Sherriff Simone L, Baur Louise A, Lambert Michael G, Dickson Michelle L, Eades Sandra J, Muthayya Sumithra
Sax Institute, Sydney, NSW, Australia; School of Public Health, University of Sydney, NSW, Australia; Children's Hospital Westmead Clinical School, Sydney Medical School, University of Sydney, NSW, Australia;
School of Public Health, University of Sydney, NSW, Australia; Children's Hospital Westmead Clinical School, Sydney Medical School, University of Sydney, NSW, Australia.
Public Health Res Pract. 2019 Dec 4;29(4):2941925. doi: 10.17061/phrp2941925.
Childhood obesity poses an urgent and serious public health challenge in Australia. Aboriginal children are more profoundly affected than non-Aboriginal children, with the gap in weight status between the two groups widening, indicating an increased risk of metabolic disorders earlier in life. Obesity is the second biggest contributor (16%) to the gap in health status between Aboriginal and non-Aboriginal people. The bulk of this gap is attributable to people living in non-remote settings who make up 81% of the total Aboriginal population in Australia. The complex interplay of socio-environmental factors that contribute to obesity are well known and include prolonged financial stress associated with food insecurity, urbanisation, substandard and overcrowded housing, and lack of adequate access to health services. In addition, Aboriginal people, specifically, contend with the loss of traditional lands, and poor dietary behaviours due to the transition from traditional to Western diets as a result of colonisation. There are very few national policies and guidelines for obesity prevention and treatment for Australian children. This is especially the case for Aboriginal children. Most Australian states and territories have a suite of programs targeting obesity in childhood through healthy eating and active living strategies but with the exception of a few programs, the reach and effectiveness among Aboriginal children is either not known or has not been adequately assessed. Where programs have assessed Aboriginal participation, completion rates have generally been lower compared with the general population. The problem cannot be addressed without proper Aboriginal governance and leadership, and collaborative program development for Aboriginal-specific obesity interventions. Meaningful engagement and empowering Aboriginal communities to have control over programs that affect their health and wellbeing are more likely to result in positive health outcomes. Importantly, appropriate funding and support is essential to simultaneously facilitate the building of an Aboriginal health workforce to develop, coordinate, deliver and evaluate programs.
儿童肥胖问题给澳大利亚的公共卫生带来了紧迫而严峻的挑战。原住民儿童比非原住民儿童受到的影响更为严重，两组儿童在体重状况上的差距正在扩大，这表明他们在生命早期患代谢紊乱疾病的风险增加。肥胖是造成原住民与非原住民健康状况差距的第二大因素（占16%）。这一差距的主要原因在于生活在非偏远地区的人群，他们占澳大利亚原住民总人口的81%。导致肥胖的社会环境因素之间存在复杂的相互作用，这些因素包括与粮食不安全相关的长期经济压力、城市化、住房条件差且拥挤不堪，以及缺乏获得医疗服务的充足途径。此外，原住民尤其面临着传统土地的丧失，以及由于殖民化导致从传统饮食向西方饮食转变而产生的不良饮食行为。澳大利亚几乎没有针对儿童肥胖预防和治疗的国家政策和指导方针。原住民儿童的情况尤其如此。澳大利亚大多数州和领地都有一系列通过健康饮食和积极生活方式策略来应对儿童肥胖问题的项目，但除了少数项目外，这些项目在原住民儿童中的覆盖范围和效果要么未知，要么未得到充分评估。在对原住民参与情况进行评估的项目中，完成率通常低于普通人群。如果没有适当的原住民治理和领导，以及针对原住民特定肥胖干预措施的合作项目开发，这个问题就无法得到解决。有意义的参与并赋予原住民社区对影响其健康和福祉的项目的控制权，更有可能带来积极的健康成果。重要的是，适当的资金和支持对于同时促进建设一支原住民卫生工作队伍以开发、协调、提供和评估项目至关重要。
