Approaching the diabetes problem through an in-depth, multi-generational study of Indigenous Australians’ food practices and experiences of nutrition promotion for diabetes management, this socially situated research contrasts with the individualistic biomedical dietary discourse presented in much of the literature. Dietary change is mostly discussed in the literature abstracted from the domestic struggles that such change engenders. This research fills a gap in the literature by using ethnographic methods of participant observation and in-depth interviews to provide an emic account of urban Indigenous foodways. It explores negotiation of healthy eating for diabetes management and prevention within families and with health professionals.
The dramatic increase in diabetes prevalence amongst Indigenous Australians that occurred during the 20th century is overviewed in the light of explanations for this proposed in the literature. It is well documented that diabetes in Australia is associated with poverty, however genetic predisposition and unhealthy lifestyle explanations have wider currency than the disadvantageous socio-political environments that have circumscribed Aboriginal peoples’ lifeworlds since colonisation.
The fieldwork was conducted over two years in a Brisbane community, building the research activities around existing activities of the Indigenous Health Program and the Elders’ Corporation to lessen the inherent power imbalances between the researcher and the researched. In-depth interviews were recorded with 31 people and coded thematically using NVivo software. An audit of the local cost of recommended foods and a discourse analysis of popular cookery media were conducted. Healthy cooking workshops were also facilitated in the last phase of the fieldwork. While there is increasing focus in the literature on the role of diet in diabetes prevention, greater emphasis is placed on dietary management and there is little integration of preventive action in nutrition promotion for diabetes management. In contrast, this research explored the nexus between diabetes dietary management and prevention in families and examines factors involved in changing or not changing family eating practices.
The research showed that while many people, especially women, strive to achieve healthy diets, negotiating family dietary changes challenges food budgets, food culture and family harmony. Bourdieu’s concept of the ‘habitus’ is used to explore what food is considered ‘normal’ in this community. It was found to differ from nutritionists’ categories of healthy food and the stylish food featured in popular healthy cooking discourses. The individualistic approach of nutrition promotion for diabetes management was found to perpetuate perceptions about ‘special’ healthy food for people with diabetes, limiting family approaches to healthy eating that could simultaneously contribute to diabetes prevention and management. It also contrasts with the family and community oriented reality of those with diabetes who feel torn between eating with family for social health and eating separate, healthy food for diabetes.
Power relations in negotiating healthy eating are a significant issue for the participants and this theme is explored by an analysis of communication with health professionals. Habermas’ theory of communicative action illuminates how power imbalances distort these interactions. It is concluded that nutrition promotion engages too much with nutrition ‘rules’ but too little with the social and environmental factors that influence eating practices and so does too little to empower people in their real life dealings with food. Foucault’s concept of bio-power was relevant too, in that many participants have internalised the individualist focus of health promotion and feel guilty about the dietary compromises they make, although these are frequently to do with financial viability and familial harmony and not with unthinking disregard for personal health. Thus the very practices that are designed to ameliorate the impact of diabetes actually provide fertile ground for worsening it by promoting negative self-evaluations and low self-efficacy.
It is concluded that nutrition advice for diabetes management limits preventive action and is often at odds with balancing the social, economic and health needs of Indigenous Australians. It is recommended that building rapport with people to establish therapeutic alliances for diabetes dietary management is essential to facilitate informed negotiation about healthy eating within its social context. However, these micro changes can only be truly fruitful when the social and structural factors that perpetuate the economic and political marginalisation of Indigenous Australians are addressed. A social justice approach is recommended to more effectively address diabetes in Indigenous Australia.