Health & Place 34 (2015) 54–62

Contents lists available at ScienceDirect

Health & Place

journal homepage: www.elsevier.com/locate/healthplace

Development of the good food planning tool: A food system approach

to food security in indigenous Australian remote communities
Julie Brimblecombe a,n, Christel van den Boogaard a, Beverley Wood a, Selma C Liberato a,
Jacqui Brown a, Adam Barnes e, Alison Rogers b, John Coveney a,c, Jan Ritchie a,d, Ross Bailie a
a
Menzies School of Health Research, Darwin, NT, Australia
b
The Fred Hollows Foundation, Indigenous Australia Program, Darwin, NT, Australia
c
Flinders University, Adelaide, SA, Australia
d
University of New South Wales, Sydney, NSW, Australia
e
Northern Territory Department of Health, Darwin, NT, Australia

art ic l e i nf o a b s t r a c t

Article history: Few frameworks exist to assist food system planning, especially for Indigenous Australian remote
Received 4 September 2014 communities. We developed a Good Food Planning Tool to support stakeholders to collectively plan and
Received in revised form take action for local food system improvement. Development occurred over a four-year period through
3 February 2015
an evolving four phase participatory process that included literature review, several meetings with
Accepted 11 March 2015
Available online 24 April 2015
representatives of various organisations and communities and application of the Tool with multi-sector
groups in each of four Indigenous Australian remote communities. A diverse range of 148 stakeholders,
Keywords: 78 of whom were Indigenous, had input to its development. Five food system domains: (i) Leadership
Food systems and partnerships; (ii) Traditional food and local food production; (iii) Food businesses; (iv) Buildings,
Food security
public places and transport; (v) Community and services and 28 activity areas form the framework of the
Indigenous Australia
Tool. The Good Food Planning Tool provides a useful framework to facilitate collective appraisal of the
Food system assessment
Multi-sectoral food system and to identify opportunities for food system improvement in Indigenous Australian remote
communities, with potential for adaptation for wider application.
& 2015 Elsevier Ltd. All rights reserved.

1. Introduction requires taking a holistic view to consider the multiple areas of

Local food systems for Indigenous Australians have changed
significantly in recent history (Lee, 1996). Indigenous Australian
remote communities now depend largely on store purchased
foods and to a lesser extent on traditionally collected foods and
locally produced foods (Brimblecombe et al., 2013). Change in local
food systems has come at a great cost to the health of communities
and individuals, with food insecurity (AIHW, 2011) and diet-
related conditions (such as overweight, obesity, cardiovascular
disease, type 2 diabetes) now major contributors to the serious
health gap between Indigenous and non-Indigenous Australians
(Vos et al., 2009).
It is well accepted that reliance on individual level approaches
and/or a focus on mechanisms within a single area of the food
system are not enough to improve food security and stem
burgeoning diet related conditions; major changes to the food
environment are necessary (Swinburn and Egger, 2002). This
n
Corresponding author at: Menzies School of Health Research, John Mathews
Building (58), Royal Darwin Hospital, PO Box 41096, Casuarina, NT 0811, Australia.
Tel.: þ 61 8 89228577; fax: þ 61 8 89275187.
E-mail address: julie.brimblecombe@menzies.edu.au (J. Brimblecombe).
the food system and to change the relevant societal, economic and
physical drivers in a direction that is health promoting (Signal
et al., 2013). The ways to do this are not straightforward as food
environments are complex and dynamic (Swinburn et al., 2005).
Evidence-based strategies for addressing the burden of diet-
related conditions are also limited (Swinburn et al., 2005; Giskes
et al., 2007, 2011; Holsten, 2009; Caspi et al., 2012). Decision-
making processes that combine best available evidence and local
knowledge to develop a course of action and to create new
perspectives and narratives that impact on how people think
and act are receiving increasing attention (Swinburn et al., 2005;
Bushe and Marshak, 2009; Edvardsson et al., 2012). These
approaches are believed to have the greatest chance of responding
to the changing nature of the food environment and in developing
strategies that are comprehensive, contextually relevant and
suited to the community of concern (Swinburn and Egger, 2002).
In the context of Indigenous Australian remote communities,
two innovative system approaches to planning that have potential
application to local food systems have been used to improve
quality of primary health care and essential service delivery
(Bailie et al., 2007; McDonald et al., 2013). These draw on the
principles of quality improvement and participatory learning

http://dx.doi.org/10.1016/j.healthplace.2015.03.006
1353-8292/& 2015 Elsevier Ltd. All rights reserved.
 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62
(Bailie et al., 2013; WHO, 2007) and use a systems assessment tool
to support stakeholders to collectively appraise practice against a
pre-defined set of best practice goals (Bailie et al., 2007). From this,
an action plan is developed and data on practice and outcome
measures are collected to provide feedback on performance. A
cornerstone of these system approaches is the focus on achieving
quality improvement through a structured ongoing cycle of
participatory assessment, planning and action, to achieve step-
by-step incremental improvement. Through this process of dis-
cussion and analysis stakeholders incrementally build their knowl-
edge of the nature of the system and how it behaves.
As far as we know there have been no initiatives in the Indigenous
Australian remote community context that have sought to engage a
group of stakeholders at the local level in a systematic and ongoing
process of decision-making for food system improvement. Yet the few
community-based interventions in this context shown to positively
impact on diet-related conditions point towards the importance of
addressing multiple areas of the food system (Lee et al., 1994; Rowley
et al., 2000; Black et al., 2013a, 2013b), and involving local stake-
holders and community leaders in planning, implementation and
evaluation activities (Black, 2007).
The unique history, governance structures and other character-
istics of the food environments of Indigenous Australian remote
communities need to be considered in food system decision-
making processes as these can offer both opportunities and
challenges. Different geographical locations exhibit unique char-
acteristics that necessitate special consideration. There are over
160 discrete communities in remote Indigenous Australia with
populations of more than 100 people that are located over vast
tracts of the nation and are geographically isolated from larger
urban centres (ABS, 2010). These communities have all experi-
enced a recent history of European invasion, colonisation and
oppression and continue the struggle of retaining their cul-
ture and rights in a wider society where a western worldview
dominates. Communities have retained structures of Indigenous
leadership that co-exist with non-indigenous governance struc-
tures. Further important characteristics are that most communities
are small in population size and yet have a large ratio of and high
turnover of non-Indigenous service providers (such as medical
professionals, public health nutritionists, aged-care managers,
horticulturalists, store managers) per capita; and, also, that food
hunting and gathering plays an important economic, dietary and
cultural role in most communities. The few food environment
related assessment tools (Wood and McDowell, 2009; Swinburn
Table 1
Outline of the GFPT development phases and associated dates, activity and aim.
Phase Date Activity
Phase 1: April-Sept 2009 Literature review
Development Expert review n¼ 22 (2 Aboriginal participants)
Phase 2: Test of 29th Sept 2009 Meeting 1a b n¼ 13 (3 Aboriginal participants)
relevance 16th-17th Feb 2010 Meeting 2ab n¼ 27 (15 Aboriginal participants)
Phase 3: Test of 2nd-4th Nov 2011 Meeting 3a b
n¼ 20 (14 Aboriginal participants)
validity
Annually 2010-2013 Annual planning meetings with community-based food-interest groups
in each of the four communitiesa n¼ 26-42
Phase 4: Sept 2012 Data review
Refinement
Meeting 4a n ¼7 (4 Aboriginal community coordinators)
a
Participant numbers include the facilitators and/or members of the research team who also provided expert content knowledge.
b
These meetings were all urban-based in contrast to the annual planning meetings that were community-based and community specific.
55
et al., 1999; DFID, 2013; Tansey and Worsley, 1995; Kelly et al.,
2011; McKinnon et al., 2009; Pomerleau et al., 2013; Glanz et al.,
2007; NEAT, 2014) that exist do not capture all elements of this
unique environment nor have they been purposefully developed
as part of an integrated quality improvement process.
In response to a heightened interest to redress food security in
Indigenous remote communities by the Australian government
and community leaders seeking opportunity to ‘have a say’ in the
development and implementation of food security initiatives, we
aimed to develop a tool structure and implementation approach
that would enable the engagement of community people and
other stakeholders to identify gaps, barriers and opportunities for
improvement of the food system, as part of an integrated quality
improvement process. The development of the Good Food Plan-
ning Tool (GFPT) occurred as part of the Good Food Systems: Good
Food for All Project (GFS Project)—a five-year case study (2009–
2013) that aimed to assist stakeholders, including Indigenous
community residents, to collectively identify food system chal-
lenges and opportunities to improve food security (i.e., food
availability, access and utilisation) over time. This article describes
the development of the GFPT and its implementation in four
communities.
2. Methods
2.1. Good food planning tool development: Evolving participatory
process
The GFPT evolved through a four phase participatory process as
shown in Table 1. It was informed by multiple sources of data
collected through literature review, expert review of an early
version of the GFPT, four stakeholder meetings with Indigenous
and non-Indigenous stakeholders (for test of relevance and valid-
ity), application with food interest groups in each of the four
Indigenous communities as part of the GFS project (for test of
application), and experience gained by all.
2.1.1. Study setting
Two of the Indigenous Australian remote communities that
participated in the GFS project and whose members contributed to
the development of the GFPT were situated on the North Aus-
tralian coast, another was inland from the coast and a fourth was
in the Central Australian desert. The communities varied in size
Aim
Determine food system domains, activity areas,
corresponding best practice characteristics and
application process
Check the activity areas and corresponding best
practices with food delivery, food retail and food
policy experts
Check all aspects of the tool
Inductively identify activity areas and corresponding
best practice characteristics for each food system
domain
Compare and contrast these against GFPT
Determine and test process for Tool application
Review all data for any emerging and/or divergent
food system domains, activity areas or best practice
characteristics
Check terminology and graphics
56 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62
(250 to over 2000 residents), were classified as very remote (ABS,
2001, 2011) (accessible by long distance road travel, by small
aircraft or boat), and socio-economically disadvantaged (ABS,
2013). The four communities were of Aboriginal heritage and
diverse in cultural practices. Multiple languages were spoken in
each community and English was the main language in only one
community.
All four communities were serviced by a local government
authority and had a community owned store, a school, arts
community, health centre, employment program and other ser-
vices such as aged-care, sports and recreation and child-care.
Three of the four communities had one or more additional food
outlets (for example—fast food outlet, club, convenience store,
butchery). Food delivery to the communities was by long distance
road (weekly or fortnightly) or by weekly barge and aircraft. Fresh
goods were usually delivered by aircraft to one community in the
wet season (  October to May). Extreme weather conditions
periodically disrupted the supply of food to all communities.
2.1.2. Stakeholders
A diverse range of Indigenous and non-Indigenous stakeholders
with different roles in the food system were invited to have input
to the development of the GFPT through review of an early version
of the GFPT and/or participation in a series of four urban-based
meetings. These stakeholders included residents from the four GFS
study communities and other stakeholders also with expertise in
aspects of food systems.
2.1.3. Community multi-sector groups (the food-interest groups)
In each community, the GFS Project supported stakeholders
with an interest in the community food system to participate in
annual planning meetings (of  2 half days) to appraise their food
system and prioritise a set of actions (for commitment to imple-
mentation) using the GFPT (or developing versions). Four annual
planning meetings took place over the course of the GFS Project in
two communities, with three such meetings in the third commu-
nity and one only in the remaining site. Participation was volun-
tary and open to any community member (both Indigenous and
non-Indigenous) or external stakeholder who had an interest in, or
who might impact on the local food system. A member of the
research team (Project facilitator) and a local resident Aboriginal
community co-ordinator (employed by the Project) facilitated
these meetings. The GFPT was progressively refined over several
versions during the course of the GFS Project.
2.1.3.1. Ethics. Ethics approval for all aspects of the Good Food
Systems: Good Food for All Project was attained from the Human
Research Ethics Committee (HREC) of the Northern Territory
Department of Health and Menzies School of Health Research (ref.
HREC 09/07), Cairns and Hinterland Health Service District Ethics
Committee (ref. HREC/10/QCH/71-678) and the Central Australian
HREC (ref 2009.02.02). Signed partnership agreements were
negotiated with participating organisations and communities.
3. Results
3.1. Phase 1. Development of the first versions of the GFPT
3.1.1. Literature review
We drew from existing system tools (Bailie et al., 2007, 2013;
McDonald et al., 2013) and food environment related assessment
tools (Wood and McDowell, 2009; Swinburn et al., 1999; DFID, 2013)
to determine tool structure and content. The structure selected for
the GFPT was that of the systems assessment tool successfully used
in the primary health care setting in the Indigenous Australian
remote community context (Bailie et al., 2007). System domains
(such as ‘food businesses’), activity areas for each domain (such as
the placement and promotion of food in the ‘food businesses’
domain) and best practice characteristics for each activity area (such
as for placement—“Food is placed in a way that encourages healthy
food choices” and for promotion—“Healthy food is promoted in the
store”) were then identified and continually refined over the course
of Tool development. In doing this, the first aim in development of
the GFPT was to systematically identify the range of activities in the
Indigenous Australian remote community context that related to
each of the dimensions of food security (food availability, access and
utilisation) for each function of a food system (Tansey and Worsley,
1995) (food collection/growing to waste disposal and recycling) and
in each area of the environment (socio-cultural, physical, economic
and political and natural) (Wood and McDowell, 2009; Swinburn
et al., 1999; Sacks et al., 2008; Environments for Health, 2001). This
occurred first through a scan of published and grey literature to
identify: (i) the factors considered to influence food security in the
Indigenous Australian remote community context (Brimblecombe
et al., 2014; Gorton et al., 2010); (ii) related food policies, programs,
services and guidelines; and, (iii) practices considered to influence
the consumer food environment (Glanz and Yaroch, 2004) and
traditional food access and use (Woodley et al., 2009).
3.1.2. Expert review
We then elicited the views of 22 expert stakeholders, repre-
senting the remote community food retail industry (7), food
wholesalers (1), academia (3), national nutrition policy (1), Aus-
tralian and territory government (5) and non-government organi-
sations (5), through written and oral feedback, on both the
proposed structure and content of the GFPT and its application.
The following recommendations were made:
(1) Include all areas of the local food system that relate to food
security including traditional food and local food production;
(2) In its application, identify actions based on what is in the best
interest of the community, community capacity to address the
problems, and local leadership capacity;
(3) Link the food system to health indicators;
(4) Include evidence-based scenarios of how to achieve improve-
ment in the different activity areas and show where linkages
within the system occur;
(5) Keep the GFPT brief, comprehensive and non-prescriptive,
with the use of plain English and graphics;
(6) Ensure strong community representation in community level
multi-sector food interest groups and address issues as deter-
mined by community decision;
(7) Support food system improvement from the angle of ‘goal-
setting’ and establish a shared vision for the food system with
the group of stakeholders.
As a result of this feedback, the scope of the GFPT was broadened
from an initial focus on the community store (as the primary source
of food in a remote community) and its community-wide linkages, to
include all areas of activity relating to the different food system
functions including the production and procurement of local and
traditional foods.
3.2. Phase 2. Test of relevance for the GFPT
Thirteen food retail and policy experts participated in a first
meeting to identify and reach consensus on activity areas and best
practice characteristics for the food system functions relating to
food delivery, food-related policy and food retailing (Table 1).
 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62 57

These were then cross-checked against the GFPT and modifications
made accordingly.
In the second meeting, 27 stakeholders including 16 residents
of the four GFS communities and 11 people with expertise in
health promotion, public health nutrition, food security policy,
food systems, store governance and retail practice reviewed each
domain of the GFPT alongside the activity areas and best practice
characteristics and provided comment on relevance to the Indi-
genous Australian remote community context, clarity of terminol-
ogy and graphic images, and gaps. Participants preferred food
system activities to be grouped by the setting or area of respon-
sibility rather than by the socio-cultural, physical, economic,
political and natural aspects of the environment. For example,
activities relating to food businesses such as the availability of a
full range of healthy food and placement of foods to encourage
healthy food purchasing, were then grouped within a domain
called “food businesses” rather than in a domain called “physical
environment”.
identified by Indigenous community representatives as relevant to
their local food systems. To begin, each community group of three to
six people expressed their view of their local food system through
use of drawings and existing photos and presented this view to the
whole group. The significance of traditional food in the local food
system was apparent and depicted separately to the settings respon-
sible for different aspects of the food system (such as the store, the
local government services, the school, and the health centre). The
whole group was then invited to inductively identify a set of activity
areas perceived as important to food security for each of the five food
system domains included in the evolving GFPT. The question asked to
participants for each domain was: “what activity would you see in
your community if this area of the food system was really strong?”
The community derived activity areas are shown in Table 2. They
were broadly consistent with the activity areas and the best practice
characteristics identified through the previous tool development
phases although different terminology was used.

3.3.1. Application of GFPT with community-based food-interest

3.3. Phase 3. Test of validity for the GFPT
Twenty people representing the four participating communities
(and Good Food Systems Project facilitators) with most being
Aboriginal then participated in a third meeting to test if the domain
and activity areas of the evolving GFPT corresponded with areas
groups
In each of the four participating communities, 26–42 different
Indigenous and non-Indigenous stakeholders participated in at
least one annual planning meeting over the GFS Project period
(2009–2013) and used the GFPT. Through these meetings a
facilitated process to support the collective use of the GFPT to

Table 2
Activity areas important to food security in several food system domains as identified by community representatives and the final GFPT.

Food system domain Activity areas (as identified by community representatives) Activity areas (final GFPT)

Leadership and Community needs assessment; strong voices in community; consulting with Elders Leadership
partnerships Sharing of resources; working together and strong communication Good linking and partnerships
Elders participating in decision-making Community plans and policies/ community
ownership
Leadership training; employment and capacity building; skill development in home Local workforce investment
maintenance; employment of Indigenous Essential Service Officers
Sector support from local government authority Commitment to action
Knowledge translation from elders; caring for elders, so they can pass on knowledge; Good information and feedback systems
information collected and reported on nutritional status of community
Traditional foods and Care and management of country; conservation practices in place; laws and regulations that Care and management
local food production protect traditional food and Indigenous land and water rights
Access to traditional food supported, e.g., hunting permits for community people easily Traditional food promotion and use; Things
accessed you need to go hunting and collecting
Teaching in two ways in schools and on country; programs in place to develop knowledge and Passing on knowledge
skills of youth
Local food production e.g., market gardens; banana farm Local food production
Community and Community-wide promotion and support for healthy eating; parents role-modelling healthy Community support
services eating
Development of cooking skills; access to meaningful nutrition information; schools teaching Promotion activities and training
nutrition; school breakfast program in place; local media broadcasting health messages;
support for festivals/ health fairs and culture week
Nutrition programs for: young women, mothers and families of children with growth and
development issues, and for people with diet-related conditions such as type 2 diabetes
Community services promoting healthy eating Health services support
Support for aged-care services Food services
Buildings, public places Adequate buildings to support healthy eating Buildings and public places
and transport Families working together for a healthy home; adequate housing and infrastructure; adequate Homes
household food storage and food preparation facilities; house owner taking responsibility for
upkeep of home
Adequate, good quality water supply; good and reliable power supply Safe drinking water and power
Frequent and adequate food delivery to community Transport and food delivery
Food businesses Community leaders ensure that store is of a high standard Community support
Well supported staff; food safety training for staff People in food businesses
Strong and functioning store committee; community support for store committee; compliance with Policies and management support
workplace health and safety regulations; compliance with food safety practices; no dogs in store
Adequate infrastructure (e.g., air-conditioning/ refrigeration) Places (buildings)
No out-of-date food in shops; healthy food available when shop opens; fresh food (such as milk Products
and bread) available; healthy takeaway options available; budgeting and financial support
available
Pricing encourages healthy food purchases (e.g., mark down on healthy foods (fruit and veg and Prices
other foods))
Healthy food promoted (e.g., store shelf-talkers, posters, food signs, fruit bowl at counter) Promotion and placement
58 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62

appraise the food system and develop a plan of action evolved
(Box 1).
Facilitated by the project community co-ordinators and/or
project facilitator (JB, JBr, CB or AB), stakeholders in all four
communities were collectively able to use the GFPT to assess their
community local food system. They could score each food system
activity area using the qualitative ripple scoring system developed
through the GFS project (Brimblecombe JvdB et al., 2014) and
shown in Box 2. This participatory and visual method of appraising
domains and activities for our purposes was found to be more
acceptable to participants than the original linear scoring scale of 0
to 11 based on the systems assessment tool used in the Indigenous
Australian primary health care setting (Bailie et al., 2007). The best
practice characteristics for each activity area helped facilitate
discussion on the strength of each activity area. Reasons given
by the group of stakeholders for the scoring of each activity area
were recorded, together with the discussions of challenges and
opportunities for improvement and the long list of identified
actions. Only in two communities did time permit prioritisation
of actions. This then contributed to the development of an action
plan (with time frame and responsibilities) to be used in subse-
quent review meetings as part of the quality improvement
process.

Box 1–The steps used in facilitation of the GFPT to appraise the food
system and develop a plan of action. More detail is available in the
Good Food Planning Tool and guide for users (Brimblecombe et al.,
2014).

– Explain the structure of the GFPT and the appraisal process

– For each food system domain, provide a verbal description
of each activity area using the best practice characteristics
as examples
– Show the visual for the activity area being discussed, and
ask the group to reflect and comment on how strongly they
see the activity area performing in their community
– After listening to and recording the group’s discussion,
place the visual on one of five circles of a ripple diagram
(where the outer circle represents very strong/fully devel-
oped and the inner circle, just developing) that seems to
best represent people’s comments and ask if this matches
with their perception; and then,
– Manage the discussion until consensus is reached and
write agreed discussion points on a sticky note to then also
display on the ripple;
– Record on a sticky note any actions or strategies to
strengthen the area being discussed that arise in the 3.4. Phase 4. Refinement of the GFPT
discussion
– Continue to discuss each activity area for each domain and 3.4.1. Information review
record the appraisal process using a different ripple for Three authors (JB, CB and SL) reviewed and cross-checked all
each domain data collected from the activities of the previous Phases (1–3) and
– Take a photo for future comparison with the next food from the food system appraisals and actions plans and/or list of
system appraisal actions developed through the GFS annual planning meetings to
– Manage a discussion to further identify actions identify any emerging and/or divergent food system domains,
– Use a participatory tool such as the ten seed technique activity areas or best practice characteristics and any other issues
(Jayakaran, 2002) or pocket chart (Donelly, 2010) to including interpretation. No emerging new themes or activity
prioritise actions and define a plan of action. areas were identified. A number of inter-related activity areas
were merged with more detail on the characteristics of best
practice included.

Box 2
An example of the appraisal of the “food businesses” domain,
by a community food-interest group; using the ripple scoring
system. Based on a facilitated dialogue and consensus by the
group, a picture card representing each activity area is placed
on a circle of the ripple where the outer circle represents very
strong/fully developed and the inner circle, just developing.
This example shows that in this community, the group of
stakeholders viewed practices relating to food price and
community support for store business as areas that needed
most strengthening in their community.
3.4.2. Community review
The last step in achieving a set of domains, activity areas and
best practice characteristics that reflected the food systems in the
participating communities was to review the last version of the
GFPT with four of the Project community co-ordinators represent-
ing three of the four participating communities. Graphic images
were slightly modified and the terminology for activity areas and
best practice characteristics made more user-friendly. Consensus
was reached on the final GFPT with five food system domains and
28 activity areas (Fig. 1), with 120 associated best practice
characteristics (Brimblecombe et al., 2014).
 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62
Fig. 1. The final version of the Good Food Planning Tool (GFPT) with the five domains and 28 activity areas.
4. Discussion
This study demonstrates that the application of the GFPT devel-
oped from a combination of best available evidence and expert
knowledge was able to engage a wide range of stakeholders includ-
ing Indigenous community residents in collectively assessing their
local food system and in considering actions to improve food security
in four contextually different remote Indigenous communities. From
the perspective of Indigenous and non-Indigenous experts we
defined the domains and activity areas that best represented the
food systems of these four communities. The activity areas identified
by community representatives were consistent with best available
evidence and other expert opinion, although different terminology
was used.
The GFPT shares characteristics of other system assessment
tools and frameworks (Wood and McDowell, 2009; Bailie et al.,
2007; McDonald et al., 2013; Swinburn et al., 1999; Environments
for Health, 2001). A key feature of the GFPT is that it was co-built
with the input of a large group of stakeholders and comprises pre-
defined domains, activity areas and best practice characteristics.
The major difference between the GFPT and the system assess-
ment tool (Bailie et al., 2007) and the healthy communities
assessment tool (McDonald et al., 2013) (both specific to Indigen-
ous Australian remote communities) is the focus of the GFPT on
the food system with the aim of supporting food security, assisted
by use of graphics and the ripple scoring tool. Although not
directly obvious, the structure of the GFPT with its settings-
based domains is similar to the ANGELO framework (Swinburn
et al., 1999; Simmons et al., 2009).
59
Similar to the settings-based approach to health promotion
endorsed by the World Health Organization in the early 2000s
(Paton et al., 2005; WHO, 2002), stakeholders in the context of this
study preferred food system activities to be grouped by the whole
setting (such as ‘food businesses’ or ‘community and services’)
rather than by the separate socio-cultural, physical, economic,
political and natural aspects of the environment. As a result of this,
the GFPT focuses the attention of stakeholders not solely on
introducing new strategies and initiatives, but on the state of
current activity and where practices can be improved within
services. Substantial improvement could occur through the differ-
ent sectors and organisations in Indigenous Australian remote
communities being supported to reflect on and improve practice
within their own service/setting, as many (but not all) of the
pathways for food security improvement operate at and are
governed at the community level.
When using the GFPT with the food interest groups in the four
study communities, the pre-defined activity areas and best practice
characteristics set the scenario for discussion of the whole local
food system, rather than part of it, and focussed the discussion. A
benefit of considering the whole local food system through use of
the GFPT resulted in the identification of community actions to
support local food security in both the short and long-term. Time
constraints however at the annual planning meetings (which
occurred over 2 half days each of 3 to 4 h duration) hindered the
completion of action plans in some instances. Failing to produce a
detailed and comprehensive course of action may cause collabora-
tive efforts to focus on easier and less significant activities (that may
not help achieve outcomes), rather than focusing on actions that
60 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62
could make more significant changes to system function (Kreuter
et al., 2000). Any action planning process that involves problem
solving, consensus building, and allocation of tasks can be complex
and time intensive (Kreuter et al., 2000). To make most effective use
of the limited time that stakeholders have available for planning
activities, we therefore recommend that completion of action plans
be undertaken concurrently with the food system appraisal when
using the GFPT. Alternatively, stakeholders could be requested to
commit extra time to the annual planning meeting, and/or commit
to extra meetings to complete planning, or meet within their own
organisation/service agency to bed down plans. A more gradual
introduction to use of the GFPT in the Indigenous Australian remote
community context could be to focus on one domain of the food
system, such as food businesses, rather than the whole food system.
This should allow time to develop a more detailed action plan in a
specific priority domain, with buy-in from relevant stakeholders. It
may also limit potential for a sense of being overwhelmed – and
consequent inertia – that might arise when stakeholders try to
address the whole food system at the one time. Additional domains
of the food system can then be considered as stakeholders build
their understanding of the food system, their capacity to plan
together and confidence that outcomes can be achieved.
In the Indigenous Australian remote community context, ser-
vices are mostly delivered and managed in a siloed fashion
through different sectors. Historically, there have been few
attempts for co-ordination across sectors. Where attempts of
service co-ordination are in place, through structures such as
interagency groups, these in many communities include mostly
non-Aboriginal service providers who head the various services
within the community. Further, informal linkages that exist
between agencies are often short-lived due to the high turnover
of non-Aboriginal people in management or service provision
positions. This high turnover of staff and pressure to deliver
long-term outcomes in the short-term, often results in imposed
quick-fix and single issue solutions and little time invested in
building relationships across sectors through planning, reflection
and evaluation, and in building community resident’s capacity in
these areas (Sacks et al., 2008; Cargo et al., 2011). This minimises
opportunity for collective learning on how different parts of the
system respond to intervention and where the leverage points are
for improvement. This study has shown that the GFPT and its
facilitated application can bring different community voices
together, and for stakeholders to learn from each other’s experi-
ences. The GFPT therefore offers a process to enable change
through specifically facilitating dialogue and interaction between
the range of stakeholders involved in food systems, and through
harnessing the unique assets and capacities of local communities;
thus helping to ensure relevant responses to identified issues.
The GFPT includes many of the environmental influences on
household food security identified by Gorton et al. through a
comprehensive international literature review (Gorton et al.,
2010). The specification of domains, activity areas and best
practice characteristics which characterise the GFPT also drew on
the literature, including the national strategic and action plan for
Aboriginal Australians and Torres Strait Islanders (SIGNAL, 2000)
and other relevant policy statements and food service and food
delivery guidelines. This Project now demonstrates how use of the
GFPT by local policy makers, service providers and communities
has the potential to translate these national strategic plans and
policies into actions that are suited to the contexts and environ-
ments of different local community settings.
The GFPT was designed for use in Aboriginal Australian remote
communities. The tool could be adapted to capture the character-
istics of food systems beyond the intended context with the input
of relevant stakeholders using a methodology similar to that
reported in this paper.
Further research is required in the application of the GFPT over
time to further elucidate and define the important levers to effect
change within the local food system. From a ‘systems thinking’
perspective, these levers are likely to relate to the mechanisms
that connect and communicate with the different parts of a system
and provide feedback to the whole system (WHO, 2009; Malhi
et al., 2009). A further development of the tool could also be to
identify the existing policy levers and policy opportunities in each
sector of the food system and to highlight these (Sacks et al., 2008;
Good et al., 2010). For example, local governments operating in
Indigenous Australian remote communities have traditionally
been involved in food and nutrition related activities including
food safety regulation, land use for agriculture, community food
services and monitoring of food retail premises (Yeatman, 2009).
Sharpening of policy levers in these areas to include food security
objectives may help in achieving food system improvements.
Other tools that objectively measure aspects of food environments
could also be considered for use alongside the GFPT to further
inform stakeholder judgement and opinion (Kelly et al., 2011;
McKinnon et al., 2009; Pomerleau et al., 2013; Glanz et al., 2007;
NEAT, 2014).
Further research is also required on the outcomes of the GFPT
on local food system quality in the long-term and the extent to
which this is associated with positive outcomes such as improve-
ment in community safety, health risk factors, and diet-related
diseases. The ripple scoring system used here to assess the
performance of the local food system is based on the collective
view of stakeholders in relation to how they perceive the quality of
their food system. Research is warranted to test the inter-rater
reliability and reliability of the ripple scoring system used with the
GFPT over time within a community particularly with the high
turnover of service providers and practitioners that occurs in
Indigenous Australian remote communities. The key purpose of
the GFPT however is not for quantification of the performance of
the food system but to facilitate dialogue and new perspectives
between stakeholders and depict the community vision of a
performing food system and assist in developing action plans.
5. Conclusion
The GFPT and its process of application supports an approach to
food system planning that recognises the importance of engaging
local stakeholders in developing plans that are acceptable and
appropriate to the needs of a community. The harnessing of local
knowledge, skills and experience and building a sense of collective
sector responsibility for food security are important strategies in
improving health and well-being in remote Indigenous commu-
nities. Ultimately, the outcome sought is to improve local food
environments, local food security, and community, household and
individual health and well-being. Improvements in relation to
complex system issues such as food security are the result of many
small incremental steps in building on existing initatives, reflect-
ing on progress and learning from others. We believe the GFPT
with support for its facilitated application is one more contribu-
tion towards the improvement so urgently needed.
Sources of support
The study was funded through the National Health and Medical
Research Council (545207).
Julie Brimblecombe was supported by a NHMRC Public Health
Fellowship, ID 545253 and is supported by a Future Leader
Fellowship (Award ID: 100085) from the National Heart
 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62
Foundation of Australia. Ross Bailie is supported by an ARC Future
Fellowship (#FT100100087).
Acknowledgments
We thank the four communities who participated in the larger
GFS study and all personnel who contributed to the development
of the GFPT. We acknowledge the invaluable contribution of the
community coordinators, Elaine Maypilama, Jacob Spencer, Frank
Nadjalaburrnburrn, Cheryl Nadjalaburrnburrn, Harold Bowen and
Tania Deemal. A special thanks also to the other members of the
GFS Project Management Committee – Megan Ferguson, Vivienne
Hobson and Clare Brown.
References
ABS, 2001. Information paper: ABS views on remoteness. ABS Cat. no. 1244.0.
Australian Bureau of Statistics, Canberra.
ABS, 2010. Population characteristics of Aboriginal and Torres Strait Islander
Australians. ABS Cat. no. 4713.0. Australian Bureau of Statistics, Canberra.
ABS, 2011. Australian standard geographical classification (ASGC). ABS Cat. no.
1216.0. Australian Bureau of Statistics, Canberra.
ABS, 2013.Census of Population and Housing: Socio-Economic Indexes for Areas
(SEIFA). ABS Cat. no. 2033.0.55.001. Australian Bureau of Statistics, Canberra.
AIHW, 2011. The Health and Welfare of Australia’s Aboriginal and Torres Strait
Islander people. An Overview. Cat no: IHW 42. Australian Institute of Health
and Welfare, Canberra.
Bailie, R., Si, D., Dowden, M., O’Donoghue, L., Connors, C., Robinson, G., et al., 2007.
Improving organisational systems for diabetes care in Australian Indigenous
communities. BMC Health Serv. Res. 7, 67.
Bailie, R., Matthews, V., Brands, J., Schierhout, G., 2013. A systems-based partner-
ship learning model for strengthening primary healthcare. Implement. Sci. 8,
143.
Bailie, R.S., Si, D., O’Donoghue, L., Dowden, M., 2007. Indigenous health: effective
and sustainable health services through continuous quality improvement. Med.
J. Aust. 186 (10), 525–527.
Black A., 2007. Evidence of Effective Interventions to Improve the Social and
Environmental Factors Impacting on Health: Informing the Development of
Indigenous Community Agreements. Office for Aboriginal and Torres Strait
Islander Health, Australian Government Department of Health and Ageing,
Canberra.
Black, A.P., Vally, H., Morris, P.S., Daniel, M., Esterman, A.J., Smith, F.E., et al., 2013a.
Health outcomes of a subsidised fruit and vegetable program for Aboriginal
children in northern New South Wales. Med. J. Aust. 199 (1), 46–50.
Black, A.P., Vally, H., Morris, P., Daniel, M., Esterman, A., Karschimkus, C.S., et al.,
2013b. Nutritional impacts of a fruit and vegetable subsidy programme for
disadvantaged Australian Aboriginal children. Br. J. Nutr. 110 (12), 2309–2317.
Brimblecombe J., van den Boogaard C., Liberato S.C., Brown J., Wood B., Barnes A.,
et al., 2014. The Good Food Planning Tool Darwin 2014. Available from: 〈http://
www.menzies.edu.au/page/Resources/Good_food_planning_tool/〉 [cited 2014].
Brimblecombe, J., Maypilama, E., Colles, S., Scarlett, M., Dhurrkay, J.G., Ritchie, J.,
et al., 2014. Factors influencing food choice in an Australian Aboriginal
community. Q. Health Res. 24 (3), 387–400.
Brimblecombe, J.K., Ferguson, M.M., Liberato, S.C., O’Dea, K., 2013. Characteristics of
the community-level diet of Aboriginal people in remote northern Australia.
Med. J. Aust. 198 (7), 380–384.
Brimblecombe, J., van den Boogaard, C., Brown, J., Ritchie, J., Bailie, R., Coveney, J.,
Liberato, S.C., 2014. From targets to ripples: tracing the process of developing a
community capacity appraisal tool with remote Australian Indigenous com-
munities to tackle food security. BMC Public Health 14, 914.
Bushe, G., Marshak, R., 2009. Revisioning organisational development: diagnostic
and dialogic premises and patterns of practice. J. Appl. Behav. Sci. 45 (3),
348–368.
Cargo, M., Marks, E., Brimblecombe, J., Scarlett, M., Maypilama, E., Dhurrkay, J.G.,
et al., 2011. Integrating an ecological approach into an Aboriginal community-
based chronic disease prevention program: a longitudinal process evaluation.
BMC Public Health 11, 299.
Caspi, C.E., Sorensen, G., Subramanian, S.V., Kawachi, I., 2012. The local food
environment and diet: a systematic review. Health Place 18 (5), 1172–1187.
Department for International Development (DFID), 2013. Sustainable Livelihoods
Guidance Sheets. wwwdfidgovuk/ [Internet]. Available from: 〈http://www.efls.
ca/webresources/DFID_Sustainable_livelihoods_guidance_sheet.pdf〉.
Donelly, J., 2010. Maximising participation in international community-level
project evaluation: a strength-based approach. Eval. J. Australas. 10 (1), 43–50.
Edvardsson, K., Ivarsson, A., Garvare, R., Eurenius, E., Lindkvist, M., Mogren, I., et al.,
2012. Improving child health promotion practices in multiple sectors—out-
comes of the Swedish Salut Programme. BMC Public Health 12, 920.
State Government Victoria, 2001. Environments for Health, Promoting Health and
Wellbeing through Built, Social, Economic and Natural Environments: Municipal
61
Public Health Planning Framework. State Government of Victoria, Department of
Human Services, 2001.
Giskes, K., Kamphuis, C.B., van Lenthe, F.J., Kremers, S., Droomers, M., Brug, J., 2007.
A systematic review of associations between environmental factors, energy and
fat intakes among adults: is there evidence for environments that encourage
obesogenic dietary intakes? Public Health Nutr. 10 (10), 1005–1017.
Giskes, K., van Lenthe, F., Avendano-Pabon, M., Brug, J., 2011. A systematic review of
environmental factors and obesogenic dietary intakes among adults: are we getting
closer to understanding obesogenic environments? Obes. Rev. 12 (5), e95–e106.
Glanz, K., Yaroch, A.L., 2004. Strategies for increasing fruit and vegetable intake in
grocery stores and communities: policy, pricing, and environmental change.
Prev. Med. 39 (Suppl. 2), S75–S80.
Glanz, K., Sallis, J.F., Saelens, B.E., Frank, L.D., 2007. Nutrition Environment Measures
Survey in stores (NEMS-S): development and evaluation. Am. J. Prev. Med. 32
(4), 282–289.
Good, E., Hammond, M., Martin, C., Burns, C., Groos, A., 2010. An audit of local
government planning tools for their potential use in addressing community
food and nutrition issues. Health Promot. J. Austr. 21 (1), 5–11.
Gorton, D., Bullen, C.R., Mhurchu, C.N., 2010. Environmental influences on food
security in high-income countries. Nutr. Rev. 68 (1), 1–29.
Holsten, J.E., 2009. Obesity and the community food environment: a systematic
review. Public Health Nutr. 12 (3), 397–405.
Jayakaran R., 2002. The Ten Seed Technique. World Vision International, People’s
Republic of China.
Kelly, B., Flood, V.M., Yeatman, H., 2011. Measuring local food environments: an
overview of available methods and measures. Health Place 17 (6), 1284–1293.
Kreuter, M.W., Lezin, N.A., Young, L.A., 2000. Evaluating community-based colla-
borative mechanisms: implications for practitioners. Health Promot. Pract. 1, 1.
Lee, A., 1996. The transition of Australian Aboriginal diet and nutritional health.
World Rev. Nutr. Diet. 79, 1–52.
Lee, A.J., Bailey, A.P., Yarmirr, D., O’Dea, K., Mathews, J.D., 1994. Survival tucker:
improved diet and health indicators in an Aboriginal community. Aust. J. Public
Health. 18 (3), 277–285.
Malhi, L., Karanfil, O., Merth, T., Acheson, M., Palmer, A., Finegood, D.T., 2009. Places
to intervene to make complex food systems more healthy, green, fair, and
affordable. J. Hunger Environ. Nutr. 4 (3-4), 466–476.
McDonald, E.L., Bailie, R., Michel, T., 2013. Development and trialling of a tool to
support a systems approach to improve social determinants of health in rural
and remote Australian communities: the healthy community assessment tool.
Int. J. Equity Health 12, 15.
McKinnon, R.A., Reedy, J., Morrissette, M.A., Lytle, L.A., Yaroch, A.L., 2009. Measures
of the food environment: a compilation of the literature, 1990–2007. Am. J.
Prev. Med. 36 (4 Suppl.), S124–S133.
Nutrition Environment Assessment Tool (NEAT), 2014. Michigan Healthy Commu-
nities Initiative; 2014. Available from 〈http://mihealthtools.org/neat/〉 [updated
4/4/2014].
Paton, K., Sengupta, S., Hassan, L., 2005. Settings, systems and organization
development: the healthy living and working model. Health Promot. Int. 20
(1), 81–89.
Pomerleau, J., Knai, C., Foster, C., Rutter, H., Darmon, N., Derflerova Brazdova, Z.,
et al., 2013. Measuring the food and built environments in urban centres:
reliability and validity of the EURO-PREVOB Community Questionnaire. Public
Health 127 (3), 259–267.
Rowley, K.G., Daniel, M., Skinner, K., Skinner, M., White, G.A., O’Dea, K., 2000.
Effectiveness of a community-directed ‘healthy lifestyle’ program in a remote
Australian Aboriginal community. Aust. N. Z. J. Public Health 24 (2), 136–144.
SIGNAL, 2000. National Aboriginal and Torres Strait Islander Nutrition Strategy and
Action Plan. National Aboriginal and Torres Strait Islander Nutrition Working
Party, 2000.
Sacks, G., Swinburn, B.A., Lawrence, M.A., 2008. A systematic policy approach to
changing the food system and physical activity environments to prevent
obesity. Aust. N. Z. Health Policy 5, 13.
Signal, L.N., Walton, M.D., Ni Mhurchu, C., Maddison, R., Bowers, S.G., Carter, K.N.,
et al., 2013. Tackling ‘wicked’ health promotion problems: a New Zealand case
study. Health Promot. Int. 28 (1), 84–94.
Simmons, A., Mavoa, H.M., Bell, A.C., Court, D., Schaaf, D., Schultz, J., et al., 2009.
Creating community action plans for obesity prevention using the ANGELO
(Analysis Grid for Elements Linked to Obesity) Framework. Health Promot. Int.
24 (4), 311–324.
Swinburn, B., Egger, G., 2002. Preventive strategies against weight gain and obesity
an official journal of the International Association for the Study of Obesity.
Obes. Rev. 3 (4), 289–301.
Swinburn, B., Egger, G., Raza, F., 1999. Dissecting obesogenic environments: the
development and application of a framework for identifying and prioritizing
environmental interventions for obesity. Prev.Med. 29 (6 Pt 1), 563–570.
Swinburn, B., Gill, T., Kumanyika, S., 2005. Obesity prevention: a proposed frame-
work for translating evidence into action. Obes. Rev. 6 (1), 23–33.
Tansey, G., Worsley, T., 1995. The Food System: A Guide. Earthscan, Milton,
Oxfordshire p. 253.
Vos, T., Barker, B., Begg, S., Stanley, L., Lopez, A.D., 2009. Burden of disease and
injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health
gap. Int. J. Epidemiol. 38 (2), 470–477.
WHO, 2002. The World Health Report 2002: Reducing Risks, Promoting Healthy
Life. World Health Organisation, Geneva.
62 J. Brimblecombe et al. / Health & Place 34 (2015) 54–62

WHO, 2007. Everybody’s Business: Strengthening Health Systems to Improve
Health Outcomes: WHO’s Framework for Action. Available from: 〈http://
www.who.int/healthsystems/strategy/everybodys_business.pdf〉.
WHO, 2009. Systems Thinking for Health Systems Strengthening. Report no.
Geneva, Switzerland: Alliance for Health Policy and Systems Research, World
Health Organisation, 2009.
Wood, B., McDowell, S., 2009. Municipal food security—dimensions and opportu-
nities. Nutr. Diet. 66 (Suppl. 1), A59.
Woodley E, Crowley E, Dey de Pryck J, Carmen A. Cultural Indicators of Indigenous
Peoples’ Food and Agro-ecological Systems. 2009:19.
Yeatman, H., 2009. Action or inaction? Food and nutrition in Australian local
governments. Public Health Nutr. 12 (9), 1399–1407.