Abstract
Background
The United Nations Convention on the Rights of the Child confirms a child's right to adequate food and the highest attainable standard of health. In New Zealand, tamariki (Māori children) experience inequitable rates of food insecurity and obesity, indicating their right to adequate food is not fully realised. Healthy food availability is a related component of the right to adequate food. Food availability is measured through the following concepts; the community nutrition environment that describes the location and type of food retail stores in a geographic area, and the consumer nutrition environment, which defines the conditions customers encounter in these stores including food availability and food marketing. The overall aim of this thesis was to measure food availability for tamariki within these nutrition environments and investigate policy options to increase healthy food availability informed by a rights-based approach.
Methods
This research was grounded within a Kaupapa Māori Research theoretical framework, utilising a mixed-method approach to address the research questions. Firstly, a narrative literature review identified influences that enable the availability of healthy food for tamariki. Findings were synthesised and analysed using Oranga Mokopuna – a rights-based approach consistent with Kaupapa Māori Research. Secondly, two studies examined the community and consumer nutrition environments for tamariki Māori, utilising image data from the Kids’Cam study. Finally, interviews were conducted with 15 key stakeholders to elicit their views on policy options to ensure the rights of tamariki to healthy food.
Results
The narrative literature review highlighted factors enabling healthy food availability for tamariki involve the fulfilment of their rights to 1) an environment that enables access to traditional foods and food practices; 2) be involved in decisions about their food environment; 3) the economic right to food; and, 4) the highest attainable standard of health (and, within this), to be protected from food marketing.
The community nutrition environment analysis on the journey to and from school for children with tamariki included within the sample showed food outlets were a feature of children’s environments. There were 444 journeys to school analysed. The camera captured image data for food outlets in 47.9% of journeys that had a component of active travel compared to 20.3% of journeys by vehicle. The most common food outlets were convenience stores, fast-food outlets and large supermarkets. Children were more likely to have image data for BMI unhealthy food outlets compared to BMI healthy food outlets and this was significantly impacted by the mode of travel, with those who spent time travelling actively either all or some of the journey being more likely; odds ratio 4.2 (95% CI 1.2 - 14.4) for mixed journeys, to have image data for a BMI unhealthy food outlet. In this study, children of all ethnicities were exposed to a higher density of unhealthy outlets compared to healthy food outlets. Of the 73 food and drink consumption occasions recorded, 94.5% were for discretionary food or drink.
Analysis of convenience stores' consumer nutrition environment showed that unhealthy foods dominated the food and drinks available to children in convenience stores at a rate of 8.3 to 1 (means, 300 non-core, and 36 core, respectively). Most of the 70 items purchased by children were non-core foods or drinks (94.6%), and all of the purchased food or beverages subsequently consumed by children was non-core.
The findings from key stakeholder interviews suggested that to ensure the right to adequate food and to healthy food availability for tamariki, there needs to be: a comprehensive policy response that supports children's rights; an end to child poverty; food provision and food policy in schools; local government policy to promote healthy food availability; and stronger Māori voices and values in decision-making.
Conclusions
In conclusion, this research suggests that tamariki live in an obesogenic environment and this effect is exacerbated by socioeconomic deprivation. This is a breach of the rights of tamariki and in fact of all children. The right to food for tamariki is linked to political and economic systems that reflect ongoing colonisation. A decolonising approach where Māori voices and values are central within NZ policies and policy-making processes related to food availability is urgently needed to give full expression to rights under Te Tiriti o Waitangi.