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https://www.youtube.com/watch?v=QkGHqeNhEgM

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Did you know that the vast majority of indigenous people are affected by diseases such as obesity, type 2 diabetes and heart disease. All because of the food insecurity that hits indigenous people every single year.

Food insecurity is caused by the Insufficient access to nutritious food. This issue disables indigenous people from meeting their dietary needs.Food insecurity is also linked to the declining access to good food for indeginous people. According to the globalnews.ca , half of all indegenous families have difficulty putting enough food on their table. Many First Nations  families don’t have enough income to buy good  traditional food. Which forces them to buy fast food. As a result, obesity and diabetes rates are rising. Again, according to global news.ca, 82% of Indeginous adults are overweight .

I think the food price should be reduced depending on the income of the family. Also, we should try educating them on what’s good and what is not good to put in their body. I think that would reduce the amount of people suffering from obesity. The last solution would be for the government to give more money each year for the food production in the North.

To  conclude, I hope you’ll continue getting informed about the issues indeginous people face every single year. I will be leaving links in the description to help you understand the subject better. Thank you for watching and have a great day!

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1-https://link.springer.com/chapter/10.1057%2F9781137555199_17
2-https://www.ictinc.ca/blog/8-basic-barriers-to-indigenous-employment
3-https://www150.statcan.gc.ca/n1/pub/45-28-0001/2020001/article/00085-eng.htm

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8 Basic Barriers to Indigenous Employment

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Listed here are just some of the more obvious barriers to Indigenous employment and meaningful, lasting careers.

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1- https://thenarwhal.ca/climate-change-indigenous-food-insecurity-report/
2-https://academic.oup.com/cdn/article/4/8/nzaa108/5865693#:~:text=Indigenous%20people%20living%20off%2Dreserve,%2DIndigenous%20households%20(30)
3-https://foodsecurecanada.org/resources-news/news-media/we-want-affordable-food-north

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ABSTRACT

Introduction

Indigenous food insecurity is a significant and persistent matter in Canada, one that deserves both greater research attention and policy action ( 1- 3). Over the past few decades, scholars have shed light on the connections between nutrition transition and Indigenous dietary patterns ( 4- 6); the increasing prevalence of diet-related diseases such as obesity, type 2 diabetes, and heart disease ( 7- 11); and the links between these diet-related diseases and a range of social determinants of health ( 12- 14). To date, however, very few studies have examined how features of place shape Indigenous food environments-that is, how does one's physical and social surroundings influence food choice, access, and availability? While it is now well understood that Indigenous conceptualizations and experiences of health are fundamentally shaped by place, and connections with the land ( 15, 16), the ways in which place shapes Indigenous dietary patterns and food security remain relatively understudied, particularly in urban areas. In addressing this gap in knowledge, our research is guided by the following question: how does place impact the differential food security experiences and dietary patterns of urban- and reserve-based Indigenous people in southwestern Ontario? Informed by a long-term, community-based research project, our work draws from structured surveys ( n = 229) with First Nations people who live in the city of London, Ontario, Canada, and on a nearby First Nation reserve, to examine and describe the place-based experiences of Indigenous food security. Herein, we pay particular attention to how place impacts experiences of food environments, dietary practices, and perceptions of food insecurity in both contexts.

Theoretical background: connecting place and Indigenous food security

In Canada, Indigenous populations experience disproportionate levels of both severe (acute) and chronic food insecurity ( 1). The concept of food security has received much theoretical and applied debate and interpretation over its use and meaning ( 17- 19). At the World Food Summit in 1996 ( 20), a definition was agreed upon by member states: "food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life." At a broad level, food security implies sufficient access, availability, and use of nutritious and culturally preferable foods. Populations with poor access to the social determinants of health-including high levels of food insecurity-are overrepresented by obesity, chronic disease, and other diet- and lifestyle-related noncommunicable conditions ( 21). In northern and remote contexts of Canada, patterns of food insecurity are linked to a number of important changes, including the following: declining access to healthy and affordable foods, shifts to the wage economy, climate change and other environmental changes, and the erosion of Indigenous knowledge ( 22- 25).

By comparison, southern Indigenous food environments have received significantly less attention ( 26, 27), despite the fact that over the past decade there has been steady growth of First Nations people in southern Canadian cities. One significant trend among Indigenous populations in southern Ontario, and more broadly in southern Canada, is urbanization. At the national level, the proportion of urban Indigenous populations increased from 13% to 53% between 1961 and 2006 ( 28). Provincially, Ontario has experienced the most dramatic rates of urbanization. In 2018, 63% of Indigenous people in Ontario lived off-reserve ( 29). Urbanization has been accompanied by a nutrition transition characterized by decreased dietary diversity, declining access to traditional foods, and the increased tendency towards "industrial diets," the core pillars of which are fats, sugars, salts, and processed foods. Rapid dietary change has had perilous health consequences in many global contexts, but Indigenous groups face disproportionate adverse health effects, including higher rates of obesity, cardiovascular disease, hypertension, anemia, and type 2 diabetes ( 1, 4, 7). Indigenous people living off-reserve are also more than twice as likely to experience hunger and food insecurity compared with non-Indigenous Canadians; 27% of Indigenous Canadians are food insecure compared with 11% of non-Indigenous households ( 30).

In large measure, research exploring the relationships between food and the social determinants of health in Indigenous contexts has been written largely from the vantage point of public health, social epidemiology, and nutrition scholars. Notably, while features of place and geographic location have played an important role in the ways this body of research has been both organized and presented, there has been little theoretical engagement with "place" as a feature that shapes food environments in measurable ways. Geography offers a disciplinary context that can contribute to improved understanding of the connections between people, food, and place.

In the broader discipline of human and social geography, an important theoretical development relates to a relatively new subdiscipline of critical human geography: the geographies of Indigenous health. This emerging area of study is informed most directly by the fields of health geography and Indigenous geography, with research problems that center foundationally around the complex and changing relationship between Indigenous people's health and the environment ( 31). As noted by Richmond and Big-Canoe [( 31), p. 179], key questions asked by researchers in this discipline include the following: How is the health and well-being of Indigenous peoples and communities shaped by features of the environments within which they live? What processes work to affect the health and environments of Indigenous peoples, and how so? Can Indigenous engagement in research support positive change for Indigenous well-being and environmental protection? In response to calls for research that serves the self-determining goals of Indigenous communities ( 32, 33), the geographies of Indigenous health support a methodological imperative that places Indigenous communities and their concerns at the forefront of research about Indigenous health and the environment, including food environments ( 34, 35).

The geographic literature on food environments offers an important lens through which to understand the differential Indigenous experiences and social perceptions of food environments and food security on- and off-reserve. Food environments play a meaningful role in shaping inequalities in such things as dietary practices, food access, obesity prevalence, and hunger ( 36, 37), in addition to how broader interconnections between socioeconomic, cultural, environmental, political-economic structures, and historical processes work together to impact household food security; place remains key to people's health and diets ( 38). The literature on food environments emphasizes how dynamic relationships between low income and exposure to low-quality food environments undermine food security and heighten risk to diet-related diseases. For example, in North America, low-income neighborhoods tend to have fewer grocery stores, less readily available fresh healthy foods, more convenience stores, and higher food prices than middle-income neighborhoods, increasing residents' vulnerability to develop diet-related conditions such as obesity ( 39, 40).

Our research contributes to this literature by shedding light on how place impacts food choices among Indigenous people and the differential experiences of food security for reserve- and urban-based Indigenous people in southwestern Ontario. It also contributes to the growing literature on the relationship between urbanization and Indigenous food security. In the past decade, an emerging body of research has begun to examine the consequences of urbanization on Indigenous well-being, health, and food security, but there has not yet been a systematic study of the determinants of food security between reserve-based and urban-based Indigenous peoples ( 41, 42). While place of residence clearly impacts Indigenous dietary practices and food security, there is little known about the differential nature of food insecurity between on-reserve and off-reserve households. Our paper builds on the existing research, both by exploring the importance of place and the ways in which it can shape Indigenous experiences of food security, but also by engaging in a community-based approach that both supports and empowers Indigenous communities and organizations to be more self-determining on matters relating to their health and well-being ( 31, 34).

Methods

This research draws from a community-based, cross-sectional study that explored the social and spatial determinants of food security among 229 First Nations respondents in southwestern Ontario: 130 who lived in the city of London and 99 who lived on a First Nation reserve ∼30 km from the city center. Within the Canadian context, the province of Ontario is home to the largest share of the national Indigenous population (21%), of whom the majority are First Nations ( 43). Often, Indigenous populations are classified by place of residence: those who live "on-reserve" (land set aside or "reserved for Indians" by the government) and those who live "off-reserve" (either in rural or urban areas). In this paper, we use the terms "reserve-based" and "urban-based" to refer to the "on-reserve" and "off-reserve" populations, respectively. The greater London area is home to relatively large populations of both reserve-based and urban-based Indigenous populations, making this an appropriate site for exploring differential food security and food-provisioning experiences between these participant groups. In particular, the close spatial proximity of reserve-based and urban-based study participants helps limit possible variances in food insecurity as a result of geographic distance (i.e., distance from food markets, geographically distinct dietary preferences between regions).

Our research is the result of a community-based research study; the findings shared here describe results from the first phase of the Southwest Ontario Aboriginal Health Access Centre (SOAHAC) Food Choice Study. SOAHAC is a community-based organization with goals to "improve access to, and the quality of, health services for Aboriginal peoples in Southwestern Ontario in the spirit of partnership, mutual respect and sharing" ( 44). This study was collaboratively designed by researchers from Western University and the University of Toronto Mississauga, and staff from SOAHAC. This study grew from a shared recognition by SOAHAC's dietitians and allied health professionals that mainstream approaches to chronic disease prevention were not working. SOAHAC staff expressed frustration with an individualized health care model, and articulated that that they did not want to continue to promote "more balanced diets" or to coach individual patients on "healthy eating," when the root causes of diet-related diseases extend far beyond the individual, and often encompass factors such as income, single-parenthood, experiences of trauma, and social isolation. There was an important acknowledgment that understanding patterns of food choice and food security required more holistic approaches that engaged with families and communities to address wider social determinants of health, especially among Indigenous women, for whom the food and health impacts of colonization and environmental dispossession have been unique ( 41, 42).

Our survey instrument was developed over a 6-mo period. During this time, we held a number of focus group discussions and small-group meetings with members of the wider First Nations community and SOAHAC staff to ensure the survey was culturally and locally relevant, and that its conception was guided by Indigenous perspectives on Indigenous food security. The final iteration of the survey included questions contained in 5 main sections: 1) background information [i.e., age, gender, marital status, place of residence (on- or off-reserve location)]; 2) food consumption and food frequency, including traditional foods; 3) food sources; 4) food security; and 5) household income.

To measure the consumption frequency of both market and traditional foods, we worked with our community partners to adapt a food-frequency questionnaire (FFQ). In the first section of our adapted FFQ, respondents were asked to describe how often they consumed different types of market food and drinks. Specifically, respondents were asked the following question: In the last week, how often did you eat or drink the following?

Market food included the following 12 categories: milk and milk products; meat and eggs; fish; beans/seeds/nuts; fruits; 100% fruit juice; vegetables; grains; salty snacks, sweets; water; and soft drinks. Eight frequencies were available: ≥6 times/d, 4-5 times/d, 2-3 times/d, 1 time/d, 5-6 times/wk, 2-4 times/wk, 1 time/wk, and rarely or never.

Traditional food consumption was measured in the second section of our adapted FFQ. First, we asked respondents to provide a list of the traditional foods they eat most often. We then asked respondents to describe how often they consumed traditional foods. Specifically, respondents were asked the following question: In the last month, how often did you eat or drink the traditional foods you listed above?

Eight frequencies were available: ≥6 times/d, 4-5 times/d, 2-3 times/d, 1 time/d, 5-6 times/wk, 2-4 times/wk, 1 time/wk, 1-3 times/mo, or never. Note that, in comparison with market food frequency, which respondents were asked to recall "over the past week," traditional food frequency was examined "over the past month." We made this decision, as we were not confident of daily or weekly consumption of traditional foods, and thus extended the temporal framing to recall over the past month.

Respondent perceptions of food insecurity were measured through 3 questions from the SOAHAC Food Choice Study, which were informed by the Household Food Insecurity Access Scale (HFIAS) to assess a household's experiences of, and access, to food ( 45). Specifically, respondents were asked the following questions:

In the last month, did you worry about not having enough food?

In the last month, did money prevent you and your family from eating the foods you prefer?

In the last month, did you ever go to sleep hungry?

Before any research was conducted, the overall study was presented to and approved by SOAHAC's Board of Directors. This research was approved by Western University's Non-Medical Research Ethics Board (protocol #15543S).

To initiate data collection and introduce community members to the study, 2 large feasts were held, one in each study site. The study team, including SOAHAC staff, agreed that this was a culturally appropriate way to introduce the project, as community feasts traditionally serve as a space to share food and strengthen relationships. During the feasts, community members were invited to participate in the self-administered survey. Two additional rounds of recruitment occurred at local SOAHAC offices to involve clients who could not attend the feasts. This recruitment process was chosen with the recognition that the perceptions and experiences of SOAHAC clients offer an important window on a demographic group highly vulnerable to food insecurity.

In our analysis, descriptive statistics were used to establish commonalities of and differences between reserve-based and urban-based Indigenous participants in 3 categories: food security, food access, and food frequency. Data analysis was completed using Microsoft Excel software. Percentages and frequencies were calculated to summarize participant food security and to evaluate differences in consumption of different food groups by place of residence. Participants were considered food insecure if they responded positively to ≥1 of the food security baseline questions from the survey. Chi-square tests ( P > 0.05) were used to test differences in levels of food insecurity.

Results

Place and Indigenous experiences of food insecurity

Our study sample was overrepresented by low-income individuals; 74% of respondents reported their household income to be <$30,000. The study sample was also overrepresented by women (73%: 75% on-reserve, 72% off-reserve) and by households led by single mothers (49%: 54% off-reserve, 43% on-reserve). The composition of our study sample reflects the particular vulnerability of low-income Indigenous women in the greater London area, a trend consistent with regional studies on the gendered nature of food security ( 46). The high number of women and the low number of male participants in this study meant that we were unable to conduct an in-depth analysis of gender-based differences. Further, our comparison of survey responses between men and women revealed there were no significant gendered differences in food insecurity. Thus, the remainder of our results focus on the place-based nature of food insecurity.

Food insecurity

The results of our survey illustrate that both reserve- and urban-based respondents experience significantly higher levels of food insecurity in comparison with national levels. In concrete terms, 35% of reserve-based and 55% of urban-based respondents describe themselves as food insecure, compared with 8.3% of Canadians ( 30). At the same time, there are important spatial differences between these groups. Not only was perceived food insecurity disproportionately greater among urban individuals ( P = 0.00053, χ2 = 7.788, df = 1), the disparity was even more stark when comparing spatial differences in high levels of food insecurity-that is, when participants responded positively to all 3 of the HFIAS questions. Urban-based participants were 6 times more likely than those living on-reserve to report that in the past month they had gone to bed hungry, worried about not having enough food for their families, and had been unable to purchase preferred foods because of money ( P = 0.0080, χ ² = 7.044, df = 1). The results are clear: urban First Nations respondents are far more likely to be food insecure. For example:

18% of urban and 2% of reserve-based First Nations participants reported that they went to bed hungry because they did not have enough food to eat;

41% of urban-based and 29% of reserve-based respondents described that they worry about having enough food to eat; and

41% of urban based and 5% of reserve-based First Nations indicate that their family is unable to eat preferred foods because of a lack of money.

Food access

Both reserve- and urban-based respondents identified key barriers to accessing foods that they prefer, including time (both time for food provisioning and food preparation), money, and distance. However, there were significant spatial differences between groups with respect to the dominant barrier to eating preferred foods. For example, 58% of reserve-based respondents and only 24% of urban participants indicated time as the most significant constraint to eating preferred foods ( P < .0001, χ ² = 24.858, df = 1). Additionally, 20% of reserve-based respondents and 39% of urban participants described money as a major barrier ( P = 0.00045, χ ² = 8.076, df = 1). Over 20% of both population groups reported that distance and lack of access to transportation made it difficult to access a grocery store.

Accessing healthy foods was difficult for all study participants, and there were no significant differences between the primary food source location for urban- and reserve-based participants. Both groups relied primarily on grocery stores, with 98% of both populations reporting shopping at grocery stores every month and 60% of both populations reporting shopping at convenience stores at least once a month. Many participants also described making very frequent food purchases from convenience stores, with ∼27% of urban-based and 29% of reserve-based residents buying food from convenience stores on a daily or weekly basis.

Despite similar patterns in the dominant barriers to food security, there was significant variance in the relative importance of secondary food sources (i.e., gardens, soup kitchens, community events) between urban- and reserve-based groups. For example, reserve-based participants were significantly more likely to source food through gardening ( P = 0.0045, χ ² = 15.039), with 54% of reserve-based participants utilizing home gardens as a food source in the previous month compared with only 45% of urban-based participants. In addition, there was significant variation in the use of soup kitchens, food banks, and church meals by urban-based and reserve-based participants; urban participants relied much more heavily on soup kitchens (33%) than reserve-based participants (11%). In comparison with the broader Canadian population, both groups were disproportionately dependent on these food sources. At the national level, ∼2.5% of Canadians make use of food banks monthly ( 47), while in our study 44% of urban-based and 17% of reserve-based participants reported depending on food banks or church meals >3 times/mo ( P = 0.0013, χ ² = 17.899).

Dietary quality

At the time of this study, Eating Well with Canada's Food Guide food-based recommendations revolved around the 4 food groups: meat and alternatives, milk and alternatives, vegetables and fruit, and grain products ( 48). [Canada's Food Guide was updated in early 2019 based on an evidence review and public consultations. It moves away from the categorization model of food-based guidance to include more holistic recommendations on healthy food choices and eating habits (reference new food guide: https://food-guide.canada.ca/en/). Health Canada and Indigenous Services Canada are continuing to work with Indigenous people to support the development of an updated set of guidance tools.] Participants' responses to the adapted FFQ that compiled data on the daily consumption of the 4 food categories and monthly consumption of traditional foods such as wild meats, berries, wild rice, and other prepared foods such as bannock and corn soup were compared with the range of recommended servings for men and women aged 19-50 y. Overall, there were no significant differences between the self-reported dietary intake patterns of urban- and reserve-based respondents compared with these national recommendations (see Table 1). However, in the meat and alternatives food category, urban participants were more likely to consume too much meat (30% compared with 20%), while a disproportionate number of reserve-based participants reported not consuming enough meat and alternatives (43% compared with 19% of urban dwellers). Despite the relative similarities in the other 3 food categories, it is important to emphasize that the dietary patterns of both groups do not adhere to the guide's food-based recommendations (see Table 1). Our data revealed overwhelming trends of insufficient consumption in 3 food categories. For example, consumption of milk and alternatives was lower overall, with only 34% of reserve-based and 27% of urban-based participants consuming the recommended range of servings. Fruit and vegetable intakes were also lower, with 27% of reserve-based and 32% of urban-based diets adhering to recommendations in this category. Grain product consumption was also extremely low; only 3% of reserve-based and 5% of urban-based participants reported consuming the recommended range of between 6 and 8 servings daily.

Alongside data indicating nutritional deficits in 3 of the 4 food categories, our research illustrates an overreliance on salty snacks, sweets, and soft drinks, with overreliance determined by consumption of the item ≥1 times daily. Over 25% of urban- and 34% of reserve-based participants reported consuming high amounts of salty snacks. Thirty-four percent of urban-based and 37% of reserve-based respondents consumed excessive sweets. And 54% of urban- and 40% of reserve-based participants consumed high amounts of soft drinks.

With regard to traditional food consumption, 54% and 52% of the urban- and reserve-based samples reported that they eat traditional foods at least once a week. One-quarter (25%) of the reserve-based sample reported eating traditional foods 2-4 times/wk, compared with only 8% of the urban-based samples. Respondents from both groups expressed strong interest in consuming more traditional foods, with 76% of urban-based respondents and 52% of reserve-based respondents indicating that they would prefer to consume traditional foods more frequently.

Discussion

Geographic and social dimensions of place and Indigenous food security

Research has shown that there are strong and dynamic relationships between financial insecurity, time scarcity, and food consumption ( 49). In our study, time was the dominant barrier to food security for reserve-based participants. Indeed, time scarcity is linked to the increased consumption of convenience foods ( 50), high rates of obesity and diet-related chronic diseases ( 47), and the decreased importance of homemade family meals ( 51). For urban participants, money was the dominant barrier to food security, and it is worth recalling that lower-income households are persistently more vulnerable to food insecurity and more likely to rely heavily on energy-dense, nutrient-poor, and more easily accessible convenience foods ( 52). Given these trends, it is not surprising that large numbers of both urban- and reserve-based First Nations individuals in southern Ontario are food insecure. Both groups have high proportions of lower-income households and are led by single mothers who are reportedly overreliant on convenience stores and their associated highly processed foods. Although the dominant barriers to consistently accessing healthy foods-time and money-are slightly different in each community, both pose risks for healthy diets.

While the survey data collected reflect broad similarities in experiences of food insecurity between on- and off-reserve participants, the place people lived in played the most important role in participants' abilities to acquire food. Compared with the reserve-based participants, urban participants were not only more food insecure, they were also more likely to rely on soup kitchens and food banks, and to express desire to consume traditional foods more frequently. Regional studies on Indigenous food insecurity have illustrated how geographic distance and disconnection from family and one's home community can influence the dietary erosion of traditional foods for urban Indigenous people ( 52). It is also known that social supports and inclusion tend to help buffer against household food insecurity ( 15), but that food-insecure households are more likely to lack these social networks and resources ( 53). Our research suggests that the different experiences of food insecurity between on- and off-reserve participants are mediated in important ways by the material and cultural resources available to individuals within their informal social supports and institutional networks. In the reserve-based sample, in particular, these resources can act in protective ways against food insecurity. On-reserve, households are more likely to be led by 2 parents (29%), families tend to live nearer to one another, and there are often strong cultural food practices, such as community freezers and food boxes, gardens, and food sharing, which strengthen social cohesion and provide a social safety net. In this case, it is both the geographic and social aspects of place-fostered through family and community ties-that may improve access to traditional and locally acquired foods. For urban-based First Nations people, access to social and kinship networks are often more restricted as a result of their spatial, cultural, and social distance from the reserve. This access to social and kinship networks may be exacerbated by the fact that the urban-based households are predominantly led by single mothers (54%) who may face greater time and financial constraints.

Among Indigenous people living in both urban and reserve contexts, access to traditional foods is eroding over time and unprecedented dietary changes are occurring. Processes of environmental dispossession, occurring at both local and global scales, have restricted access to traditional lands, water, and food resources to such an extent that there has been a marked erosion in physical access to traditional foods in Indigenous diets. Indigenous communities have undergone unparalleled experiences of political and cultural violence. Operating largely through the Indian Act (1876), Indigenous people continue to be regulated by the only race-based legislation globally. While the assimilationist and colonial agenda that led to the development of the Indian Act has been revised many times, its legacy continues to harm traditional ways and livelihoods of Indigenous people in the contemporary context. The health consequences of environmental dispossession have occurred almost exclusively through disrupted food systems. In practical terms, this means that traditional food systems are increasingly being replaced by market foods. The associated nutrition transition of dietary change has been so profound that Indigenous diets in southwestern Ontario-both on- and off-reserve-are principally sourced by market foods purchased from grocery and convenience stores, and very minimally from traditional foods. Multiple studies have shown that traditional foods tend to be healthier and more nutrient dense than commercial foods ( 22, 24, 27) and that the vast proportion of food stock in grocery and convenience stores is made up of highly processed foods that are high in fats, sugars, and salts and low in micronutrients ( 53). Meals purchased at grocery and convenience stores are more likely to be higher in total calories, saturated and trans fats, and sodium and to include fewer servings of fruits, vegetables, and whole grains than food prepared at home ( 54). In addition, scholars have shown that convenience stores are more likely to be located in lower-income neighborhoods or food deserts, and that close proximity (<1 km) to convenience stores decreases the resident's likelihood of healthy eating and increases the risk of obesity ( 55). Convenience stores are also far more expensive than grocery stores. For example, in London, Ontario, identical food items cost an average of 1.6 times more at convenience stores compared with supermarkets, and residents of low-income neighborhoods have very limited access to grocery stores ( 56). These trends represent significant barriers for lower-income Indigenous families whose traditional foods are increasingly difficult to access, and for whom convenience foods are increasingly available. In our study, both urban- and reserve-based participants were heavily dependent on convenience and grocery stores, and both reserve- and urban-based families expressed a strong desire to consume more traditional foods. This suggests that these food environments are not only increasing the risk of First Nations people to obesity- and diet-related diseases but are providing foods that are incompatible with cultural preferences.

One of the motivations for the Food Choice Study was to assess and compare the dietary practices of urban- and reserve-based SOAHAC clients in relation to the Canada's Food Guide food-based recommendations, and the dietary practices of the Canadian population at large. In Canada, there has been a national trend toward healthier eating over the past 2 decades, including higher consumption (and greater diversity) of vegetables and fruits and lower consumption of red meats and other sources of saturated fats. Canada's updated Food Guide reflects this transition by recommending increasing consumption of whole grains, fruits, and vegetables as well as plant-based sources of protein. But these trends in healthy dietary components are not necessarily accessible, or affordable, for lower-income Indigenous populations ( 57). Our study shows insufficient consumption of both meat and milk and alternatives categories, low fruit and vegetable intake, and an overreliance on highly processed foods such as salty snacks, sweets, and soft drinks among both reserve- and urban-based participants. While there were some important differences in dietary patterns and food insecurity between sample groups, with urban Indigenous participants more likely to experience food insecurity, the common experiences of Indigeneity, dispossession, and marginalization are the driving force of Indigenous food insecurity in the greater London area. Further, while our sample was overrepresented by women, it must be emphasized that First Nations communities in southwestern Ontario, irrespective of gender or geographic location, are at considerable risk of food insecurity. Indigenous food environments are shaping dietary overreliance on processed foods of lower nutrient density that go against the former and current national food policy recommendations. Processes of environmental dispossession have made it extremely challenging to access healthier and culturally preferred traditional foods.

Conclusions

As we consider the implications of this study, and possibilities for improving access to healthy, culturally appropriate diets for Indigenous people in both reserve and urban contexts, we follow the direction of Cidro et al. ( 41), Daigle ( 58), and Delormier et al. ( 59), who promote the concept of Indigenous Food Sovereignty (IFS). In the broadest sense, IFS implies a central commitment for communities to make their own decisions about their food systems, and it relies on a number of important concepts, including sharing practices, self-determination, and decolonization ( 34).

In our understanding, the uptake of IFS and its related concepts necessitate a return to the cultural values and ways of knowing about food that has been interrupted in the past hundred years, which is through processes of environmental repossession. In its widest framing, environmental repossession refers to the social, cultural, and political processes by which Indigenous peoples and communities are reclaiming their traditional lands and ways of life ( 60). The concept of environmental repossession is rooted in the idea that Indigenous peoples' health, ways of living, and Indigenous knowledge systems are highly dependent on access to their traditional lands and territories. While the unprecedented urbanization of Indigenous people has been characterized as paradoxical to traditional ways of knowing and understanding, we challenge this assumption by sharing an example wherein urban organizations and communities have supported principles key for IFS, and with positive implications. In Vancouver, British Columbia, the Urban Aboriginal Kitchen Garden ( 61) is a project that brought Indigenous people from Vancouver's downtown east-side, one of the poorest and most disenfranchised neighborhoods in the city, to the University of British Columbia Farm to teach them how to garden. Over the course of several weeks and months, food is tended to, and grown, then harvested and eaten together. Alongside the important social relationships this garden created for people who tended it, the garden also provided an important place for the resurgence of Indigenous knowledge. The garden created an intentional space for people to re-engage with cultural practices, knowledge, and a whole food system from which they had been disconnected.

The research reported in this study illustrates that, in the reserve context, there are multiple ways in which social supports positively mediate the relationship between income and food security. This represents an important area of hope and future investigation. Indigenous communities in southwestern Ontario are collaborating to provide for each other, and to continue to create dignified food systems that not only improve food security but also restore long-held cultural and social values, knowledges, and practices that have historically maintained community health. Scholars, activists, and community organizations who work to improve Indigenous food security in the off-reserve context must keep this in mind and find ways to both acknowledge and support the critically important work of urban Indigenous organizations, such as the Southwest Ontario Aboriginal Health Access Centre and its affiliated centers across Ontario. In Canadian urban centers, many of these organizations are chronically underresourced and often regulated by the larger provincial programs through which they are fiscally funded ( 62). Despite the strict funding rules and political pressures endured by urban Indigenous organizations, their willingness to engage in research, and to search for solutions that will not only improve health outcomes for their clients but also support cultural resurgence, is a shining example of what is possible.

In this project, we engaged in an interdisciplinary framing of Indigenous food security that sought to understand it and its determinants in a way that was congruent with Indigenous knowledges and place- and land-based ways of understanding and experiencing food and food security ( 31, 34). Our partnership with SOAHAC was critically important, as it was they who steered this research from its early development through to the data analysis and dissemination. SOAHAC recognized a need for a comprehensive evaluation of broader constraints that influenced food choices among their clientele, and entered this research collaboration with a goal to use the findings in a way that could inform more appropriate programming, especially for Indigenous women. Moving forward, we urge those working in food and nutritional sciences to consider such collaborative and interdisciplinary approaches in their studies of food security. The pathway toward IFS contains important cultural, social, and political dimensions that are fundamentally place-based ( 58, 59), and will become knowable through integrative, collaborative research programs that places Indigenous peoples, their concerns and their knowledges firmly at the center of the research.

ACKNOWLEDGEMENTS

This study developed over time with great care, support and guidance from the staff, leaders, and clientele of the Southwest Ontario Aboriginal Health Access Centre. The authors' responsibilities were as follows-CR, HN, KW, RBK, and MS: undertook analysis of the data; CR and MS: led the writing of this manuscript; and all authors: designed and carried out this research, provided feedback on various drafts of this manuscript, and read and approved the final manuscript.

Notes

This research received funding from an Aboriginal Pilot Project of the Heart and Stroke Foundation of Ontario.

Author disclosures: The authors report no conflicts of interest.

The Heart and Stroke Foundation played no role in the design, implementation, analysis, or interpretation of the study.

Abbreviations used: FFQ, food-frequency questionnaire; HFIAS, Household Food Insecurity Access Scale; IFS, Indigenous Food Sovereignty; SOAHAC, Southwest Ontario Aboriginal Health Access Centre.

References

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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First Nations Food Environments: Exploring the Role of Place, Income, and Social Connection

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Indigenous food insecurity is a significant and persistent matter in Canada, one that deserves both greater research attention and policy action ( 1- 3).

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Note: This content may be emotionally difficult. The Hope For Wellness help line is 1-855-242-3310 or via online chat, Additional supports are available through We Matter.

A new report on Indigenous suicide in Canada has generated the most comprehensive picture of the crisis to date, despite health authorities continuing not to collect data about the problem.

Released at the end of June, the Statistics Canada report titled " Suicide among First Nations people, Métis and Inuit (2011-2016)" found that, overall, Indigenous people in Canada die by suicide at a rate three times as high as non-Indigenous Canadians.

While comprehensive, the report acknowledges there are limitations to the findings that likely result in underestimations of the actual rates. The report's analysis includes a number of socio-economic factors, as well as comparative differences based on age, sex and location - on or off reserve.

The lead researcher of the report, Mohan Kumar, said he wants readers to remember that for each of the numbers in the report "there is a person behind them, and their deaths meant an incredible loss to family, friends, community and the society at large."

He also contextualizes the findings in light of existing research that shows how aspects of colonization contribute to the Indigenous suicide crisis. So that the high rates, he says, shouldn't be taken as indicative of personal, community or cultural failings.

Canada doesn't track suicides specifically by Indigenous identity, and the process that Kumar and co-researcher Michael Tjepkema used to overcome this is important to look at, as are the limitations inherent to these findings. The findings are estimations not full counts, as they're based on only a sample portion of the full population, and there are some population groups not surveyed.

But as Indigenous researchers Roland Chrisjohn and Shaunessy McKay wrote in Dying To Please You: Indigenous Suicide in Contemporary Canada, their 2017 book on the suicide crisis, discourse about the problem and solutions is often unhelpful and not evidence-based: "It sounds like drumbeats of a PR bandwagon, like Native people are being recruited to a mainstream viewpoint rather than being convinced with real data; with all parties repeating a mantra over and over again until they parrot it without any real understanding."

Thus, the Statistics Canada report's contributions in terms of new, fuller data analysis are important.

The report's central finding - that First Nations people die by suicide at three times the rate of non-Indigenous Canadians, Inuit at nine times the rate, and Métis at two times - illustrates a crisis but is not likely to surprise those familiar with previous statistics. For those unfamiliar, it puts Inuit among the people with the highest rates of suicide anywhere in the world.

The report examines each of the three groups separately, and is based on 2011 populations, when the census had 851,560 people self-identify as First Nations, 59,445 as Inuit and 451,795 as Métis .

The report estimates that there were 1,845 total deaths by suicide of the Indigenous population in Canada from May 10, 2011, through Dec. 31, 2016. This total consists of 1,180 First Nations people, 250 Inuit and 415 Métis.

Looking at it side by side with murder data can help contextualize the scale of the problem.

For the five years since StatCan started tracking homicides by Indigenous identity, there have been 710 recorded Indigenous victims of homicide. The number of estimated suicides from the StatCan report is approximately two and a half times larger, though it applies to a slightly longer period.

The public interest in addressing the problem of missing and murdered Indigenous women and girls (MMIWG) in Canada illustrates the scale of the energy that could be mustered in service of a similar reckoning with the suicide crisis.

A Statistics Canada report found that Indigenous people die by suicide at a rate three times as high as non-Indigenous Canadians. But the report acknowledges there are limitations to the findings that likely result in underestimations of actual rates

Younger Indigenous people suffer higher rates of suicide

When comparing overall populations of the identity groups, the report uses age-standardized suicide rates to account for the groups' different age distributions - the 2011 census shows median age was 26 for First Nations, 23 for Inuit, 31 for Métis and 41 for non-Indigenous. Kumar said the approach ensured that the findings were in the form of "the rate that would be expected if the age structures of the populations were the same."

The highest rates of Indigenous suicide are seen in youth and young adults, between the ages of 15 and 24, Kumar told National Observer. For First Nations people, the rate for these ages is 6.2 times higher than for non-Indigenous population in the same age range; for Inuit people, the rate is 23.9 times higher. (There wasn't enough data to generate accurate rates for Métis by age range.)

Not all communities are equally affected by the suicide crisis

For the First Nations population, the suicide rate was two times as high for those living on-reserve as those living off-reserve.

While a critique of much of the general discourse around Indigenous issues is that it is negative or problem-focused, this report did aim to "to look at it from the perspective of resiliency (instead) of having a deficiency-based estimate," according to Kumar.

In conversation, he highlighted that the report's findings show that of "close to 600 bands ... 60% of those FN bands had not experienced suicides (of any people in the sampled population), so they have a zero suicide rate."

For Inuit Nunangat, "11 out of 50 Inuit communites had a zero suicide rate."

These numbers do need qualifying, as these zero suicide rates don't necessarily mean there were no deaths by suicide from these bands and Inuit communities over the roughly five-and-a-half-year period covered by the report. This is due to the methodology.

How to count Indigenous suicides when the government doesn't track Indigenous suicides

This research is based on the 2011 National Household Survey (NHS), which replaced the long-form census, and was based on voluntary responses. These responses accounted for a total of just over six million of the Canadian population, including what was then approximately a third (466,000) of self-identified Indigenous people in the country.

For the First Nations communities that participated in the NHS (over 90 per cent of the over 600 in Canada), all households on reserve received the survey while First Nations people living off-reserve were, like those in the general population, selected to receive the survey at random. All Métis living in households in surveyed areas, including the Métis Settlements of Alberta, received the survey while Métis living outside of survey areas were part of the random selection process to receive the survey.

For Inuit, every household in Inuit Nunangat (spanning parts of Northwest Territories, Quebec, and Labrador as well as all of Nunavut) received the survey, but individuals outside of the territory were selected for the NHS at random as part of the general population.

The NHS was used as a way to determine who among the suicide deaths were Indigenous, because the Canadian government doesn't track that in its records of health statistics.

"In the Canadian Vital Statistics Database (CVSD), there are no Indigenous identifiers, so you can't say if a death that occurred is of a First Nations person or a Métis or Inuit," Kumar explained.

"So the only way we can do that is we link the mortality records (from the CVSD) to the National Household Survey records, and in the NHS people self-identified as either a First Nations person, Inuit or Métis, or they didn't identify as Indigenous and so they would be considered non-Indigenous."

He noted a small percentage identify as belonging to more than one of the three Indigenous groups, about 0.8 per cent of the 2011 Indigenous population, though there is no separate analysis of their data in this report.

The report uses the deaths by suicide recorded in the CVSD starting from the day the NHS was collected, May 10, 2011, through the end of December 2016 - the period of 5.6 years.

Who - and what - was and wasn't counted

The NHS is a survey of private dwellings that omits people living in institutions (jails, medical facilities, etc.), collective dwellings (group homes, hostels, etc.), and many of those who are homeless.

These unmeasured groups may have higher rates of death by suicide compared with those who were surveyed; also, a higher proportion of the Indigenous population may be in those unmeasured groups than of the non-Indigenous population. It is for these reasons, and other less specific factors relating to the counting of deaths by suicide, that the report states "suicide rates presented (here) may underestimate the true rates."

The NHS also doesn't include data on gender or sexual identity, so there are no specific suicide rates in this report for two-spirit people or by sexual orientation or trans and non-binary gender identities - though these individuals are part of the overall statistics, except for those who are part of the unmeasured groups.

Kumar said the government is looking at having gender identity and sexual orientation identification included for the 2021 long-form census in consultation with Indigenous organizations.

"There are so many other factors that are behind the suicide rate we couldn't look into because we were restricted to what was collected in the NHS," Kumar said. The report itself identified some of these factors: "historical and intergenerational trauma, community distress, cultural continuity, family strength and mental wellness were not explored here."

Socio-economic factors

The report was able to do an analysis based on five socio-economic factors contained in the NHS: household income, level of education, labour force status, marital status, and, for First Nations, on- or off-reserve, while for Métis and Inuit, the size of the community in which they lived.

This itself, may be a unique contribution to the knowledge base of research on Indigenous suicide, especially with the large population range covered in this research.

But there were limitations to this too: only individuals 25 and older could be included to accurately analyze the roles of education, labour and marital status. This is a problem, because suicide rates for Indigenous youths and young adults are disproportionately high, and they are not reflected in this part of the report's analysis.

Adjusting for these socio-economic factors found that for the applicable age groups, 78 per cent of the difference in suicide rates disappears when the five factors are controlled for between First Nations and non-Indigenous; for Métis, 37 per cent of the difference disappears; and for Inuit, 40 per cent disappears (and closer to 50 per cent when household income was factored with the northern higher costs of living).

To illustrate what this adjustment means (in statistical terms, 'controlling for' these variables), is that First Nations median income in 2011 was $15,615 compared to $28,239 for non-Indigenous, but this part of the analysis compared the rates of suicide for First Nations and non-Indigenous who have similar incomes (and similarly adjusts for the other four factors), and found rates that were only 22% different. This also implies that for the non-Indigenous population in and of itself, suicide rates are not uniform, but vary corresponding with these socio-economic factors.

Kumar commented on the differing percentages of difference (i.e. the 78, 37, and 40 per cents, respectively) that disappeared for First Nations, Métis, or Inuit: "There are so many other things that are going on ... probably the better answer is that we don't quite understand why there is a difference."

It's also important to note the difference between causation and correlation: this analysis doesn't necessarily mean these factors are the cause of the different suicide rates, but that they are occurring together, which may be indicative of what is behind the problem.

Where to go from here

This analysis indicates that widespread societal imbalances between Indigenous and non-Indigenous populations are a large aspect of the Indigenous suicide crisis. Thus, individual-focused suicide-prevention programs are not a full solution.

That idea is parallel to how the Calls For Justice from the MMIWG inquiry final report do not solely focus on directly stopping murderers or murders, nor say that the murders and disappearances are the genocide itself, but look more to changing the current conditions that result from the continuity of genocidal practices and that cause Indigenous victimization.

Three of the five socio-economic factors - the areas of education, employment and poverty - are included in parts of the MMIWG inquiry Calls For Justice ( pages 170-221), as well as in the " Master List of Report Recommendations" that the inquiry compiled from 100 previous reports they reviewed during their process.

The need for repair, to create equitable conditions and treatment, was also recognized recently when the Canadian government was ordered by the Canadian Human Rights Tribunal to pay $40,000 each to all individual First Nations children and some parents/grandparents who were affected by the government's discriminatory practices in child welfare and service provision, including in the area of suicide-prevention services, as part of an ongoing tribunal case to end discriminatory policies.

The Statistics Canada report findings may help shape future research on Indigenous suicide, "There are lots of questions that probably come up (based on this report), which need to be addressed in future research," Kumar said. "I think it's up to other researchers to come up with questions or what sort of direction other research should go."

Kumar, who previously worked at the National Aboriginal Health Organization, also noted the importance of the involvement of national Indigenous organizations, including Inuit Tapiriit Kanatami, the Métis National Council, and the National Association of Friendship Centres, and their contributions to the research process: it's important that Indigenous peoples do have a leading role in such knowledge production, and in developing approaches to these problems.

​​What people, communities, organizations, and governments do about the continuing suicide crises is crucial. It is a long-term problem that hasn't been adequately addressed, often only appearing in the general public consciousness when a specific community is forced to declare a state of emergency - as God's Lake First Nation, about 1,000 kilometres northwest of Winnipeg, did at the end of August.

International Suicide Awareness Day was marked on Sept. 10, with the annual Celebrate Life event hosted by Inuit at Canada's Parliament Hill and other events across the country. The report's findings will add to these discussions, as well as those at the bi-annual World International Suicide Prevention Conference, being held next Aug. 25-27 in Winnipeg, an opportunity for all working on this problem.

But perhaps the most important part of the report may be its affirmation, with the best quantitative evidence currently available, that there continues to be a crisis and that the approaches used to address it have not been sufficient.

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Canada's Indigenous suicide crisis is worse than we thought

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A Statistics Canada report's central finding - that First Nations people die by suicide at three times the rate of non-Indigenous Canadians, Inuit at nine times the rate, and Métis at two times - illustrates a crisis but is not likely to surprise those familiar with previous statistics.