I would like to acknowledge the traditional
owners past and present of this beautiful land I
stand on today, and thank them for allowing me
to be here.
NICOLE TURNER
ABORIGINAL NUTRITIONIST
My journey.




Started many years ago.
Shocked at the results from research that I gathered
I know I had to do something about it
Looked into where and how I can do a course with 4
kids and full time work.
How many Aboriginal Nutritionist
???
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
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

Good question ???
I'm 1of Five that I know about in Australia
We need so many more
What are our people dying from ???, mostly
preventable diseases
A lot of the gap is related to risk factors such as
obesity and physical inactivity, which nutrition plays
a large role in.
And the current “GAP”, differs in many areas
What change has to be made




Capacity building of nutrition workforce
Education delivered by Aboriginal people
Make community aware of problems and where
they can help.
Its about prevention and looking after our young
kids before that get chronic diseases.
Many Layers of the Many Rivers
Diabetes Prevention Project.…
The Many Rivers Diabetes Prevention Project.
Nicole Turner
Manager Health Promotion
Background


Initiative of Durri ACMS in Kempsey N.S.W.
Started in 2000
‘To prevent children from growing up to get
Diabetes’




University of Newcastle
Biripi ACMS in Taree
Durri ACMS in Kempsey
Awabakal AMS in Newcastle

Centre for Public Health Nutrition at
University of Sydney

Associate Professor Vicki Flood – University of
Wollongong.
My Team
Staff and Project

3 fulltime Aboriginal staff (NSW ministry of health )

20 casual Aboriginal staff (survey workers)


Research and data Manager.
Many partnerships and Linkages – local councils,
Red cross, Education Dept., Universities, AMSs,
Cancer council, Menzies, NSW health, OATSIH.
PROCESSES to SUPPORT COMMUNITY CONTROL




MOU’s /data access
agreements
Co-management of the project
Community directed not
“tweaking the mainstream”
Intellectual property:
Authorship
 Acknowledgements
 Other



Return of data to community
Very Unique project, consisting
of research and health
promotion.
Governance structure



Multi levelled
governance model
Publications including
Aboriginal staff
Community
involvement
,engagement and
direction
Figure 1: ABORIGINAL COMMUNITY CONTROLLED GOVERNANCE STRUCTURE
ADVISORY GROUP (2 x year)
STEERING GROUP (up to 6 x year)
Expertise on the “National Picture” regarding
Indigenous and Child Health and Well-being.
Provide guidance on the direction, evolution and
sustainability of the program; ways to address any
barriers; meeting National Priorities/Initiatives in
Indigenous and Child health (including ‘Closing the
Gap’ Initiatives); advice on activities of other
research programs to ensure that this program
augments other work and aims to maximise benefits
to participating Aboriginal communities
Managerial advice on every aspect of the project including planning
and direction of each phase of the project; Intellectual Property matters
(See Figure 2); collaboration matters between all partner
organizations; financial management; accountability to funding
bodies; community advocacy and governance; regional and
organizational needs and issues that impact on the development and
delivery of the program.
ABORIGINAL COMMUNITY REFERENCE GROUP (meets 6 to
8 x year dependant on activities of the project)
METHODOLOGY GROUP (up to 1 x
month dependant on strategies)
Advice on matters relating to research
design and data analysis.
Provides community advice to the Many Rivers project on all aspects
of the project includes: all publications and conference presentations
vetted; development of research and health promotions activities and
advice on benefit, feasibility and acceptability of these activities to
their communities; community and partnership matters that impact on
the delivery of the program; community controlled governance matters
(see Figure 2).
PROJECT IMPLEMENTATION GROUP
Co-Managed: Manager Research and Evaluation and Manager Health Promotion (the latter designated for an Aboriginal and Torres Strait
Islander person)
All Project Officer positions are designated for Aboriginal and Torres Strait Islander people. Project Officers implement all strategies of
the program in the communities and in doing so liaise and collaborate with other organizations / sectors involved in the project such as
the schools and non-government organisations.
Figure 2: DOCUMENTS TO SUPPORT COMMUNITY CONTROL AND GOVERNANCE
These documents are regularly reviewed and updated , and others added to ensure relevance to all matters
related to community control of research
Intellectual property
•Authorship
•Acknowledgements
•Conference and other
presentations
•Reports
•Artistic and photographic
work
•Indigenous cultural and
intellectual property
•Sharing of proceedings /
benefits from published
research or service delivery.
Memo’s of Understanding
between
•All partners: over-arching MOU
regarding intent and conduct of program
•Individual partners: location and
management of project staff (all
positions designated for Aboriginal
people) within partner organisation
•External experts /others (such as
NGO’s) and partners: statement of
extent and duration of involvement in
any component of the research program
Data agreements
•Access to data by
experts for the purposes
of assisting with data
management: statement
of extent and duration of
involvement , and date
by which data returned
•Return of data to
community:
•Results
•Data
MANY RIVERS DIABETES PREVENTION PROJECT
AIM: To prevent children from growing up to get Diabetes
COMMUNITY ASSET MAPPING
1. Focus Groups: parents,
children & community.
2. Mapped PA and food services
VALIDATION
of
Food and
Physical Activity
Surveys
MANY RIVERS
PROGRAM
FOR
CHILDREN
EVALUATION
DESCRIPTION
Food Intake
Physical Activity
GLYCEMIC INDEX
Methodology
Description
Surveys
Food Intake
Physical Activity
STRATEGIES
Schools
GPs
Health assessments
WHAT NOW??
Surveys 2011-2012
Publications
More communities
Capacity building

Research is about capacity building of staff as much as
the research.
 “…giving
something back to community...”
 “…this will last long after you go…”


Skills acquired have a ‘ripple effect’.
Survey worker example:
 Numbers
 Training
/ benefit
Mean daily intake of nutrients
Boys (n = 93)
Nutrient
Energy (kJ)*
Total Fat (g)
Monounsaturated fatty
acids (g)
Carbohydrate (g)
Sugars (g)
Starch (g)*
Fibre (g)
Sodium (mg)
Aboriginal & Torres
Strait Islander
(n=34)
nonIndigenous
(n=59)
9689.2
8422.1
87.4
78.9
31.1
27.7
289.1
148
139.7
21.6
2934.5
241.7
122.1
118.8
17.9
2396.9
Daily per capita quantity (gms) of highest ranking food
categories contributing to energy, fat, saturated fat,
sugar, fibre and sodium
Food Category
ATSI
NonIndigenous
2007
NNS*
Breads
105.1
88.5
Milk
282.3
273.3
Soft drinks, cordial,
sports drinks
441.5
297.1
Higher fat processed
meat
61.7
57.3
Take-away meals
41.1
30.6
Fruit juice
208.3
153.4
Hot chips
46.5
31.8
29.3g
Potato crisps and other
salty snacks
19.2
13.5
12.9g
364.7g
Saturated fatty acids


Saturated fatty acid
contribution to energy is
high for all children at
around 15%.
2007 NNS = 13.6%
Fruit and Vegetable intake
Fruits
Vegetables
Aboriginal
and Torres
Strait Islander
nonIndigenous
child survey
½ serve
2/3rd serve
1 serve
1 ½ serve
1 2/3rd serve
2 serves
2007 national
Proportions Meeting Guidelines
non Aborigina Indigenou
l

s
Nutrient
%
%
77
79
9-11yrsf
65
60
12-13yrsg
86
80
Fibre <AI
Calcium
<EAR
Potassium
<AI
Nutrient
Sodium >UL
74
66X2
p-value
70
0.04
26
36
0.02
15
28
0.04
Boys 62 Girls
%
Fibre <AI
84
Folate <EAR
Magnesium
74
%

Majority of children
fail to meet
guidelines for key
nutrient intake.
Some differences
are evident by
gender alone.
Current stats




41% Aboriginal kids
overweight/obese
Compared to 35%
Non- Aboriginal kids
Underweight went from
4% to 15 % ????
75 % overall clients
who have BMI stated.
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Many Rivers Diabetes Prevention Project “health
promotion strategies 2012-2013”
Deliver Diabetes education package in schools.
School canteens with a priority to high schools
Physical activity photo voice project
Traditional Indigenous games in schools
Social Marketing multi media campaign
Health support for children identified as overweight
or obese from our previous survey
Explore Local store healthy food promotions
Health Promotion Strategies
SCHOOL: fruit
breaks; veg
gardens; diabetes
education…
COMMUNITY: social
marketing; fruit and
veg boxes; TIGS
comp; water
fountains; Vending
machines; bread
promotion…..
CAPACITY BUILDING
of STAFF
Community
Directed /
based on
Research
findings
COLLABORATIONS:
Local Council; Red
Cross; AECG….
COMMUNITY
DEVELOPMENT ROLE
HEALTH CHECKS:
improve uptake in
AMS’s
Determinants
Environmental


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
Availability, Access,
Affordability*
Public Transport*
‘Junk Food’ advertising
Government regulation*
Funding, sustainability and
support for health promotion
programs
Historical
Cultural
Individual

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
Income / income
management
Private Transport*
Education levels
Role Modelling*
Physical Activity levels*
RACISM
Where to from here, Prevention
and Protection.

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
More Education for parents
More Education in schools
More Education for communities, extending to other
areas.
Increase health assessments and screenings
Screenings important for all age groups especially
young boys.
REMEMBER


To have a successful
project in a community
it must have many
layers.
This must include
involving the
community and
knowing what the
needs are . ????


We can not presume
we know everything
and what is right for
the community.
Do a bit of
researching before
you start any new
project.
Publications
MANY RIVERS DIABETES PREVENTION PROJECT
PUBLICATIONS AS PER MARCH 2012
1.
Gwynn, J.D., Flood, V.M., D’Este, C.A.., Attia, J.A., Turner, N., Cochrane, J., Smith, W.T., Louie, J.C.,
and Wiggers, J.H. (2012) The Food and Nutrient Intake of Australian Aboriginal and Torres Strait
Islander and non-Indigenous rural children. BMC Paediatrics. doi:10.1186/1471-2431-12-12
2.
Louie, J.C., Gwynn, J.D., Turner, N., Cochrane, J., Wiggers.,J.J. and Flood, V.M. (2011) Dietary glycemic
index and glycemic load among Australian Indigenous and non-Indigenous children aged 10 – 12
years. Nutrition. doi:10.1016/j.nut.2011.12.007
3.
Gwynn, J.D., Flood. V., Smith, W.T., D’Este, C.A., Attia, J.A., Turner, N., Cochrane, J., and Wiggers,
J.H. (2011) The Reliability and Validity of a Short Food Frequency Questionnaire among Australian
Aboriginal and Torres Strait Islander and non-Indigenous Rural Children. Public Health Nutrition. 14
(3), 388-402.
4.
Louie, J.C., Flood, V., Turner, N., Everingham, C. and Gwynn, J. (2011). Methodology for adding
glycemic index values to 24 hour recalls. Nutrition. 27(1):59-64.
5.
Gwynn, J.D., Hardy, L.L., Wiggers, J.H., Smith, W.T., D’Este, C.A., Turner, N., Cochrane, J., Barker,
D.J. and Attia, J,A. (2010) The validation of a self-report measure and physical activity of Australian
Aboriginal and Torres Strait Islander and non-Indigenous Rural Children. Australian New Zealand
Journal of Public Health. 34, S57-S65.
=======================
Acknowledgements

Children of Taree, Kempsey and
Lower Hunter and their families.

Biripi, Durri and Awabakal ACMSs.

nturner@durri.org.au