The+increase+of+child+obesity+has+placed+the+health+of+an+entire+generation+at+risk

Tutor: Jey Rodgers Tutorial Time: Friday 11am - 12pm Trinh Tran (0882154)

= **Artefact - A photograph from a project known as 'Los Intocables'** = The photograph I will be focusing on presents an overweight child who is hung similar to Jesus from the cross, but in the place of the cross is Ronald McDonald. The artefact I will be subsequently analyzing is a photograph taken, along with a few others by Erik Ravelo, a Cuban-born sculptor, painter and multi-media artist who is currently a creative director at Fabrica, the Benetton Group Communication Research Center. The series of photography is a project originally conceived, created and edited by Erik Ravelo and Daniel Ferreira and is known as ‘Los Intocables (The Untouchables)’. Ravelo and Ferreira’s // Los Intocables // project purely depicts the infringements of the rights to childhood.

In the seven portraits (to the left), each child is crucified to what is recognised as their representative villains. Ravelo’s intention is to expose that each of the very different yet similar issues depicted in his project is underexposed. // Ravelo’s // overall intention is to highlight and expose that the ‘right to childhood should be protected’ (Ravelo, 2013).

= **PUBLIC HEALTH ISSUE** =

My cultural artefact represents the public health issue of obesity in children. From the photograph the overweight boy is positioned like Jesus on the cross and as the cross, is a famous fast food chain recognized as McDonalds. Ravelo’s creative photograph epitomizes the sacrifice and loss of childhood. Whilst in the photograph the blame seems to be toward the fast food chains, adults play a significant role in the result of obesity in children too. However the main public health issue inferred from this image is that the vulnerability to diseases like obesity in Indigenous children is the cause of history, genetics, socioeconomics and geography.

= LITERATURE REVIEW =

Among a quarter of all Australian children between the age of 5 and 15 years were considered obese in 2007-2008 (ABS, 2012). Obesity in children is one of the major public health challenges of the 21st century, arising in Australia, along with many other countries including the United States, Mexico, New Zealand, United Kingdom and much more (WHO, 2013). Obesity is the result of an imbalance between energy intake (diet) and energy output (exercise), of which can be considered as a significant risk factor of high death-related diseases such as ischaemic heart disease, renal disease and diabetes (Hugo & Franzon, 2006). The prevalence of obesity occurs in all population groups in Australia ranging from children, men, women; Indigenous and non-Indigenous people and individuals from all socio-economic backgrounds – however, the most susceptible is that of the Indigenous people from low socio-economic backgrounds (Australian Indigenous HealthInfoNet, 2006).. Given the concern on the prevalence of child obesity and its long-term medical consequences, most statistical information on Australian obesity and obesity research relates to adults. The focus of this literature review will be on how morbidity and mortality are affected in identifying as an Aboriginal and Torres Strait Islander, therefore the obesity especially in children from Indigenous backgrounds will be reviewed. The development of an obese environment within Indigenous groups can be attributable to the genetic, historical, socioeconomic and geographical factors.

GENETIC AND HISTORICAL FACTORS
The factors contributing to obesity among Indigenous children can be varied and complex. However, the genetic and historical factors may be substantially responsible for the result of Indigenous child obesity. According to James Neel’s thrifty genotype hypothesis, the incidence of obesity is the outcome of genetic variants that have been subjected to positive selection from exposure to feast and famine conditions during historical periods (Southam et al., 2009). The favoured thrifty genotype was thought to become highly efficient at food storage and utilisation, hence be more likely to survive. Corresponding to Neel’s thrifty genotype hypothesis, from the hunter-gatherer lifestyle the Indigenous traditional populations had adapted, it may have influenced the development of high levels of insulin resistance in reaction to the cycles of feast and famine (Burns & Thomson, 2006). The cause of rapid weight gain in the thrifty genotype is influenced by being situated an environment with abundant food and less physical activity. Encountered with a history of colonisation, the Indigenous population underwent a drastic change to a ‘westernised’ lifestyle where they became vulnerable to obesity.

The lifestyle change affected both dietary and physical activity elements of Indigenous people due to colonisation of Australia by the European settlers. The traditional Indigenous diet would have been associated with complex carbohydrates, high protein and low sugar foods. Hence, the diet was usually low in energy and high in nutrient (NHMRC, 2000). As opposed to the current Indigenous population, the diet is often high in refined carbohydrates and saturated fats. During the traditional hunter-gather lifestyle, a great deal of energy would have been used to search for and prepare food. The transition to a western lifestyle would denote a loss of these roles (Burns & Thomson, 2006).

And as a result of these factors having affected older generations, this may have lead to the outcomes of obesity in the future generations of Indigenous people, especially the children. As stated by the Australian Bureau of Statistics (2012) in 2004-2005, 62% of Indigenous males and 58% of Indigenous females aged 18 years and over were obese. Whilst there was more data found on the prevalence of obesity in Indigenous adults, the incidence is not an ‘adult’ problem but it could possibly have originated in childhood, or perhaps, during their intrauterine life (NHMRC, 2000). In 1998-2001, the Aboriginal Birth and Cohort Study in Royal Darwin Hospital reported that 4% out of 344 Indigenous children were obese. Later in 2007-2009, health checks conducted at Inala (Brisbane) indicated that 11% out of 332 Indigenous children were obese. Therefore, almost a decade later the percentage of child obesity in Aboriginal children has tripled. Although both genetic and historical factors can arguably be influential in Indigenous child obesity, geography and socioeconomics may be questionable too.

SOCIOECONOMIC AND GEOGRAPHICAL FACTORS
In a peer-reviewed article written by Graeme Hugo and Julie Franzon, evidence has revealed the incidence of obesity is greater among lower than higher socioeconomic groups. Directly overlapping the socioeconomic factors is geography. In circumstances where there are individuals who suffer both socioeconomic and geographical disadvantage, the chance of obesity is relatively high (Hugo & Franzon, 2006). According to the National Aboriginal and Torres Strait Islander Social Survey (NATSIS), Indigenous adults were more likely to be found obese than the rest of the population for all geographic locations. (NHRMC, 2000). As of 2001, the largest proportion of 30% of Indigenous population is found in Northern Territory and more than 66% live in New South Wales, Queensland and Victoria (ABS, 2012). Being mainly located in the Northern Territory where it is considered rural, Indigenous children are likely to experience disadvantage where their location is presented with inadequate access to services, which hinders their ability to exercise. Furthermore, in Nestle and Jacobson’s Public Health report (2000), it was stated that Indigenous people adapted sedentary lifestyles that associated with extend television viewing and decreasing safety and high levels of car usage.

The relationship between geographic locations and socioeconomic status and obesity in children can be clearly evident in the data presented by the study in South Australia. In a study conducted in northwest Adelaide, researchers found that the income of households significantly affects the prevalence of obesity. As a result of disadvantage in insufficient economic and social resources, the Indigenous community are likely to affect their diet adversely and have lack of access to appropriate knowledge and services and therefore lead to obesity.

The conditions in which an Indigenous is born, grows, live, work and age can significantly impact on their vulnerability to disease, especially obesity. Whilst the focus of this review was specifically on obesity amongst children, most of the data found in Australia associated with adults. However, the results of adults in terms of the interrelationship between genetic and historical factors and socioeconomic status and geographic location may arguably be the cause of the tripled percentage of obesity in Indigenous children. Through the loss of tradition and culture from the colonisation of Australia by European settlers, which has subsequently given rise to an era of vulnerability to disease such as obesity in children with the addition of socioeconomic and geographical disadvantage. Obesity in Indigenous children is a major public health issue that needs to be attended to. Although the health gap between the Indigenous and non-Indigenous counterparts has been recognised, the health care system must consider the future health issues that may develop and worsen the current health gap at hand.

= CULTURAL AND SOCIAL ANALYSIS =

In order to understand the cause of many social and cultural issues, including the prevalence obesity in Indigenous children, theories are often applied to provide a deeper philosophical understanding. The social theory of Marxism was believed to be applicable in explaining the social and cultural problems in Indigenous Australia.

For every individual in any relationship there is an existence of power. It is described as the ability of a certain group to control another group to undertake some form of desired action through consensual power and occasionally by force. In relation to society, governments and organisations make choices that impact on the lives of the rest of the population. Consequently, these choices cause inequality in society. According to Karl Marx, a 19th century sociologist, particular groups aim to dominate and exploit others to serve their own economic interests and values. In other words, he believed that ruling classes took advantage of working classes and as result created disparities in society on a historic, health, and economic and ethical level.

In relation to public health issue of obesity in children, one of the main ethnic groups relevant to Marxism theory is that of the Aboriginal and Torres Strait Islander people. Ever since 1788, the society and culture of the Indigenous population have been affected detrimentally. Confronted with a history oppression of racist intervention, cultural genocide, loss of cultural identity from the colonization of Australia by European settlers, the Indigenous have underwent significant social changes that has created and caused such occlusion and health disparities from the rest of the Australian society such as the life expectancy gap of 11.5 years between Indigenous males and their non-indigenous counterparts and 9.7 years for females (ABS, 2012).

Land was a significant symbol to Indigenous culture, they believed that land was not owned but rather one belonged to the land. In contrast, European settlers believed the possession of land was a good opportunity to expand and invest in their economy (Zubrith et al, 2009). In referral to the Marxism theory, Europeans would likely be considered as the ruling class and Indigenous people as the working class. The turmoil to the traditional life of the Indigenous could also apply to the concept of ‘otherness’ introduced by Hegel in 1807.

Hegel expressed that “**Each consciousness pursues the death of the other.**” Through interpretation, the essence of Hegel’s statement meant that in noticing separateness between a certain social group and another, the feeling of alienation is developed. In the context of the presented public health issue, the result of vulnerability to disease was probably caused the Indigenous to feel the concept of ‘otherness’ as the Europeans occupied their land. Through the loss of land, Indigenous people loss their culture and identity. Through loss of culture, this meant that the traditional hunter-gatherer lifestyle was lost too and as a result, impacted on their nutritious diet along with the energy that was used to gather and prepare for the food. Ultimately, contributing to the vulnerability of obesity in Australian Aboriginal and Torres Strait Islanders.

= ANALYSIS OF ARTEFACT AND YOUR OWN LEARNING REFLECTIONS =

Through literature review and additional research, this overall assignment piece has provided me with an extensive amount of information concerning the topic of obesity amongst Australian Aboriginal and Torres Strait Islander people. Although my focus was on the children, most of the information I found was based on the adults. However, through analyses it has open my eyes to how such factors like genetic, historical, socioeconomic and geographic can heavily impact on the health of such social groups like the Indigenous community.

The photograph taken by Erik Ravelo symbolises the prevalence of obesity in children, which is one of the major health concerns of the ongoing future and attempts to highlight that the innocence of childhood becomes lost because of the expansion of such famous fast food chains like McDonalds. In view of the fact that fast food chains like McDonalds are relatively cheaper than nutritious food and that it is quick and easy to obtain, more parents from low socioeconomic backgrounds seem to be more susceptible towards it. Hence, they become more vulnerable to obesity. Although, my artefact did not completely reflect my presented topic, it is still to an extent interrelated in the fact that future generations are being affected by the choices which adults make.

I feel that my understanding on Public Health has improved significantly through understanding that today’s outcomes of Indigenous people are from the decisions that society made and the past events that have occurred and that our past does makes us who we are now.

= LEARNING ENGAGEMENT AND REFLECTION TASK =

[|Reflection 1] [|Reflection 2] =

= =REFERENCES=

Australian Bureau of Statistics (ABS). (2011). The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/lookup/4704.0Chapter218Oct+2010.

Australian Bureau of Statistics (ABS). (2013). Gender Indicators, Australia: Overweight/Obesity. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4125.0main+features3330Jan%202013.

Burns, J., & Thomson, N. (2006). //Summary of overweight and obesity among Indigenous peoples.// Retrieved from http://www.healthinfonet.ecu.edu.au/health-risks/overweight-obesity/reviews/our-review

Creative Spirits. (2013). //Aboriginal population in Australia//. Retrieved from http://www.creativespirits.info/aboriginalculture/people/aboriginal-population-in-australia.

Hugo, G., & Franzon, J. (2006). Child obesity in South Australia. //Food, culture, & society//, 9(3), 299-316. doi: [].

National Health and Medical Research Council (NHMRC). (2000). //Nutrition in Aboriginal and Torres Strait Islander Peoples//. Retrieved from http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/n26.pdf.

Ravelo, E. (2012). //Los Intocables (The Untouchables): The Right to Childhood Should be Protected// [Image]. Retrieved October 11, 2013, from http://erikravelo.info/los-intocables/#more.

Scultz, R. (2012). Prevalences of overweight and obesity among children in remote Aboriginal communities in central Australia. //Rural and Remote Health,// 12, 1-5. Retrieved from http://www.rrh.org.au/publishedarticles/article_print_1872.pdf.

Southam, L., Soranzo, N., Montgomery, S. B., Frayling, T. M., McCarthy, M. I., Barroso, I., & Zeggini, E. (2009). Is the thrifty genotype hypothesis supported by evidence based on confirmed type 2 diabetes- and obesity-susceptibility variants?. //Diabetologia//, 52, 1846-1851. doi: 10.1007/s00125-009-1419-3.

Zubrick, S. R., Dudgeon, P., Gee, G., Glaskin, B., Kelly, K., Paradies, Y., Scrine, C., & Walker, R. (2009). //Social Determinants of Aboriginal and Torres Strait Islander Social and Emotional Wellbeing//. Retrieved from http://childhealthresearch.org.au/media/54874/chapter6.pdf