureTHS Territory Health ServicesWA Western AustraliaWaltja Organisation for training support and advocacy, accredited and

non-accredited skills training for families.

5

Contents

Executive Summary 5

Workshop Outcome 9

Introduction 10

Activity 1 – Introductions 11

Presentation - What is Policy?, by John Coveney 11

Activity 2 – 3 vignettes 13

Activity 3 – Video activity 15

Presentation – Mai Wiru Regional Stores Policy 16

Activity 4 – Mapping the food and nutrition system in the NT 19

Presentation – The evidence base for food policy in the NT, by Mark Lawrence 25

Policy Case Studies

Policy Case study 1 – NT Food and Nutrition Policy 27

Policy Case study 2 – Mai Wiru (implementation) 33

Policy Case study 3 – Central Australian Aboriginal Buying Service 36

Policy Case study 4 – Alice Springs Hospital Food and Nutrition Policy 38

Policy Case study 5 – Anzac Hill High School Canteen 40

Policy case study 6 – Gap Neighbourhood Outside School Program 42

Policy Case study 7 – ALPA Food and Nutrition Policy 43

Activity 5 – Identifying barriers and enablers in the transition process 45 of moving a problem to a solution

Activity 6 –“The Problem of Jonestown” 57

Presentation – Advocacy, by Mark Lawrence 60

The SA Food Alliance Case Study 61

The Coalition on Food Advertising to Children Case Study 62

Activity 7 – Strategy Planning 63

6

The birth of FARA (Food Alliance for Remote Australia) 70

Appendices

Appendix 1: Workshop program 74Appendix 2: List of Participants 77Appendix 3: Presentation “The evidence base for food policy in the NT” 79Appendix 4: The “muddiest” point from Day 1 83Appendix 5: Evaluation results 85Appendix 6: Media Release 91

7

Executive Summary

A food policy action workshop was held in Alice Springs from the 13 to 15 of October,2003. Dr John Coveney, a senior lecturer Department of Public Health, FlindersUniversity and Dr Mark Lawrence, a senior lecturer School of Health Sciences, DeakinUniversity, co-facilitated the workshop. John Tregenza, an Alice Springs based consultantwith a background in food policy was a key presenter on the “Mai Wiru” regional storesregulations for the Anangu Pitjantjatjarra Lands policy.

Expressions of interest to participate in the workshop were sought from Central Australianorganizations with a stake in health and community economic development and fromremote community people with an interest in developing food policy.

Twenty-eight people participated in the workshop representing various governmentdepartments, non government organizations, Aboriginal medical services and academicinstitutes from across three government jurisdictions – NT, WA and SA. The workshopwas funded by the Central Australian Division of Primary Health Care and was approvedas a professional development activity for NT Nutritionists. NT nutritionists participatedin the workshop and remained in Alice Springs for their annual meeting whichimmediately followed the workshop.

Food policy governs who gets to eat what, where and when. The impact of food policy issignificant and has a role in shaping individual and community food buying patterns andfood consumption. It also impacts on community health and safety, and can influencecommunity economic development. The issue of food policy is highly relevant to thehealth, well being and economic development of communities in regional and ruralAustralia. Appropriately developed and implemented food policy has the potential toreduce the development of overweight and obesity and related preventable chronicdiseases such as diabetes, hypertension and cardiovascular disease which continue tothreaten the quality of life of Australians in general, and which are particularly prevalentamong indigenous Australians.

In remote Aboriginal communities, dietary quality is poor (with particularly lowconsumption of fresh vegetables and fruit) due to a combination of inter-related factors.These include poverty and associated conditions, the high cost of good quality perishablefoods and progressive loss of food quality owing to prolonged transport times due toisolation and remoteness. In terms of food affordability, people in remote communities areclearly disadvantaged. There are serious disparities in access to basic healthy food whenone compares the situation of remote Aboriginal people and Torres Strait Islanders withpeople living in the major cities of Australia.

Food policy has the potential to address inequities and gaps in the food supply includingthe production, distribution and consumption of food. This workshop presented anopportunity for people interested in food policy to reflect on factors key to the successfuldevelopment and implementation of policy. The workshop was designed to be highlyinteractive with the aim of exploring food policy, the politics of food and theinterconnections between these at the local and national level. Through various activities,the facilitators encouraged participants to reflect on policies governing the food supply inthe NT and to identify the enablers, barriers and key stakeholders in the process of policydevelopment and implementation. Throughout the workshop, various elements of policy

8

were explored such as what is policy, the values and beliefs underlying policy, movingfrom barriers to solutions, limits of policy, advocacy and coalition building. Workshopactivities and presentations were developed around the themes of:

- Policy, principles and evidence,- Case studies of local food policy in NT,- Planning strategically for local food policy action.

The Mai Wiru Regional Stores Policy and associated regulations for the AnanguPitjantjatjara Lands was central to many of the discussions throughout the workshop onfood policy for remote areas. The Mai Wiru policy developed over a lengthy andcomprehensive consultation period of 2 years and is now at the implementation stage. Thekey factors presented at the workshop that enabled the development of this stores policywere:

- Identifying a specific problem and staying focused on the problem. In thisexample the problem was poor diet contributing to the high rates ofchronic disease experienced by Aboriginal people and the lack of healthyand affordable food in the community stores.

- Advocating for change from a human rights perspective. That is,Australian citizens have a right to access healthy and affordable food.

- Using economic modeling to inform policy decisions.- Deconstructing the community store as a commercial enterprise and

reconstructing it as a community service.- Facilitating a regional approach where 20 communities are involved and

are striving for community control.- Taking a comprehensive approach eg. incorporating the government

regulations governing store actions.- Political action for enforcement – incorporating Mai Wiru into

Pitjantjatjara lands council as a by-law.- Developing the policy on principles of activism, community control and

empowerment.

Other food related policies were presented as case studies to consider the enablers, barriersand stakeholders in policy development and implementation. The enablers listed belowwere common to each of the policies presented.

- Strong leadership, champions and champion makers within community andgovernment departments.

- Appropriate and extensive consultation with all stakeholders to achievecollective action.

- Lobbying and advocacy for political commitment.- Intersectoral commitment and collaboration.- Developing policy on available evidence and clearly identified problems.- Co-ordination in implementation of policy strategies/ activities.- Policy linking with government regulations relevant to the food supply and

national accredited standards, such as those in child care centres.

9

The challenges identified to the development and implementation of food related policywere:

- High staff turnover.- Government restructuring and management changes.- Achieving commitment beyond the health sector.- Entrenched corruption- Misperceptions about costs of healthier food.- Lack of funding and resources to effectively implement policies.- Inequities in enforcement of government regulations relating to the food

supply at the community level.- Lack of appropriate infrastructure eg. refrigeration, facilities for food

preparation.

Throughout the workshop there were points raised by the facilitators in response topresentations and discussions generated from group activities. These points relate to theunderlying elements of policy such as advocacy, capacity building within the coalition,measuring progress, values and sustainability. These points were:

• The degree to which policy gets up depends upon how policy ispropounded, made public, taken seriously, and the number of levers it has.

• Collaborating with powerful lobby organisations and professional groups,such as Medical doctors.

• Many of the issues identified through the workshop are about history. It isimportant to remember that speed of change and speed of progress is goingto be slow. Measuring processes as well as outcomes is important eg. thelining up of activities around areas of policy.

• Engaging in things where you can make a difference and starting withsomething that does have potential to influence.

• Policy is driven by values and whose values become prioritised and mostimportant.

• Linking initiatives that support and complement each other gives a policymore momentum, such as food advertising to children and child obesity.

• Developing policy is about taking the problem and defining the problem ina way that you think will have the most success.

• Sustainability involves continuing to build coalitions and reformulating thepolicy problem in light of new developments.

• Valuing skills development of people involved in policy is important tobuild capacity within the coalition. A system of mentoring and nurturingthat fosters skills of advocacy, networking, negotiation, and facilitation isimportant for capacity building.

• Coalition building requires drawing on the strengths of others andsometimes having to get in other people’s canoes. It is also about findingthe people who share the same commitment and have the same outcomesand values in mind.

• Speaking with a coherent and united voice and predicting the sort ofarguments you are going to come up against is important for effectivelobbying.

10

Main Outcome from the workshop

The last group activity involved identifying a problem relating to the food supply andconstructing an advocacy strategy to highlight the issue. Participants were asked toconsider:

1. the stakeholders – friends and foes2. how to optimize the facilitating factors3. how to deal with barriers4. what resources will be used, and5. who to involve and how to get started

The energy generated through this last activity was channeled into creating a statementthat would reflect what the workshop was about. The discussion moved quickly intosupporting a coalition to focus on the food supply to remote communities. The followingstatement transpired:

This workshop resolves that the health and well being of Indigenous Australians,especially those living in remote areas, can only be improved when healthy food isavailable, affordable and safe, and calls for collective action to:

- Increase the range of affordable healthy foods available in remotecommunity settings

- Rigorously enforce current regulations governing retail operations- Provide training and support for better retail operations and achieve

greater community control of local food supply.The participants in the workshop have formed an alliance tentatively called FoodAlliance for Remote Australia (FARA).

Actions:1. Investigate funding possibilities.2. Promote the coalition.3. Consider a form of communication between members of the coalition.4. Link with other initiatives such as NATSINSAP and other alliances such as PHAA

& DAA.

Points to consider in establishing the alliance:

- constitution and structure- developing and nurturing skills, including skills of reflexive practice

among members of the coalition- developing connections at all levels of government- Collecting facts and figures to support lobbying and advocacy- Reporting on progress

From the evaluation (refer to appendix 5), the workshop was considered a success.Participants generally viewed the workshop as a worthwhile, enjoyable and valuableexperience. The participants in general considered the workshop to be well presented andfacilitated. There were suggestions for greater involvement from other sectors relevant tofood and nutrition policy including the representation of targeted beneficiaries.

11

Workshop Outcome

This workshop resolves that the health and well being ofIndigenous Australians, especially those living in remoteareas, can only be improved when healthy food is available,affordable and safe, and calls for collective action to:

- Increase the range of affordable healthy foodsavailable in remote community settings.

- Rigorously enforce current regulations governingretail operations.

- Provide training and support for better retailoperations and achieve greater communitycontrol of local food supply.

The participants in the workshop have formed an alliancetentatively called Food Alliance for Remote Australia(FARA).

(For further information about FARA see the website:http://www.fara.bite.to)

12

Introduction – Roy Price

“Welcome everyone. Thank you all for coming

I’d like to begin by relating to you the background to this workshop, which evolved out ofan offer of a Short Course in Food Policy from Dr John Coveney at Flinders University.

When Alice Springs nutritionists saw the offer we said “wouldn’t it be great if the shortcourse was conducted in Alice Springs rather than at Flinders and available to all NTNutritionists as a professional development activity?”

So we began planning but soon realised that in order for this to happen, funding to conductthis workshop was needed. CADPHC had funding, not for a short course but for “ObesityPrevention”. In the development of our submission for funding it was not difficult to linkthe issues of the food supply in remote communities with problems of obesity andresultant chronic diseases. However, to have the greatest impact, our workshop needed toengage other players in the food supply and not just nutritionists. We proposed that bymaking the workshop open to other important stake holders and players we would be ableto progress the discussion and activity around Food Policy in the Central Australia andperhaps the rest of the Territory.

So what began as an offer of a “short course”, began to be promoted as an “ActionWorkshop”. With our submission for funding successful, calls for expressions of interestwere sent out to a wide variety of individuals and organisations seeking their participation.The concept was promoted widely amongst stakeholders and this week’s forum is theresult.

Why do we need this workshop? The NT Health Department has had a food policy since1996 and there has been a lot of activity and effort go into implementing it. However, thenutritionists can only go so far in their implementation of food policy when so many otherfactors are involved in food supply issues, many of which are outside the control of theHealth Department. This might sound a bit unfair but our inability to impact significantlyon the food supply is evidenced in our own work; that after 5 years of implementing foodpolicy, the results from the Market Basket Survey show that there has been little or nochange in the variety, availability and affordability of healthy food in remote communitystores. This points to the fact that nutritionists are poorly placed to impact on the quality,variety availability and affordability of the food supply by themselves. We need to formactive collaborative working partnerships with other organisations such as ATSIC,Department of Community Development, Sport and Cultural Affairs (Local Government),Central Lands Council (in Central Australia) and others to achieve real change in the foodsupply.

This workshop is an attempt to bring the key players and significant others together to oneforum where we can discuss, learn, think, and plan together on how we can begin toimpact on and improve the food supply, particularly out bush, but also in schools, day carecentres, etc.

I would like to thank the Central Australian Division of Primary Health Care for the $6500of funding, Dr John Coveney and Dr Mark Lawrence for taking the trip into the desert,and Alison McLay and Penny Fielding for their support.”

13

DAY 1Presentation – What is Policy?, John Coveney

Slide 1 Introduction and Aim

• Can examine food policy broadly at a variety of levels. People are working in avariety of places – communities, schools, hospitals etc.

• Once fundamentals in place can apply to any setting.• Talk broadly, but engage quite specifically.• To consider how to remove barriers, how to push forward.• Plan – where to from here – this depends on us. Need some kind of sustainability.

Slide 2 What is Policy?

• Look at words and give them a colour. Policy is always presented in a very formalway. Often policy appears to be murky and the concept of policy is often notunderstood well. It often seems official, lofty and remote from daily workings – itis certainly not colourful.

• Policy is often considered in association with politics.• We often hear what the government policies are. Policy is intimately bound with

what the government proposes to do, for example, the government’s policy onasylum seekers.

• Policy involves people, values and beliefs.• When are we doing policy?

Activity 1

Task: In pairs, find outeach others name,department ororganisationconnected with, andwhat expect to gainfrom participating inthe workshop.

14

Slide 2 Cont……..What is Policy?

• Policy is central to decision making.• Policy provides a common stand point for action.

For example in Vignette no. 2, Mary was part of a group.• In many ways policy can demonstrate agreement and commitment.• Policy development at a local level is about bringing people together and engaging

a range of stake holders.• It is about participation and collective action.• Policy is a vehicle for control and for coming to an overall agreement on such and

such an issue – “what is the policy here?”

Slide 3 (Colebatch, 2003) Policy is about:

• Order – creating priorities• Authority – gives policy its clout• Policy is informed by expertise. This gives policy its Oomph!

Slide 4 Limits of Policy

• Strong policies are strong because of the support they achieve• It’s often about how much authority it has been given

Activity 2

Presented with 3 “vignettes” concerning people involved in various activities.

Task: As a group identify the vignettes where people are engaging in “doingpolicy’.

Purpose: To consider and discuss what is policy

Summary of group feed back• People identified in vignettes were engaged in policy at different levels -:

o Policy developmento Policy implementation and programso Policy advocacy

• The second vignette involved actually doing policy as it involved beingpart of an action group, informing policy, key stake holders and decisionmaking.

• Vignette did not clearly state that the activities were informed by policy –made an assumption in stating that the activities were about policyimplementation and evaluation/ advocacy.

• Different meanings of words – eg. guidelines and strategies seem tosometimes be used as a proxy for policy.

Round up of activity• Made the assumption that John and Anna’s actions were informed by

policy. John’s program could have fallen out of policy, but may not have.• Mary however was involved in a collective effort as part of a group in

developing policy.• How do we distinguish policy and programs?

15

Slide 5 Policies that haven’t done anything

• An example – the South Australian Food and Health policy.• A wonderful job at developing the policy involving rounds of consultation with

various groups. A working group was established. The policy was released in 1996but was not implemented. It was not given any money and had no Oomph! It nevermade its way out of the policy development section.

Reflecting on workshop participants expectations, it was stated – "We want policy to havebite, we want to see action”.

Slide 6 Values and beliefs

• We need to remember that policies are informed by certain values, beliefs andprinciples. Reflect on John’s practice in vignette 1.

• Not everybody signs up to policies.• The objective of ‘Food for the future’ was to increase South Australia’s produce

export into Asia. This policy worked. It was not driven by a health agenda but apolitical and economic one.

• Not everyone is going to share the same values.• Need to develop some common ground – develop a set of principles that can work

from.

Slide 7 Policies are derived from problems

• Policies do not drop from the sky they derive from problems.• For example, consider the school canteen. As a Nutritionist the problem may be

defined as kids not making healthy choices. However some other people may viewthe problem as the canteen not being profitable and not making enough money.The problem for these people is that the canteen is not a profit making venture.There are therefore two different sorts of concerns. These sit in different ways,however both parties are talking about the same problem but from a differentangle.

• The media plays an important role in defining the problem.

Slide 8 Stakeholders

• Look at what people are doing and if we thinkpeople are doing things that are close to the policy – thencan collaborate with them.• Working with a range of stakeholders and beingsavvy on what you can compromise on – diluting yourprinciples can be a sell out.• Collective action is important if going to havestakeholder commitment.

• Lobbying is about strengthening your position and getting support for yourposition.

Activity 3 – VideoactivityChildren’s TV programs areeducational. Part of children’stelevision programs is about the wayparents should relate to children andabout the way children should relate toparents and behave. Through studyingthese shows, one can identify the valueand belief systems of the society or thegroup involved in developing them.These programs are informed bycertain beliefs and are informed byeducational policy.

16

• For example, the green movement has been able to make some headway. Theywere not going to make a compromise on the Franklin Dam, but havecompromised on commercialisation of some products. This has enabled workingtogether and although previously the Greenies would have nothing to do withbusiness, compromising in this situation has helped to popularize green issuesthrough commercial channels.

• Need to know what you can compromise on.

Presentation – Mai Wiru, Regional Stores Policy, John Tregenza

Mai Wiru (Good Food) – Regional Stores Policy and associated regulations for theAnangu Pitjantjtjara Lands

• John has been involved in this work for the last 30 or so years.• Regional Stores Policy covers an area in South Australia immediately south of the

NT border.• The cultural group actually includes part of NT, WA and SA.• For a long time there has been a problem with nutrition and food supplies in

remote areas.• The problem – poor health in all communities, therefore policy to address this has

been a necessity.• Historically on these communities there were ration depots. The communities were

established as government reserves controlled by a superintendent. With the LandRights movement these became Aboriginal controlled lands. Eleven communityowned stores grew out of the ration depots.

• During these times, 90% of people’s diet was derived external to the reserves. Thissituation has now almost reversed.

• There are a number of wider contributing factors, such as :o The massacre in Port Arthur that disarmed peopleo Cost of fuel – considering people on unemployment benefits

• 1982 – UPK came into being.• In 1987 – UPK published 10 guidelines that have guided community development

and health programs and strategies. Some of these are:o Ability to wash selfo Ability to wash clothes and blanketso Secureo Prepare and store healthy food

• Working through these 10 guidelines has been a long and slow process – now up to4 out of 10.

• 1997 – 10 years later SA was going to increase electricity tariffs. Health Serviceand nutrition through JT started to look at people’s capacity to access healthy food.

• Store pricing structures, incomes in families, NOT about education or knowledge.Basically people could not access healthy food from store.

• Talked to people about what they want from stores.• 85% of people are on social wages. The other 15% live in the same communities

where people live in absolute poverty. The money goes into the family pool.People can’t afford to buy tucker.

• JT involved in community consultation – Pitjantjatjara is his second language.

17

• Vested interest and resistance to change. Freedom to hold meetings in bush and sowith a mobile PA system, JT held meetings in the communities.

• Asked the question – What is it you want from your store?• People want access to healthy, affordable food.• How are we going to achieve healthy and more affordable food?• A steering committee was formed with representatives from all communities –

their directive was to develop the policy.• Problem was a health issue – just need to go to dialysis unit. Horrific health status

of people in remote communities. Although these chronic diseases are referred toas western lifestyle diseases, the biggest sufferers are those who don’t live thewestern lifestyle.

• Values – Human and Australian citizens rights to access healthy and affordablefood. Just because they live in remote areas does not mean that they should not beable to access healthy and affordable food.

• Accessibility – right up the back of the store is the fruit and vegetable. Needed tohave a rethink – range of food, availability and cost structure needed to change.

• Fiscally impossible to be healthy, needed to look at how cost structure couldchange.

• People also need to have knowledge on how to go about preparing other foods.• Preparation and storage – cupboards in houses / storage places.• These facilities are not in place. Shift in dependency on take away foods. To

address this there has been a shift in policy to control of take-aways.• 93 regulations in Mai Wiru policy book.• Having rights in place that people in towns take for granted when they go into a

shop.• Policy states that community store will not have soft drinks and high sugar foods –

people decided that they did not want children to have the same high level of riskof disease and therefore it was best to eliminate them.

• Came from the women mainly demanding healthy food and saving children fromthe bad health path that they were on.

• Community having the say through health service.• Regional approach – every community involved and signed off on policy.• Comprehensive approach including government regulations – many government

regulations governing actions of stores, many of these are not enforced.• Statutory obligations must be equally applied to these remote areas. The policy

incorporates all of the government statutory regulations.• All of the food in this area must be at the same price that people with the same

income are confronted with. Same citizens – same rights.• This has problems particularly regarding freight costs.• In development of policy – it is a political action. Involved state governments.

Once draft of policy was developed, took around the communities and all signedoff including land councils, health service - written to have incorporated intoPitjantjatjara lands council as a by law. This gives it more strength for monitoringand power to enforce stores to co-operate.

• It has become like a CLUB “Djudinba”. It is a policy. It has been made, now it isbeing used on the stores. It is a tool to make sure people have access to healthyfood.

• Council on Australian Governance: Tier 1 / Tier 2 etc.• Everyone is saying store is a priority – the implementation of the policy however

has been problematic.

18

• It is well known, well supported. Getting requests from other areas wanting tocome on board or develop a policy of their own.

• End of 1999 – signed off on the policy.• Problems with implementation:

� Costs still too high� Complaints re cost structure still confronted with� Development of policy was the easy part – How do we make

policy a reality?• Reflects what communities and individuals in communities wanted.

F – start to unpack the policy. Look at values and beliefs that are embedded in policy.• Policy principles: health imperative.• Problem: health.• Issues: human and citizen right – this is a belief system that informs policy.

Competition problems – covers 3 jurisdictions.

P –Worked with Australian Competition and Consumer Commission (ACCC) to come upwith Store Charter. ACCC tries to increase competition for better store pricing. Problemwith local policy is that it cannot be broad enough to follow.

P - Wanted to make sure not contravening Australian law. There are welfare issues. MaiWiru wants to fix prices as believes stores are not enterprises, they are monopolies. Thereis no competition.

P - How hard the policy bites, depends on the number of levers there are to push it.For example on the issue of smoking there has been anti-tobacco legislation and numerouseducation programs. Smoking levels have decreased. If you pointed to the time whenthings moved, it seems it was when it was advocated as a passive smoking issue. It wasthen advocated as not just a problem for the smoker. It became a problem in work places.Then there needed to be a ban on smoking in public places. Then followed, that smokingwas not acceptable in public places. It is now a moral issue.

Issue shifted from health to another angle, pushing another problem eg. Human rights. Inorder to get leverage with a policy, need a number of levers depending on coalition you’reworking with.

Policy always represents values, beliefs. The degree to which policy gets up depends uponhow policy is propounded, made public, taken seriously, and the number of levers.In developing policy need to consider -what you agree to compromise on and let go.

19

Mapping the Food and Nutrition System in NT (Based on Peter Heywoods mapping of the food system)

Food sellinganddistribution/marketing

Foodconsumption

NutritionOutcome

Foodproductionincluding foodimports

Activity 4

Task:Working around a setting that is relevant eg. Remote community stores, identify;

1. What are the factors that influence each of the systems components?a) Issuesb) Stakeholdersc) Contexts

2. Where do you fit in relation to the food and nutrition system?3. What are the barriers to “healthy” nutrition outcomes in the NT?

20

Group 1: Remote Community

FoodProduction

Food Retail &Distribution

FoodConsumption

NutritionOutcomes

Issues Ltd localproduction

Largedistances/isolation

Access:* availability, variety* store opening hours* community issues:

ceremony, violenceetc.

Diet:* chronic disease,diabetes, renal disease, over - & under nutrition, FTT, anaemia, dental caries,

infections etc.Environment:

*water, temperatureclimate

Access restrictions

Infrastructurecost

Transport

Local productsexported

Profit driven

Lack of skills Lack of competitionColdchain…cost/spaceStore rangeLack of knowledge

Stakeholders Communitymembers

Community members Community/familymembers

Individuals

Primaryproducers

Store ctt’es & comm.councils

Health Centre staff Health Centre staff

Store managers Store managers Store managers Store managersRetail “Co-ops” Store workers Food industry Community membersGovt. bodies &NGO’sinvolved

Retail “Co-ops”

Freight companiesWholesalers,distributors

Context Market price –supply + demand

Natural disasters –road closures

Religion Housing

Subsidies Commercialagreements

Poverty Education

t Natural disaster:* drought, flood

State of economy Housing issues Employment

TV advertising Lack of purchasingpower

Genetics

Cultural factors:* kids

• Issues in food production• Local products exported and not available for local consumption.• Commercial agreement, eg. if store in debt to a particular wholesaler or freight

company.• Family relationship – hierarchy within family – seasonal variation eg. Magpie

geese.• Cultural factors – foods that some people won’t eat eg. Kangaroo.• Poverty, funding, isolation, ownership, community development

knowledge/education, resources, ignorance, hierarchy of needs, priorities etc.

Barriers – People have to want to act on knowledge.

21

Group 2: Remote Community Store

Food Production Food Retail &Distribution

Food Consumption NutritionOutcomes

Issues Access to marketgardens

Product placement Consumers ability Health status

Access to bush tucker Ownership of store &transport

Afford/budget Special determinantsof health:* employment, housing etc.

Distance Profit $$$ TransportSkills/knowledge ofproducers

Store infrastructure Store

Skills/knowledge ofstorestaff/management

Preparation

Cost Choices/qualityTransport,infrastructure, roads, vehicles, weather

Family – culturalcommitments

Availability oftakeaway foods

Skills/knowledge interms of choices andpreparation

Book up Influence of foodadvertising* e.g. Paul’s Ice coffee

Stakeholders Community/CDEP Community Health Dept. CommunityCommunity enterprise Store managers Training providers Store manager/ownerVarious communities:* council/store, healthcouncil

Transport companies NGO’s Health Dept./NGO’s

Private enterprises Owners (of stores) Community groupsHealth Dept. Training providersTraining providersCommunity groups:* store committee* School council* childcare* aged care programs etc.NGO’s

Context USA governmentpoliciesAustralian

Legislation Govt. policy

Legislation Policies programs GuidelinesHistory PovertyRemoteness/isolation EmploymentGeographical/climate/natural/resources

22

Group 3: Remote Community Stores

Food Production Food Retail &Distribution

Food Consumption NutritionOutcomes

Issues Limited productioncapacity

Remoteness* freight* quality/seasonal

Food hardware Nutrition vs.profit/costrecovery

Hunter/gatherer AD Hoc storesstructure* operationalmanagement

Sharing/priority food Minimalist nutritionstrategies

Social/economy Knowing what foodreq.

Services (lack of) Habits – white bread

Bush tucker depletion House design/facilities Lack of store mgmttraining

Introduced Beyond rations mentalityPortion sizes

Stakeholders Primary producers Wholesale grocers Storemanagers/committees

Politicians

Local “killers” Abattoirs Community people CommunityFreight Cost Govt. Dept.’s

Traditional ownersContext Climatic constraints Evaluation of market

sizeDiminishing resources Debts/wholesaler

monopoliesIntellectual property* bush medicine

• Ad hoc nature of stores and structure of stores.o Take awayso One persono Community enterprise

• Stores that function well and clear governance in store operations.• Imposed cooking methods that are inappropriate for cooking bush foods eg.

Kangaroo may not fit into stove• Stoves left on because no warning lights.• Portion sizes – how things are packaged – have to buy 4 not 2 etc.• Make more money on a can of softdrink than a fruit juice or water.• Habits – difficult to break habits.• In Central Australia, no training for store managers. There is for ALPA.• Local Killers – kill cattle and provide to communities.• Traditional owners may get a royalty or inkind produce and support. Often an

arrangement between store manager and traditional owners.• Evaluation of market size. Don’t know potential size of market eg. dry goods sales

– 30 million dollars.• Recovery cost – pass on additional costs of bad debts onto other stores. Sometimes

cheaper to buy from Coles and Woolies than the wholesalers.• Necessity to look at governance of community stores to improve the service to

community people and to stop exploitive practices.

23

Group 4: Urban School Aged Children (Preschool→Year 12)

Food Production Food Retail &Distribution

FoodConsumption

NutritionOutcomes

Issues National food system Schoolcanteens/Tuckshops* F + N policy* no monitoring mechanism* Management (lack of training management, business)* line of responsibility/ accountability - School Council?

Peer pressure Overweight/obesityissues

Local food supply Food safety* refrigerated foods fromhome* access to drilled water

Food preferences(parents influence +child)

Dental carries

Growers*fruit

Fund raising activities* chocolate bars etc.

Food beliefs socialmarketingof foods + advertising

Bowel movementsproblems

Wholesalers* poor availability ofcanteen accredited schoolproducts

Incentive awards*rewards* often unhealthy foods

Food for convenience Physical activity issues

Inappropriatemenus/foods forcooking classes – homeetc.

Climate (hot/coldfoods)

Self esteem &acceptance

Out of school hours care Food presentation Chronic diseaseBreakfast program Access to fast food

outlets& other food outlets

Anemia

Infrastructure/financial DehydrationSchool Curriculum* less health & PE incorporated* ↓ home etc.

Stakeholders Children Children Children ChildrenParents/carers Parents/carers Parents/carers Parents/carersTeachers Teachers Teachers TeachersEducation system* school council

Education system* school council

Education system* school council

Education system* school council

Local Govt. Local Govt. Local Govt. Local Govt.Fooddistributors/cateringagencies

FD/catering agencies FD/catering agencies FD/catering agencies

Transport companies Transport companies Transport companies Transport companiesAccredited bodies forSchool Cant.

A bodies for SchoolCant.

A bodies for SchoolCant.

A bodies for SchoolCant.

DPI DPI DPI DPISport & Rec. Sport & Rec. Sport & Rec. Sport & Rec.Fast food outlet Fast food outlet Fast food outlet Fast food outlet

Context DAA School Nurses Nutrition workers Nutrition workersSIGNAL Nutrition workers

* EHOs & HPOsSchool Nurses*EHOs & HPOs,* SHAPES ?

School Nurses* EHOs & HPOs* SHAPES ?

IntersectionalAdvisoryGroup

• Issues based around food and nutrition in schools. Changes in governmentdepartments and high staff turnover can affect sustainability of food and nutritionprograms.

• Fit in at food production eg. DAA, SIGNAL, intersectoral advisory group.

24

Group 5: Remote Community Food Supply

Food Production Food Retail &Distribution

Food Consumption NutritionOutcomes

Issues Supply and demand Transport Obesity MalnutritionKnowledge and skills Store management

issuesCookingfacilities/functionality

Obesity

cost, time & ownership Limited supply Food preferences DiabetesAccess issues Cost Advertising Renal disease

Access to bush tucker P.C.D.Peer pressure

Costs tosystem/society

Cultural satisfaction* fat, sugar & salt

Cost to family

Money availability Loss ofculture/wisdom

UnemploymentGamblingSharing/obligations/humbug

Stakeholders Landowner Freight companies Consumers ConsumersFarmers/food growers Consumers Store managers Health Dept.Community people Store managers Advertisers ResearchersTrainers + localexpertise’s

Food companies Tax payers

Store committee CommunityCommunity council Service providersParents/carers/relativesTraditional owners

Context Cultural Infrastructure Poor infrastructureMoreimportant/immediatepriorities

Weather Access to healthfulinformation

History Road conditions Distance/remotenessEnvironment/climate Lack of Govt.Talking up economicpotential/possibilities

Commitment

Profitability

STAKEHOLDERS

• JC – List of stake holders• Example – homework policy

o Group involved – school principal, teachers, parents, representative fromkids, after school care staff .

o Even with a small policy there were a range of people who were consultedwith and brought in.

• If look at number of stake holders involved with food supply – enormous.• If policy is about bringing people together collaboratively on an issue.• Around food and nutrition there are a number of stake holders that sit outside of

health and outside of government. Interesting that medical doctor does not appearsingularly in the list of stakeholders and that this key person has been lumpedunder health department personnel.

• If make a health issue only a top priority for health people.• How do you engage with a range of stake holders to engage around an issue when

their priority is not health?

25

• A number of stake holders that kept coming up eg. store managers, store owners –training for store managers.

General comments relating to Activity 4

• In terms of context – remoteness.• What is the difference between a pastoralists company and remote community - a

pastoralist company have means to buy up big, cook, infrastructure.• A level of wealth – privileges that are built into the contracts that people have to

work in remote communities, such as receiving a remote area allowance to pay forfreight etc.

• Assumptions – communities treated differently to stations.• Cattle station – consumer not retailer – this is not always the case.• Cattle stations are sometimes the retailers to local people.• Community councils under local government act or can be associations or

incorporations or Aboriginal corporation under federal government act.

Presentation – Evidence base for NT Food and Nutrition Policy,Mark Lawrence

• Lessons from food policy experience.• Experience from previous policy experiences.• Leadership is about the process of change and managing that process.• 2 types of leaders

o champions – high profile, passionate, pull people inchampion makers – build other people up behind the scene.

• Intersectoral nature.• Different levels of governance.• National, global, economic policy, exchange rates.• Resources – dollars and time – often given 3 or 5 years to prove success• Action plan and implementation agency.• Values – a statement about values. It is political, competing with people with

competing values.

F – Many of the issues that have been identified are about the history. It is really importantto remember that speed of change and speed of progression is going to be slow.So for people involved in local policy, engaging in things where you can make adifference and starting with something that does have potential to influence is important.

Conclusion to the day-

Today’s discussions have been a fabulous back drop to what we are going to be talkingabout Tuesday and Wednesday. By Tuesday afternoon, we will be talking about not justbarriers to change, but facilitators; things that people can make use of for change.

26

DAY 2Recap on previous day’s activities and discussion

F- Policy is driven by values and whose values can become prioritized and mostprominent. For example, genetic modification around crops and food is a good example ofthe value system. There are 2 camps. One camp says we don’t know enough aboutGenetically Modified (GM) food and its impact on environment and health and thereforewe should be very careful. The problem in terms of a policy position is that it is a healthand environment thing.

Australia cuts the GM mustard in the international food trade environment. If we are notthere exploring markets for GM foods we will lose our export drive. The problem here iscreating an export to move from a pastoralist economy that has been dominated by cattleand traditional method of agriculture to a bio-tech economy.This is how the argument and debate rages and it is a question of which side of the debateis getting the most coverage. The health issue is a non issue – interested in the wholeexport thing because this is about trade, economy, money etc. However in the EuropeanUnion (EU) the health issue is dominant. In the EU there has been a history of food scareseg. mad cow disease, salmonella and a whole host of problems embedded in the foodsupply and so health is way up on the agenda. This has not happened in Australia,Australia has not had a health scare. Each side will roll out its evidence to show there hasnot been enough evidence or that GM crops can contaminate the local environment. Theother side will roll out the evidence to show how important it is for Australia to becomebetter at exporting its commodities.

In the afternoon we looked at the food supply, the issues, the players and the context.

Yesterday we looked at policy broadly. Today we will concentrate on a more focuseddiscussion.

3 muddy points in particular that people identified from the previous day (refer toappendix).

1. Weren’t clear about making paper lanterns!2. What is policy – what do we mean by this funny term policy – what’s a

programme and what’s a policy. Talking about 2 things here. Policies for activities– JT presented a set of priorities about what should happen – what is the flow on –such as the access to affordable food, there are some areas that need to beaddressed for that policy to take place. How do we get agreement?Programs are being informed by a number of considerations brought together by anumber of stakeholders that bring breadth etc.What is our policy on fair trade, what is our policy on equal opportunity? SA foodand health policy thought a whole lot of programs would roll out but ended up withpolicy on issue. For example, what’s our policy on food and nutrition – a benchmark that they can always go back to. They did not roll the policy out completely,they used it as a benchmark. “our policy on this issue is….”There is a difference between policy on an issue and policy to inform activities.

27

Policy is about principles about organizing a range of activities that should flow onand that organisation is essential – who is involved, the clout people have etc.

Medical people are a bit invisible in the list of stake holders. Yesterday we pulledthe nutritionists out as stakeholders. Suggest to leave in the back ground one of themost powerful lobby organisation and professional groups is worthy ofreconsideration. Imagine if you had the General Practitioner association backing itup. This is about clout.

How are these people being engaged in order to bring about this coalition. It isabout bringing in the groups that you could work with. The compromise would bethat doctors are highly clinical.

3. Context – what do we mean by this?The idea of context is that issues don’t arise in a vacuum there is some backgroundon why these issues arise. What was the underlying anchor for a lot of these issues.For example looking at the historical context – what are the overriding forces thatyou have to tackle. Poverty – contextual stuff about economic rationalisation. Thefood supply can be driven by this – technological change etc.Ask the question why and then get to understand the context.

Todays program –• Presentation from people who have done policy.• Pull out from these case studies things around what made this policy work –

things that enable and things that are barriers.• Mark and John – will be interviewing presenters.

Case study 1NT Food and Nutrition PolicyPresenter - Megan Wingrave

The process of development

• 1995 – 2000 policy – one of the main contributors was the audit of nutritionactivities in the NT. This audit identified greater potential for collaboration andconsistency in approach.

• It provided the baseline information.• Outside of the Territory was the National Food and Nutrition Policy. This is the

context. A background initiative setting the pace for the development of the NTFood and Nutrition Policy.

• Funding was provided to develop the NT F & N Policy.• Good tucker workshop held in Katherine. Provided opportunity to share stories in

nutrition and networks were developed.• Commonwealth funding from 16 funded projects and NT government matched the

funding. Key to the process were the Aboriginal and intersectoral advisory groups.• Consultations in over 50 communities.• 4 background papers developed:

o Food supply – mapping process of distributiono Educational issues – role of school canteenso Nutrition and the health system – the cost of diet related disease

28

o Food and nutrients in remote Aboriginal communities- using store turnoverto evaluate nutrition and how store managers can influence what sold in thestore.

• After this a draft plan was developed – sent out and received lots of feed back.• Priority areas of action were identified.• Through policy implementation, THS was seen as the lead agency. The aim was to

get whole of government involvement. There were representatives from othergovernment departments involved in the process, but this did not reach ministeriallevel. The policy was endorsed by THS.

• Findings from the evaluation of the policy (conducted by D. Mackerras)o direction was right, needed to fine tune.o work on the goals and targets.

• The development. The process for the revision of the policy included addressingthe recommendations from the NT Food and Nutrition Policy evaluation andincorporating feedback from NT consultations which were conducted by SIGNALfor a national policy.

• Key points in the development processo Gathering information process ie. original audit, broad consultation and the

background papers.o Engaging relevant non health sector people.o Funding for development, NT matched Commonwealth funding.o 2 stages – the need to get the policy up (policy development) and then need

for policy implementation.

P – Leadership factor – this was a facilitator. The person up front talking policy at anational level was Vikki Taylor. In exchange Cheryl Rae ( the then president of DAA)saying if they put up this money we will match it. It was a policy for activities. Theleadership was of someone who had a very high public health profile and was able toencourage people at a national level and territory wide level and consequently the dollarscame in so that we could do so much more – for consultations, back ground papers, andthe intersectoral meetings, particularly to support the Aboriginal committee who camefrom all over the NT.

P - Work on food supply, market gardens, a lot of links with fisheries, agriculture etc. Interms of the three elements of policy– order, authority, expertise - what the policy did wasdemonstrate a number of policy areas. It had authority. The expertise was very much interms of the consultation phase and also establishing the authority. The consultation phasebrought in communities but also ATSIC and those bodies that represent the issues ofindigenous people.

• F - The term that is used a lot in terms of policy in practice is ‘building capacity’in order for policies to bring about change there has to be attention given to thingssuch as how are workforces going to respond to some of the activities that aresuggested by policy.

• F- The term ‘capacity development’ rather than ‘capacity building’ – this suggeststhat there are already things in place that we can take advantage of. Was capacitybuilding an important element of the policy recommendation?

• F - Where were those things in this kind of policy development?P - There is a statement about skilling indigenous people and some of the grants have beenfor nutrition workers. Batchelor was to get training up for nutrition workers. Also moneyfor IT assistance such as market basket surveys and this fed into the process. We have datathat informs the policy makers at different levels – community, management and a

29

political level. And when it goes to cabinet it goes to a higher level. Money was put asideto build resources for this IT infrastructure that could support information gathering. Alsomoney was set aside for training of health care workers in nutrition.

• P - An enabling factor would be that there was money available for nutritionworkers. Looking at ways to attract more funding all the time. Can’t just sit there,have to work with the policy all the time.

• F - Making the policy come alive – giving it grunt. Using the policy to lever morefunding. These are enabling factors.

• F - When we looked at the stake holders and the range involved in the food supply,where were these people in the policy development process in engaging these nonhealth issues? Clearly a lot of people important in influencing policy but perhapssat outside this process.

• P - Many of the Aboriginal people did not come from a health background. BobHughes did a very good job of involving stake holders. Impression that theconsultation was very extensive.

• F - 2 issues – one is consultation and the other is engagement. We can consult witha range of stake holders and then it is about getting some kind of commitment fromthese stakeholders.

• P - An example of an enabling factor in working with stakeholders outside ofnutrition is – Darwin Bakery and the high fibre bread & ALPA – the Good FoodPeople

• F - How would you judge the success?• P - The program has been so good. One of the barriers is the continuing

restructuring and turnover – lost some of the champions and some long termers.Use the policy to develop service plans, report every 6 months against performancemeasures that had been negotiated. People’s activities are implemented in terms ofpolicy priorities.

• P – Nutritionists doing extremely well. In terms of the work of the nutritionists inrelation to the policy there seems to be very good agreement – the day to day workthey were doing and the policy priorities. Nutritionists have a strong policy and sohave been able to continue despite the restructuring.

• F - Broaden focus – the extent to which the food and nutrition policy engages withanother area of work.

• Work together at the local level.

• F to P - what level would your organisation (outside health sector) engage with thepriorities of the nutrition policy statement ?

• P - Absolutely, see this as a critical component of the development. A goodnutrition policy in a holistic sense. There are some foundation issues to do withnutrition that the Dept. is dealing with such as the structure and governance ofstores. That is why we are here so that we can get a greater interaction.

30

• F - More than an awareness that there is something called a food and nutritionpolicy. Is there more than engagement with?

• P - No

• P - Environmental health standards – only 10 years ago stores built basically forstores eg a garage, one toilet, one room for cooking etc – there were a lot of issuesbeyond nutrition. In the last 8 or so years, we have got better at delivering betterinfrastructure, before used to throw a bucket of money. Activities complement – awhole lot of other policies and own core activity and given that normallyunderstaffed, we’re not walking around saying we have to do this under the Foodand Nutrition Policy but we interact with it.

• F – any planning or anticipation on what is going to happen after 2006.

• P – the stretch goal is 2005. However policy changes can come with changes ingovernment.

• P – with the new structure have a better chance of planning further.

• P – Australian drinking water guidelines is a policy if you like- it has a rollingreview which helps to keep them alive. Annual reviews are important for this.

Summary of Enablers and Barriers

Enablers - leadership, consultation and intersectoral commitment at a fairly highlevel, a good sense of collecting the data, the evidence, linking with other policies.• Linking to relevant policies• Information from SIGNAL consultation• AUDIT (1993)• Consultation – ALPA + engagement• Obtaining evidence• Funding (THS matched Commonwealth) to develop policy – support policy team,

paid for consultation, travel, intersectoral meetings, background papers etc.• Leadership – Vicki Taylor, Cheryl Rae – helped secure funding• Review and further development• Policy then used as a lever to pursue and secure increased funding• Policy then used for planning service delivery• 6 month activities were then measured against policy indicators

Barriers –• Did not receive intersectoral support• Continual restructuring and management changes• Staff turnover

• F- While there may not be overt direction from intergovernment agencies thatinform their various working areas that this is a top priority there is somethinghappening on the ground – this is quite organic – initiatives grow up around localproblems.

31

• F - In terms of using policy as a lever - can’t think of a better state or territorypolicy - it is probably the model.

• P – so why do I feel frustrated – I guess there hasn’t been much improvement inthe food supply after 5 years work we still have a food supply out bush that takesup 30% of the income of people on unemployment benefits, still limited variety.The last year’s market basket survey shows that there has not been much changein the food supply in the last 5 years.

• P - Cost, availability, management – these outcome measures have generally notchanged.

• F - If you measured processes instead of outcomes would you have recognized ormeasured changes in terms of the lining up of activities around areas of the policy?

• P - We have a lot of tools, information, we know the food supply really well, butthere is something that the policy misses - tragedy that there has not been thatwhole of government approach.

• P - The recognition – the Northern Australian Nutrition Group feeding up to theMinisters. These activities have led to this being one of the key activities that couldpotentially be beneficial. For example, the Pit Lands, some of this has fed into theMai Wiru policy.

• F - Local collaboration agreements - people can do things locally and achieve greatthings, but need to get going.

• P – looking at it from a 25 year spectrum – there have been major changes – beforethere was no consensus we were all collecting different information the fact thatthere are ATSIC meetings and nutrition is on the agenda is a significantachievement. The roll out of the zones, the fact that we have nutritionists who areworking and committed to overall ideals and values. We have Aboriginal peoplewho have been empowered to say something when the store manager says ‘I amnot going to bring in fruit and vegetables,’ that the council will charter in a plane.

• P - Northern Australia – QLD, WA, NT looking at nutrition issues. For example,tidy towns we have engaged with this initiative. Big things and little things andhave been plodding around.

• P - Engagement of NGO’s eg. Fred Hollows.

• F - Let’s take this to a larger context – for every step forward there are 2 stepsback. Frustrating area – overall sexiness and overall appeal. It doesn’t seem toengage in the same way as HIV AIDS, these infectious disease that get money andmake big changes pretty quickly. Nutrition is an area that struggles if you look at itfrom the bigger picture. A whole set of constraints – food industry etc.

• F - Get the point that you have not seen the kind of outcomes you would expectafter 5 years, important to look at spectrum of process and changes at this level.

32

CASE STUDY 2Mai Wiru – ImplementationPresenter: John Tregenza

Access and equity - the 2 principles that drove the policy. We did not look just at food,but other things that affect health.

Enforcement – ability to monitor the frustration - you can have a policy but nothinghappens. Remote area stores, the only place where people get their nutrition from.A lot of activity came out of the policy.

Necessary to firstly look at the issues - income too low and costs too high. The only areathat could realistically target was the cost structure. Can’t do anything about the income.Engaged a whole lot of people and developed a healthy stores box. Three categories weredeveloped for subsidizing and fixing food process. Used the capital city as a marker forcost of foods. It is a matter of equity. Need to identify what things are going to subsidise –looked at healthy food, asked nutritionists to identify that, also looked at healthconsumables, and health hardware ie. Utensils, tucker boxes, frying pans. Decided that allof these things should be targeted and at an affordable price. Relied on a lot of otherorganisations such as the Women’s Council to do parts of the work.

Classic lunch of Coke and chips. A lot of discussion about this in the community – to banchips and Coke. We were told that Coke will sue. Instead the senior Coke executives camefrom Sydney and said “we have read your policy we think it is great - here are all the otheralternative products”. This was a total non issue – not illegal to have them, just won’t findthem in the stores. Water is a principal staple – policy is that the stores will provide freecold water. Implications for these changes. There are 93 regulations. The policy is togovern all food outlets eg. Even including football carnivals. Take-aways are a big issuebecause of problems with preparing food in the home, people are reliant on the take away.

Training of Aboriginal workers and recruitment in the stores -employment of people whohave no understanding of Aboriginal issues or nutrition. There is huge unemployment, yetnon local couples, their extended families etc. removing ½ million dollars in wages andother illegal practices. Standardise practices across the community stores. Many storemanagers are recycled from one community to the next. Transparency and communitycontrol in terms of the control. The community people are the owners but the owners don’tknow what is going on in the store and the managers don’t know either. Not one of thestore managers had a budget. Retailing millions of dollars a year. Councils have strictbudget guidelines – their employees, the store managers running without budgets a bigbucket – this is the reason for high costs of goods. For example, if fridge breaks down dipinto the big bucket surplus. Aim to have better financial management of stores. What wedid about pricing and cost – implementation has been a very slow process, and we areawaiting funding from all the people who support the policy to put their hands in theirpockets.

Fixing prices to Adelaide retail prices – one thousand dollars per head per year would beneeded ie. 3 million dollars per year needed to make these items affordable. Crosssubsidies was mentioned and rejected by the community eg. $1 on cool drink andsubsidise fruit and vegetables. All this does is for the addicts, less money – a poorapproach to the problem. Contracted some people in Adelaide who run some IGA stores –

33

one of the lowest in the social ratings – needed some retail information and expertise – tofind out what is happening in these stores and their mark ups – mark up between 50 and100%. IGA know the freight costs and estimated that would not need any more than 30%mark up on costs if ran store efficiently. Mismanagement or dishonesty. Where are wegoing to find the money to plug the gap. Mismanagement accounted for about 1/3 of thegap, therefore if managers rotated stock efficiently etc etc, could eliminate this cost fromthe cost of food. Eg. Red heart tick a whole line of products that are available to people.What about a “D” for diabetics. Whole range of alternative products eg. acceptablealternatives to fizzy drinks and sweet foods. Tasting events to educate people onalternatives. Keep hearing that theft is a big problem – not Aboriginal people – experiencethat the people are not thieves, the thief is sitting at the desk. The other 1/3 of thedifference between affordability and cost was freight. Got on to SA depot. Left out theNorth West, so now are having transport studies and looking at options for freight eg.maybe should just have one company that does cold and another dry goods for allcommunities. High costs as no efficiencies of scale. Remoteness is an issue. Issues ofcentral storage. For example, if have opportunity to bulk buy, can buy a heap.

At the end of the day there will be a gap. Given that the policy states that these prices willbe available at Adelaide city prices, left with a problem – only solution that there will haveto be a subsidy. Problem that belongs to the citizens and not the victims of disadvantage.All the richest people in Australia get subsidies why should not poor people. SocialEconomic Modelling through ANU is modelling options for subsidising identified foodand other items. Use this for ammunition so that when the political lobbying starts at theend of the day going to need 500 000 dollars off you fellows. This is currently happening.Have a computer model if you subsidise on this what is the affect on pricing, should it beon freight, wholesaling or what. Wages and salaries are a huge cost. Having deconstructedstores from a place where you make money to where you provide healthy food is a healthenterprise. When ATSIC or another agency has not enough money to fund projects theysay get it from your community store. Telling them that now that the stores are no longerenterprises but community services, ATSIC should be giving the wages etc. Noaccountability – pay off significant debts, like bribes, leadership in communities often tooembarrassed to attend meetings as in debt to store manager and so if advocate for change,will have to pay the store manager back. Rather than booking up $10 000 and the storemanager using it as a lever, allocate this amount of money in the budget for these leaders.

Repercussions – everyone driving to pastoralist’s store – leaving key card behind. Musthave subsidies ready and needs to be a co-ordinated process so as don’t have negativerepercussions.

People involved – ATSIC (word of mouth), community councils, principal funding hascome from FACS in Canberra to develop the policy and carry out some of theimplementation.

Impediments – these are local and people have invested interest in chaos in the store, andthe people in the communities who are linked to this kind of activity. Put the wages ontoATSIC – if acknowledge this for the 10 Pit Lands store, will have to do this for some 300community stores in Australia. If roll over on the argument have no where else to stand –some reluctance and tardiness – verbal support saying wonderful policy saying yes we willsupport it - a hiatus at the moment – Nganampa Health has carriage on the policy, LandCouncil not in the position to administer and manage this program. Willing to do it foranother 2 years to be responsible for the funding, to be responsible for the changes in the

34

store and set up a monitoring unit. Funding has been used for steering committee costs andthe consultative process demanded that have these people, JT to go around thecommunities, IGA consultants, 4 Pit Lands project officers who lived on the lands andwent around having community meetings, reporting back problems, issues to be looked atetc. Most community controlled organisations are short of money and too big a task toincorporate in their everyday program.

Policy directed at activities – policy statements and regulations have to be implemented. Alot of hiddens that have come up that didn’t think of – eg. Case offs – These are specialsso that the store managers can buy 10 boxes of weeties instead of 8, for example and getsent to refund. These cheques turn up in the store manager’s office. How much money isgiven off in case offs – $300 000 to $400 000 comes into the stores every year. Thisperhaps could start a fund to offset profits. For example, women’s groups misses out on itsfunds, money goes back to specialized groups. Put these ‘case offs’ in a special account –use these funds to distribute to stores that have made changes in line with policy ratherthan being used by store managers to manipulate people.

Some improvements have been made – bigger fridge spaces, more variety of fruit andvegetables. Some of the money to be used for the policy went into paying for fridge space.Have improved the situation and now the store managers are better off but the communitymembers are not.

$800 000 across the lands for store managers. Cost savings - economic rationalists wouldbe able to appreciate that food coming in would benefit health costs. Health service isbasically a palliative care service.

Huge infrastructure to set up a garden, not many survive for very long, and people’slifestyles don’t lend themselves to looking after gardens and maintaining them eg duringceremonial time. Require outside expertise – a lot of demands for vegetable seeds.

Enablers• Establishing agreement on healthy stores box.• Elimination of unhealthy foods from healthy stores although this turned out to be a

bit of a barrier.• Some accountability back to the community.• Bringing some expert group into economic modeling.• Deconstructing a commercial enterprise and reconstructing as a community service

– not for profit but community minded.• Has to be historically and contemporary parallels that can be drawn on.• Champions in the community.• Start up funding to get things moving.• Community control.

Barriers• Non indigenous managers in stores not knowing the history, culture etc.• Low skills in store management.• “Big bucket” accounting.• Corruption – “Payola” – paying off leadership in communities.• Unco-ordinated effort which is about the way if you do something to this store the

customers will find something elsewhere – flow on effects.

35

• Commitment from ATSIC - if commit to this then have 300 stores have to make acommitment to.

• Lack of local support especially funding for implementation ie. lack of local accessto funds ie. State government.

F - Talking about a policy process happening in the North West of SA, from a jurisdictionpoint of view does not engage with the NT. The question is why would this policy not bepopular in the NT? One of the advantages is that it is enforceable as have a group wherecan be enforced across whole area.

P - There is the store charter that has a similar feel to it but trying to cater to issue ofacross jurisdictions.

P - Environmental health – community driven not government driven. Have haddiscussions with Dept. of Health and Community Services looking at fridge temperatures,cleanliness, some of these things can be done by local people on the land in line withpolicy. Under the new food legislation – EH officer may only get to a store 2 times a year,more responsibility put on actual operators required in new legislation to make sure thatthis happens.

P – well informed about what is happening in the Pit Lands. Store Policy came up severaltimes. Positive example. Deconstruction of store to community service, difficult to getfunding. Know what they are up against. Part of the process of policy activity, justbecause you have policy does not mean that everyone is going to act on it.

F - In terms of progress, this is fabulous, now what you have is a really savvy policy thatnot just talks about citizen and human rights but has a number of legs - the economicargument. The thing about policy work is that already you have a policy and you knowwhat the battle field is like. Get a sense of how far you are going, how close can we get toit. This is the strength starting from a broad base of commitment etc. It’s about activism,community control and empowerment.

CASE STUDY 3Central Australian Aboriginal Buying ServicePresenter: Peter Clements

Good policy is derived from those people that it most affects. The evolution of storesstarted when people were hunting kangaroos. Back then, it was difficult to store food thatwas hunted, so people shared a co-operative way of dealing with too much food on thebasis that the next person that gets a kangaroo will share it with them. This was mainlydone with family groups and kin. When the white man came, the missionaries gotinvolved in communities and used food as an enticement to spread their faith and togenerally indoctrinate people into a western style of living. As an extension of this,government policies of the time included the use of food kitchens, these were designed toconcentrate people in one area while allowing pastoralists a fair go at ‘owning’ the landfor raising cattle. Food kitchens started up where there was a water supply which led to .concentrating people in an area away from their homelands.

In the early 80’s in Dept. of Aboriginal Affairs, started to look at development of ownstores mainly because people were not getting a fair go as principles of self management

36

came in where people were encouraged to look after their own welfare. Money waspushed out to individual groups, council etc to commence their own stores, a lot of thesewent belly up, very little expertise. There was so much confusion about what peopleshould be buying, what they should be eating and who should be funding what. I wasinvolved as a finance person in winding up community stores due to bad management,people rorting the system, not just white store managers but traditional owners havingtheir share of things too. Following this period of about 10 years, there have been a lot ofinitiatives all over Australia. l think probably the best one so far is the Mai Wiru conceptand the Store Charter that help to provide some solid guidelines. There are exciting thingsgoing on in Central Australia. In the last 6 months there has been a growing awareness ofdealing with nutrition and stores policy.

The CAABS has developed with 22 community stores, a central buying awareness towork as a type of Co-operative. A stand-alone buying service, a fee for service charged ondistribution of goods that are planned to be about 15% less than the price of goodsavailable to stores now. The plan would involve contracting the service out to a third partyusing a trial of 4 or 5 stores, and depending on the extent of success, using the findings ofthe trial to develop a central warehouse.

The Deputy CEO of Local Government has taken a key interest in food and nutritionissues affecting communities. Discussions are taking place currently with grocerycompanies in the eastern states. As manager of Policy and Projects my task is to co-ordinate the project and form a working group in CA and take advantage of work that isalready done and collaborate with nutrition groups who have already made in roads intothis area. A more comprehensive study would reveal that communities in CA spendsignificantly higher that 30% of their incomes on food.

Where is the funding coming from for the initiative? This is why we are getting a workinggroup together. It is imperative that alliances be formed that reveals the truth about thethird world standards in existence in CA with food and nutrition. There are some figuresavailable on the cost benefits of bringing good nutrition into remote communities. Thesefigures will startle many people when it is realised that the cost of good nutrition is faroutweighed by the cost of poor health. If I can use the analogy of prescribed maintenanceon a community vehicle. Without periodic maintenance a vehicle realises a fraction of itsworth prematurely in its life and provides less use because of down time due to lack ofservicing.

We cannot equate the cost of human life with money, so far, I don’t think anyone hascome up with a value on human life. But if we have to use an economic argument toconvince the government of the folly of poor nutrition we should.

Enablers:• Availability of an existing policy (Mai Wiru)• Changes to government’s reactive policies through lobby groups• Trialing in 4 to 5 stores first• Lobbying

o Central Land Councilo Office for Aboriginal Developmento Nutrition Section of THSo Politicians

37

Barriers :

Biggest barrier – discussion and deliberations with the CLC. The Central Land Councilare aware of the issues but there are 2 problems. One is that CLC works for the traditionalowners and these people have rights to royalties, rentals etc. One of the challenges will besatisfying the traditional owners. These people have a right to certain things on theselands.

• Discussions with Central Lands Council – the new approach will requirecompensation with respect to its impact on traditional system.

F- Having some centralized buying service may detract from some of the benefits thatflow onto Traditional owners.P - If we come in with a new structure for stores we will have to think of ways tocompensate Traditional owners.

F - To what extent has “Payola” become embedded in a quasi traditional setting ?

P – A Take away owner on a remote community has high overheads in Payola.

P - worked on the steering committee. Lobbying was an important component in gettingthis initiative up. Took a lot of ground work talking about possible benefits.

F – Why so much concentration of concern at the moment? The planets have lined upsomewhere in the universe, finally for this matter. A number of issues arose at the sametime that dovetailed with other initiatives from different sectors. Among these was thecoalition building around the issue of food advertising to children, the problem ofoverweight children, the store manager’s fraternity etc. When these all lined up we hadsome critical mass to work with.

CASE STUDY 4Overview of Alice Springs Hospital Food and Nutrition PolicyPresenter: Megan Scott

Developed in 1996. First step to run focus groups with the kitchen staff. Asked thequestion to kitchen staff - you are providing the service what do you want to provide? Thisgave a sense of ownership and opportunity to draft goals. These goals were then discussedmore broadly. What made it work was the sense of ownership, the kitchen staff took it onboard, they know the clients etc. as well as the previous work done by the dietitians, thatthere were the low fat, low salt, low sugar foods, working within dietary guidelines andNHF. The turnover of staff was a barrier, just another poster on the wall, many casualworkers, but then some long term staff, providing the “corporate memory”. Other playerswere the catering manager and operations manager. The tyranny of distance andmanagement sitting in Darwin for Central Australia was also a barrier. Kangaroo is nowon the menu.

F - The initial consultation – was the accountant involved?P - no but the kitchen staff – what do they want to do, how do they see their roles.F - would it have been important to have an accountant involved. Would it have beenimportant to have someone to look at the cost implications?P - Don’t think it went past the catering manager.

38

F - In terms of the three levels that Colebatch talks about, it gives it the face of authority.The economic argument always comes up.

Enablers:• 1996 – coincided with food and nutrition policy• Enthusiastic new graduate• Previous work of dietitians• Initial consultation

o Meal providerso Catering manager

Barriers:• Staff turnover• Dealing with other personnel

o Catering managero Referring to Darwino Accountant with hospital

• Perceptions about costs of healthier food

CASE STUDY 5Anzac Hill High School CanteenPresenter: Avenal LockettThere was no record of when the policy was developed or whether dietary guidelines wereconsidered when developing the canteen policy or who was involved in the policydevelopment. It depends on whom you talk to – those who believe in an inclusiveapproach include most of the key stakeholders. If you talk to others it appears there waslimited involvement. So who developed the policy is unknown.

Enablers:This school prides itself on being a healthy campus. Staff still can purchase coke from thestaffroom fridge, but it is not sold in the canteen. The school council and the principal arereally supportive. We tap into the local nutritionists for information and support. There areregular school canteen meetings. The school canteen manager is leaving and the previousmanager with an interest in nutrition and healthy lifestyle is returning. The students are onthe school canteen committee. Prices in the canteen are low and healthier choices have aneven lower mark up. There are lots of displays around the school, fat and sugar displaysand posters. Super Food Ideas (food magazine) is available in the library for the students.The students work in the canteen as volunteers. Students working in the canteen havetraining sessions with the nurse on occupational health and safety issues - discussions onspills and hygiene, personal presentation, hand washing etc. plastic gloves, food safety.The canteen sells hot dogs at present but hopefully that will change. Rather than sausagesizzles for celebrations and fundraisers, we now have hamburgers with vegetables andfruit.

• ANZAC prides itself on being a healthy campus eg. No soft drinks• School council and principal are supportive• Canteen meetings – regular communication• Links to Nutritionists in Alice Springs• Price of healthy food

39

Barriers: Some of the barriers to this canteen are the transient nature of junior secondary schools,and that of AS. The lack of ownership of the canteen policy and it's ability to be open toindividual interpretation. The canteen is very small space and is poorly designed for itspurpose. There is limited time for preparation as well as a desire to have some profit.Lack of support from some staff, the attitude – “the food doesn’t look good, I cancomplain about it but I don’t think I can initiate any changes ”. Lack of service evaluation.The size of the school also impacts on the number of food varieties that can be sold. Amajor problem is competition to the school canteen from a fast food outlet across the road.Double standard of foods provided at the school, the homework centre – tends to providefatty sugary types of foods.

• Lack of ownership• Technical barriers in canteen – not enough space• Policy open to interpretation – being used for increasing profit• Lack of staff support for change• Lack of supervision/ direction for canteen manager• Size of school limits variety of foods available• Food brought in from outside eg. Coke from nearby shop

F - Notice how some of the barriers and enablers in a micro setting are similar to themacro ones like champions outside support etc.

40

CASE STUDY 6Gap Communtiy Child Care Centre and Outside School ProgramPresenter: Jane McDonald

Jane is the Co-ordinator of the outside school program. They also run a day care centre.Outside school hours care only started last November. The Policy specifies certain foodsthat aren’t allowed.The Policy was in place before Jane started and has been around for a while. Centres areregulated by a national accreditation standard. Accreditation standards are a driver toenforce policy. Have authority to close the service if policy is not practiced as considereda serious breach of practice. How easy it is to enforce the policy? – problem with the childcare - have a high staff turnover and making sure staff and parents are aware of the policy.All families are given a copy of the policy. Have a committee that runs the service.Parents, staff and interested parties are on the committee. This committee speaks to staffand dietitians and nutritionists are involved. The centre provides alternatives so that ifchildren bring bag of chips, it is replaced with a piece of fruit.

F - If you have to replace an item of a lunch is there a cost involved that flows onto theparents?P - No, morning and afternoon tea is provided.Some parents do have a problem. They think it is too rigid and does not allow themenough input into what they are choosing to feed their children. The policy does not gointo enough detail eg. What is sweet custard and acceptable custard.

F - Running into the restrictive nature of policy.

P - Outside school hours – should have some more flexibility – children asking why can’twe ever have chocolate etc. The policy was changed and has been approved and is beingimplemented and is to be reviewed in a month. It does not state what you can’t have.Need to educate children and parents on healthy eating practices rather than restricting andallow students to choose and develop the menu and help prepare and cook the food. Thisis a great way to get children involved and teach about healthy foods. Modeling healthyeating behaviour eg. eating sandwiches before eating chips.

F - An example of the complexity of policies at different levels and for different agegroups.

Enablers:• National accreditation standards for child care• Links both with parents, staff and Nutritionists• Complement with nutrition education to parents and children• Practical food demonstrations

Barriers:• High staff turnover• Enforcement• Some parents believe it is too rigid• Some believe it is not specific enough regarding foods – good/ bad

41

CASE STUDY 7ALPA Food and Nutrition PolicyPresenter: Robin Lion

ALPA Food and Nutrition Policy – to give a historical perspective 1989 to 1993.Robin worked with ALPA years ago on this policy. ALPA is a retailing co-op and isowned by Aboriginal residents in NT Arnhemland. They also manage some communitystores.Board of directors made up of Traditional owners from each represented community. Thestore managers have to comply with what the Board of Directors say.

A team of people from MSHR – Mandy Lee and Annie Bonson. Mandy was looking at thestore turnover method of validating food intake in remote communities. Two young menin Minjilang had died from heart attack. People were very distressed about these suddendeaths and went to council to discuss the issue of food. This happened over about 3 years.Together with the community they decided to look at what was being sold in thecommunity at the time of these 2 young men’s deaths.

Slide on store turnover data from Mandy Lee’s study – 14% of energy intake from flour.Soft drink 7%. This only confirms what we saw with ALPA sales data.Looking at fat intake – fatty beef was a big issue. Communities were being supplied withfatty beef – half of it was fat, the rest was meat.

What did ALPA do as a group? – they came up with a policy. Slide showing aim of policyand policy statements etc.

People were chosen from the community as “Good Food People” and provided somesessions on healthy foods etc.

Shelf talkers were to be paid for by Independent Grocers.

The price of cigarettes was increased by 30% to offset freight of fruit and vegetables.

Preconditions for the policy –• Sense of community cohesion.• Council actually flew in fruit and vegetables when store manager refused to bring

it in.• Support for the policy etc.• Clearly identified problems on which to work.• Community motivation.• Familiarity with and trust of non Aboriginal staff.• Supports of local councils and boards of authority – one of the people involved on

ALPA board, senior administration person was really into food and health.

Health and nutrition were up on the agenda in 1989. In 1993 there was a change ofreconciliation - it went from a church person to a lawyer who was involved in the board.The change was less of a commitment.

The outcomes achieved at the time (presented as a slide)• Increased recognition and community power over the store.• Capacity building with the Good Food People.

42

• Increased skills of store people – training, time out of community.• Not seen just as store workers, there was a status involved.• Increased sale of fresh fruit and vegetables after 3 years of policy.• Less energy from fatty foods and more energy from fruit – Mandy did some spot

checks, most stores had Good Food People, confusion over their role, not all ofthem were trained.

Enablers:• Sense of community cohesion – had heard success stories• Clearly identified problems on which to act – deaths in Minjilang• Community motivation• Familiarity with, and trust of, non Aboriginal staff• Support of local councils and boards of authority• Leadership from senior woman, traditional owner

Barriers:• Minister of Health and Community Services and chief medical officers did not

support implementing the strategies used on Minjilang on other communities• ALPA change of leadership• Lack of resources

F - Notion of the sustainability of policy – important issue how you need to keep on thefront foot of the policy issues. In many ways it is about continuing to build coalitions andreformulating policy problem in light of new developments. We have seen a decrease insmoking in many areas. We have kind of won that battle. The tobacco companies are onthe back foot. Public access to legislation – news about dangers of smoking – a lot ofpolicy work going on all the time.F – Regarding change in leadership and how that may have influenced the direction andcommitment. What we are on about is very evangelical. It is about talking up your issueand getting up and championing your course.

43

F – We have looked at a number of policy and policy context. What we will do is – avery pivotal point – about formulating some sort of action - an exercise that requires youto work in pairs. Pick up on an issue – and talk about how will this issue have to change,what are the resources, what are the skills required, where are they going to come from.What sort of action needs to take place around these issues – how will it take placecollectively and individually.

Activity 5: Identifying barriers and enablers in the transition process of moving aproblem to a solution

Task:State the problem and then draw the problem, and then draw the problem if the problemhad not been addressed. Then consider those factors that would help move the problemfrom the solution. Take advantage of the facilitating factors that were identified thismorning. Use imagination so that can translate into context. For example, reputation as afacilitating factor. Select no more than 5 factors that will help with the transition. Then 5factors that will be barriers to the transition, for example changes in leadership, staffturnover. To avoid all doing the same problem, each group will have different areas of thefood chain to work on.

JC presented a picture example: failure to thrive – sick children in hospital, health stafflooking very worried. The problem as it stands. What would the problem look like if it hadbeen solved – healthy children. This is a fairly generic problem.

Another example – lack of fresh produce grown in local communities. House with nothing,a couple of dogs.

We will then pin up the 10 problems along the wall and then each get 5 votes. Each personis to place 5 stickers on what you think are the 5 big priority areas. This is a graphicillustration of ranking priorities.

We have to get back to the settings, the context being mainly about remote access to food.

Placing three dots according to: priority, feasibility and sustainability.

44

45

46

47

48

49

50

51

52

53

54

Activity 6: Policy – JonestownTask:Read the scenario on the 2 courses of action to take to address the problem ofJonestown. If we are to go for one particular action approach, identify what kind ofskills are needed for this kind of action approach, what kind of skills do we have, andwhat kind of skills do we need to get.

Advantages of the 1st

approachAdvantages of 2nd

approach

• Easier• Fewer resources

required• Familiarity• Easy to control• Shorter time frame

or results• Cheaper• Less threatening• Getting stuck in• Politically

appropriate

• less band aid• addresses real

issues• broad strategies• shared

responsibility• long term solution

Disadvantages of 2nd approach:

• takes a long time• limited half life ?• Outcome ?• Community alienation

What are the skills that are required and are absolutely required for this task forceoption ? (2nd approach).

• Awareness of own value system• Big picture view/ vision• Strategic planning skills• Participatory leadership• Facilitation skills• Community leadership• Representation prowess• Tolerance• Slow education and assisting• Shared vision• Knowledge of group process• Documentation skills• Promotion and advocacy skills• Resolve conflicts and interests• Negotiation skills• Liaising

55

F - So often we expect people to get on our canoe. But it is important that we findopportunities to jump into somebody else’s canoe. We might have to think of gatecrashing other peoples parties. It means getting involved in other issues that might not bedirectly our focus.

Where do we get these skills listed in activity 6 from?Respect, reflexive practice – thinking about what you are doing.A sense of informal/ formal nurturing/ mentoring- a much clearer picture of how you getthese skills transferred. A system of mentoring that fosters these skills. About beingaround, putting yourself about, getting involved in things like this. These skills areabsolutely crucial to the policy skills we are pushing here. Think about how you developthese skills.One of the barriers that came up was staff turnover. You feel you are out of your depth. Alot of these skills are hard to report on. The structure does not recognize these kind ofskills because it is hard to report on. Networking is not a category you can tick and reporton. These are the skills of capacity building in a crude way. The whole notion of skillsdevelopment is important, these are highly developed skills.

Day 2 Summary

What has been done in the area of policy – what worked and what did not work?We have shared policy experiences and looked at what did we learn from that. Weparticipated in an exercise on prioritizing policies.

Tomorrow is about advocacy and coalition building. Then we will move into some actionaround these priority areas. Identifying your mates and your enemies – friends and foes.Identifying resources. Separating stake holders into enablers and barriers.

56

Day 3Introduction

We heard from a number of people talking about policy from a variety of perspectives.Some people were talking about the development of policy and the issues arounddeveloping policy. This demonstrated that however micro or macro policy is, certainthings apply and are important, such as ownership, and those people that are going to beaffected by the policy, so consultation is important.

We also heard from people twho were involved in policy implementation and some of thedifficulties around that eg. Mai Wiru. Now in a process of implementing policy – somemovement where the policy has been picked up but also there are a whole range ofbarriers. Then we looked at a range of problems that the group identified and talked aboutthe things that would help move from the problem to the solution. We sorted out those thatwere given most priority. Lastly we talked about the kind of skills that you would need ifyou were involved in policy making eg. getting together a task force.

Back to the very first session – so many of the expectations were around getting policyinto practice, getting action out of policy, getting movement. How do you put grunt intopolicy? What are the factors that help to move policy into action and similarly what aresome of the things that get in the way?

We talked about some of the things that appear to be important in getting this movementin policy. What the success stories are, what the failures are. Do not think that policy willactually solve the problem that you have identified? Policy moves in that direction ofsolving the problem. It is about opportunities and constantly reformulating policy. Youhave to be on the policy all the time, working out how best you can take advantage of thepolicy area.

How do you give some kind of grunt to these? When you are in the process of policydevelopment it is about taking this problem and defining the problem in a way that youthink will address the overall issue and also in a way that you think will have mostsuccess. The notion of consultation is also really important. It is about the way in whichyour definition of the problem is shared by others. If not you have to do heaps of lobbyingto change people’s attitudes or you have to think of a way that you can redefine theproblem to make it look different.

Coalition building – drawing on the strengths of others, getting in other people’s canoes. Ifyou were to get a book about policy – a cycle of activities.

Policy implementation has similar things that give it grunt. Lobbying is taking place withthe Mai Wiru policy. Many of the things that give the policy grunt during policydevelopment are also important for policy implementation.

57

Presentation – AdvocacyPresenter: Mark Lawrence

Advocacy is seen as central to skills needed in policy.Slide 1 – advocacy is that you are calling for something. WHO have done a lot of work inthis area. Can access WHO headquarters website for information on advocacy.

Slide 2 – a statement about values and intentions. Different stakeholders are going to havecompeting values and interests in how the system is needed to be developed.

Slide 3 - It’s about whose values are going to prevail and whose values are going to beobscured.

Slide 4 – Advocacy PlanWHO global strategy consultation.Analysis, strategic (who is the audience, this will shape the advocacy you will develop),mobilisation and then action. Take advantage of other things happening, piggy back onother things.Evaluation – organic ongoing process.Continuity – fine tuning, learning from mistakes.

Slide 5 –• Leadership, who are the people you are going to put forward to the public and who

are the ones that are going to build the champions.• Building a coalition – to maintain the strength of advocacy – who are the people

that share the commitment and have the same outcomes and values in mind?Mapping who your foes are going to be then, can predict the sort of arguments thatyou are going to come up against. Need to speak with a coherent and united voice– speaking from the same song sheet.

• Strategic research – gathering the evidence. What proportion of the diet is beingcontributed by stores for example.

• Framing the issue – what are the key issues. Don’t get distracted into side issuesthat your opponents might put up.

• Some say that you can’t have advocacy without media – perhaps not entirely true,but it is a great way to get your issues out.

• Advocating in a more formal setting – sounds obvious, but need to prepare, need tocaucus beforehand – what are the main issues that you are going to drive. You arepresenting what you have decided, what you want the meeting to achieve.

• Anticipate what your opponents are going to be doing, always be very prepared forthat with the arguments and strategies.

Case Studies - Go through a couple of case studies –

P - if you work for the government do you become muted in doing advocacy?F - There are other vehicles, such as the Public Health Association. We can be effectivebecause we collaborate widely and listen to people involved in implementing food andnutrition changes.. These people are effectively doing the advocacy.

PHA – Public Health Association of Australia. Has several roles but sees itself as a leadadvocate on PH issues. It develops policy statements – eg. policies on gun controls, GM

58

foods. It forms special interest groups and you can focus your area around that group.There is a website on the handout.

Mark Lutschini – convenor of the TSI and Aboriginal interest group, followed up onNATSINSAP. Mark drafted the letter and sent it across to the nutrition special interestgroup. What Mark is doing is a great form of advocacy.NATSINSAP – built from current state & territory policies. Covered a broad range ofissues. There was no financial support for the implementation.Letter went to the Health Ministers and some responses were received. These responsesare on the website. States saying some money needs to come from the Commonwealth.There was some national funding that has gone to SIGNAL to progress the NATSINSAPagain.SIGNAL has a working group, several NT Nutritionists are members.It is interesting to see how the ministers responded to Mark’s letter.You have to constantly work at it because people have different agendas. Lessons to drawfrom this correspondence. Mark wanted to push the issue and make people moreaccountable.

F – a couple of examples of advocacy through coalition building. The first was successful,the second was a failure, it was lots of fun and has grown legs and been taken upelsewhere.

1. South Australian Food AllianceThe SA Food Alliance grew from a conference ‘Eating into the Future” held in the UK.Tim Lang presented the keynote address. Tim has done a lot of work around coalitionbuilding, advocacy etc. After the conference Tim ran a workshop on coalition building.

Government is there to make policy and then outsource funding to provide a service.Thatcher shrunk UK government, this opened up a space for NGO’s to address foodissues.

There was a broad range of people involved in the workshop. After the workshop, TimLang asked, well what are you going to do now? What is going to happen now? Theconference developed a statement about what the conference wants to do, what it believesin etc. This was the statement “to raise awareness about issues relating to foodsafety…….” (OH)

Someone came up with the name SA Food Alliance. People started saying – “we couldhave a PO Box number and an address, I have someone who could draw a logo – lets havea meeting in a weeks time”. There was born the SA Food Alliance. The theme of themeeting was what are our priorities. A whole range of issues came out. You have to createpriorities in all of this. Looked at three things – one group was very interested in callingANZFA to account. ANZFA seemed to be spinning out of control. Called themselves‘ANZFA watch.’ A group was interested in community gardens. Another group wasinterested in permaculture.

There was panic, manic and enthusiasm. Everyone wanted to get going. Decided to focuson GM issues, needed to get a handle on it. There was enough interest in the group, sostarted responding to a number of articles that ANZFA was putting out. ANZFA wereresponding to this group. It gradually got out of control. All the members had day jobs, so

59

had to happen outside of office hours. GM issues were getting on a roll, large documentswere sent out for review, etc etc etc.It was a lot of fun, a lot of experience. Experience that developed from things that weresuccessful – identify, movement, being recognized.But the negatives – how do you work with something like this when you have limited timeavailable? There is often a core group who usually hang on, people come and go.This is why coalitions are important – for support and protection.

This was a group of professionals who were calling into account the work that ANZFAwere doing.

No-one person in SAFA had all of the skills identified in the last activity. All of themembers drew from each other. Coalition building is not static, so even when it fracturesknow who to contact.

2. The Coalition on Food Advertising to Children – CFAC

CFAC was successful, but not necessarily on outcomes.Students at Flinders University did a large research elective component. A student went towork with a child care centre and presented some resources. A group of really concernedparents from a small child care centre were wanting to take on the food industry.Funded a 0.2 project officer. This person and a few other people started talking about howto build this coalition. On the horizon started looming some literature about increasingrates of obesity in children. This literature showed how obesity and overweight haddoubled in the last 10 years. Suddenly the planets started lining up. Food advertising tochildren started getting connected to high rates and increasing rates of overweight andobesity in children.

Overweight and obesity in children started getting on the agenda and the Royal Australiancollege of GP’s started coming on board.The whole thing then started rolling with media involvement, conference presentationsetc.They audited food ads to kids – 4/5 advertisements directed to children were aboutunhealthy food. The opponents were saying it is about physical activity not diet. A letterwas received from Flinders University disassociating themselves as an institute fromCFAC.The last thing that happened was that CFAC was invited to give evidence at the SAparliamentary inquiry into obesity. The presentation was excellent – bringing in WHO’sstatement on the issue, overseas evidence etc.

Discussion about the position CFAC are going to take – are we going to restrictadvertising to children, for example, or only allow healthy food choices to be advertised.Advertisers are very clever – therefore members thought that needed to call for a completeban on advertising food so as not to get sidetracked into arguments such as, is the foodhealthy etc etc. So therefore decided to take the position that food advertising directed tochildren should be banned. This was not accepted by DAA – their position was thatcommunity announcements be exempt from this. For a number of reasons, DAA did notbecome a part of CFAC. Need to know the history here. Has CFAC been successful inbanning food advertising to children? No, but there has been an enormous amount ofcoverage about advertising to children. Both have rewritten codes of practice to read that

60

advertising has to be socially responsible. This is movement in the general direction ofconcern for advertising to children.

What are the lessons we can draw from this:1. Coalition building is crucial at policy development, at consultation. Not just asking

people is it OK, but bringing people on board which also can mean taking on theirissues.

2. Positioning the problem to one that would get attention and gain momentum.3. Building capacity within the group to continue the group. The reason why SAFA

did not continue was that we were not taking the trouble to nurture ourselves andto build the skills that were necessary, we just kept piling work on each other.

P – in coalition building to what extent do you include those who may be your enemy?F - Depends on the entry criteria to the coalition.

Think about the friends and the foes, don’t write the foes off. Think about ways that theycan be friends. Sometimes may realize that the value belief thing may mean you cannotbuild a coalition. Can work the other way in how you respond to the overtures of youropponents. You have to work out where does conflict of interest kick in etc. For examplethe Coke industry with Mai Wiru.

P - The store managers are a big block. One of the best store managers believed that hewas a good operator. Need a regional co-ordinator who has expertise. So now trying tobring in this store manager as the overall co-ordinator rather than the opposition.

Different food manufacturers vying with each other – can often go to another group andget support from them.

F - Building on what has gone on before. Eg. Environmental Health was showing a StoreCharter. How many are part of this group?Things are happening, initiatives are already out there. Coalition building is getting insomeone else’s canoe, may not be welcomed with a red carpet, but may have to stand backand work hard at getting in. Sometimes our canoes are fairly empty, need to get into thecanoes of others and see the similarities eg. Oh! Your issue is profit, health fits into that aswell.

F - Coalition building is also about pushing button at a higher level. Why not write SandraCapra a letter and say a workshop in Alice Springs came up with a statement - why can’twe get this taken up as an issue.

How can you optimize facilitating factors? How will you deal with barriers? Whatresources will be needed? How can coalitions and advocacy be employed - who mightthese be?

1. Stakeholdersa) Friendsb) Foes2. Optimizing facilitating factors3. How to deal with barriers4. What resources will be used?5. Coalitions + advocates; who?

Activity 7: Strategyplanning

Task:Construct one advocacystrategy to highlight issue. Thiscould be a press release ormedia stunt. Be creative as youcan.

61

6. How do we get started?

Group 1: Inefficient Food transport systems

• Food transport with a lot of inefficiencies.• Transport companies could be interested because of the railway looking for new

opportunities to transport out bush.• Friends - Shadow Transport Minister and other NGO’s. Potential foes – transport

companies that may want to maintain inefficient systems.• No department or organisation has responsibility for transport problems – so take

over problem. People with expertise, feasibility study, sell the concept of problemto the public.

• There will be a formation of a new coalition with interested people on the board.• There will be lobbying with media.• There will be lobbying of existing coalitions to join cause.• Are you in it?• NT food alliance!

Group 2: Store mismanagement

Stakeholders OptimizeFacilitatingFactors

Barriers Resources Coalitions +advocacy beEmployed

GettingStarted

Friends: Education +training

Form united coalition(core)(people/participantsNT Nut. Forum)

There will beenforceableregulations

Store owner/ALPA Communitygovernance to bewell informed +involved in thestore

Collate info/evidence→ background paper→ identity key issues

There will be aTASK force on thejob (developing alarge alliance -professionals inhealth, law, human+ comm.. rights,store managementetc)

Store management Establish aprocess which isopen + transparentfor people to beapple todisseminate info

Make links & otherrelevantadvocacy/lobbygroups

There will beformalized trainingtied to industrialwork conditions

Traditional owner Enforcementneeded bystakeholders toimplement

Partnership coalition→ form positionpaper

Communitycouncil

Identifying the“champions” +the “championmakers”

Lobby potentialpartners

Govt. Dept.officers:* e.g. nutritionist’s

Local women’sgroup

62

Dept. consumersaffairsTraining providers* e.g. Batchelor,Waltja etc., IT training, NTETA, Centralian , DEWRATSIC/REPLocal communityorganizationsCommunitymembersUNILEVER +other sponsorsAdvocacyOrganizations +NGO’s – Women’sCouncil + Waltjaetc.Store committee

Govt. regulatoryagencies or bodies:* CHO, OLG, policePowerful politicallobbying groups –NHF, DiabetesAustralia etc.AMA/ HealthDept.Community leadersFOE:Town clerk/localgat.Transport/freightcompanies

• Local, regional and national stakeholders – trying to bring in the legislative side ofthe world such as consumer affairs, police etc.

• Enablers –Education and training, community governance. Already a lot ofexisting regulations, not only making friends with agencies that are supposed to beenforcing these but generating a public awareness of the issues, such as no refund.

• Identifying champions and champion makers. We wanted to do a lot of communityconsultation but then thought we needed to take to a regional level and then thenational level.

• Actions – there will be a task force, we have proposed a department of food supplyjust like we have a department of health.

• Enforceable regulations.• Formalised training like a registered profession.

63

Group 3: Lack of Community control over Store business

Stakeholders OptimizeFacilitatingFactors

Barriers Resources Coalitions +advocacy beEmployed

Getting Started

Friends: (education +training inmanagement,accountability,governance)(support)

Network &stakeholders toform coalition

Funding Action group Runcompetitions/awardfor best store

Landowners Set appropriateselectioncriteria for storemanager’sposition

Collectevidence &lobby

Training –manuals;trainers(staff)

Community people “body art” – fruit +veggies into thestore – is this “theonly way we can getfresh F & V intostores?”*Imparja/ParliamentHouse (naked peoplepainted with F + Vpictures)

Communitypeople

Manager toreport on keydesirableoutcomes,period leally

Consult/engagecommunity

Search forexistingresources

NGO’s Release statementsummonsing issueof lack ofcommunity controlover communitystores

Store owner Individualcommunities todevelop theirown storepolicies

Requireadvocate/leader+ supporters

Environmentalgroups

Store manager Gain supportfrom TAFE,NTEETA etc.

AMA

Communitycouncil

Update existingstore trainingmanuals +provide meansto implement +training

Volunteer:*organization./churches

Govt. Dept. Employ localstore staff

Food Co.

NGO’s e.g.:* world vision* AboriginalHealth Boards

Trainers fromUNILEVER

Nutritionist’sFOE: WHODepends onbackground:* interests differs between communities

transport Co.??

Private enterprise

• A lot of the issues were support for training and a whole lot of structure aroundtraining.

64

Group 4: Food Consumption and Food Availability

Stakeholders OptimizeFacilitatingFactors

Barriers Resources Coalitions +advocacy beEmployed

GettingStarted

Internal Advocacy,appears:* Social Justice* Human Rights* National responsibility

Time Communication+ negotiationswithstakeholders

Make links &other relevantadvocacy/lobbygroups (e.g. DAA,PHA,NATSINSAP)

Community members Promotion ofBenefits tostakeholders.(Pressuretactics)

$$$ Formation ofthink tanks fordiscussion

Form unitedcoalition &participants fromNT Nut. Forum

Community agencies:* councilstore committee +manager* local health centre* ♀’s Centre/Resource Centre/Family Centre* school* CDEP, Centre link (local office)* traditional owners* outstation groups/agencies* HACC/Aged Care + Disabilities (Meals on Wheels)

Human Resource(expertise,strategicthinking, admin,management)

Formation ofaction groups,work on issues +lobby

Lobby potentialpartners:* ATSIS* AG* transport* Land council* Govt.

External agencies Communicationlinks

Commonwealth/statehealth

Non - Govt.lobby groups forsupport

Dept. Transport +WorksDept.10 Industry +FisheriesLand councilsNGO’s – NACCHO –health, ♀ business,Communitydevelopment agenciesATSIC/ATSISDept. Local Govt.,Sports, CulturalAffairs + CommunityDev.ACCCDept. Chief MinistersofficeFederalFood IndustryAttorney GeneralNT/Commonwealth

• Food consumption and food availability – went beyond this.• Have identified the external stake holders. Top down approach.• Action plan is the most important. A 6 point plan, been condensed to 3.• Issue around evidence – existing evidence – resist wanting to get new evidence.

65

Group 5: Limited local Food Production

Stakeholders OptimizeFacilitatingFactors

Barriers Resources Coalitions +advocacy beEmployed

GettingStarted

Communitymembers

Gettingcommunity onboard byconsultation

Send communitymembers toTAFE as a largegroup & seekfunding & mediacoverage for this

Money Employ a facee.g. MichaelLong who iscommitted toadvocate withmedia

Get CathyFreeman, to starta marathon run toraise awarenessstopping atcommunities

Store managers Reflecting onpast experiences– success +challenges

Use communityexpertise fortraining

Committedpersonal

Form a taskforceto co-ordinatethe – training –funding

National Concertwith IndigenousBands to raiseawareness +money

National Assoc. likePHA

Identify leaderswho haverespect of thecommunity

Include allstakeholders forfunding avenues

Equipment High SocietyBall, selling art +providing bushfoods

NGO’s (Worldvision, FAO FredHollows)

Optimizenetworks for‘seed’ funding

Tangentyerecouncil, CDU,TAFE

Expertise

Nutritionists/Health Makingchampions

Trust

Council RelationshipFunding bodies EnergyATSIC GlueTO’s/Clan leaders ToleranceEducations FacilitationBRACS (CAAMA) CommitmentAustralia of the Year NetworkImparjaGP’sFreight CompaniesEarly childhoodassoc.

• No local food production, being dependent on an imported food supply.• Seeding funding to get consultation process going, look at past experiences.

Stakeholders in the whole perspective• Producers of food/local killers• Store managers/storeowner• State/local Government bodies + NGO’s – education, employment + training,

comm. development• Retail co-ops• Store committees• Freight companies• Wholesalers + distributors• Health Centre staff• Food industry• CDEP• Communities• School• Child care• Training providers

a) Employment

66

b) Family skills• Store manager’s programs• Nutritionists• Local Government e.g. EHO• Fast food outlets/manager• Traditional owners• Politicians• Pastoralists• Community councils• ATSIC• Land council

P - If you are in charge of 90% of the food that people eat, this is a huge responsibility.Class action is a really good thing – need enough people to take class action, to take actionfor your state of ill health. Sue your own community council or owner of the store – amedia stunt.Give politicians the amount of money that people have to live on communities and saylive on this for a fortnight.

The Birth of FARA

F - Lots of kernels of ideas, which could gel, take shape and grow. Small initiatives cangrow to the national stage. “From small things big things grow” – Paul Kelly.

What are we going to do? Here we have a group that comprises so many people fromdifferent backgrounds.

An opportunity has come up to bring a nice closure to the workshop. ABC radio want tointerview someone after 4pm . We need to know what to say.P – what is the action that we are going to follow through on? Do we want to start talkingabout some coalition coming out of this workshop.

F - Give thought to just a statement that follows from here. Something that we can reflectback on what was this workshop all about.

For example, this workshop proposes that………….

What is the process, do we come up with something now or later on. Do we vote for it andthose people who think it is a good idea sign up for it.P – maybe we can formulate a goal before we advance further. Maybe then we havesomething concrete to hang our coats on.P – not only the NT but also parts of WA and QLD. It is almost a remote Australiannutrition alliance. Not only about the NT.We would like to improve the food supply particularly in remote communities.F – lets go back to the process. We had people working on different bits of the food chain.The 2 issues that came out as priorities were around the store, to do with food availability.The process has focused on those issues of rural and remote food availability and localfood production issues. Talking about an initiative or problem that is shared by this group– ie. The notion of food security which is very much on the agenda world wide. Thereforethis is part of an overall initiative and bringing into a remote/ rural setting.

67

P – does this have an indigenous nature?F – most of us will be effected by these issues one way or the other. Do you draw strengthfrom the fact that there is a larger group of people that are dealing with similar issuesfurther upstream or down stream. An alliance would be helpful to give opportunity tosupport the initiative. The strength of the alliance will be that you are coalition building inthe first place. You are bringing people in who sit outside of nutrition. As long as you baseit on food, as this is much more generic and popular than nutrition.The next step is working out what you would call yourselves and how you would operate.Formulate some kind of declaration that could have a very functional purpose eg. formedia interview. The statement only has to be short as long it brings in the elements.F – the first tangible outcome would be the media statement at 4pm.P – heard that it was poverty week this week.F – identify three things to say in a media statement.

F - Around a statement that says the health and well being of indigenous Australiansespecially in remote areas will only be improved when there are major improvements inlocal food supply or when local food supply is safe, affordable.We know that there are going to be motor vehicle accidents, we know there is povertyBUT we are working in the food area and this is our focus.The other thing you might want to say is as it’s too easy to shoot yourself in the foot – thealliance will work collaboratively with important stakeholders that are crucial to local foodsupplies.

Can make a general sweeping statement that then calls for the following actions.One of the mistakes with SAFA was being pulled into all different areas. The call foraction around local food availability, which is about stores, means not just being critical ofstore management but looking for opportunities to work with them.

P - from his experience – leadership, this is one of the mechanisms.

NT Food Policy Action Workshop 2003This workshop resolves that the health and well being of Indigenous Australians,especially those living in remote areas, can only be improved when healthy food isavailable, affordable and safe, and calls for collective action to:

• increase the range of affordable healthy foods available in remote communitysettings

• rigorously enforce current regulations governing retail operations• provide training and support for better retail operations, and• achieve greater community control of local food supply

The participants in the workshop have formed an alliance tentatively called FoodAlliance for Remote Australia (FARA)

• Need to consider a bit of funding to do administrative stuff such as arrangingmeetings, writing minutes.

• Action 1 – investigating funding possibilities. The timing seems right to work withNATSINSAP.

• Action 2 – promote the coalition – eg. The medical profession should be given aninvitation to take part in the conversation (Top End Division of GP’s and CentralAustralian Division PHC) around this issue. CFAC had a very focused issue thatwas food advertising for children. Remember your focus.

68

• Need some form of communication between members of the coalition. Need tosort out some type of system such as emailing.

• A priority action would be to send this up to NATSINSAP.

Points to consider

Constitution and structure – sometimes impossible to bring everybody into the decisionmaking. For example, a couple of CFAC people were invited in as spokespeople and thenan executive group was identified. Perhaps could have 4 people who could make decisionsand get together on a regular basis and then a couple of times a year the whole coalitioncomes together. Need to make a decision if a smaller group forms the executive. Mightwant to find an existing initiative so not reinventing the wheel. Something that is alreadyout there would be sensible to get hold of eg. Mai Wiru.

Skills that are needed for this kind of work. The way in which to nurture these skillsamong yourselves. How are you going to nurture those skills. You need to take care ofyour own network, otherwise degree of burn out will be high. Don’t dump on someonewho is less senior, support them. An experienced person working with a less experiencedperson. Nurturing among core membership.

Network with other alliances – PHAA and DAA.

Taking advantage of some of the government connections. Getting connections at alllevels. In the NT, currently have 3 Aboriginal members of parliament. There are avenueshere.

At your finger tips some facts and figures – be prepared for reactions such as surely storesare selling what people want. Be prepared, rehearse your response.

You might want to build in the skills of reflexive practice. To be reflexive on what you aredoing and how you are doing. Have opportunity to say this is a democratic process. Createa climate where you can be honest and open with each other. It is very annoying whenpeople go out and do things without the recognition of the alliance. This creates heartache. Need open communication channels within the alliance.

There has to be a reporting back about some kind of progress. Need to have a time frameof say 6 months, 12 months to say what have we done. Measure successes in small ways.Celebrate small successes. Look for small seeds of change and be prepared to run upagainst massive barriers. The Penrith Food Project – has been a wonderful trainingground. Still runs into barriers, for example the time when no-one came to a meeting. Youreally have to get through this, you can’t just dissolve when there has been one majorproblem.

Celebrate the birth of FARA.

F - Thank you to Mark, Alison, Roy, Amanda and John T. Thank you to people whofunded the workshop. Thank you all for your energy, tolerance and input and co-operation.The workshop has been absolutely wonderful.

69

Appendix 1 Workshop program

MONDAY 13 OCTPolicy, principles and evidence

Objectives for day

- examine the nature and importance of foodpolicy within the local, territory and nationalsetting

- explore the dynamics (commercial, political,community) that influence the food policycontext

- identify the major players and interestsinvolved in the development andimplementation of food policy, especially inNT

(Summary: What is policy? What can, andcan’t, it do? Who is involved? What are thepolicy issues in the NT?)

TUESDAY 14 OCTCase studies of local food policy inNT

Objectives for day

- explore the opportunities and barriers thatexist in the implementation of food policyat the local and Territory-wide level

- develop a policy implementation planthat situates local and Territory food policyin a national food policy setting

- identify actors and resources to assist infood policy implementation at the localand Territory-wide level

(Summary: What has been done? What didand did not work? What can we learn?What is needed to address the policy issuesin the NT?)

WEDNESDAY 15 OCTPlanning strategically for local food policyaction

Objectives for day

- examine appropriate strategies for the translatingpolicies in to practice, including effective policyinstruments

- examine the role of advocacy in translating foodpolicy into practice

- explore mechanisms for monitoring, evaluating andsustaining local and Territory food policy

(Summary: Where do we go? How do we get there?What resources can we muster? How do we keepgoing?)

70

MONDAY 13 OCT

9.00-10.30

Welcome and introductions

Outline of the purpose and structure of theworkshop

What is policy?*

11.00-12.30

• Values and assumptions in policy*• Food policy and food programmes*• (Jonestown activity)• Implications for food policy in local,

territory and national settings

Presentation:Mai Wiru Regional Store Policy –JohnTregenza30 mins (plus discussion)

* includes small group activity

TUESDAY 14 OCT9.00-10.30Recap on previous day’s work

Case studies of examples of food policydevelopment (panel discussion)

• NT Food and Nutrition Policy – MeganWingrave 30 mins

• Mai Wiru – John Tregenza 30 mins• CAABS Central Australian Aboriginal Buying

Service – Peter Clements 30 mins• Alice Springs Hospital – Megan Scott 15 mins• Anzac Hill High School – Avenal Lockett – 15

mins• Gap Community Childcare Centre – Jane

McDonald - 15 min• ALPA Store Policy – Robin Lion – 15 min

Examination of the following:What resources were used in development?Which players were involved?What barriers were encountered?What enabling factors helped policytranslate into practice?(in particular look at areas outside healthsector jurisdiction)

WEDNESDAY 15 OCT

9.00-10.30Recap on previous day’s work

Strategic planning exercise*Coalition buildingAdvocacy for policy actionGaining and sustaining momentum

11.00-12.30Continued

71

1.30-4.30pm

Evidence base for policy ie. What do weknow about nature of food security and dietand diet-related diseases in NT? What do weknow about the causative factors? (eg social,economic, geographical, political etc)*

Mapping the food and nutrition system inNT*

Identification of the major players(stakeholders and institutions) and interests infood policy in NT.*

Conclusions for day

1.30-4.30pm

Translation of food policy into practice- enablers- barriers

SWOT analysis of policy case studies invarious settings*

Report back to the whole group of findingsfrom SWOT analysis

Summary of challenges and opportunitiesfor food policy

Development of an implementation plan toaddress the local and Territory-wide foodpolicy issues identified on Day 1

Identification of the what? who? how? ofpolicy plan implementation

Conclusions for day

1.30 – 4.30pm

Planning for policy action:*GoalsStrategiesPerformance indicators

Monitoring, evaluating and sustaining local foodpolicy

Bringing together the workshop learnings andproposed actions

Conclusion of workshop

*includes small group activity

72

Appendix 2 List of ParticipantsName Department or

organisation connectedwith

Expectations of workshop

Julie Brimblecombe MSHR translation of policy intoaction

Megan Wingrave DHCS Success stories, fill gaps,path forward

Roy Price DHCS Local collaborativepartnerships

Alison McLay DHCS Policy with balls!Peter Clements DCDSCA Integrate nutrition policy

with development/ deliveryMegan Scott Alice Springs Hospital Increased understanding of

food policyAvenal Lockett School nurse, ANZAC high Networking & supportJoe Fitz MSHR New ideas/ better

understanding of nutritionMary Williams DHCS, SWSBSC Sound understanding of

nutrition policyMaria Scarlett MSHR Policy processNerisa Walton Environmental Health,

DHCSCollective action

Katie Allen Waltja, AS Greater lobbying power forpositive change

Pennie Clifford MSHR Improving food supplyAmanda Justice DHCS Nutritionist AS

RemoteCentral Australian FoodPolicy Action framework

Leisa McCarthy Danila Dilba Questioning NT food policyPam Gollow DHCS, Nutrition &

Physical Activity, DarwinUse policy to inform policydelivery

John Tregenza Kutjara Consultants Workable strategies todeliver action on policies

Alexandra Walker Nutritionist, Katherine WestHealth Board

Everything about foodpolicy

Amanda McGregor Danila Dilba Learn, listen and understandFood policy problems

Frances Turner DHCS, SWSBSC Hoping for policy forremote stores

Mia West DHCS, Nutrition &Physical Activity, Darwin

Greater understanding ofpolicy

Georgina Boston DHCS, Katherine How to implement existingpolicies

Alison Lorraine DHCS, Tennant Creek Work with communities todevelop store policies

Philippe Porigneaux Environmental Health,DHCS

Knowledge exchange inpolicy and operations

73

Anna Szava Ngaanyatjarra (StrongerFamilies)WA Department of Health

Gain supporting knowledgeand meet people

Lottie Robertson Yuendemu Understand NT nutritionpolicy

Maree Meredith CDU Meet people & understandnutrition issues

Lisa Fox NHFRobin Lion DHCS, Darwin Changing food security

environment with policyTrina Vangsgaard MSHR Process of change

74

Appendix 3 Presentation – Dr Mark Lawrence

The evidence base for food policy in the Northern TerritoryThe evidence base�What do we know about food and nutrition status in the NT?�What is the history of food policy work in the NT?

1. Food and nutrition status• Burden of diet-related disease• NT has the highest age-standardised mortality for both males and

females• Diabetes, CHD• Malnutrition in foetal stage and over-nutrition in others• Cost of diet related morbidity and mortality in the NT is approx

$41 million• Equivalent to 20-33% of the total NT Health budget

Breastfeeding�Data from 1992-93, highlighted that the NT had Australia’s highestbreastfeeding rates for both Aboriginal and non-Aboriginal people (Rae1993). At hospital discharge, 3-months and 6-month follow up

Mothers and children�Data from the evaluation in three remote Top End communities of theStrong Women, Strong Babies, Strong Culture program found that(Mackerras 1998):•the weight of the Aboriginal women before pregnancy was much lowerthan the national average•the amount of weight they gained during pregnancy (average 10 kg) wasalso lower than NHMRC recommendations (1979)�In 1995, the average birth weight of NT Aboriginal babies was 3,123grams�an increase of 85 grams over the previous 10 years�this was still lighter than the average birth weight of non-Aboriginalinfants, 3,348 grams.

75

Anaemia�In 1995, the prevalence of anaemia in NT non-Aboriginal women was 3%(Markey & others 1998).�The prevalence of anaemia among pregnant Aboriginal women was 41.3%(Mackerras 1998).

Children body size• In Aboriginal communities in the Katherine region, about 2,500

children were measured approximately 13,000 times between 1987-1996

�Up to the age of six months, the children’s weight and lengthmeasurements were close to what would be expected in well-nourishedchildren.

�After this age, the proportion of low weight-for-age measurements wasthree times greater than would be expected in well-nourished children.

�Weight-for-height measurements were also low.

Adult body size�There is no information about the measured body size of non-Aboriginaladult Territorians.

�In the Katherine region, the 1994 National Aboriginal and Torres StraitIslander Survey found that 46% of Aboriginal adults were overweight orobese. This compares with the 1995 National Nutrition Survey figure of55% for Australians (ABS & H&FS 1997).

Market Basket Survey of Remote Community Stores in the NT�70 rural and remote stores in NT surveyed April - June 2002

�Cost of food basket in remote stores was 27% more expensive than theDarwin supermarket

�Ave No of fruit choices in remote stores = 7�Ave No of fresh veg choices in remote stores = 13

76

2. NT Food and Nutrition Policy�1993: an audit of food and nutrition programs and activities in theNorthern Territory was conducted and approximately 200 programs wereidentified. The audit identified the current status and key directions ofthese food and nutrition projects and this provided baseline data toinform policy development.

�1995-2000: NT Food and Nutrition Policy was endorsed by theTerritory Health Services’ Executive in September 1995. The purpose ofthe policy was to encourage action and cooperation throughout the foodand nutrition system to improve the nutritional status of all Territorians.

�1995-2000: In April 1999 Dorothy Mackerras, Menzies School ofHealth Research Darwin, was commissioned to do a review of the firstphase of the implementation of the NT Food and Nutrition Policy. Thisreview concluded that the general direction and priorities of the policyshould not change.

�2001 – 2006: At the annual NT Nutrition Team Workshop in late 1999,future strategic directions for nutrition and priorities for action weredetermined.�At the same time SIGNAL had commissioned consultation for thenational strategy, ‘Eat Well Australia’, and NATSINSAP.�Findings from consultations were made available to the NT NutritionTeam for incorporation into the NT Food and Nutrition Action Plan 2001 –2006.

3. NT Food and Nutrition Policy Action Plan 2001 – 2006�The goal of the NT Food and Nutrition Policy is to improve nutritionalstatus and health of all Territorians and to reduce the burden of diet-related early death, illness and disability.�The three priority areas for action identified in this new strategic planare:�Maternal and Child Health�Food SupplyHealthy Lifestyle (+ activity)�Indigenous people, particularly those in remote communities, are a highpriority group for nutrition interventions.

77

4. Lessons from food policy experiencesKey lessons that emerge of why food policies succeed or fail consistentlyidentify the role of:�Leadership�Inter-sectoral nature�Different levels of governance�Resources ($$ and time)�An action plan and implementation agency�Competing values, beliefs and interests

Resource list�Food for Thought�Healthy Choices and Consumer Rights (Video)�Community market Gardens (Video)�About Healthy Eating – A Guide For Aboriginal Health Workers�The Store Book – Food and Nutrition Guidelines for AboriginalCommunity�Good Store – Healthy People Poster�The Store Video�Store Managers Contract�Keeping Fit, Keeping Healthy, Keeping Strong – information leaflet�Northern Territory School Canteen Guidelines�Tummy Rumbles – Guidelines for Remote Area Canteens

Mapping the Food and nutrition systemTasks�What are the factors that influence each of the system components?

�Issues�Stakeholders�Contexts

�Where do you fit in relation to the food and nutrition system?�What are the barriers to ‘healthy’ nutrition outcomes in the NT?

78

Appendix 4 The Muddiest PointAt the end of Day 1

What was the muddiest point so far in this workshop?(In other words what was least clear to you?)

Participants Responses• Understanding the jargon associated with “context” “issues”

“stakeholders” and the pathway should have been better explained.Too many repetitions of the remote store story

• What was meant by “doing” policy?Difference between “issues” and “context”

• The definition of policy as opposed to guidelines or regulations –and if that is important or not.

• Things out of our control eg. Climate, politics, values

• Understanding the children’s programs videos and relating to policy

• The difference between the different levels of food production –how do we know where everything fits?

• The understanding of world contextHuman factorscynicismburn out“fly in/ fly out” branding and labellingNot really brought up. Just continuing my thoughts

• Understanding the kid’s shows?How does it refer back to policy?

• Not clear about contextual issues we identified in brainstormingfood system segments. I don’t really know what it means.

• Contexts• Too many different minds wanting different outcomes

79

Also looking at problems and barriers which is negative/ notsolutions

• The definition of “doing policy”. Everything else was crystal clear.Thanks for a great day.

• It was all goodDefinition of “context” in the food chain process

• Trying to get a clear definition of “policy”what it is and what it isn’twasn’t summarised clearly at the end of discussion

• How different programmes that run around NT are connected andhow they are evaluated

• When we were writing the Context, and food Policy and couldn’tunderstand some wording

• The education examples to examine

• “Contexts” definition1st activity - ? definition for “DOING”

• Took a bit of time to clarify issues vs contextbut talking through helped this. Thank youConcepts well described/ explained/ facilitated through

• Definition of the pathway from production to nutritional outcome

• It was all fairly clear apart from the story about the lantern

• This is not really a muddy moment. I know that this is to be talkedabout more, but I’m wondering if it is realistic or actually possibleto have an intersectoral policy that has improved food and nutritionas its overriding goal.

80

Appendix 5 Evaluation Results

PART A

Please indicate the extent to which you agree or disagree with the following statements by circling theappropriate number

MONDAY AMVery Moderately Somewhat Slightly Not Very

What is policy?Values and principles 18 6 nil nil nil

MONDAY PM

Evidence base for policy. 14 7 nil nil nil

Mapping the food & nutritionSystem 19 5 1 nil nil

COMMENTS (Monday)

• Stimulating & exciting day. Set the scene for group cohesion & storming

• Monday was very good. I came to find out (what) policy meant and I did on the Mondaysession. Learnt a lot and I got what I came for, and very well presented.

• Good start

• Interesting & informative finding out about policy and how the system works.

• Fills some gaps and reinforced the positive things we are already doing. Gave a good overviewand gave perspective to important (sometimes missed) steps.

• Loved the lantern exercise. The stars started to sparkle.

• Excellent day could have more info with mapping model.

• Needed a clear summary if …… at policy is and is not

• Excellent frame-work to develop ideas

• It was all good, it gave me a better understanding of policy

• John Tregenza’s “Speech” on Mai Wiru was excellent. Really grabbed my attention for the day(and the rest of workshop).

81

TUESDAY AM

Please indicate the extent to which you agree or disagree with the following statements by circling theappropriate number

Very Moderately Somewhat Slightly Not Very

Case studies in food policy 19 5 nil nil nil

TUESDAY PM

Food policy into practice 15 6 nil nil nil

COMMENTS (Tuesday)

• Thinking outside the square. Good Work. Fostering creativity – we all need it.

• Tuesday was a bit harder but still got a lot out of the workshop

• Good with the practice

• Completed picture, excellent review of some good work in policy development.

• The stars got brighter.

• John’s presentation was very important and interesting.

• I was feeling a little flat because I thought that no one else was interested in collaborativeaction.

• Good to start looking at the practical issues to problems and how these might be overcome.

• Interesting & educative examples

• All good.

WEDNESDAY AM

Please indicate the extent to which you agree or disagree with the following statements by circling theappropriate number

Very Moderately Somewhat Slightly Not VeryStrategic Planning

20 3 2 nil nil

82

WEDNESDAY PM

Planning for PolicyAction 21 3 1 nil nil

COMMENTS (Wednesday)

• Wednesday was good, got everything together, and the photo …the group. Got to know othernutritionist and their ideas.

• Really great to pull it all together.

• Good conclusion – galvanised action

• The stars aligned brilliantly

• Great group facilitation skills. Great to get FARA off the ground.

• A really enjoyable, worthwhile and valuable experience. I am excited about the alliance andmotivation is renewed. Some excellent ideas to work on.

• FANTASTIC exactly what I wanted to come out of the workshop.

• I liked Wednesday’s session the most, the action bit – “Policy with balls”

• Very challenging to try to put things into practical strategies, but useful once done.

• Very practical at putting policy into practice. Great idea to assist with dev’t of an “alliance” andgive us ideas of how it could work.

• Got very lost here (wed am) Too much working in the field – found difficult thinking on apolicy level

• Found this a difficult exercise (Wed am), but it did make me think about where I sit in theimportance of communication at different levels.

• Good pulling together of previous day’s work.

• Yes it was all worthwhile.

PART B

Please indicate the extent to which you agree or disagree with the following statements by circling theappropriate number

83

Characteristics Strongly Agree Unsure Disagree StronglyAgree Disagree

I understood the subjectmatter. 10 14 nil nil nil

The workshop was wellco-ordinated. 18 6 nil nil nil

The workshop waschallenging.. 18 6 nil nil nil

I learned somethingvaluable 20 4 nil nil nil

The group work was valuablein enhancing my understandingof the subject matter. 14 10 nil nil nil

Administrative issues associatedwith the workshop were wellorganised. 16 6 2 nil nil

PART C

What improvements would you make to the workshop or to the teaching?

• Teaching was excellent. Perhaps some printed info of some of the matter displayed onthe overhead projector

• Social activity for all workshop participants

• A safe forum to bring out some issues that we are faced with continually and need toshare these and learn from how other people deal with these.

• Not much, just the timing of each presenter

• None. Had a great time and enjoyed the learning experience.

• Clearer expectations of presenters prior to the workshop would have been useful.

• More involvement from other sectors ie. stakeholders. People should not sit in sameplace every day.

• Circulate/Advertising a little earlier. Everything else good.

84

• Allow more time to discuss potential ideas for an alliance in small groups, then reportback to bigger group, so that the ‘shy’ members ideas are included too.

• Very little.

• There is always place for improvement in every activity but I found this workshopvery interesting and positive. The teaching had a great dynamic and at moments I hadgreat fun.

• The only problem I had was that bloody drill going off.

• More enforcement re: keeping to time.

• Is there any way that we can have workshops like this when we will include thetargeted beneficiaries of our policies/programs and not just talk about them? Or isthat entirely unrealistic given the nature of the subject and structure?

Do you have any other comments about the workshop?

• Thanks for an excellent delivery of a subject which was at times challenging.It was enjoyable and I have learnt quite a lot and have enjoyed meeting people.

• More time for discussion.

• I thought it was great. It made me think about a lot of things – particularly in relationto people working at different levels.

• Overall it was very good, as I said I learnt a lot. Thank you very much.

• It was very inspiring, very good “teachers”, great atmosphere.

• Very enjoyable and worthwhile

• Good mix of activity and theory. You both have a great capacity to engage andsupport people from various backgrounds. Very well facilitated. Fantastic that thewhole workshop was largely based on NT eg – helps us further understand, exploreand progress local issues.

• Very pleased to have had the opportunity to join you for the third day and sorry Ididn’t get to attend all of it. We now have a focus and some plans to put into action.I’m excited because there will be……..

• Only that it was great in bringing together participants from various areas that have arelationship to Nutrition whether it’s policy development or delivery.

• Well done!! Facilitated the workshop well.

85

• Worthwhile experience.

• Excellent. Very well presented and great to apply the info immediately as its learned,to give some action for the future. Great that non-nutritionists were invited/involvedin workshop to look at the bigger picture.

• Excellent facilitation, creative work which was well thought out.

• Thank you very much!!

• The whole workshop was excellent. Was very informative and I learnt a lot.The running and pre-organisation should also be commended. ie: room & facilities (ie:cups, H20 etc.) : Morning tea and afternoon tea delivery (+food choices) Well done.

• Better than I thought!!! Really enjoyed your outsider’s perspectives and smallcomments throughout helping us be realistic and to understand the realities of publichealth initative.

• Loved it Thank you.

• Thank you very much, it really was great, thanks for coming to Alice Springs. I hopewe make you guys happy when we have wins with FARA.

• Great to meet you John and for paths to cross with you again Mark. Cheers Robin.

86

MEDIA RELEASEFriday 10 October 2003

Food Policy Workshop in Central Australia– Developing healthier communities

The Department of Health and Community Services in conjunction with the CentralAustralian Division of Primary Health Care is conducting a Food Policy ActionWorkshop in Alice Springs on 13 – 15 October 2003.

Food Policy controls who gets to eat what, when and where. The impact of foodpolicy ranges from shaping individual food purchasing patterns and food intakes, topopulation health and safety, to world trade and economics.

Dr John Coveney, Senior Lecturer of Public Health at Flinders University, Dr MarkLawrence, Senior Lecturer, School of Health Sciences, Deakin University, and JohnTregenza, a local consultant with a background in Food Policy, will facilitate theworkshop.

This workshop will explore Food Policy, the politics of food, and the interconnectionsbetween these at the Alice Springs and NT level.

The first day of the workshop covers food policies, principles and evidence and looksat the commercial, community and political dynamics influencing what we eat. It willalso examine the main institutions, stakeholders and commercial interests affectingour food supply and consumption. John will also give a presentation on the Mai WiruRegional Store Policy for the Anangu Pitjantjatjara lands.

Day two of the conference will look at the NT Food and Nutrition Policy, and casestudies of the food policies of the Central Australian Aboriginal Buying Service, theAlice Springs Hospital, Anzac Hill High School and the Gap Community ChildcareCentre in Alice Springs. Participants will consider what policies did and didn’t workand why.

Day three will look at how to develop, influence and advocate for an improved foodsupply and improved food policies.

Food Policy, properly implemented has the potential to reduce development ofobesity and related preventable chronic disease such as diabetes, hypertension andcardiovascular disease. Better health through access to better food can contribute toincreased life expectancy and community economic development.

The aim of this workshop is to form a collaborative working group to developstrategies to improve the food supply in Alice Springs and the surrounding districts.Contacts:Chris Hallett, DHCS Media Liaison Central Australia 8951 5123 - 04 01114113Roy Price/Alison McLay, DHCS Nutritionists 8951 6902 – 0409695949