Public Health Nutrition from Foodies in the Field

Unpacking the rising cost of food in Australia, with Professor Amanda Lee

October 04, 2022
Public Health Nutrition from Foodies in the Field
Unpacking the rising cost of food in Australia, with Professor Amanda Lee
Show Notes Transcript

Professor Amanda Lee, of Public Health Policy in the Faculty of Medicine’s School of Public Health at the University of Queensland and Affiliate Professor at the UQ Poche Centre for Indigenous Health. Amanda is a Senior Adviser with The Australian Prevention Partnership Centre, an Adjunct Professor at Curtin University, Griffith University and the Queensland University of Technology, and Nutrition Consultant for Nganampa Health Council.

In this episode we focus on food pricing and affordability in the Australian context, and the inequity seen within our nation. We talk about why we've seen a dramatic increase in the past two years and what can be done to ensure healthy food remains affordable into the future.

Professor Amanda Lee has more than 35 years’ experience as a practitioner and academic in nutrition, obesity and chronic disease prevention, Indigenous health and public health policy including chairing the NHMRC Dietary Guidelines Working Committee (2008-13), current Chair of Food Standards Australia New Zealand’s Consumer and Public Health Dialogue, member of the Australian Academy of Science’s Nutrition Committee and Co-convenor of the Food and Nutrition Special Interest Group of the Public Health Association of Australia. Globally, she leads the food price and affordability domain of the International Network for Food and Obesity/non-communicable diseases Research, Monitoring and Action Support (INFORMAS).

For further information, check out Amanda's researcher profile at the
University of Queensland and the Sax Institute; and Amanda's Twitter

Key papers related to this episode

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CREDITS
Host: Sophie Wright-Pedersen
With thanks to Professor Amanda Lee for her time and thoughts

The Foodies in the Field podcast would like to acknowledge the traditional owners of the land on which this podcast was made and where Amanda was speaking from, the Turrbal and Yuggera people, as well as where you may be listening from today. We pay respects to elders both past and present and acknowledge that Aboriginal and Torres Strait Islander

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Sophie: [00:00:00] Hi, welcome to Public Health Nutrition from Foodies in the Field, a podcast showcasing stories from passionate foodies about who they are and what they do. I'm Sophie Wright-Pedersen, your podcast host. And on today's show we have Professor Amanda Lee from the University of Queensland. The list of Amanda's achievements and 35 years of experience is extensive alongside working at the University of Queensland, she's also currently a senior advisor with the Australian Prevention Partnership Centre, an adjunct Professor at Curtin University, Griffith University, and the Queensland University of Technology, and is also a nutrition consultant for Nganampa health council. Amanda also chaired the NHMRC Dietary Guidelines Working Committee and Infant Feeding Guidelines Subcommittee in 2008 to 2013. She also worked as the Director of Nutrition and Physical Activity in Queensland Health for 12 years during the heyday of Eat Well Australia, and NATSINSAP and oversaw the development and evaluation of effective policies and programs such as Smart Choices and a Better Choice within Queensland Globally. She leads a food price and affordability domain of INFORMAS and has done extensive research into food pricing and affordability, of which is a topic of today's podcast. We talk about the inequity scene within our nation's food pricing. Why we've seen a dramatic increase in the past two years and what can be done to ensure healthy food remains affordable into the future. Over the past year we've been barraged with headlines stating that the cost of living is going up and up and up. And among that, an ongoing increase in the price of food and a lot of the conversation on how to manage this from what I've personally seen in the media has been around how individuals can budget, better. But I thought today that we could perhaps shed a little bit more light on some of the wider determinants of the increase in the food pricing that we've seen, both generally and even between like different contexts within Australia, and I guess then also what we can do to address these determinants, both as a profession or, um, within the different, um, places we work and that we have an impact in as well. So I guess my first question to you, Amanda, is generally in Australia, do you, do you think that healthy food is actually unaffordable and how do we go about, or how do you go about measuring this?

Amanda: So in the literature, Sophie, um, it's been, uh, stated that affordability of, uh, diets is set at about 30% of the, uh, household income. So where, uh, you know, families are spend in households are spending more than 30%, 30% or more of their disposable income to feed themselves, that's considered unaffordable. And it's also the level that housing affordability is set. So, um, I think it's important to think about all the other pressures on, uh, household budgets at the moment. So we use that as a benchmark. Yep. Um, and it's like all benchmarks. It's a comparator and it would be different for different families in different locations and times.

Sophie: Yeah. Okay. And so using that 30% of disposable income, you've done a lot of work at measuring the affordability of food across Australia. What are you seeing there in terms of how affordable food is? 

Amanda: Well, I, I guess, I guess the issue is, you know, like all. Research, particularly in nutrition, the issue is, well, what questions do you ask? Mm. And you know, to get to that question of what's the affordability of food, you probably need to work a little bit backwards and think, well, what are the components of the affordability of food and what had been done in the past. Because until about 2014, we didn't have a standardized systematic approach to assess the cost of healthy diet yeah. Um, and, uh, and even a way of standardizing, looking at income, particularly amongst welfare families. So I guess all this perhaps goes back to, you know, the work of INFORMAS, which is a group of public health advocates that are trying to measure components of the food environment with the, uh, theory that, you know, what gets measured, gets talked about. And we've been trying to establish international benchmarks. To inform monitoring and surveillance of food environments, including the cost of foods. So up until that stage, a lot of the, um, assessment around the cost of foods was done just on selected foods where people [00:05:00] would, you know, choose a list of, of foods that were relatively healthy and then counter pose those with unhealthy foods. And it's all very arbitrary when you do that because you know what is the unhealthy, um, uh, pair of an apple often list would say, oh, well that's a snack, so we'll cost potato chips there, instead. You know, and it doesn't really, um, it's not grounded or centred from a nutrition perspective. So through the group, INFORMAS what we did say, you know, we'll optimally, which we can do in Australia because we have excellent, um, health and costing data, what we can do is actually try and anchor those foods in a diet. So think about, you know, what is the, um, long term driver of poor diet related health is actually not individual foods. Or selected foods, but habitual diet through the lifespan. So we wanted to cost as a basis the current diet, which is based on what Australians of different age and genders say they eat during the most recent National Nutrition survey, which now is 2011/12. So it's getting a bit old. They're about to do another one. Um, that should be available in 2025, but in 2011/12, What does the average Australian family, two adults, two children, what are they admitting to eat? And we cost that and then compare it to the minimum change that would be made need to be made on the that current diet to be more. Healthy more equitable and more environmentally sustainable. And we did that by looking at the minimum changes that would be made consistent with the Australian dietary guideline recommendations. And then we costed, you know, the total cost for that family of buying a healthier diet. And we did this because if you are going to inform policy you really need to look at the difference between what you're doing now and what could be done under the policy, policy scenarios and modelling that you would be recommending. And I think that's really important. So everything is grounded and it's also so comparable. 

Sophie: And I'm assuming that what you're talking about there is the ASAP tool that you've developed. 

Amanda: Yes, yes. So we developed a, a, um, tool called Healthy Diets ASAP Healthy Diets, Australian Standardized Affordability and Pricing protocol and we developed that, um, in partnership with, um, over 60 stakeholder groups around Australia. And in 2015, I think it was, um, organized a national forum where stakeholders came together to, um, make decisions around some of the more arbitrary components of the, the protocol. For example, if you go into a store and you wanna cost WeetBix, which side size pack of WeetBix do you take. You know, it really varies as people know from those unit pricing, um, data that's available in stores to help people budget. It really varies, um, based on, uh, the size that you choose. And it also varies on if you use, um, common branded popular items versus say, um, generic items or supermarket brands too. So you need to standardize all those individual things, even, even which stores would you collect? You know, do you collect from ALDI or do you collect from just Coles and Woolworths? And we try to make our standardized methods very centred on what an individual family would do if they lived in a place in a location, and that is shopping from a variety of outlets, including things like perhaps bakeries and fish and chip shops and McDonald's. A lot of the pricing on assessment on foods that has been done in the past in Australia is centred on knowing how much it would cost you to buy a relatively healthy diet at a particular store. And that's good to inform what the store managers should do, but it doesn't really help the broader society or the government decide what policy options are going to be [00:10:00] the best in improving affordability of food and, you know, all that. I think it was really telling that although we'd been collecting food price data in those dietary surveys for over 40 years, there'd never really been, um, any policy influence or impact. So we really, uh, devising this approach to inform what can be done in terms of regulatory and legislative reform.

Sophie: And so when you've conducted that tool, what have you found in terms of the affordability of healthy, that healthy diet that it, you know, that aspirational healthy diet versus the current less healthy diet that Australians are eating? 

Amanda: Well, we were really shocked when we first did this data. We collected the prices to test the tool during development stage just here in Brisbane. Um, and we looked at, you know, 13 different locations around the broader city, Brisbane Centre. Is one of the biggest, um, electorates in the world, in, in Australia. I don't think people realize that the greater Brisbane extends a long way down to the Gold Coast, et cetera. Um, so there was quite a bit of variance in, uh, in the locations that we could collect from and we controlled for socioeconomic, um, area as well. And surprisingly, We found that, uh, the healthy recommended, more sustainable equitable diet was between about 15 and 20% cheaper, I don't wanna say cheap, let's say less expensive than the cost of the current diet that's being consumed. And this was a real surprise because the rhetoric is that when people choose foods, price is a major determinant. And there. Uh, a strong belief that healthy foods are more expensive than unhealthy foods. When we discovered that data, firstly we thought we must have made a mistake and we went back and checked everything. Yeah. Then two things. I think we were thinking, well, well, why would this be what contributes to the price of, uh, foods? And the differential between healthy and discretionary ultra process foods in Australia. What, what, what's going on there? And then I think there's a second question about, well, what might be the drivers of food choice other than price? Um, so in the first bit, I think. You know, it was interesting to consider, you know, Australia's only one of three countries in the world that has a differential taxation GST structure for healthy and for unhealthy foods. So this came in in 2000, in the year 2000 in Australia, where politically to get support for the introduction of the GST the government of the day was pressured by then the Australian Democrats, who, um, insisted that basic healthy foods should be free of GST in Australia. They needed to put in through that amendment to get political support for the whole program. So we are very fortunate in that basic healthy foods have got 10% less tax on than non healthy foods and I think this is really important cause every so often there's a bid to expand the base of the GST yeah. And what that means is to, uh, introduce some taxes around schooling. Around education, but for the purposes of this conversation, also to extend the GST to basic healthy foods and it's in, and that used to come up maybe every three or four years. We're actually seeing that call more regularly now because it would be a revenue raising issue for government, but also you need to think who would be advocating for that. And it's often those unhealthy food industries. Yeah, that would do that. But then the other thing that when we looked at, um, the price differential, the other thing was that in our current diets, you know, of course Australians report take away foods and alcoholic beverage. It might be surprising, but often when some groups look at the costs of foods in Australia, they [00:15:00] don't include alcohol, and there's either one group at the moment that doesn't include takeaway foods. Now we're not really comparing apples and oranges, almost literally, so we were really interested see that alcoholic beverages comprise 12% of the cost for a family's diet of their budget and take away foods were 14% the price of a family budget, so that's nearly a quarter that is sometimes not included in assessments of the costs of the current diet .

Sophie: Yeah. Definitely. And so why do you think, like from that outcome, did it kind of inform, I guess, policy or your thoughts, or I guess the way that you thought about why people would still be purchasing like unhealthy foods when perhaps the price isn't as big of a factor as maybe we initially had thought?

Amanda: Okay, so, so we, we look at the, um, the usual price of the most commonly consumed brand. So, you know, this is a challenge when you're doing population health nutrition. We're looking at the median family, so there's enormous noise either side and huge variation. But for a monitoring tool, we wanted to start with looking at the median family. So, What we found when we first did that was, as I said, the healthy diet was uh, about between 15 and 20%, relatively more affordable or looked more affordable. The other thing that was surprising, and I think this is really critical to understand what's going on in public health nutrition policy in Australia, is when we looked at the cost breakdown across the different food groups and components of each of the diets, the current diet, and the healthier diet. In the current diet, we also thought we must have made a mistake because, you know, currently discretionary foods, or unhealthy, whatever you want to call them, nutritionist could argue for days about what we call these foods, uh, let's just deal with the, you know, the concept of unhealthy foods. If you look at the costs of the discretion of your unhealthy foods, that median Australian family was spending 58%. Of the food budget on those unhealthy foods. Yeah. Now those foods provide 38% of the energy of the median family, the Standard family that we're looking at in Australia. So they provide 38% of the energy, but 58% of the cost of the budget. So, you know, we write up these results and it took two years to get them published because editors and reviewers kept saying, you must have made a mistake. This is wrong. You've, you've, you know, everyone knows healthy foods are, are more expensive and Australians wouldn't spend that much on unhealthy. And it wasn't until I worked with the ABS and some, um, connections we have then they did the CPI for Healthy Foods in Australia in 2015 and the ABS came up and they, and they used a different method looking at household expenditure survey. And you know what? They came up with a figure of 58.2% of the household budget is spent, food budget is spent on the unhealthy discretionary options. Now, the minute we had that, we had some independent triangulation that, um, justified. Um, the results and supported the results that, that we had. So to me, the really interesting thing about that is if you are looking at what's going on in society, there's that old adage, follow the money. Mm. And. You know, that's our whole research program is looking at the money side of this thing. So it immediately raises question, who benefits from this most, from the status quo in Australia, like we know we need a radical transformation of our food systems and our dietary intakes. Less than 1% of Australians consume diets that are consistent with the Australian Dietary Guidelines, we need a radical change, and this shows the degree to which there's a problem. But it also pointed that clearly the people that benefit from the status quo are those that grow, manufacture, transport, advertise, wholesale and retail, these basic, unhealthy foods [00:20:00] that are just so dominant in our diet. And so the commercial determinants of health are really, you know, our insight was that that's the driver of why we're eating what we are. And when you look, so you'd ask me, you know, if it's, why are people buying diets that are, that look less affordable? Mm. I think the answer there is price is important, of course. And it might change over time. I think we're going through a period at the moment where price is particularly important, but there's also other factors driving what we choose and um, to eat. And these are the convenience of having, you know, pre-prepared and, uh, and ultra processed foods Also, uh, the fact that these are the foods that are most available. They surround us everywhere. They're also the ones that are most advertised. They're also the ones that are most price promoted. So we see these cheap, you know, two for one. Um, if you just think about McDonald Hamburgers, you know, a Big Mac is $8 50, so to feed our family, maybe the dad will have two. You know, you need five of those. That's a lot of money, and it's only really when they're on the two for one deals or the price promotion that people might eat them and then have chips with that too. So, you know, it starts to make sense when you look at particular scenarios and particular foods. 

Sophie: It's really interesting because I guess from like, from just discussing even those points and what you found is saying, we don't need to focus so much on the, the price of healthy food compared to unhealthy food. It's all those other things that we need to, you know, focus on developing policy whilst still ensuring, you know, that the GST is, is not applied to healthy foods and, and really lobbying for like, Like you say, the commercial determinants of health, um, to be acted upon and controlled, um, as well.

Amanda: Exactly. And I dunno why people are so surprised that, you know, the answer to what we need to do is to take a whole of systems approach that ticks off con things like the advertising or the promotion of these foods particularly, but also things like, you know, ensuring that there's no, you know, that we use all instruments that we have to ensure that there's no, um, more, uh, fast food takeaways built close to schools, that there's no junk foods at the checkout aisles, amongst everything that is designed. The whole food environment is designed to get us to eat more of those unhealthy foods and hence benefit the people that you know, 58% of our food dollar. That's an enormous amount of money. That's up for grabs here and you can really see why there's all these efforts to get us to keep buying all these stuff that we don't need that makes us sick and makes the planet sick. 

Sophie: You've done this in Brisbane, but I, I also know that you've done this in other parts of Australia, and particularly you've done this in, um, remote areas of Australia, and I wanted to ask like, what have you seen in terms of the affordability between different parts of Australia and, and how affordable it is compared to, you know, remote versus urban areas?

Amanda: Yeah, so that's, um, a really important question. Um, Sophie, and you know, in the past a lot of the studies on the cost of those sort of healthier diets were done to highlight the disparities between the costs of foods in rural and remote areas versus urban areas in Australia. So we were particularly interested to apply these foods. We actually wanna have a national survey, and I've put in a grant to try to get funding for that. But in, in the lack of that, we were able to, uh, look across Queensland, um, and control, not just the stores that we selected around the different socioeconomic areas, but we also control for what's called aria categories. So the um, so that controlled for the services and the remoteness of the different locations around the state and we found as had been, um, signed posts previously that in rural, in the very remote areas, healthy diets cost around 30 to 35% more than in the capital city and, and extended urban areas. So [00:25:00] that reinforced what we've known for years. Um, but it really highlights what we need to do to address that problem. And, you know, so far, I suppose we've been just looking at the component of affordability that is based on food cost. But the other component, of course, is income. So I think it's really very salient that in these most remote areas, they're also the areas that have got the highest price, which is seen about 30% higher cost of healthy foods, but also they've got the lowest income. So they have that double whammy. And in some areas, particularly Aboriginal and Torres Strait Islander communities where there's only a single store and they don't have much choice around shopping around, you know, there's a monopoly of the, the food outlets in those locations usually. But in those communities, we've actually measured that up to 60% of the median income of Indigenous people living in remote communities needs to be spent to secure a basic healthy diet. So, you know, no wonder, no wonder, people in those communities have got higher risk of diet related disease like diabetes, heart disease, renal disease, some forms of cancers. It's not gonna get any better until we address nutrition. And I find it very frustrating that food and nutrition is not a part of the close the gap initiative, policy initiative in Australia. 

Sophie: Yeah, that's a really important point. And I guess like with that, like, you know, you talked about some of the drivers of, of food affordability in the urban area, but between those two contexts, they're different, um, drivers as to why it's different between those contexts, or is it more about the income disparity?

Amanda: So in, um, uh, remote areas, there's many factors that contribute to that higher cost of food. Mm. We've had in Australia since I've been working. I graduated in the late seventies , and since then I can remember six national inquiries around the reasons for these costs of high foods in remote communities, particularly Aboriginal and Torres Strait Islander communities, and recommendations about what we need to do. But there's been no action. So it's very easy because, well, I mean, we had an inquiry just two years ago. Yeah. Yeah. The most recent one, I can't see any of those recommendations have been implemented yet. And I'm not gonna hold my breath waiting for them. So we know, you know, they can, the reasons and what needs to be done can be divided up into different things. So first is transport costs. So Australia's huge nature and look at the moment with the problems. I work a lot on the APY lands, the Anangu Pitjantjatjara Yankunytjatjara Lands to the north of South Australia. And in those communities at the moment, it's over $3 a Liter for diesel. Yeah. But even when we don't have this sort of perfect storm that's leading to increased food prices and low incomes at the moment, um, even before that, the transport costs and the fuel costs to those places are really high. Then you've got incredibly high overheads in those community stores. Uh, people don't think, you know, they, they actually have to provide housing for the store manager. There's a lot of, um, costs, which just store maintenance. You can imagine things like the freezers and the, um, control, you know, and, and that's another reason why transport's so high, because you have to have cold chain, um, protection right throughout those, um, enormous kilometres that are travelled, um, by road or even more costly by barge to island communities. Um, so, and things like the infrastructure of the store just making sure that the lighting and that the flooring is safe and that they're presentable places and that there's not a problem with tripping and the, you know, all those things are huge overheads. There's also some opportunities and there are some really good stories where, you know, store groups have been able to, Band together to get reductions on the cost of transport and on the cost of goods themselves. They're able to do things like cross subsidize the price of food so that in most of the [00:30:00] stores that we work in now, a cost of bottle of water is a dollar compared to about $3 for the same amount of Coke. You know, all that cross subsidization helps to drive healthier food choices and there has been some examples and the APY lands prices now are only about 10% higher than Alice Springs. 

Sophie: Yeah, right.

Amanda: And I don't think it's going to be possible to get them down any lower than that, but that gets to the second part of the equation cause still people ring me and say the store's too expensive the store's too expensive and what they mean is I don't have enough money to buy the food. And it's really more that they're impoverished. They just have very, very, very low incomes and welfare incomes, as people would realize, haven't really shifted in Australia for over 10 years. There's been, uh, you know, $4.20 per week increase. So some people they shop around and find a cheap coffee, they can have another coffee per week, but it really is a, an an absolute problem. 

Sophie: We did see the COVID supplements come in in what, 2020 and 2021. And, and they're, I assume they're gone now, but do you have any, um, insight into, I guess, the impact that those had on people who were able to access them in terms of how they could afford food or 

Amanda: Yes, we do. Sophie. Um, I have a PhD student, Merrin Lewis. Um, you know, so far we've been talking about the median family, but Merrin's, uh, PhD is centred on low socioeconomic groups specifically and incorporates a lot of lived experience that advises what that means for incomes, but also what it means for shopping practices and things. So, and in terms of Covid, Merrin was able to look for low-income groups and the median groups who've been talking about what the differences were during the time of the supplements due to COVID. So she wrote a letter advocating for the findings of these studies to be considered in welfare policy. So what we found looking just at Brisbane for the first time, low socioeconomic groups on welfare that received that additional job seeker funding and also the one-off payments for the first time healthy diets became affordable.

Sophie: That's amazing. 

Amanda: Those families and the Australian Council of Social Services, a cost actually did some surveys during that time for people that received the, uh, job, uh, seeker payments and the additional supplements, and they found that 80% of those groups reported. They ate better than any other time. 

Sophie: And that's really telling. I'm so glad that they collected that data.

Amanda: Yes

Sophie: as well. And so I guess from that information that both, you know, your team and ACOSS have collected, do you think that there's gonna be any change, I guess from the current situation of job seeker payments are back to, you know, next to nothing really. What's gonna happen from that, do you think?

Amanda: Yeah, well, ACOSS and other groups that are across all the detail and, um, data in this area, uh, have an active program called Raise the Rate. Yeah. And that is centred on trying to leverage and increase so that welfare payments are adequate in Australia. They're not adequate for people that need them. They're set at a rate, which is just supposed to buy people over for a couple of weeks, but we are talking about habitual situations where people just can't afford the basic healthy foods they need to feed their families and maintain their health. So the cost to the health system, I mean, the cost to society is enormous because of this, you know, it makes so much sense to provide additional funding upfront than to keep building additional hospital beds to accommodate those that have got chronic long term diet related diseases. 

Sophie: Yeah, definitely. And even things like funding, you know, the PBS so that people can have cheaper medication to manage chronic disease and 

Amanda: Yes, well, exactly, and that goes, goes back to thinking it's not just the cost of food, it's the cost of the whole system. Now, it, you know, at the moment, the, um, the prices, uh, that [00:35:00] people's affordability, you know, affordability of healthy food is problematic, but it's also getting worse because of other drivers to the costs in our food system.

Sophie: I guess, what's your insight into what's driving the increased cost of, of food generally and particularly of healthy food items, um, across Australia? 

Amanda: So, I mean, it's been called a perfect storm. So when you look at food security, which is the basic issue here, we're talking about the economic access components of food security. You know, they're affected. It's affected by shocks such as the pandemic and the floods and the bush fires that we had prior to those. And in long term changes too, such as climate change and in population changes as well. And things like, you know, the Covid pandemic, meaning that our supply chains have been interrupted because people are sick and they're off and they can’t, you know, so there's a thing about not having the food to distribute, but then there's not the workers. There hasn't been the workers to make sure that supply chains are maintained. So seeing things like those empty shelves in our supermarkets really highlights we've got to do better than have our just in time focus on getting, you know, every food item turned over every three days. We need to have longer. And more sensible, uh, solutions to food distribution systems in Australia. Were quite vulnerable. 

Sophie: Definitely. And I guess like, going a bit more into detail, you know, at the, I can't remember how long it was like maybe a few months ago, we were seeing lettuces being sold, iceberg lettuce being sold for, you know, or was it like eight to $10 just a lettuce and there was a huge media uproar about it, but how has, you know, the COVID pandemic and then flooding and other things, you know, increased petrol prices and stuff, how, why has that led to things like lettuce, having that kind of price put on it?

Amanda: Yeah, so again, we've written, had a paper published on changes before and after COVID specifically that went up to, uh, the end of 2020. And we are collecting, we collected prices in 2021 and prices in 2022. So the impact of COVID was really multiplied by what has happened since with the war in Ukraine. Yeah. Um, and, and, uh, workforce shortages, et cetera too. Um, so what we found for just the COVID period was, uh, looking at how the prices had changed. There was an increase in, um, meats and dairy food specifically, and fruit. And interestingly, in Brisbane, we didn't see as big increase in vegetable prices had occurred elsewhere. I don't know if they were used again as lost leaders, like sort of at the front of the store and they looked nice and green and encourage people to come in. And there'd been a lot of publicity about the cost of vegetables, so maybe there was more scrutiny on those. But in the last couple of years, we've seen just a massive increase across the board and the components are things like the transport costs, even in urban areas now with, uh, pricing, uh, hike in fuel due to well, You know, there's some interesting articles. It's presumed to be due to the war in Ukraine and the, um, demand for fuel markets elsewhere, but there is some evidence that there's some, uh, profit gauging also occurring in around some of these drivers as well. And I think we have to be very, very critical. When we look at trying to analyse what the flow on effect of some of these increases are, we're seeing that with the price of gas, particularly in Australia at the moment too. Firstly, we had problems in COVID where, you know, our, our workers, people that came from overseas and particularly, you know, our work in a university, our students then often find employment, fruit picking, et cetera in the end of the year, during the summer period, were really told to go home and we were left without, um, having an adequate workforce. And a lot of, uh, fruits were fruit and vegetables where they were produced, right to picking point couldn't be picked because of the lack of workers. But also then we had the fires, which, which destroyed some, um, productive area land, but then the floods, particularly in Queensland and Northern New South Wales, it's a part of a food bowl of Australia, really affected the availability of many [00:40:00] vegetables, particularly green leafy vegetables. So there was multiple drivers that coalesced. 

Sophie: and then I guess flowing from that, you've worked in this space for quite a while and, and you've done so much work looking across different sectors of our communities and, and parts within, within Australia, what do you see as, um, some of the big things that we can do? Collectively, um, or individually to help address these issues around the affordability of food? Both, I guess from a cost perspective of, of food pricing, but then also I guess from, um, you know, an income perspective, particularly for people who, um, do rely on welfare payments. 

Amanda: Yeah, so from a cost perspective, we've really got to increase the differential between the cost of healthy and unhealthy foods. We've got that 10% saving on, um, the cost of basic healthy foods in Australia. But all the literature from overseas would suggest that, particularly things around sugar tax and fat taxes. There's not adequate dose until there's about 20%. 

Sophie: Okay. 

Amanda: Taxation there. So to me, at a population level, the structures and systems are in place and it should be feasible, but there'll be a huge political objection. And those powerful corporations that are undermining our, our health at the moment, um, will object, um, strongly. But what I really recommend, number one, is to increase the GST on unhealthy discretionary ultra process food to a level of 20%. GST and to keep the GST off basic healthy foods, then you could hypothecate that tax additional tax revenue that comes in to use that to promote additional income from people in the lowest socioeconomic groups or to help support and or help support nutrition education. It's billions of dollars of revenue that is being, um, avoided because of those that wish to maintain the status quo, and that would have enormous societal and economic benefit to Australia if we could do that. Um, one way that our work has been used to help guide policy and practice, um, is that we've been working with Queensland Council of Social Service Q costs to, um, inform more realistic standards. For the cost of foods for low socioeconomic groups. Okay. And they've now adopted the methodology that Merrin used to look at the cost of diets in low socioeconomic groups healthy, sustainable, affordable diets. Not just getting enough food. Yeah. But getting the quality foods that are required for health in. And they will use those in their cost of living studies. Now. So I think that's, that's a really exciting development that really embeds those, uh, standards of food cost and expenditure in a more realistic way and that will help inform welfare settings as well. 

Sophie: Yeah. Yeah, definitely. And I think like you've touched on earlier, like it really emphasizes why having these standardized tools is so important because it can be used by multiple different groups and organizations across different disciplines, but you're still looking at a similar thing.

Amanda: Yes, there's also the rigor of having, you know, a whole, quite sophisticated, um, program around the quantitative components, but everything is informed by qualitative lived experience. Yeah. For those people that are most affected. So I think the tools then become much more powerful and much more attractive to be used by other disciplines and sectors too.

Sophie: Definitely. And is there any other kind of recommendations? 

Amanda: Yeah, well I guess that's where we start talking about that whole food system and the intersection with, uh, with other components. So definitely in Australia, the current housing crisis is an issue. People are not going to be able to exercise their food, uh, preparation skills or be able to afford to cook or prepare healthy foods if they don't have [00:45:00] ongoing, um, housing. So there certainly needs to be more public housing and more support available for people to have what we call health hardware so that they can act on things they need to do to keep their families healthy and fed well. Yeah. Um, and then, you know, the broader thing about everything like advertising foods, we shouldn't be advertising unhealthy foods, governments could start, like here in Queensland, we had a proposal in 2019 to stop advertising of junk foods on government owned, uh, billboards and premises. And it's gone nowhere. And in fact, the other day I saw our deputy premier was promoting, um, Kit-Kats. 

Sophie: I did see that as well. Oh my gosh, yes.

Amanda: You know, the tentacles that we've really gotta address the commercial determinants of health and just start having these conversations that shine a spotlight on what's really going on. 

Sophie: To kind of finish up, I wanted to ask, um, just a bit about your own career and why did you kind of go down the public health and community nutrition pathway through your career?

Amanda: Oh, well, Sophie, I think I wanted to be a nutritionist from when I was six because would you believe at school when I was six years old, there was, uh, a, um, famine Bangladesh. Oh yeah. Can you imagine the mess there would be now if we did this? But we were all asked to bring eggs into school that could be dried to send to Bangladesh, and I was fascinated. And there was a woman who worked in that area that came to talk to us, you know, and thank us for the eggs. And it really struck me that that would be a fun thing to do. 

Sophie: that's, I mean, you've gotta get inspiration from somewhere. So that's a pretty good one. 

Amanda: Sort of, they're going to risk all that mess. It must be really important. Yeah, definitely. Yeah. And when I graduated, Sophie, would you believe I only had one lecture on community nutrition when I was at, um, 

Sophie: I will believe it cuz I think I had the same, 

Amanda: so Pat Crotty was the person who, who lectured us at Deakin. I did my degree in Deakin. And uh, there really wasn't, public health nutrition wasn't a thing or community nutrition was just starting to be a thing through community health centres. But so I used to work in hospitals and in outpatient clinics, but I think very early on, I. I found it a bit challenging working at an individual level because you would just hear the same stories over and over and over again, and it was never going to have an impact on, you know, societal change and improvement for the population. I, I think that's a common thing that some people find if you are interested in policy and practice, you'll gravitate more to population health. It's not saying that individual treatment isn't important, it's just a lot slower and it's harder to engage in those upstream, um, issues. But really for me, I got a job at Mildura. Um, when I first graduated, a position I was going to have in Melbourne fell through and it was the best thing that ever happened because I had to go to Mildura to find a job. And that's where I first was taught by Aboriginal and Torres Strait Islander people. The aboriginal community, there were, they lived over in New South Wales and they had the greatest need, but the hospital didn't like them coming over to see me in outpatients. And I was taught, I couldn't see people from New South Wales. Um, so I started working with those communities at the weekend and they took me out for, you know, food gathering and really became interested you know, a better way of eating, I suppose. And then went to Alice Springs and worked at the hospital as well as a regional and outpatient, um, extension service and gravitated more and more as more funding became available and there were positions working at community level and then more at a coordinated policy level. I was really fortunate that my career paralleled. Those opportunities and was able to take them. I've always worked, um, and I think this is a, a good thing to do. If you're really interested in policy, don't stay in academic settings, but go and work in health departments, in government, in non-government organizations, everywhere you can to get [00:50:00] an idea about the different perspectives and opportunities. I think that's really, important. Having those dual insights, I think is really critical to be able to, um, identify opportunities in the system. 

Sophie: Definitely. Have you had any, you know, big moments or, oh, not so big moments, but more enjoyable moments or highlights that you kind of look back on and go, oh wow, like that was, you know, that was quite incredible.

Amanda: Yeah, the highlight to me was working and being invited to work at Minjilang on Croker Island. I'd been visiting that place and um, working out of Darwin as a, as a dietician. And there was the deaths, unfortunately, of two quite young men playing football within three months of each other, and both of them had heart disease. I mean, when I worked in Central Australia. At Hermannsburg, there was the first diabetic in Aboriginal communities identified, and the same in Minjilang. This was the first time that there'd been heart disease identified, and it's because people had been taken to Croker Island during the war and exposed from early age to Western diet. Mm. And the coroner came out, explained to people and the community, that wonderful health worker, Daisy Army, who was a nurse that ran the clinic, local woman, um, invited me to go and work with them. I did that through getting funding for PhD, but in 12 months, that community changed their diet. One of the things, when we gave feedback, every three months we looked at biochemical indicators and height and weight and, and when we provided the information back to people, there was the council president who kept telling me, tell people about the worms. You must tell people about the worms. And it wasn't until maybe about 10 years ago I was listening to a program from Arnhem Land that described the worm as a metaphor for rainbow serpent. And what he was trying to tell me was that western food was full of, uh, the anti worm and was gonna make people sick. So, you know, just that thing about telling people, oh, and Jumbo says, Remember the worms and watch out for the worms. That, that real understanding about the, the way that people could building on own systems and approaches. So learning, um, you know, very obviously, The Aboriginal communities have already got the answers to these problems, and it's a matter of helping to get resources and then being part of that capacity building that occur needs to occur. So I'm very excited at the moment with the opportunities around. Voice to, um, to the issues in Parliament that that will affect Aboriginal and Torres State Islander people. It's a no brainer that that needs to happen in our country. 

Sophie: Yeah, absolutely. Um, I'm gonna finish up, Amanda, with asking you what your favourite food experience has ever been?

Amanda: All right. Oh, well, I was very lucky because we got to live in Japan for four years when my children were little, so it would have to be going to Hakone to the royal palace and having a kaiseki dinner which was just exquisite. Uh, um, really amazing to sit in those lovely rarefied environments and enjoy just incredibly crafted art, as food. Um, but I, but you know, that was a very elitist perhaps, um, opportunity. I just love markets, particularly throughout Southeast Asia and street food and enjoying all those different cultural insights into that wide variety of, of food sensations that we're so lucky to be exposed to here in Australia.

Sophie: So thanks for your listening. There'll be links to Amanda's research profile and a few other things that we talked about in the show notes where you can also get in contact with her and read further into all her amazing work within this space. And remember, we're on Instagram or Twitter if you'd like to get in touch or ask any questions. And I've also included the foodies email and the show notes if you'd like to connect that way. And if you do get the chance, please leave us a review or a star rating from wherever you're listening to this podcast to help us spread the word all about public health nutrition.