We are the co-authors of a study published today in the Medical Journal of Australia, which shows that the federal government’s income management policy is not making an impact on tobacco and health food sales in remote community shops in the NT. Smoking and poor diet are responsible for much of the health gap between indigenous and other Australians.
We are concerned that indigenous affairs minister Jenny Macklin has responded to our study by highlighting the results of the government’s evaluation. She has told journalists that the government intends to press ahead with plans to roll out income management more broadly, and has appeared to dismiss our findings.
The evaluation cited by the minister was based on interviews with 76 income management clients in four communities, telephone interviews with 66 store operators as well as interviews with business managers and other stakeholders across several locations.
This is poor use of qualitative research to answer a question that essentially requires quantitative data: are people buying more healthy food as a result of income management?
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Our study provides that quantitative data. It used sales data to measure how much was being spent each month across 10 stores in the Northern Territory, 18 months before and 18 months after income management was introduced. In contrast, the government’s evaluation report of income management and spending relied entirely on people’s perceptions in a large number of interviews.
We confirm store managers’ claims that there was no change in people’s spending on tobacco.
However, in contrast to the government report, we found that spending on food and drinks and fruit and vegetables did not change with income management. Soft drinks sales increased.
The one time during income management that spending went up for all store commodities was when people actually had more money: at the time of the government stimulus payment.
Telling people of low income how they can use 50% of their income may make no difference to their spending, but giving a lump of cash does.
(Source: Medical Journal of Australia — click to enlarge)
The government’s evaluation report claims that “the main benefit identified [of income management] was the increase in the amount of money spent on food for community members, especially children”. This is now questioned by our evidence.
Even its minor claims of improved food choices, more fresh and more healthy food being purchased, are linked to the new licensing of stores in these communities — not income management.
Continued income management in remote NT Aboriginal communities and its extension to all welfare recipients does not seem to fit with the government’s credo of evidence-based policy.
Whilst the government’s defence of income management with only very shaky evidence has been controversial, gaining little support from public health experts, it has received applause for its work on prevention, and smoking in particular.
It has allocated $100 million to indigenous tobacco control, using the limited local indigenous research but extensive international evidence from other contexts. Its recent decisions to increase the tax on cigarettes and to restrict tobacco companies’ advertising using cigarette packets are also likely to reduce indigenous smoking.
But attempts to tackle indigenous people’s poor diet have not been as coherent and are off to a shaky start. There is no funding for either the COAG food security initiative or the National Aboriginal and Torres Strait Islander Nutrition Strategy and Action Plan. The government is yet to respond to the 33 recommendations of the Senate inquiry into remote community stores.
But store licensing, which is setting minimal standards in remote stores in the NT, and the funding of 100 new indigenous healthy lifestyle workers are welcome and positive steps.
Less welcome is the reluctance to consider food subsidies. Yes, they are expensive and difficult to monitor, but there is increasing international evidence that modifying price and monetary benefits, such as food stamps, help to improve the diet of economically disadvantaged groups.
As Amanda Lee and colleagues have stated, we need rigorous testing of economic solutions to increase access to healthy food in remote communities.
Skirting the real issue of affordability and poverty, while defending and extending income management policies, may delay improvements in indigenous people’s poor diet and the government’s pledge to “close the gap”.
*Dr Julie Brimblecombe and Associate Professor David Thomas are from the Menzies School of Health Research in Darwin