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City-based journos and policy: a threat to remote Indigenous health?

One of the problems with people like me (journalists) is that when we find a problem, we want someone to solve it. And because most of us are based in the major cities, we tend to look to state or federal governments to come up with the solutions.

Unfortunately this can create all sorts of new problems, including that centralised policy-making tends to promote one-size-fits-all solutions.

This was one of the lessons I took from reading the inquiry into remote Aboriginal and Torres Strait Islander community stores, recently tabled by the House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs.

I began reading the report, which is called Everybody’s Business: Remote Aboriginal and Torres Strait Community Stores, thinking: How hard can it be? Of all the problems in health, surely this one – the need to make fresh, healthy food more available and affordable to remote communities – must be more straightforward than most. Surely it can’t be as difficult as, let’s see, trying to reform the health care system…

By the time I’d finished the report and skimming several of the submissions, I’d changed my tune, having gained some little inkling of the many complexities involved. So many different communities with so many different issues, histories, needs and arrangements.

One of the refrains from the report and many of the submissions was that there isn’t one solution to this problem. There’s a need for many solutions which are flexible enough to be adjusted to suit the various needs and capacities of the various communities.

It’s a timely point because, as the report notes, COAG is considering establishing national licensing of remote community stores as part of its closing the gap strategy (not to mention the Feds’ push to extend income quarantining more widely)

The report gives general support to the plans for national licensing of remote stores, but with a number of provisos. It cites some of the lessons that have been learnt from the NT, where licensing of community stores was introduced primarily to facilitate income management under the Northern Territory Emergency Response.

While the report concludes that there have been some benefits from licensing, it also documents many examples of adverse unintended consequences. In some communities, where stores were unable to gain a licence, people had to travel long distances to shop elsewhere, sometimes by air and often by taxi at great expense.

In at least one community, licensing created a distortion which gave the government funded OutbackStores a commercial advantage over existing stores that are unlicensed.

The Committee also expressed concerns that the licensing criteria may be too prescriptive and said they “should support rather than exclude well functioning Indigenous business models that provide benefits within Aboriginal cultural frameworks”.

“Government policy should not restrict the entrepreneurial flair of communities or individuals, but rather seek toprovide safeguards to ensure the continuance of successful and innovative models,” the Committee said.

The report also cited evidence that licensing had not improved  store standards significantly. Instead there was wide variability, with high prices, limited range, and poor quality.

The report noted that the “range and significance of unintended consequences reported by the Commonwealth Ombudsman also suggested the need for more caution and review” before such a system is introduced nationally.

And this was a telling comment: “One of the strongest messages to this inquiry was that whatever regulatory arrangements are imposed, they must be flexible enough to allow for diversity of store models to not only survive but to thrive.”

As well as the bad news in the report – there were some distressing examples of some of Australia’s poorest communities having access to only poor quality, hideously expensive food, and often not having basic facilities for cooking and storing it – there were also examples of successful local solutions, including:

• The committee was told of  a doubling of fruit and vegetable sales at Jilkminggan, after the Sunrise Health Service had nutrition demonstrations in the store.

• Similarly, the high turnover of fruit and vegetables in Kowanyama was attributed to the nutritional education work of the local health centre.

• Examples were given of the power of evidence to change behaviour. In some places, monitoring of sales, and explanation of the implications for the community’s health, helped lead to changes in stores’ ordering practices. The store at the Amata community, for example, stopped selling Coke, Passiona, Gatorade and Disney poppers, and data a year later showed there was an increase in orange juice and water sales.

• Some stores have associated businesses which supplement the supply of fresh local produce as well as keeping prices down. For example, the Northern Peninsula Area Regional Council owned Seisia store runs a beef farm which is the source of the majority of its meat.  Also, the Jarlmadangah Burru Aboriginal Corporation in remote Western Australia runs a cattle station so the meat they buy in is minimal.

There are some useful lessons for both policy makers and journalists out of the report, including the need for both groups to pay close attention to the actual impact of policy “solutions”.

I wonder how closely the roll out of income management will be evaluated and investigated?

Update: Readers interested in these issues might also find this  Medical Journal of Australia editorial useful.

Update: Dr Julie Brimblecombe at Menzies School of Health Research in Darwin, has sent in the following comment on the report:

“What strikes me is the need for some framework for the co-ordination and implementation of many of the recommendations. This framework needs to be based on building Indigenous capacity for local people to define their food system and to develop local solutions as well as receive government support at a broader level to reduce freighting costs, ensure quality, improve availability and affordability etc.
I think store licensing is needed in monopoly situations as is the case in remote communities to ensure fair pricing of food stuffs and other goods, display of prices etc etc. However this should be store licensing without income management.”

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Australian Palliative Care Conference
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