Using public health nutrition to help reduce table sugar consumption in East Arnhem Land

Between 2015 and 2017, East Arnhem Land recorded the highest rates of avoidable deaths in Australia. (1) In 2018, coronary heart disease emerged as the leading cause of avoidable death among First Nations people, with poor diet contributing to 50% of the total burden. (2) Yolŋŋu people in East Arnhem Land are aware of the health challenges and actively seek community-led support from organisations to create health-promoting food environments. The Arnhem Land Aboriginal Progress Corporation (ALPA), governed by a Yolŋu Board of directors, operate six grocery stores in East Arnhem Land. Through analysis of store sales data more than half of total sugar sales are attributed to table sugar. Despite the successful implementation of strong nutrition policies across their retail stores, which have significantly reduced the sale of sugary products like soft drinks, lollies, and cordial, there has been limited success with reducing purchasing of table sugar. Overall, free sugars from all sugar products purchased remains above the World Health Organization’s recommendations. To tackle this public health issue, the Heart Foundation, in collaboration with ALPA and Miwatj Health Aboriginal Corporation, have embarked on a project aimed at reducing table sugar consumption in East Arnhem Land. Consultations with community members and health professionals in Galiwin ‘ku and Milingimbi were held from July 15 to 19, 2024, to assist in the co-design of culturally relevant nutrition resources. Microsoft Teams was utilised for recording and transcription, and artificial intelligence software for thematic analysis. The consultations explored community perceptions of table sugar, its use, and its health impacts. It was identified that sugar consumption is deeply ingrained, particularly in tea drinking, where large quantities of sugar are consumed daily. The addictive nature of sugar was acknowledged, making it challenging to reduce intake. Thematic analysis revealed that while there is an awareness of sugar’s harmful effects, such as its links to heart disease and diabetes, challenges like food insecurity, addiction, and ingrained consumption habits persist. Community members preferred resources that are culturally sensitive, employ positive storytelling methods, and use both modern (Youtube, TikTok, Instagram and Facebook) and traditional (posters in stores and clinics) media. Suggested strategies included emphasising gradual reduction techniques and involving community to enhance the authenticity of resources. Draft resources will be further refined through a second round of community consultations in late October 2024, with final versions distributed by the end of the year and accessible on the Heart Foundation’s website. Success will be measured through ALPA store sales data on table sugar, website engagement, and social media metrics. This initiative seeks to promote sustainable behaviour change and improve health outcomes in East Arnhem Land.