Problems, policy and politics – perspectives of public health leaders on food insecurity and human rights in Australia

Background: To achieve zero hunger targets set within the United Nations’ Agenda 2030, high-income countries such as Australia must reconsider current efforts to improve food security. This study aimed to; explore perspectives from public health nutrition experts on the usefulness of drawing on the international human right to food, and associated mechanisms, to address food insecurity; identify potential roles of key stakeholders in Australia to implement a rights-based approach; and examine barriers and enablers to achieving the right to food in Australia. Methods: Qualitative in-depth interviews were conducted with key informants ( \u3e 10 years professional experience). Braun and Clarke’s (2006) six-phase approach to thematic analysis was employed to analyse data, using Kingdon’s multiple streams framework (1984) to examine interactive variables which affect policy-making processes. Results: Thirty interviews took place, with most participants representing academia (n = 16), majority had 10–14 years of experience (n = 12) and almost one quarter (n = 7) were in senior leadership roles. Participants believed that framing food insecurity as a human rights issue could be effective when communicating with some audiences, however alternative rhetoric is more popular and potentially more effective. Citizens, government, food industry, non-profit sector, research/tertiary and legal institutions were described as playing critical roles. Barriers to progress were identified as lack of awareness and acknowledgement of the problem, prioritisation of the private sector, lack of political will and domestic laws, and an inefficient/ineffective charitable food sector. Participants identified various enablers and opportunities for implementing a rights-based approach such as grass-roots advocacy efforts to raise awareness of the issue, integrating human rights into government frameworks and community projects and the political will to support action aligned with sustainable development. Conclusions: Human rights language and mechanisms have the potential to trigger genuine commitment to addressing food insecurity however should be used with caution. Australia’s public health workforce requires increased capacity to implement a human-rights approach and framing such efforts to align with sustainable development may achieve greater political action. Trial registration: Ethics approval was received from the Deakin University Human Research Ethics committee (project ID HEAG 168_2018)

Strategies to address the complex challenge of improving regional and remote children’s fruit and vegetable consumption

Fruit and vegetables (F&V) are imperative for good health, yet less than one per cent of Australian children consume these food groups in sufficient quantities. As guided by Social Cognitive Theory (SCT), this paper aimed to: (i) understand key informant perspectives of the amount, types and quality of F&V consumed by rural and remote Western Australian (WA) children; and, (ii) determine strategies that could increase F&V consumption among rural and remote WA children. This qualitative study included 20 semi-structured interviews with health, school/youth and food supply workers, focusing on topics including: quantity and type of F&V consumed and strategies to increase children’s consumption. A thematic analysis was conducted using NVivo qualitative data analysis software (Version 10, 2014. QSR International Pty Ltd., Doncaster, Victoria, Australia). Key informants reported children consumed energy-dense nutrient-poor foods in place of F&V. Strategy themes included: using relevant motivators for children to increase their preference for F&V (i.e., gaming approach, SCT construct of ‘expectations’); empowering community-driven initiatives (i.e., kitchen gardens, SCT construct of ‘environment’); increasing food literacy across settings (i.e., food literacy skills, SCT construct of ‘behavioural capacity’); developing salient messages and cooking tips that resonate with parents (i.e., parent newsletters, SCT construct of ‘self-control’); increasing F&V availability, safety, and convenience (i.e., school provision); and, considering the impact of role models that extend beyond the family (i.e., relatable role models, SCT construct of ‘observational learning’). Overall, a comprehensive strategy that incorporates relevant motivators for children and families, supports local initiatives, reinforces the range of role models that are involved with children and creates healthier environments, is required to increase F&V consumption among children

Food supply impacts and solutions associated with the COVID-19 pandemic : a regional Australian case study

This study aimed to explore how food supply chains were impacted by COVID-19 and identify how the region could be better prepared for future crises. An online survey was completed by 107 consumers. In-depth interviews were conducted with 27 food supply stakeholders working in food production, distribution, retail, hospitality, institutions (i.e., childcare), logistics/freight and local government. Pre-COVID-19, farmer-direct distribution options and hospitality businesses comprised a substantial proportion of local food producer businesses. During the COVID-19 pandemic, consumers favoured local food supply options, farmers collaborated, and produce usually destined for export was redirected into local markets. Critical food supply actions included keeping borders open to food freight, enhancing social capital through real-time business communication, and business flexibility. Solutions included business adaptation, for example, farmers selling produce boxes and hospitality businesses selling excess stock, COVID-safe delivery, and collaboration through digital networks. To better prepare the region for future crises, actions to support communities could include a community approach to agriculture, increasing food supply diversity, facilitating transport to aid food distribution and purchasing, and more effective messaging to discourage panic buying. Actions to support retailers could include increasing access to wholesalers through online platforms. Actions to support producers could include improving infrastructure, such as more regional distribution facilities

Canadian children from food insecure households experience low self-esteem and self-efficacy for healthy lifestyle choices

The objectives of this cross-sectional study were to: (i) determine whether there are differences in self-esteem and self-efficacy for healthy lifestyle choices between children living in food secure and food insecure households; and (ii) determine whether the association between household food insecurity (HFI), self-esteem and self-efficacy differs by gender. Survey responses of 5281 fifth-grade students (10 and 11 years of age) participating in the Canadian Children\u27s Lifestyle and School Performance Study II were analyzed using logistic and linear regression. HFI status was determined by the six-item short-form Household Food Security Survey Module (HFSSM). Students from food insecure households had significantly higher odds of low self-esteem, and significantly lower scores for global self-efficacy to make healthy choices, compared to students from food secure households. These associations were stronger for girls than for boys and appeared independent of parental educational attainment. Household income appeared to be the essential underlying determinant of the associations of food insecurity with self-esteem and self-efficacy. Upstream social policies such as improving the household income of low-income residents will reduce food insecurity and potentially improve self-esteem and self-efficacy for healthy choices among children. This may improve health and learning, and in the long term, job opportunities and household earnings

A mixed-methods study to determine the impact of COVID-19 on food security, food access and supply in regional Australia for consumers and food supply stakeholders

Background: The COVID-19 pandemic has impacted the Australian food supply through changed consumer purchasing patterns, and potentially, household food security. The aim of this study was to determine the impact of COVID-19 on the prevalence of food insecurity and food supply issues, and perspectives of food supply stakeholders in regional Australia. Methods: A mixed-methods consumer survey and in-depth interviews with food supply stakeholders were conducted in regional Australia, more specifically South West Western Australia between May and July 2020, immediately after the 1st wave of the pandemic. Results: The prevalence of food insecurity was 21% among consumers, and significantly more prevalent for those aged less than 30 years and living with a disability. Most consumers (73%) agreed that the COVID-19 pandemic had impacted the food supply. Food insecure respondents were more likely to report that food was more expensive, resulting in changes to the types and quantities of food bought. Food supply stakeholders perceived that consumers increased their intention to buy locally grown produce. Panic buying temporarily reduced the availability of food for both food suppliers and consumers, regardless of their food security status. Conclusions: This study provided novel insights from South West Australian consumer and food supply stakeholder perceptions. Food insecure consumers provided insights about the high cost of food and the subsequent adaptation of their shopping habits, namely type and amount of food purchased. Stakeholder perceptions largely focused on supply chain issues and corroborated consumer reports

Application of a sustainability framework to enhance Australian food literacy programs in remote Western Australian communities

Issue addressed: Food literacy programs aim to build individuals’ knowledge, skills and self-efficacy to adopt healthy food choices conducive to reducing the risk of chronic diseases, such as obesity. Foodbank WA’s (FBWA) Healthy Food for All ® nutrition programs have supported the improvement of food literacy knowledge and skills among vulnerable people living in the Pilbara. Methods: A Sustainability Framework containing ten sustainability factors was overlaid with social ecological model (SEM) levels of influence to form a matrix. The use of this matrix facilitated sustainability strategy appraisal within three food literacy programs delivered in remote WA. Results: Programs included multiple sustainability strategies across levels of influence; all programs addressed all ten sustainability factors at community and organisational SEM levels of influence. Few sustainability strategies were employed at the public policy level of influence. No program employed formal governance structures to guide program direction, such as steering groups; however, school and parent program staff developed Memoranda of Understanding to ensure the continuation of program delivery between the FBWA teams’ regional visits. Conclusions: This study has showcased the comprehensive assessment of food literacy program sustainability across levels of influence and identified gaps for improvement by FBWA teams. So What?: The sustainability of food literacy programs aiming to increase knowledge and skills could be enhanced by conducting a similar analysis, during program planning or at program review. Using the matrix provides the opportunity to focus resources to address sustainability; supporting health promotion practitioners to transform the impacts of short-term food literacy interventions into long-term sustained outcomes

Digital behaviour change interventions to increase vegetable intake in adults: A systematic review

Background: Digital interventions may help address low vegetable intake in adults, however there is limited understanding of the features that make them effective. We systematically reviewed digital interventions to increase vegetable intake to 1) describe the effectiveness of the interventions; 2) examine links between effectiveness and use of co-design, personalisation, behavioural theories, and/or a policy framework; and 3) identify other features that contribute to effectiveness. Methods: A systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Scopus, CINAHL, Cochrane Library, INFORMIT, IEEE Xplore and Clinical Trial Registries, published between January 2000 and August 2022. Digital interventions to increase vegetable intake were included, with effective interventions identified based on statistically significant improvement in vegetable intake. To identify policy-action gaps, studies were mapped across the three domains of the NOURISHING framework (i.e., behaviour change communication, food environment, and food system). Risk of bias was assessed using Cochrane tools for randomized, cluster randomized and non-randomized trials. Results: Of the 1,347 records identified, 30 studies were included. Risk of bias was high or serious in most studies (n = 25/30; 83%). Approximately one quarter of the included interventions (n = 8) were effective at improving vegetable intake. While the features of effective and ineffective interventions were similar, embedding of behaviour change theories (89% vs 61%) and inclusion of stakeholders in the design of the intervention (50% vs 38%) were more common among effective interventions. Only one (ineffective) intervention used true co-design. Although fewer effective interventions included personalisation (67% vs 81%), the degree of personalisation varied considerably between studies. All interventions mapped across the NOURISHING framework behaviour change communication domain, with one ineffective intervention also mapping across the food environment domain. Conclusion: Few digital interventions identified in this review were effective for increasing vegetable intake. Embedding behaviour change theories and involving stakeholders in intervention design may increase the likelihood of success. The under-utilisation of comprehensive co-design methods presents an opportunity to ensure that personalisation approaches better meet the needs of target populations. Moreover, future digital interventions should address both behaviour change and food environment influences on vegetable intake

Strategies to Address the Complex Challenge of Improving Regional and Remote Children’s Fruit and Vegetable Consumption

Fruit and vegetables (F&V) are imperative for good health, yet less than one per cent of Australian children consume these food groups in sufficient quantities. As guided by Social Cognitive Theory (SCT), this paper aimed to: (i) understand key informant perspectives of the amount, types and quality of F&V consumed by rural and remote Western Australian (WA) children; and, (ii) determine strategies that could increase F&V consumption among rural and remote WA children. This qualitative study included 20 semi-structured interviews with health, school/youth and food supply workers, focusing on topics including: quantity and type of F&V consumed and strategies to increase children’s consumption. A thematic analysis was conducted using NVivo qualitative data analysis software (Version 10, 2014. QSR International Pty Ltd., Doncaster, Victoria, Australia). Key informants reported children consumed energy-dense nutrient-poor foods in place of F&V. Strategy themes included: using relevant motivators for children to increase their preference for F&V (i.e., gaming approach, SCT construct of ‘expectations’); empowering community-driven initiatives (i.e., kitchen gardens, SCT construct of ‘environment’); increasing food literacy across settings (i.e., food literacy skills, SCT construct of ‘behavioural capacity’); developing salient messages and cooking tips that resonate with parents (i.e., parent newsletters, SCT construct of ‘self-control’); increasing F&V availability, safety, and convenience (i.e., school provision); and, considering the impact of role models that extend beyond the family (i.e., relatable role models, SCT construct of ‘observational learning’). Overall, a comprehensive strategy that incorporates relevant motivators for children and families, supports local initiatives, reinforces the range of role models that are involved with children and creates healthier environments, is required to increase F&V consumption among children

Interventions to address food insecurity among Aboriginal and Torres Strait Islander people: A rapid review

Food insecurity disproportionately impacts Aboriginal and Torres Strait Islander Australians. This review sought to investigate research and evaluations of programs and interventions implemented to address food insecurity among Aboriginal and Torres Strait Islander communities. A rapid review was conducted to collate the available research from 6 databases. The search was conducted in May 2020. Search constructs related to food insecurity, Aboriginal and Torres Strait Islander people, and Australia. Twenty-five publications were included in this review, 24 reported on an intervention, while 9 were evaluations of an intervention. Interventions included behaviour change projects, including projects that sought to change purchasing and cooking behaviours, school-based education programs, and gardening programs. In general, the studies included in this sample were small and lacked a systematic consideration of the factors that shape the experience of food insecurity among Aboriginal and Torres Strait Islander people specifically. Based on the findings of this review, authors suggest greater consideration to the systematic determinants of food insecurity among Aboriginal and Torres Strait Islander communities to have lasting and sustainable impact on food insecurity. This review has been registered with the international prospective register of systematic reviews (PROSPERO: CRD42020183709). Novelty: * Food insecurity among Aboriginal and Torres Strait Islander people poses significant risk to health and wellbeing. * Small-scale food security interventions may not provide ongoing and sustained impact. * Any intervention to promote food security will need to involve Aboriginal and Torres Strait Islander people and be sustained once external parties have left

Strategies to Address the Complex Challenge of Improving Regional and Remote Children’s Fruit and Vegetable Consumption

Fruit and vegetables (F&V) are imperative for good health, yet less than one per cent of Australian children consume these food groups in sufficient quantities. As guided by Social Cognitive Theory (SCT), this paper aimed to: (i) understand key informant perspectives of the amount, types and quality of F&V consumed by rural and remote Western Australian (WA) children; and, (ii) determine strategies that could increase F&V consumption among rural and remote WA children. This qualitative study included 20 semi-structured interviews with health, school/youth and food supply workers, focusing on topics including: quantity and type of F&V consumed and strategies to increase children’s consumption. A thematic analysis was conducted using NVivo qualitative data analysis software (Version 10, 2014. QSR International Pty Ltd., Doncaster, Victoria, Australia). Key informants reported children consumed energy-dense nutrient-poor foods in place of F&V. Strategy themes included: using relevant motivators for children to increase their preference for F&V (i.e., gaming approach, SCT construct of ‘expectations’); empowering community-driven initiatives (i.e., kitchen gardens, SCT construct of ‘environment’); increasing food literacy across settings (i.e., food literacy skills, SCT construct of ‘behavioural capacity’); developing salient messages and cooking tips that resonate with parents (i.e., parent newsletters, SCT construct of ‘self-control’); increasing F&V availability, safety, and convenience (i.e., school provision); and, considering the impact of role models that extend beyond the family (i.e., relatable role models, SCT construct of ‘observational learning’). Overall, a comprehensive strategy that incorporates relevant motivators for children and families, supports local initiatives, reinforces the range of role models that are involved with children and creates healthier environments, is required to increase F&V consumption among children