Hello, everyone. My name's Sarah Burke. And I was introduced on Omondi Fill, an anthropology student here at Oxford.
My current research looks at indigenous Australian health and wellbeing.
But the research I'm preventing today is based on my master's work,
which was looking at narratives of obesity in Australia around for indigenous Australians in particular.
I'm an indigenous Australian. I'm descended from the javu and Kamilaroi peoples.
I also have ancestry from England, Ireland, Germany and China.
So I think of myself as kind of embodying Australia's diverse and complex history.
But I have to say, it's my indigenous heritage which has had the largest impact on my upbringing and my identity.
And it's the perspective that I brought to my research as a graduate.
Another perspective I have, and I'm kind of curious about what the percentage of researchers who have been obese themselves is.
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.
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.
And I think a lot of it for me anyway, from my perspective as an indigenous person.
It had a lot to do with structural dynamics that meant that it was harder for me to be healthier than the average Australian.
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
that obesity itself should be decolonised or thought about in those sorts of ways.
So the process of decolonising obesity must begin with an understanding of how obesity is related to the colonial experience.
Therefore, the majority of my talk will be focussed on addressing that and presenting that evidence.
Firstly, I'll discuss how obesity metrics such as BMI and waist circumference may not represent indigenous body norms.
I will then look at the statistical data that suggests that obesity is the embodiment of structural inequalities.
I will then present some qualitative research which describes obesity as an intergenerational experience which is deeply rooted in historical traumas.
At the end, all suggests potential avenues for decolonising obesity at the individual and community levels,
which focus on strengths based interventions. That is, interventions which focus on the power that culture has to impact health positively.
So I have to say that there is not a lot of research about obesity at indigenous perspectives in Australia.
Full stop. And a lot of statistics that we do know about obesity for indigenous Australians.
Always have caveats about how this isn't necessarily reliable, may not be representative.
These things like that. So bear that in mind as I present this stuff.
So the WHO guidelines for BMI are applied almost universally for indigenous Australians.
The indigenous Australian population in the literature. Waist circumference has also been proposed as a can be equally convenient measure of obesity,
which may also be more indicative of cardiovascular risk.
However, there is evidence to suggest that the reference groups who both BMI and waist
circumference are an accurate indicators of obesity for indigenous Australians.
One study by Leigh McDevitt compared the correlation between BMI,
waist circumference and waist hip ratio and cardio metabolic risk factors such as diabetes and hypertension.
In a sample over two thousand eight hundred people, indigenous Australians.
And they found that's what the study produced optimal BMI polyps, which are well below the guidelines for obesity.
So from their data, they said that the any men, indigenous men,
a BMI of 23 or above would be equivalent to obesity and at twenty five or above for indigenous women.
And it was similar findings for waist circumference. So here, like the Australian nose for women and men, you see for indigenous women,
it's 10 or more said to me this higher as the optimal waist circumference and hajjis men.
It's a little bit lower than women, but it's the reverse relationship for the rest of the population.
Thus, current estimates for obesity in the indigenous Australian population may either underestimate or overestimate obesity rates,
depending on which measure is use and if it is for males or females.
Thus, by continuing to apply the standard guidelines to describe the rate of obesity for indigenous Australians, its real impact becomes modest.
Furthermore, there is an issue around the cost to comparison between indigenous populations and non-Indigenous
populations because it means that indigenous people continuously fail to meet non-Indigenous standards.
And this reinforces the deficit discourse present in indigenous Australian health, which Frayn's conditionality itself as a respected.
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,
let me summarise it by saying that national statistics about indigenous health collected by the
government paint a very bleak picture of almost universal inequality across all measures of health,
education, employment and housing. Indigenous people die younger, faster and more often than the general population and die from avoidable conditions.
At three point five times the rate than the rest of the population.
And these deaths are seen as avoidable, had appropriate healthcare and timely health care being provided at the right time.
As a result, life expectancy at birth is ten years low for males and almost 10 years low of females.
The constant comparison that exists even has a catchphrase.
Close the Gap, which is based on a public awareness campaign by the Australian government, which began in 2007 and continues to today.
That is aimed at raising awareness of the gap between the lives of indigenous Australians and the rest of the population.
Now, I'm not saying raising awareness is bad,
but I am saying that this idea of constantly comparing rather than looking at kind of within population measures is a systemic issue.
Start with that in mind. What do the statistics tell us about obesity and its causes?
Well, the general population rates will be seen.
Australia resemble those of other developed countries and comparable countries like Canada and New Zealand.
And likewise,
the indigenous Australian population represents us an increase in obesity rates similar to those other countries with indigenous populations now.
Wow. That's the most recent statistics I could find for the general population were reset.
And for indigenous Australians, it's a little bit older. The difference doesn't seem like that much.
But once you account for the fact that the indigenous Australian population is much younger,
on average, I think the average age of twenty three compared to 38 for the general population.
It really emphasises that the difference in obesity rates, which here is one point sixty indigenous traits of one point six,
four times more likely to be obese, and for women it's even higher.
Now, some of the most recent information about obesity comes from data collected in the 45 and up study, like the data suggests,
it focuses on a large sample of adults aged 45 and over living in New South Wales and gathers
comprehensive information about the social determinants of health in this population.
One paper conducted by Sabbar and her colleagues conducted the statistical analysis
of the basically prevalence and its relationship to socio demographic factors,
health behaviours and health status amongst Aboriginal and non Aboriginal adults.
The study also sought to quantify the extent to which key factors such as physical activity,
screen time, education, remoteness and others accounted for any excess obesity.
So their findings actually found that many of the causes for obesity,
but the same whether you're indigenous, indigenous things like less formal education,
lower incomes, high level area level disadvantage, less because sexual activity, the less standing time and more screen time.
And the strongest correlation between obesity rates before cigarettes was found for poor self reported physical and mental health.
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.
They just didn't think to measure or also the ongoing effects of colonisation.
And I'm going to talk a little bit about that. Yeah. SEC.
But what the findings of Thurber and colleagues found that correlated with other
evidence that says obesity is associated with a lower rating of self-assessed health.
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.
Disability factors also play a huge role. As you become more obese,
you become less able to take care of yourself and your health and indigenous Australians experiences at higher levels as well.
Contributing factors are at the greater levels of insecurity across Social Security,
economic insecurity and food insecurity, which in turn produces further stress.
And this is a mechanism which is known to mediate the prevalence of obesity on a population level.
And I've just given like one example of the statistic.
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.
Thus, where the contributing factors for obesity are measurable and ditches, strains almost always experience more of it.
And at a greater severity than the rest of the population on average.
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.
There's a scarcity of literature in Australia which incorporates indigenous points of view in relation to obesity.
However, what is out there? Frames obesity and related behaviours within the context of the colonial experience,
which has become intertwined with indigenous identities and cultural practises today.
I think the best way to examine this is to look at how historical events stemming
from colonisation have changed the relationship indigenous people have with food.
So the food colonisation. The population was estimated to be between seven hundred and seventy thousand two million people.
It was highly diverse. Over two hundred and fifty distinct languages thought to be spoken.
And after colonisation, as a result of genocide and the spread of disease, the population dropped to just 75000.
Estimates of. Across the continent,
indigenous people were removed from their traditional homelands and forced to live in concentrated groups at stations or missions during the eighteen,
hundreds of a 200 Christian missions were established to provide rations, minor health care,
housing, education, religion and in some cases, protection from other white Australians.
Indigenous health and wellbeing suffered from a severance with traditional lifestyles and foods, and control over their lives was taken away.
Over several generations, lighter skinned children were systematically removed from their parents and extended families and taken
to be trained as domestic servants for White Middle-Class Australians living in larger towns and cities.
This policy was actually enacted right up until the 1970s, and its victims are now called the Stolen Generations.
Maintaining family connexions has always been a key part of culture for indigenous people.
The experience of such historical traumas have emphasised the desire for this connexion.
And many indigenous people seek to make that maintain this connexion through food.
For example, foods which were given expressions on Christian missions in the past, such as sugar, tea, flour and other starchy,
salty and fatty foods, are now thought of as a way to connect people to their childhood, parents and ancestors.
And I just included a quote here from the literature where a woman is describing
that her mum would always cook these foods and wasn't conscious of the content.
And that's how she in turn has learnt to cook.
In fact, the colonisation itself has led to the progressive limitation of food knowledge over successive generations.
Now, an ethnographic study by Thompson and Giffard conducted almost 20 years ago but still good,
examines the meaning of health and diabetes for Aboriginal people living in Melbourne.
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.
And they say that that sugar, while understood by the participants to be something that was introduced,
also had an important cultural role as a food which was passed down the family line through come through through customs.
It reinforced family identity and connexions over time and place.
The sugar took on both positive and negative meanings when it when it was described as running in the family.
The high consumption of sugar across generations meant that the experiences of obesity related diseases like diabetes have become
woven into family narratives where some people see their experience of diabetes as inevitable and inherited from the parents.
The participants in Thompson and Gethard study extended this to the sharing fast food with the family,
which was seen as a protective factor for health because it contributed to social well-being.
This was particularly the case for men. And I'm going to read you a quote from their article.
Eating family food, particularly meat with fat, is more important to men for the symbolic connexions it provides.
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.
The risk of being disconnected is a more serious outcome than the risk of complications of diabetes.
So these beliefs have implications for obesity, interventions for the general population,
GDP and other health professionals focus on individual behaviour change to facilitate weight loss.
However, as Thompson and Gifford pointed out, for indigenous people,
such an approach would isolate individuals from their families, both in a social sense as well as a historical sense,
disrupting patterns of identity, production and reproduction that have been developed as a coping strategy to process historical trauma.
Sir, the good stuff. I mean, for cop decolonising ABC.
These are my opinions based on the literature.
But then also the big gaps in the literature where I think these interventions would be well-placed to avoid isolating individuals.
Health professionals should implement whole family or community approaches to encourage positive behaviour change.
So when you go see the GP, maybe it shouldn't just be you.
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.
This should be done using culturally appropriate indigenous led initiatives because this
inherently works against defs discourse and constant comparison with non-Indigenous norms.
And the collection of holistic data related to indigenous experience of obesity would be welcome.
I'm just going to put a plug in here for the Mike. City.
It's actually the focus of my defo research and it looks at the cultural determinants of health for indigenous Australians.
And so far, they've got over twenty thousand people who have filled out the survey,
which means it is the largest collection of health data for different strains ever collected following the government's got.
So by applying the strength space model, this would leverage the significant advantages that indigenous cultural practises can provide.
And it's already been shown the language in this example by Bertsch, where indigenous Australians respect traditional languages,
had a twenty seven percent chance of being obese, compared to thirty four point one percent for those who are English speaking English.
So to conclude, indigenous Australia, obesity, it's both directly and indirectly related to colonisation.
It is important that the reference points to metrics such as BMI and waist circumference accurately reflect indigenous,
male and female norms of body shape, fat accumulation and disease risk.
When examining the causes or solutions to the high rates of obesity,
the lived experience of inequality and intergenerational trauma should be taken into account.
Finally, avenues for decolonising obesity can be grounded in indigenous perspectives and
draw on the significant advantages that aspects of just cultures can provide.
Thanks for your attention.