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The 'Rent to own' initiative is another element of the broader Food-for-all program; providing an opportunity for low income residents to own their own refrigerator. Welfare agencies in the area identified the lack of household infrastructure such as fridges and washing machines among low income residents, many of whom were using eskys filled with ice to keep food cold. Welfare agencies provided the initial point of referral for people to enter the program, which was managed through a partnership between the local credit union, Centre Link, the local housing authority and the Aboriginal Medical Service. When accepted as being eligible for the program, people are provided with a refrigerator and agree to participate in a budgeting program to assist them to establish a loan from the local credit union. Through small monthly contributions on a no interest basis, successful participants will own their own fridge over an agreed period of time.

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The essential role of nutrition and food security in improving health outcomes within the Aboriginal and Torres Strait Islander population has led to a critical need for an experienced nutrition and health promotion workforce orientated towards 'prevention' activities. Specialised nutrition and food security positions are required to drive 'good practice' interventions forged through local partnerships. Such positions would have a focus on broad based program development and coordination and may be based at health services, councils or relevant community service organisations. Increasing the number of local and regional positions will extend the geographic coverage and access (increase the 'dose') of well informed policies and programs. In their absence, the best intentioned policies fail to gain traction at the local level or are short term and poorly implemented.

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'Access to nutritious food makes more of a difference than nutrition education.'

The term food security is increasingly used to broaden understanding of the causes of poor nutrition and to encourage a spectrum of changes a community can take in order to prevent its occurrence. As described by Marmot and Wilkinson [16],

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While conventional risk factors influence food security for urbanised Aboriginal communities, such as poor income; access to transport and storage and cooking facilities, there are also confounding issues relating to history, identity, racism and the quality of relationship to the wider mainstream [26].

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Across Australia the average equivalent household income of Aboriginal and Torres Strait Islander people in 2003 was only 59 per cent of the corresponding income of non-Indigenous people [3]. As an indicator of financial stress, the 2004-05 NATSIHS determined that about half (49%) of all Indigenous persons aged 15 years and over reported they were living in households in which they could not raise $2,000 within a week in a time of crisis[18].

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Chronic diseases are responsible for the majority of the Indigenous health gap. Cardiovascular disease is the leading cause of death and disability for both Indigenous males and females followed by diabetes [8]. For endocrine, nutritional and metabolic diseases such as diabetes, the inequalities are particularly marked, with death rates among Indigenous males and females 8 and 10 times higher than the rate for non-Indigenous males and females respectively [5].

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While national surveys of the cost and availability of healthy foods do not exist in Australia, research and monitoring undertaken in select states shows evidence of a disparity between the cost of healthy foods compared with unhealthy food items. Across Queensland annual surveys of food cost are undertaken using the Healthy Food Access Basket (HFAB) which includes standard commonly available foods selected to provide 70% of nutritional requirements and 95% of estimated energy requirement of a reference family of six people over a 2 week period [100). Across Queensland, the cost of the HFAB has increased above Consumer Price Index (CPI) for food (based on a wider range of food items including cakes, biscuits, confectionary, takeaway foods and fast foods and soft drinks), across 56 stores surveyed between 1998 and 2004 in both urban, regional and remote areas. This suggests that the cost for basic foods necessary to achieve good health has become, and continues to be more expensive than less nutritious alternatives. Similarly, a study of food cost in 34 supermarkets in rural areas across Victoria found a high absolute cost and higher variation in the cost of healthy foods compared with unhealthy food items. This study estimated that typical family would need to spend 40% of their welfare income to consume a nutritionally adequate diet [101]. This varies substantially from the 17% of income which the average Australian will spend on food [101]. Both studies demonstrate that the increasing cost of healthy food is a potential barrier for people of low socio-economic status, such as Indigenous people to achieving good health.