Original articles (peer reviewed)

The potential impact of mainstreaming government services and water on the food security of a regional Indigenous community: insights from a focus group

Posted on: 9 July, 2012
Issue: Vol 12 No 3, July 2012 - September 2012
Related to Social determinants

Willis E1, Pearce M2 and Thallon A3 (2012)
The potential impact of mainstreaming government services and water on the food security of a regional Indigenous community: insights from a focus group. Australian Indigenous HealthBulletin 12(3). Retrieved [access date] from http://healthbulletin.org.au/articles/the-potential-impact-of-mainstreaming-government-services-and-water-on-the-food-security-of-a-regional-indigenous-community-insights-from-a-focus-group/

1School of Medicine, Flinders University
2School of the Environment, Flinders University
3WA Country Health Service, Great Southern Community Health Services

Abstract

Objective: This study assessed the potential impact of increased household costs associated with mainstreaming government services and charging for water on the food security of a regional Indigenous community.

Methods: Qualitative data were obtained through focus group sessions held with members of the community in June 2009. Participants were asked to quantify their living expenses and how the move to individual household water billing would affect their expenses and food security.

Results: Residents in the community were found to be particularly vulnerable to food insecurity due to their low-incomes, disproportionately high living expenses, and lack of transport. Findings indicate that it is not uncommon for residents to run out of food, however, the altruistic nature of neighbours, particularly in relation to food, meant that nobody went hungry for long periods.

Conclusions: It is expected that as a result of increased water costs residents will experience higher levels of utility stress and be at a greater risk of food insecurity due to their reduction in disposable income.

Implications: The heightened level of utility stress and food insecurity is likely to have implications for the well being of residents in the community. Furthermore, where there is existing morbidity, ill-health may be aggravated by poor diet and food insecurity.

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Introduction

This paper assesses the potential impact of mainstreaming Aboriginal services and the increased utility stress on the amount of disposable income available for purchasing food, and thus indirectly how it would impact on the health of a regional Indigenous community. Mainstreaming services refers to recent government policy that has transferred responsibility for Indigenous services from Aboriginal specific organisations or government departments to those that cover the total Australian population. One example in South Australia is the disestablishment of the Aboriginal Housing Trust and the creation of a unit within Housing SA devoted to Indigenous housing.

Utility stress refers to the inability of an individual household to meet the cost of water, electricity, fuel or telephone expenses by the due date and is considered to be a social determinant of health [1]. Low income households are particularly vulnerable to utility stress and its impacts which include poor health, social isolation, financial hardship and bankruptcy [2]. A continuous struggle to meet basic living costs, such as rent and utility bills, and being unable to participate in ordinary societal activities, and unreasonably low standards of living compared to others within society, are indicators of poverty [3,4]. Low-income households also spend a greater proportion of their income on utility services compared to more affluent households [5].

There is a well established association between low socio-economic status (SES) and higher rates of morbidity and mortality from preventable, diet-related chronic diseases [3,6]. SES governs food choice and food purchasing patterns [6,7,8]. In order for people to consume a nourishing diet, it is essential to have both physical access and the economic capacity to obtain healthy foods [9]. Although Australia as a nation has good access to high quality, nutritious foods, disadvantaged sub-groups, such as those on low-incomes or unemployed [10], Aboriginal and Torres Strait Islander peoples, homeless people, the elderly and disabled, and those living in remote areas, are particularly vulnerable to food insecurity due to impaired physical or economic access. Food insecurity exists when social, economic and institutional factors affect the ability to obtain nourishing foods in a socially acceptable manner, or the uncertainty that one may be unable to do so [3,11,12,13]. In contrast, food security is ‘when all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life’ [14]. Food security relates to the capacity of individuals, households and communities to acquire sufficient quantity and quality of food on a reliable and regular basis [8,12]. Key disabling factors are insufficient income; inadequate material effects such as storage, preparation and cooking facilities; inadequate transport; low health status; and, other living costs which reduce the amount of disposable income available for groceries [3,8].

Food insecurity is widespread in remote Australian communities. Although rural and regional areas have only limited restrictions to goods and services, it is still likely that poor access is an issue [5], especially when poverty is prevalent. Food insecurity can affect the physical, mental and social wellbeing of families [10]. Anxiety and other psychological effects are common as a result of not having enough food to eat or from a fear of running out of food and not being able to buy more [3,8]. In a population sub-group which already has a substantially greater burden of chronic disease compared with non-indigenous Australians, poor nutrition can have an even greater impact on health outcomes [12].

Context of the study

Over the last decade changes have occurred within Federal and State government departments which have resulted in the mainstreaming of essential services in discrete Indigenous communities. Following the abolition of the Aboriginal and Torres Strait Islander Commission (ATSIC) in 2005, responsibility for services and programs formerly managed by ATSIC were transferred from Commonwealth Departments, to State and Local Governments agencies [15]. In the same year, the Council of Australian Governments (COAG) endorsed the ‘National Framework of Principles for Delivering Services to Indigenous Australians’ [16]. Previously in South Australia, the Commonwealth primarily funded local government services to these Indigenous communities though the Municipal Services (MUNS) and Community Development Employment Projects (CDEP) programs [17]. In some cases, the removal of MUNS funding has resulted in community councils discontinuing the employment of municipal workers who provided vital administrative services, such as collecting rent, rates and money for water bills, and communicating with external agencies [17]. It was expected that the mainstreaming of services (i.e. housing, infrastructure, essential and municipal services) would lead to improvements in the standard of living and health outcomes of Indigenous Australians, ultimately facilitating ‘Closing the Gap’ since mainstream government agencies are expected to provide services to Indigenous communities at the same standard as non-Indigenous communities [15, 16]. What appears to have been overlooked is the increased costs of these services.

In the community under discussion, their water costs had previously been covered under ATSIC. Following the disestablishment of ATSIC no provision was made for their water costs to be met, nor were they consulted about the outcome. At the same time with the shift in MUNS funding the community lost its capacity to employ individuals to collect rent, organise house maintenance and other public health services such as garbage collection. Because they did not pay rent they were not eligible for the annual SA Housing allowance of $1500 for house repairs. At the time of the study, the local shire had taken up responsibility for refuse collection, but was also moving to insist the residents pay council rates.

In addition to mainstreaming of services, under the National Water Initiative governments are required to ensure that water supplies are sustainable and economically viable and move towards the implementation of full-cost recovery and consumption-based pricing of water [18]. In South Australia, this has seen responsibility for Indigenous water supply move from a government department dedicated to water supply, to SA Water. Despite this, the move to full cost recovery within the Indigenous community context is complicated by current billing arrangements.

In some rural Indigenous communities, water usage is read from a single meter reflecting the total community usage (households, community buildings, watering of sports facilities [where present], and service agencies [health, education]) rather than at the individual household meter [19, 20]. This is because Water Utilities are not authorised to enter these communities to read the meters. Communities receive a bulk bill which is either divided equally among the residents regardless of individual use or administered and paid by the community council. In those communities that have already moved to full cost recovery the Community Council may add a levy to the weekly housing rent and charge government and other resident agencies a percentage [5]. A number of communities manage electricity supplies in a similar manner [5]. While this approach ensure the bills are paid and everyone has access to electricity and water it does not encourage conservation. It also requires staff paid by the community council to collect the levy. Individual household billing, will resolve the issue of equity in dividing a bulk bill, and may encourage water conservation [16], but raises the potential for increased utility stress. It is this latter aspect that is under investigation in this paper.

The study area

According to the Australian Bureau of Statistics [21], the population of the community in 2007 was around 147. Due to the high mobility of the population numbers fluctuated; at times as many as 200 people were found to be resident in the community. The community is in a semi-arid, regional area of South Australia where the nearest small town (population: 1000) is 20 kilometres away. The region is characterised by long-term, high unemployment. The majority of residents rely on Centrelink benefits for income. Several interviews with a part-time community advisor revealed that there had been a concerted effort in 2006-7 to place individuals in jobs in towns in a radius of 100 kilometres. This had been spectacularly unsuccessful due a range of issues. These included a lack of reliable transport to jobs, racism, a general down turn in the pastoral industry, a result of the drought which had resulted in closure of many commercial services such as banks and shops, and a reduction in unskilled labouring jobs linked to farming. Before mainstreaming was proposed, residents were not required to pay for water. The low income (Table 1) and lack of employment (Table 2), and employment opportunities within or near the community raise questions as to how individuals may cope when their cost of living increases.

Table 1: Person characteristics of the community 

Characteristic Selected community Australia
Total persons 147
Females 78 (46.9%) 49.4%
Males 69 (53.1%) 50.6%
Median age 20 years 37
Children 0-14 58 (39.5%) 19.8%
Over 55 14 (9.5%) 24.3%
Total families 31
Families with children 9 (29.0%) 45.3%
Couples without children 5 (16.1%) 37.2%
One parent families 17 (54.8%) 15.8%
Median individual income $203 per week $466
Median household income $342 per week $1,027
Median family income
Average household size $511 $1,171
Median rent $ weekly 3.6 persons
Total rented 35 190
38 (97.8%)

Source: [19]

Table 2: Employment characteristics of the community

Characteristic Total % Australia
Total persons <147  100
Persons 15 years and over 60.4%
Employed full time 0.0 0.0% 60.7%
Employed part-time 5 23.8% 27.9%
Not in labour force 66*
Unemployment rate 16 76.2% 5.2%

Source: [19]

*Individuals ‘not in the labour force’ range from pensioners to those who have given up looking for work.

The community has a small clinic and there is an Aboriginal health service in the nearest town. The health status of the community generally matches that of other Indigenous populations. For example, the Managing two worlds report examined hospital admissions in country and city hospitals for eight major conditions (circulatory, digestive, endocrine, genitourinary, kidney, and respiratory disease, injury and mental health) for Indigenous people in South Australia and found admission rates for Indigenous people to be higher than non-Indigenous for all conditions [22].

Methods

Qualitative data were collected from community members using a semi-structured focus group, conducted in English, with the women’s sewing group in June 2009; approximately 12 women attended. This method was designed to provide insight into the experiences of participants and the wider community, from the perspective of women given their role in shopping and preparing meals [19]. The research team also attended two community meetings with key service agencies and did a site visit of water infrastructure with the second author in attendance, who is a hydrologist. The team had a number of informal conversations with residents and leaders over the three month period, and provided the community and Aboriginal Lands Trust and the State government agency responsible for Aboriginal Affairs with a report of the impact of cost recovery for water.

No attempt was made to gather specific information on what foods were purchased, or the mark-up of essential food items at the major supermarket in the nearest town. However, a visit to the supermarket indicated that prices were consistent with those noted in a previous study for rural and remote regions, where some essential items were marked up to 23% above Adelaide prices [19].

The Flinders University Social and Behavioural Research Ethics Committee and the Aboriginal Health Research Ethics Committee granted permission to conduct the research. Participants remained anonymous. Prior to the focus group sessions, participants were given a letter of introduction, information sheet, and signed a consent form. Although a set of questions guided the discussion, other issues which arose were embraced. Discussions focused on the proposed move to individual household water billing and how it would influence living expenses, and food security. The community wished to remain anonymous and is hence not named.

The data from the focus group were transcribed and thematically analysed to identify common issues, ideas, and opinions. In order to examine the potential implications of increased utility costs, the focus group had two main objectives: i) to determine the living expenses of residents; and ii) to assess the women’s perceptions of impact of increased utility costs on food security

Results

General living expenses and accessibility to shops

Figure 1 provides an indication of weekly expenditure on housing rental, electricity, food, fuel, and communications. Costs for items such as clothing, transport, pay-television, health hardware and health consumables, medical expenses and entertainment are not available but would have to be paid from the remaining third of the income. Health hardware refers to items such as brooms, and cleaning products, while health consumables include shampoo and soap required to maintain hygiene [19]. While there is no report of the percentage of family income spent on cigarettes or alcohol, we did observe several men smoking during our visits. This appeared to occur outside community buildings, not inside, suggesting that while smoking was still prevalent; there was a move to restrict it to the open air. This is consistent with the health promotion Give up smokes for good campaign which encourages Aboriginal people who are unable to quit, to smoke outside [23].

Figure 1: Proportion of income spent on select utilities, housing rental and food for host community and Nepabunna

In the interviews, concerns over the high electricity bills and possible imposition of water costs were raised, which had implications for diet. This concern is summed up in the comment: ‘How much you spend on food depends on how much rent you pay and your electricity bills’.

In comparison with other communities, the electricity bills appear high, that is, between a third and 50% more than that spent on electricity bills in Nepabunna, Yarilena, Scotdesco and Davenport Aboriginal communities – an Aboriginal community where similar study has been conducted [19]. The high cost for electricity at this community is a factor partly attributed to the use of reverse cycle air conditioners as opposed to evaporative cooling systems used in other communities. While reverse cycle cooling results in high electricity costs, evaporative cooling systems can consume vast quantities of water [19]. The decision to use either reverse cycle or evaporative cooling is not made by individual householders renting government funded housing, such as that provided through SA Housing; this is a government decision. Significant cooling cost-related savings could be made through the installation of passive measures such as wide verandas, and shaded areas but these features add to the overall housing costs. Whatever the choice made by the agency providing the housing stock, it impacts on householder’s utility stress either through increased water or electricity costs [19].

Households on limited incomes have been shown to spend a greater proportion of their budget on groceries [7]. It is estimated that the average Australian household spends 17% of their income on food [3,11], while welfare recipients spend at least 20% of their weekly earnings on food [3]. In this study, the finding that 31% of income was spent on food is within a similar range to that found in other remote Aboriginal communities, namely, Nepabunna where the proportion of weekly income spent on food was around 27% of weekly income [19].

Not having access to cooking and refrigeration appliances has been shown to contribute to food insecurity [8], but this was not an issue in this study where all households had functional second hand whitegoods. However, transport and its associated costs were raised as a concern. Although actual figures are not available in this study, the fact that the nearest shop was 20 kilometres outside of the community meant that residents had to rely on car-sharing to get to the shops where they lacked their own transport. Shopping usually occurred on a fortnightly basis to coincide with their Centrelink payments. The fortnightly shop meant that it was necessary to not only buy in bulk but also to buy goods that had an adequate shelf-life to last until the next shop. Participants emphasised that the lack of transport hindered them from accessing more competitive prices in larger supermarkets in more distant towns.

Quality of the food purchased and food security

Some participants said they would buy more fruits and vegetables if they had access to better quality, cheaper produce: ‘Why should we pay top prices for the food we get, when we’re getting rubbish? A lot of the stuff you get a lot of the time is bruised’. However, for many residents fresh fruits and vegetables were perceived to be too expensive to eat regularly. This finding corresponds with other studies demonstrating that the cost of a basic healthy diet is more than what low income households can afford [24].

The nutritional content was not considered; rather the focus of discussions with the women was on having enough to eat and satisfying hunger. It was for this reason that participants did not seek to buy fresh produce if the same amount of money could buy a greater quantity of alternative food and feed more people. This behaviour is consistent with the economics of food choice theory that suggests that people on low incomes will purchase food high in energy, but possibly low in nutrients in order to reduce hunger [8]. In the summer months some households supplemented their diet with fish that they had caught, and when the catch was good this was shared among the community. Participants reported on some families within the community who went without food, however, a community spirit of sharing and assisting those in need in relation to food meant that people did not often go hungry for long periods. Even though people shopped fortnightly for their families, as the food often had to feed more people than expected (due to shortages experienced by others), they consequently exhausted their own supplies before there was money to buy more. This theme emerged strongly in the discussions with the women:

You get your pay fortnightly, you get your food, but that food doesn’t last you for the fortnight…everybody shares… You walk into anybody’s house and you’re welcome to what they’ve got…It’s about helping one another out.

The money doesn’t cater for you having to feed everybody else.

It’s not necessarily great food, it’s more about cooking enough to make it go around and feed everybody – that’s the most important thing.

If there are extra people we’ll dish that extra plate out and make it go around…You’re not just cooking for your family, you’re cooking for everyone.

The 1995 National Nutrition Survey estimated that 5% of all Australians suffer some level of food insecurity [3, 11]. These statistics, however, are much higher among susceptible groups. Twenty-three percent of unemployed people, 20% of people in the second lowest income quintile, and 20% of those living in rental accommodation reported experiencing food insecurity at some stage in the preceding 12 months [3]. In relation to Aboriginal and Torres Strait Islander peoples, Booth and Smith (2001) report that 27% of men and 32% of women admitted to worrying about going without food [11]. Food insecurity is divided into two categories: food insecurity without hunger and food insecurity with hunger [3]. In this study, the sharing nature of the community ensured that although some residents did experience food insecurity, they did not go hungry. Food quality was compromised, but not necessarily quantity. These findings concur with those of others who show that where people experience food insecurity as a result of limited economic resources they tend to consume a less varied diet of poor nutritional quality [3,8]. Such diets are often characterised by energy-dense, nutrient-poor foods, leading to high rates of obesity [8] and the development of chronic, diet-related ailments such as diabetes and cardiovascular disease.

Potential impact of utility stress on diet

When participants were asked how they thought the increased utility costs (specifically the introduction of paying for water) would affect their food purchases, the general feeling was that although water bills would use some of their income, they would still manage. For some, however, it was apparent that the new utility expense would impact on their ability to purchase food: ‘We’re going to have to pay big water rates, then we’re going to be starving…’.

There was the added concern that water bills would be excessively high due to leaking taps and lack of infrastructure maintenance within homes. Although participants claimed they would ‘… feed our families first, then worry about paying bills…’, the research shows that food is one of the few areas where families can cut-back to meet the other living expenses [25]. Money for food is often the only flexible aspect of the weekly budget and other household payments usually take priority over the food allowance [25].

Discussion

By mid 2010, the community had instigated a scheme to begin repaying weekly rental to Housing SA of approximately $50 per week and to meet all water utility expenses. This was achieved by negotiating with Centrelink for each family to have a percentage of their payments quarantined to meet these bills. A similar arrangement was also put in place to meet electricity costs. However, the issue of unemployment remains unresolved. The amount of disposable income has reduced which presumably exacerbates food insecurity.

It is highly unlikely that individual families will go without essential water for healthy living. However, it is probable that excess water will not be used to establish gardens or grow edible plants. Research on rural Indigenous responses to the high cost of water suggests that beautification of the home gardens is the first practice to be sacrificed in meeting costs and one felt keenly by Indigenous people. They see this as a characteristic that sets them apart and generates racism [19, 20].

In discussing the findings with various agencies, comment was made on the seemingly unnecessary expense of Pay TV and cigarettes. While we agree that these items are unnecessary, or in the case of cigarettes, unhealthy, and an additional expense that reduces the amount available for nutritious food, there are few pleasures or activities in isolated rural communities; Pay TV is one of the few sources of entertainment available.

Conclusion

Key enabling factors of food security are adequate income, transport, household appliances, alternative food sources, and appropriate access to a sustainable, affordable food supply. Residents of remote Indigenous communities are particularly vulnerable to food insecurity due to their low incomes, housing situation, locality and remoteness. The results of this study contribute to evidence of food insecurity within regional Indigenous populations particularly as a result of shifts in government policy. In a population sub-group which already has a greater burden of disease than their non-Indigenous counterparts; decreased food security will lead to a further decline in health status, especially concerning diet-related chronic illnesses. In this study there was evidence that some residents experienced food insecurity, but due to the sharing nature of others better-off in the community, they were unlikely to go hungry for any length of time.

This study is limited to one focus group, three visits and several interviews with key people in the community over a three month period, focusing specifically on how the community might move to meet the cost of water and what impact they saw this having on their capacity to purchase food. The focus was on motivating the group to ‘sort out’ the issues for themselves given the loss of government funding for water and community council services. It represents one case study of what may have occurred in a number of small Indigenous communities around Australia in the hiatus between the disestablishment of ATSIC, and the loss of other funding sources, and points to the need for a more coordinated response to Closing the Gap.

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