1 00:00:00,150 --> 00:00:08,340 Hello, everyone. My name's Sarah Burke. And I was introduced on Omondi Fill, an anthropology student here at Oxford. 2 00:00:08,340 --> 00:00:13,560 My current research looks at indigenous Australian health and wellbeing. 3 00:00:13,560 --> 00:00:18,030 But the research I'm preventing today is based on my master's work, 4 00:00:18,030 --> 00:00:26,650 which was looking at narratives of obesity in Australia around for indigenous Australians in particular. 5 00:00:26,650 --> 00:00:32,610 I'm an indigenous Australian. I'm descended from the javu and Kamilaroi peoples. 6 00:00:32,610 --> 00:00:37,500 I also have ancestry from England, Ireland, Germany and China. 7 00:00:37,500 --> 00:00:43,830 So I think of myself as kind of embodying Australia's diverse and complex history. 8 00:00:43,830 --> 00:00:51,150 But I have to say, it's my indigenous heritage which has had the largest impact on my upbringing and my identity. 9 00:00:51,150 --> 00:00:56,610 And it's the perspective that I brought to my research as a graduate. 10 00:00:56,610 --> 00:01:07,080 Another perspective I have, and I'm kind of curious about what the percentage of researchers who have been obese themselves is. 11 00:01:07,080 --> 00:01:17,460 I suspect it's lower than the population average. But I was actually based in my early 20s, nothing too dramatic early like BMI 631. 12 00:01:17,460 --> 00:01:27,840 But I think it had a really big impact on the way that I'm viewing the obesity epidemic of the obesity question, why it's happening. 13 00:01:27,840 --> 00:01:32,520 And I think a lot of it for me anyway, from my perspective as an indigenous person. 14 00:01:32,520 --> 00:01:43,930 It had a lot to do with structural dynamics that meant that it was harder for me to be healthier than the average Australian. 15 00:01:43,930 --> 00:01:51,300 So that's what I'd like to break down for you today, kind of looking at statistics and qualitative data to sort of support this idea 16 00:01:51,300 --> 00:01:59,030 that obesity itself should be decolonised or thought about in those sorts of ways. 17 00:01:59,030 --> 00:02:10,170 So the process of decolonising obesity must begin with an understanding of how obesity is related to the colonial experience. 18 00:02:10,170 --> 00:02:16,530 Therefore, the majority of my talk will be focussed on addressing that and presenting that evidence. 19 00:02:16,530 --> 00:02:26,790 Firstly, I'll discuss how obesity metrics such as BMI and waist circumference may not represent indigenous body norms. 20 00:02:26,790 --> 00:02:34,690 I will then look at the statistical data that suggests that obesity is the embodiment of structural inequalities. 21 00:02:34,690 --> 00:02:44,970 I will then present some qualitative research which describes obesity as an intergenerational experience which is deeply rooted in historical traumas. 22 00:02:44,970 --> 00:02:52,020 At the end, all suggests potential avenues for decolonising obesity at the individual and community levels, 23 00:02:52,020 --> 00:03:06,120 which focus on strengths based interventions. That is, interventions which focus on the power that culture has to impact health positively. 24 00:03:06,120 --> 00:03:13,800 So I have to say that there is not a lot of research about obesity at indigenous perspectives in Australia. 25 00:03:13,800 --> 00:03:19,830 Full stop. And a lot of statistics that we do know about obesity for indigenous Australians. 26 00:03:19,830 --> 00:03:25,680 Always have caveats about how this isn't necessarily reliable, may not be representative. 27 00:03:25,680 --> 00:03:31,620 These things like that. So bear that in mind as I present this stuff. 28 00:03:31,620 --> 00:03:38,850 So the WHO guidelines for BMI are applied almost universally for indigenous Australians. 29 00:03:38,850 --> 00:03:46,950 The indigenous Australian population in the literature. Waist circumference has also been proposed as a can be equally convenient measure of obesity, 30 00:03:46,950 --> 00:03:53,760 which may also be more indicative of cardiovascular risk. 31 00:03:53,760 --> 00:04:00,720 However, there is evidence to suggest that the reference groups who both BMI and waist 32 00:04:00,720 --> 00:04:06,540 circumference are an accurate indicators of obesity for indigenous Australians. 33 00:04:06,540 --> 00:04:12,060 One study by Leigh McDevitt compared the correlation between BMI, 34 00:04:12,060 --> 00:04:19,230 waist circumference and waist hip ratio and cardio metabolic risk factors such as diabetes and hypertension. 35 00:04:19,230 --> 00:04:24,120 In a sample over two thousand eight hundred people, indigenous Australians. 36 00:04:24,120 --> 00:04:33,000 And they found that's what the study produced optimal BMI polyps, which are well below the guidelines for obesity. 37 00:04:33,000 --> 00:04:38,880 So from their data, they said that the any men, indigenous men, 38 00:04:38,880 --> 00:04:47,190 a BMI of 23 or above would be equivalent to obesity and at twenty five or above for indigenous women. 39 00:04:47,190 --> 00:04:56,940 And it was similar findings for waist circumference. So here, like the Australian nose for women and men, you see for indigenous women, 40 00:04:56,940 --> 00:05:04,380 it's 10 or more said to me this higher as the optimal waist circumference and hajjis men. 41 00:05:04,380 --> 00:05:13,410 It's a little bit lower than women, but it's the reverse relationship for the rest of the population. 42 00:05:13,410 --> 00:05:22,890 Thus, current estimates for obesity in the indigenous Australian population may either underestimate or overestimate obesity rates, 43 00:05:22,890 --> 00:05:28,170 depending on which measure is use and if it is for males or females. 44 00:05:28,170 --> 00:05:37,440 Thus, by continuing to apply the standard guidelines to describe the rate of obesity for indigenous Australians, its real impact becomes modest. 45 00:05:37,440 --> 00:05:45,180 Furthermore, there is an issue around the cost to comparison between indigenous populations and non-Indigenous 46 00:05:45,180 --> 00:05:52,440 populations because it means that indigenous people continuously fail to meet non-Indigenous standards. 47 00:05:52,440 --> 00:06:04,110 And this reinforces the deficit discourse present in indigenous Australian health, which Frayn's conditionality itself as a respected. 48 00:06:04,110 --> 00:06:13,090 All right, so in case you are unfamiliar with the ways in which the health of indigenous people is framed at the structural level in Australia, 49 00:06:13,090 --> 00:06:19,450 let me summarise it by saying that national statistics about indigenous health collected by the 50 00:06:19,450 --> 00:06:26,740 government paint a very bleak picture of almost universal inequality across all measures of health, 51 00:06:26,740 --> 00:06:37,540 education, employment and housing. Indigenous people die younger, faster and more often than the general population and die from avoidable conditions. 52 00:06:37,540 --> 00:06:41,170 At three point five times the rate than the rest of the population. 53 00:06:41,170 --> 00:06:51,910 And these deaths are seen as avoidable, had appropriate healthcare and timely health care being provided at the right time. 54 00:06:51,910 --> 00:07:01,180 As a result, life expectancy at birth is ten years low for males and almost 10 years low of females. 55 00:07:01,180 --> 00:07:05,470 The constant comparison that exists even has a catchphrase. 56 00:07:05,470 --> 00:07:16,720 Close the Gap, which is based on a public awareness campaign by the Australian government, which began in 2007 and continues to today. 57 00:07:16,720 --> 00:07:24,070 That is aimed at raising awareness of the gap between the lives of indigenous Australians and the rest of the population. 58 00:07:24,070 --> 00:07:26,830 Now, I'm not saying raising awareness is bad, 59 00:07:26,830 --> 00:07:38,210 but I am saying that this idea of constantly comparing rather than looking at kind of within population measures is a systemic issue. 60 00:07:38,210 --> 00:07:44,630 Start with that in mind. What do the statistics tell us about obesity and its causes? 61 00:07:44,630 --> 00:07:46,880 Well, the general population rates will be seen. 62 00:07:46,880 --> 00:07:54,290 Australia resemble those of other developed countries and comparable countries like Canada and New Zealand. 63 00:07:54,290 --> 00:07:55,220 And likewise, 64 00:07:55,220 --> 00:08:08,260 the indigenous Australian population represents us an increase in obesity rates similar to those other countries with indigenous populations now. 65 00:08:08,260 --> 00:08:13,950 Wow. That's the most recent statistics I could find for the general population were reset. 66 00:08:13,950 --> 00:08:18,950 And for indigenous Australians, it's a little bit older. The difference doesn't seem like that much. 67 00:08:18,950 --> 00:08:23,270 But once you account for the fact that the indigenous Australian population is much younger, 68 00:08:23,270 --> 00:08:29,750 on average, I think the average age of twenty three compared to 38 for the general population. 69 00:08:29,750 --> 00:08:37,650 It really emphasises that the difference in obesity rates, which here is one point sixty indigenous traits of one point six, 70 00:08:37,650 --> 00:08:45,440 four times more likely to be obese, and for women it's even higher. 71 00:08:45,440 --> 00:08:57,500 Now, some of the most recent information about obesity comes from data collected in the 45 and up study, like the data suggests, 72 00:08:57,500 --> 00:09:04,340 it focuses on a large sample of adults aged 45 and over living in New South Wales and gathers 73 00:09:04,340 --> 00:09:09,680 comprehensive information about the social determinants of health in this population. 74 00:09:09,680 --> 00:09:14,810 One paper conducted by Sabbar and her colleagues conducted the statistical analysis 75 00:09:14,810 --> 00:09:19,100 of the basically prevalence and its relationship to socio demographic factors, 76 00:09:19,100 --> 00:09:26,000 health behaviours and health status amongst Aboriginal and non Aboriginal adults. 77 00:09:26,000 --> 00:09:31,240 The study also sought to quantify the extent to which key factors such as physical activity, 78 00:09:31,240 --> 00:09:38,570 screen time, education, remoteness and others accounted for any excess obesity. 79 00:09:38,570 --> 00:09:44,390 So their findings actually found that many of the causes for obesity, 80 00:09:44,390 --> 00:09:51,500 but the same whether you're indigenous, indigenous things like less formal education, 81 00:09:51,500 --> 00:10:01,350 lower incomes, high level area level disadvantage, less because sexual activity, the less standing time and more screen time. 82 00:10:01,350 --> 00:10:11,030 And the strongest correlation between obesity rates before cigarettes was found for poor self reported physical and mental health. 83 00:10:11,030 --> 00:10:20,630 The authors also asserted that the rest. So the other 50 to 60 per cent of the excess obesity may be explained by other factors. 84 00:10:20,630 --> 00:10:25,610 They just didn't think to measure or also the ongoing effects of colonisation. 85 00:10:25,610 --> 00:10:43,170 And I'm going to talk a little bit about that. Yeah. SEC. 86 00:10:43,170 --> 00:10:48,550 But what the findings of Thurber and colleagues found that correlated with other 87 00:10:48,550 --> 00:10:54,370 evidence that says obesity is associated with a lower rating of self-assessed health. 88 00:10:54,370 --> 00:11:03,760 Indigenous Australians are more likely to rate their health as poor or fat and less likely to write their health as very good or excellent. 89 00:11:03,760 --> 00:11:08,560 Disability factors also play a huge role. As you become more obese, 90 00:11:08,560 --> 00:11:17,320 you become less able to take care of yourself and your health and indigenous Australians experiences at higher levels as well. 91 00:11:17,320 --> 00:11:24,400 Contributing factors are at the greater levels of insecurity across Social Security, 92 00:11:24,400 --> 00:11:29,350 economic insecurity and food insecurity, which in turn produces further stress. 93 00:11:29,350 --> 00:11:36,610 And this is a mechanism which is known to mediate the prevalence of obesity on a population level. 94 00:11:36,610 --> 00:11:39,730 And I've just given like one example of the statistic. 95 00:11:39,730 --> 00:11:52,980 We can see the median weekly household income for indigenous adults is just a fraction of what it is for non-indigenous adults on average. 96 00:11:52,980 --> 00:12:00,670 Thus, where the contributing factors for obesity are measurable and ditches, strains almost always experience more of it. 97 00:12:00,670 --> 00:12:06,100 And at a greater severity than the rest of the population on average. 98 00:12:06,100 --> 00:12:15,930 Sir, let's talk about what might be contributing to that 50 to 60 percent of excess obesity that can't be measured at the moment. 99 00:12:15,930 --> 00:12:22,530 There's a scarcity of literature in Australia which incorporates indigenous points of view in relation to obesity. 100 00:12:22,530 --> 00:12:29,640 However, what is out there? Frames obesity and related behaviours within the context of the colonial experience, 101 00:12:29,640 --> 00:12:35,460 which has become intertwined with indigenous identities and cultural practises today. 102 00:12:35,460 --> 00:12:40,620 I think the best way to examine this is to look at how historical events stemming 103 00:12:40,620 --> 00:12:46,110 from colonisation have changed the relationship indigenous people have with food. 104 00:12:46,110 --> 00:12:53,490 So the food colonisation. The population was estimated to be between seven hundred and seventy thousand two million people. 105 00:12:53,490 --> 00:13:01,740 It was highly diverse. Over two hundred and fifty distinct languages thought to be spoken. 106 00:13:01,740 --> 00:13:08,520 And after colonisation, as a result of genocide and the spread of disease, the population dropped to just 75000. 107 00:13:08,520 --> 00:13:12,760 Estimates of. Across the continent, 108 00:13:12,760 --> 00:13:21,640 indigenous people were removed from their traditional homelands and forced to live in concentrated groups at stations or missions during the eighteen, 109 00:13:21,640 --> 00:13:28,990 hundreds of a 200 Christian missions were established to provide rations, minor health care, 110 00:13:28,990 --> 00:13:35,650 housing, education, religion and in some cases, protection from other white Australians. 111 00:13:35,650 --> 00:13:46,910 Indigenous health and wellbeing suffered from a severance with traditional lifestyles and foods, and control over their lives was taken away. 112 00:13:46,910 --> 00:13:53,620 Over several generations, lighter skinned children were systematically removed from their parents and extended families and taken 113 00:13:53,620 --> 00:14:00,310 to be trained as domestic servants for White Middle-Class Australians living in larger towns and cities. 114 00:14:00,310 --> 00:14:11,260 This policy was actually enacted right up until the 1970s, and its victims are now called the Stolen Generations. 115 00:14:11,260 --> 00:14:16,900 Maintaining family connexions has always been a key part of culture for indigenous people. 116 00:14:16,900 --> 00:14:22,540 The experience of such historical traumas have emphasised the desire for this connexion. 117 00:14:22,540 --> 00:14:27,250 And many indigenous people seek to make that maintain this connexion through food. 118 00:14:27,250 --> 00:14:35,140 For example, foods which were given expressions on Christian missions in the past, such as sugar, tea, flour and other starchy, 119 00:14:35,140 --> 00:14:42,620 salty and fatty foods, are now thought of as a way to connect people to their childhood, parents and ancestors. 120 00:14:42,620 --> 00:14:47,470 And I just included a quote here from the literature where a woman is describing 121 00:14:47,470 --> 00:14:52,360 that her mum would always cook these foods and wasn't conscious of the content. 122 00:14:52,360 --> 00:14:56,740 And that's how she in turn has learnt to cook. 123 00:14:56,740 --> 00:15:09,370 In fact, the colonisation itself has led to the progressive limitation of food knowledge over successive generations. 124 00:15:09,370 --> 00:15:16,060 Now, an ethnographic study by Thompson and Giffard conducted almost 20 years ago but still good, 125 00:15:16,060 --> 00:15:20,470 examines the meaning of health and diabetes for Aboriginal people living in Melbourne. 126 00:15:20,470 --> 00:15:30,970 So in an urban environment, they looked at the meeting that sugar has for Aboriginal people as both an ingredient and as a way to describe diabetes. 127 00:15:30,970 --> 00:15:36,760 And they say that that sugar, while understood by the participants to be something that was introduced, 128 00:15:36,760 --> 00:15:44,890 also had an important cultural role as a food which was passed down the family line through come through through customs. 129 00:15:44,890 --> 00:15:49,090 It reinforced family identity and connexions over time and place. 130 00:15:49,090 --> 00:15:57,220 The sugar took on both positive and negative meanings when it when it was described as running in the family. 131 00:15:57,220 --> 00:16:05,320 The high consumption of sugar across generations meant that the experiences of obesity related diseases like diabetes have become 132 00:16:05,320 --> 00:16:14,110 woven into family narratives where some people see their experience of diabetes as inevitable and inherited from the parents. 133 00:16:14,110 --> 00:16:19,930 The participants in Thompson and Gethard study extended this to the sharing fast food with the family, 134 00:16:19,930 --> 00:16:25,180 which was seen as a protective factor for health because it contributed to social well-being. 135 00:16:25,180 --> 00:16:31,030 This was particularly the case for men. And I'm going to read you a quote from their article. 136 00:16:31,030 --> 00:16:38,110 Eating family food, particularly meat with fat, is more important to men for the symbolic connexions it provides. 137 00:16:38,110 --> 00:16:47,530 If a man eats diet food, he may have few other connexions and may therefore risk severing one of these few remaining symbolic links for men. 138 00:16:47,530 --> 00:16:55,320 The risk of being disconnected is a more serious outcome than the risk of complications of diabetes. 139 00:16:55,320 --> 00:17:00,990 So these beliefs have implications for obesity, interventions for the general population, 140 00:17:00,990 --> 00:17:07,110 GDP and other health professionals focus on individual behaviour change to facilitate weight loss. 141 00:17:07,110 --> 00:17:11,250 However, as Thompson and Gifford pointed out, for indigenous people, 142 00:17:11,250 --> 00:17:18,600 such an approach would isolate individuals from their families, both in a social sense as well as a historical sense, 143 00:17:18,600 --> 00:17:29,850 disrupting patterns of identity, production and reproduction that have been developed as a coping strategy to process historical trauma. 144 00:17:29,850 --> 00:17:35,850 Sir, the good stuff. I mean, for cop decolonising ABC. 145 00:17:35,850 --> 00:17:40,110 These are my opinions based on the literature. 146 00:17:40,110 --> 00:17:48,540 But then also the big gaps in the literature where I think these interventions would be well-placed to avoid isolating individuals. 147 00:17:48,540 --> 00:17:55,530 Health professionals should implement whole family or community approaches to encourage positive behaviour change. 148 00:17:55,530 --> 00:17:58,290 So when you go see the GP, maybe it shouldn't just be you. 149 00:17:58,290 --> 00:18:07,320 Maybe it should be you and your family and that there should be a whole conversation about family dynamics and its relation to basically behaviours. 150 00:18:07,320 --> 00:18:12,510 This should be done using culturally appropriate indigenous led initiatives because this 151 00:18:12,510 --> 00:18:18,720 inherently works against defs discourse and constant comparison with non-Indigenous norms. 152 00:18:18,720 --> 00:18:25,170 And the collection of holistic data related to indigenous experience of obesity would be welcome. 153 00:18:25,170 --> 00:18:28,740 I'm just going to put a plug in here for the Mike. City. 154 00:18:28,740 --> 00:18:37,110 It's actually the focus of my defo research and it looks at the cultural determinants of health for indigenous Australians. 155 00:18:37,110 --> 00:18:42,210 And so far, they've got over twenty thousand people who have filled out the survey, 156 00:18:42,210 --> 00:18:53,130 which means it is the largest collection of health data for different strains ever collected following the government's got. 157 00:18:53,130 --> 00:19:04,110 So by applying the strength space model, this would leverage the significant advantages that indigenous cultural practises can provide. 158 00:19:04,110 --> 00:19:11,880 And it's already been shown the language in this example by Bertsch, where indigenous Australians respect traditional languages, 159 00:19:11,880 --> 00:19:22,430 had a twenty seven percent chance of being obese, compared to thirty four point one percent for those who are English speaking English. 160 00:19:22,430 --> 00:19:30,530 So to conclude, indigenous Australia, obesity, it's both directly and indirectly related to colonisation. 161 00:19:30,530 --> 00:19:36,680 It is important that the reference points to metrics such as BMI and waist circumference accurately reflect indigenous, 162 00:19:36,680 --> 00:19:42,440 male and female norms of body shape, fat accumulation and disease risk. 163 00:19:42,440 --> 00:19:46,700 When examining the causes or solutions to the high rates of obesity, 164 00:19:46,700 --> 00:19:51,680 the lived experience of inequality and intergenerational trauma should be taken into account. 165 00:19:51,680 --> 00:19:57,290 Finally, avenues for decolonising obesity can be grounded in indigenous perspectives and 166 00:19:57,290 --> 00:20:02,090 draw on the significant advantages that aspects of just cultures can provide. 167 00:20:02,090 --> 00:20:07,605 Thanks for your attention.