A request from a rural health service for help with reducing avoidable hospital admissions has led to an award winning collaboration that’s improving the health and wellbeing of Victoria’s rural and remote communities.
Almost four hours’ drive from Melbourne, Yarriambiack Shire Council stretches from the Wimmera River just north of the Grampians in the south, to the centre of the Mallee in the north. The 7,158 square kilometre Shire is home to just over 7,000 people and produces a quarter of Victoria’s wheat and barley. It’s also known for its legume and oilseed crops, lamb and wool production and the unique “Silo Art Trail” immortalising local residents on the sides of the area’s ubiquitous grain silos.
But despite the Shire’s bucolic rural image, in 2014 local health services became acutely aware of a darker reality. That year, the annual Victorian Population Health Survey identified Yarriambiack Shire Council as the most overweight and obese council in Victoria. Yarriambiack also topped the highest sugar sweetened beverage consumption per capita and was lower than the State average in fruit and vegetable consumption. With four of the ten chronic disease risk factors at the highest level, the Shire also claimed the unenviable title of the worst chronic disease profile of any in Victoria.
Fortunately, that’s not the end of the story. Just two and a half years later the picture is changing, thanks to an award-winning approach from a collaboration between Yarriambiack Shire Council, Rural Northwest Health Service, West Wimmera Health Service and researchers from Deakin University’s Global Obesity Centre (GLOBE) and School of Medicine.
Funded through the Ian Potter Foundation, Rural Northwest Health Service, Royal Flying Doctors Service (Victoria) and the Department of Health and Human Services (Western Division Health), ‘Yarriambiack Creating Healthy, Active, Nourished Generations’ – YCHANGe – is a unique, long-term community-led project that seeks to identify and address the causes of unhealthy weight in Yarriambiack, develop sustainable local solutions and “make the healthy choice the easy choice”.
Recognising that prevention was key to stopping chronic disease in the community becoming unmanageable for local hospitals and health services, Rural Northwest Health, one of the two largest employers and main health provider in Yarriambiack, first approached Deakin in 2014 for help in developing a sustained intervention to reduce the prevalence of overweight and obesity and reduce avoidable hospital admissions.
Apex Park and Yarriambiack Creek at Warracknabeal
With a research team led by members from GLOBE and School of Medicine, including Professor Colin Bell, Professor Steven Allender, Dr Penny Love and Dr Lynne Millar, providing relevant evidence, process and evaluation and the hands-on expertise of Deakin PhD student and public health researcher Jill Whelan, YCHANGe puts power in the hands of the community to make lasting changes to health and wellbeing, while acknowledging that wider economic, commercial and social barriers can make this an uphill journey.
In a society seemingly obsessed with food and healthy eating, it’s difficult to realise that not everyone has the same access to fresh, healthy food. But, according to Ms Whelan, in Victoria’s rural and remote communities, food supply is a hidden issue that’s taking a toll on the health of the population.
“It’s much harder for them to eat well than it is for people who live in major centres,” Ms Whelan said.
“In Yarriambiack Shire Council, it’s hard to get fresh fruit and vegetables outside Warracknabeal. In the smaller towns, it’s very difficult to buy healthy food and it’s usually more expensive than in regional or metro areas. For example, the cheapest loaf of wholemeal bread is 60 cents more expensive than the cheapest white bread.
“There’s also a lot of socio-economic disadvantage. So you have this combination of low income, fewer physical activity options as rural sports clubs amalgamate and limited healthy food options that contributes to health issues.”
For Ms Whelan, YCHANGe has been a rare opportunity to work with a hospital and health service on prevention in the community and a perfect PhD project investigating how best to develop sustainable efforts to prevent overweight and obesity in rural and remote communities.
While she jokes that if she’d known how far away Yarriambiack Shire Council was from Geelong, she may have not been so keen, her passion for this project and this community is obvious.
In two and a half years of working on YCHANGe she has clocked up thousands of kilometres, played the ‘Pea Person’ at kindergarten events aimed at educating children about healthy eating, helped to rewrite the kindergarten nutrition and active play policy, improved school canteen menu options and worked with sporting clubs and local pubs to put fresh, healthy food and smaller portion sizes on the menu.
The implementation of YCHANGe has also included Heart Foundation walking groups that encourage social, incidental and planned physical activity, the mobilising of health promotion resources throughout the Shire Council and, in partnership with the community, the installation of exercise equipment on walking tracks along the Yarriambiack Creek in Warracknabeal.
It has also involved an extensive investigation into the barriers that residents of the Shire face when it comes to healthy eating.
“During the project, the food and drinks provided in places where people spend much of their time, such as childcare, school, sports clubs and workplaces, was identified as a key focus area,” Ms Whelan explained.
The two largest employers in Yarriambiack, Rural Northwest Health and the Shire Council itself, have taken significant action to ensure their employees can access healthy food and beverages during their work hours, changing catering for staff meetings from cakes to fruit platters and reviewing the choices on offer at onsite vending machines and kiosks.
Just one of YCHANGe’s many positive stories so far is the YarriYak café at Rural Northwest Health’s campus in Warracknabeal. Open to staff and the public, the café’s food and drinks options meet Victoria’s Healthy Choices guidelines, which use a “traffic light system” to categorise foods into the healthiest (green) and least healthiest (red) choices, and encourages the provision of at least 50 per cent ‘green’ and less than 20 per cent ‘red’ options on menus.
The Brim Silos painted by Guido Van Helten generated inspiration for the Yarriambiack Shire Silo Art Trail
The menu at YarriYak provides 68 per cent ‘green’ options, 16 per cent ‘amber’ items and 16 per cent ‘red’ items. Beverages include only water and hot drinks based on low-fat milk. The strategy is proving a success, both in customer satisfaction and the bottom line.
“I analyse the data monthly, and sales of ‘green’ items haven’t dropped below 79 per cent since opening day. Both in units sold and dollars made, they’re exceeding their goals and are determined to keep on doing so,” said Ms Whelan, who stresses that the changes are only sustainable because they are realistic and driven by staff and the community.
“It’s one of the project’s top objectives: that nothing happens in YCHANGe without community support, simply because it doesn’t work if it isn’t what the community prioritises,” she said.
In October 2017, Yarriambiack Shire Council was named National Winner in the Heart Foundation 2017 Local Government Awards ‘Councils with populations under 10,000’ category for YCHANGe’s achievements so far, following its success as a Victorian State Winner the week before.
“Everyone has worked so hard to build a healthy Yarriambiack community and we are starting to see significant health behaviour changes in just over two and a half years,” Ms Whelan said, pointing out that that’s a “pretty big achievement” when talking about community change.
“The end results in terms of BMI and reducing avoidable hospital admissions may not be obvious for another three to five years, because reaching 7000 people in 7000 square kilometres is going to take time,” she added.
“But what we can see now is positive – changes to kids’ lunchboxes, vending machines that no longer sell soft drinks, the café that only sells water. These are changes in behaviour and purchasing patterns that should lead to a healthier community down the track.”
And that’s what everyone involved in YCHANGe is working towards.
“We want to emphasise sustainable changes to the food and physical activity environments that will last beyond this ‘catalyst’ phase,” Ms Whelan said.
“The key difference between YCHANGE and other health promotion ‘programs’ is that this collaboration is drawn from, and led by, the community in an attempt to develop their own long-term solutions that in the end will make the healthy choice the easier choice.”
Published by Deakin Research on 22 January 2018