Fun, Food and Fitness for Noongars

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					Fun, Food and Fitness for Noongars

    Alison Lorraine, Gail Cummins, Lynley Pickett.
        Presented by: Jo Webb, Michelle Gahler

            6th National Rural Health Conference
    Canberra, Australian Capital Territory, 4-7 March 2001
                                                                                        6th National Rural Health Conference
Fun, food and fitness for Noongars
Alison Lorraine, Gail Cummins, Lynley Pickett, Central Great Southern Health
Service Western Australia
Presented by Jo Webb and Michelle Gahler

In the Central Great Southern Health Service requests from local Noongar community
members, Aboriginal health workers and other health professionals has inspired a
community-based and driven program called Fun, Food and Fitness for Noongars. The
program aim is to improve the health of the Noongar population through a flexible but
co-ordinated partnership between a variety of health professionals and the local
community members. The program focuses on primary health care and the
communities recognition that sustaining good health is a means of sustaining the
community as a whole.

The Central Great Southern Health Service (CGSHS) is comprised of seven local
government shires in the Wheat Belt area of southern Western Australia. The region
has a combined population base of approximately 13 000. The main shires that the
community health extends its services to include Katanning, Gnowangerup, Tambellup
and Kojonup. The Indigenous population for this health service is 5% of the total
population compared to 3.2% across Western Australia 1,2..

Figure 1   The CGSHS is situated in the south of Western Australia

                                      Central Great Southern Health Service

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Figure 2   Central Great Southern Health Service

The Noongar people of Western Australia (WA) have been shown to have an increased
risk of developing certain lifestyle diseases such as cardiovascular disease and diabetes.
Mortality data for 1994–1996 showed that diseases of the circulatory system, including
cardiovascular disease and stroke, was the leading cause of death for Indigenous
Western Australian’s 3.

Indigenous people are more likely to have cardiovascular disease than other Australians
across all age groups. The overall cardiovascular deaths were twice as high in 1995–
1997 with coronary heart disease being 1.7 times higher and stroke 3 times higher than
the rest of the population 1.

Non-insulin dependant diabetes mellitus (NIDDM) is a significant health problem
among Indigenous people. The data also showed that the overall prevalence of NIDDM
amongst Indigenous people is between 10 and 30%, two to four times that of non-
Indigenous people. In 1995–1997 deaths from diabetes were nine times more common
in males and 16 times more common in females living in WA than the rest of the
population 3. The common outcomes of diabetes in Indigenous people are
cardiovascular disease, renal failure and vision loss 4.

The onset of NIDDM occurs at a much lower age in Indigenous people than in non-
Indigenous, therefore the prevention of complications is very important 3,1. Diabetes
and cardiovascular disease contribute to the excessive morbidity of Indigenous people
and is associated with many risk factors including obesity, dyslipidaemia, hypertension,
cigarette smoking and a sedentary lifestyle 1.

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While there is no proven preventive therapy for NIDDM, the onset can be significantly
delayed and possibly prevented in high risk populations with early intervention to
reduce obesity and inactivity. As NIDDM shares many risk factors with other chronic
diseases such as cardiovascular disease, similar prevention strategies can be
co-ordinated across disease programs 4.

Appropriate healthy eating and exercise are key issues in the management of all people
with diabetes as blood glucose control involves an interaction between diet, exercise
and medication. In NIDDM the effect of exercise in improving insulin sensitivity is
important in both treatment and prevention of the disorder 5.

Therefore, it is essential that any health promotion program target these risk factors but
also to provide the intervention in a culturally secure and practically oriented way to
enable the participants to apply these new skills and knowledge to daily living 5.

The target audience for this program are Noongar men and women aged 18 to 65 years,
however, because of the family relationships and strength of community bonds the
program impacts on a far broader audience. The majority of people that attend the
program are Noongar women of child bearing age. Many of their children also attend
and are encouraged to participate in the activities. Men attend sessions on a more
sporadic basis due to work, TAFE and commitments with the local Community
Development and Education Program (CDEP). Fun, Food and Fitness has used these
community groups, such as TAFE and CDEP as a means of accessing the target
audience. The co-ordinators of these groups value Fun, Food and Fitness and are
willing to allow a few hours each week for the program to be undertaken, hence
strengthening and encouraging participation. Hence, the target audience can be
willingly accessed through these other pre-existing community activities.

The program is currently running in three towns in the region, Tambellup, Katanning
and Gnowangerup. Weekly sessions are held at the local Noongar community centres
where kitchen facilities and floor space for exercise is available. Use of the Noongar
community centre provides a comfortable, accessible and culturally appropriate
environment for the participants. Not only are kitchen and other facilities available but
some centres also have access to outdoor barbecue areas and bush walking trails are
situated nearby.

The program goal for Fun, Food and Fitness for Noongars is to reduce by 10% the risk
factors for developing diet-related diseases in 55% of participants, within one year of
commencing the program. In order to achieve this goal the following objectives have
been set.

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♦   For 40% of participants who attend the program to decrease their intake of dietary
    fats, especially saturated fat, by 10% after 3 months of participating in the program.

♦   For 40% of participants who attend the program to increase their physical activity
    by 20 minutes per week after 3 months of participating in the program.

These goals and objectives were developed in conjunction with the community
members, Aboriginal Health workers and allied health team.

The program is co-ordinated by community health services, Aboriginal health and
dietetic departments. Other health professionals also involved include community
nurses, physiotherapists and a diabetes educator.

Fun, Food and Fitness for Noongars is an ongoing program that addresses the
components of a healthy lifestyle including regular exercise, healthy cooking and
shopping practices, stress reduction and motivational techniques.

The structure of the program is based on the requests and desires of the participants.
The group meets regularly, approximately one day per week but allows for changing
circumstances and flexibility in the participant’s routines.

The activities are conducted in an informal relaxed atmosphere where the participants
are simply encouraged to enjoy themselves. The program is designed to be flexible
enough to allow any reasonable suggestions or requests from participants to be

Some of the activities that are undertaken include the following.

♦   Walking group. A walking group provides a way for participants to motivate each
    other by walking together. Different routes are taken around the surrounding areas
    including bush land. Everybody is encouraged to walk at their own pace so that
    people with different levels of fitness are able to join in.

♦   Healthy cooking classes. Cooking classes provide a way for participants to learn
    new skills associated with healthy cooking and make behavioural changes easier
    when applying these new skills at home. The cooking classes are facilitated by the
    community dietitian who provides cooking ideas and recipes such as muffins, stir
    fries, curries and other meals as requested by the participants. The meals are
    prepared and cooked by the participants at the Noongar centre and then eaten
    together at lunch.

♦   Gentle exercise classes. Exercise classes are conducted by the community
    physiotherapist and are designed to improve cardiovascular fitness, strength,
    flexibility and increase muscle tone. The classes suit all levels of fitness ad were
    designed so that the participants conduct their own sessions with occasional input
    from the physiotherapist.

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♦   Supermarket tours. Supermarket tours are conducted by the community dietitian to
    highlight examples of healthy foods available in each local area. The tours also
    enable participants to have the skills to understand and read food labels.

♦   Discussion groups regarding healthy eating, benefits of exercise, healthy strategies
    to lose weight and risk factors associated with heart disease and diabetes are
    undertaken informally with the community dietitian. Participants identified with
    specific treatment needs are referred on for individual appointments with the
    appropriate allied health staff.

♦   Tae bo classes. Tae bo is an aerobic style kickboxing that provides participants with
    a different and varied approach to exercise. Participants find the sessions enjoyable
    and rewarding as their skill level improves.

Due to the informal structures of the program evaluation was kept as informal and as
non-intrusive as possible.

Process evaluation is conducted by keeping records on attendance and the content and
activities that are covered in each session. The attendance is usually between 6 and 9
adults plus children.

Ongoing evaluation is conducted by the facilitator on any particular day recording any
observations such as group dynamics or particular discussion points in the form of a
weekly log. This allows for regular informal feedback and for changes to take place
immediately if things were not to the satisfaction of the group.

A similar approach was taken to measure impact evaluation. To assess the participants
reduction in dietary fat and increase in exercise, discussion questions were informally
included in the conversation. The questions related to suggestions that were made in
previous weeks, for example dietary changes or level of activity outside of program

All the facilitators and program co-ordinators are aware that flexibility and a relaxed
approach are essential for a program such as this to be successful in the long term.
Attendance may not be possible on a regular basis and means that the health
professionals time is not always used entirely effectively especially when travel to rural
centres is required. However, patience is required as success with behavioural change
programs require a long-term persistent approach.

Accessing the target audience is often a barrier with Aboriginal health programs. This
barrier is overcome, however, in Fun, Food and Fitness by collaboration with the
Aboriginal health workers. Aboriginal health workers have an important role in
co-ordinating the community, ensuring a culturally appropriate program, promotion of
the events and assisting in maintaining the enthusiasm in the participants. It is

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necessary to recognise that the Aboriginal health workers are not outside the
community themselves and that this means that certain roles, responsibilities and
relationships must also be taken into consideration.

The continual participation and requests for different exercise or cooking ideas is a
strong indicator that the program is achieving its aim of promoting well-being and
healthy lifestyle through a focus on enjoyment and fun. This is the most rewarding
element of the program for both the participants and the facilitators involved in
implementing the program.

In addition to this other community projects have been inspired by the program. The
development of a cookbook with colour photos of the participants and a selection of
recipes used in the program. The cookbook has received a positive response from
participants and the wider community.

The Central Great Southern Health Service in combination with the Upper and Lower
Great Southern Health Services, Family Futures and Southern Aboriginal Corporation
have worked together to develop three television commercials to be screened on the
rural television network in Western Australia. The television commercials represent a
positive approach towards the prevention and early diagnosis and treatment of NIDDM.
The advertisements represent a variety of images related to healthy food choices and
preparation techniques, sporting activities, availability of Aboriginal health workers
within the region. Local Noongars feature in the commercials and in the Central Great
Southern Health Service the Fun, Food and Fitness groups were actively involved in the
production and filming of the scenes shot in the area. The community health services
has a long and well established rapport with the local Noongar community and looks
forward to many more joint projects and to the continuation of Fun, Food and Fitness
for Noongars in the future.

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1.   National Aboriginal and Torres Strait Islander Health Clearinghouse (1999) Summary of
     Indigenous health status, 1999.

2.   Health Department of Western Australia, Epidemiological Statistics for Cardiovascular Disease
     and Diabetes in the Central Great Southern Health Service.

3.   Australian Bureau of Statistics (1999) National Health Survey: Aboriginal and Torres Strait
     Islander Results, Australia Distributor 27-JAN-99.

4.   General health purchasing Division of the Health Department of Western Australia. Western
     Australian Diabetes Strategy 1999, Western Australian Diabetes Services Taskforce.

5.   National Health and Medical Research Council (1994) Diabetes and Exercise: Series on
     Diabetes No.4. Commonwealth of Australia.

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Lorraine Green has qualifications in occupational therapy, adult education, health
economics and tomfoolery! She is the Manager of the Rural Health Unit in the
Tasmanian Department of Health and Human Services. She is passionately committed
to two things: firstly, achieving improved health status for rural Tasmanians; and
secondly, wearing her pink rabbit costume at national conferences!

Gail Cummins graduated as a dietitian from Curtin University in 1995. She has
worked for the Central Great Southern Health Service for the past five years. She was
initially employed as a clinical/community dietitian and then as the position expanded
she filled the newly created diabetes co-ordinator/dietitian position. Gail has completed
all three levels of the Diabetes Australia Western Australian diabetes educator course.


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