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The role of provincial social policies and economic environment in shaping household food insecurity among families with children in Canada.

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The role of provincial social policies and economic environment in shaping household food insecurity among families with children in Canada.

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Ionescu-Ittu R, Glymour M, Kaufman J. A difference-in-difference approach to estimate the effect of income-supplementation on food insecurity. Preventive Medicine. 2015;70:108-16.  

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Ionescu-Ittu R, Glymour M, Kaufman J. A difference-in-difference approach to estimate the effect of income-supplementation on food insecurity. Preventive Medicine. 2015;70:108-16.  

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Abstract

Climate change impacts on the Canadian food system pose risks to human health. Little attention has been paid to the climate change, food security, and human health nexus, resulting in a number of knowledge gaps regarding food system components that are most vulnerable to climate change. The lack of understanding of key dynamics and possible future impacts challenges the ability of public health officials and partners in other sectors to prepare Canadians for future health risks. A series of literature reviews were conducted to establish the relationship between climate change, food security, and human health, and to identify vulnerabilities within the Canadian food system. Evidence suggests that key activities within the food system are vulnerable to climate change. The pathways in which climate change impacts travel through the food system and affect the critical dimensions of food security to influence human health outcomes are complex. Climate-related disruptions in the food system can indirectly impact human health by diminishing food security, which is a key determinant of health. Human health may also be directly affected by the physical effects of climate change on the food system, primarily related to the impacts on nutrition and foodborne illnesses. In this study, we propose a novel analytical framework to study and respond to the climate change, food security, and human health nexus. This work is intended to help public health officials, researchers, and relevant stakeholders investigate and understand current and future risks, and inform adaptation efforts to protect the health of Canadians.

Keywords: food security, food systems, food insecurity, health, climate change, framework

1. Introduction

It is well established that slow- and rapid-onset climate change effects will cause adverse impacts on natural and human systems. Health risks associated with extreme weather and climate events have already been observed, and are increasing globally and in Canada. For example, in 2003, a heat wave in Europe resulted in over 70,000 deaths [ 1]; flooding in High River, Alberta, in 2013 resulted in a number of adverse mental health outcomes [ 2]; and Lyme disease cases increased by over 1300% from 2009 to 2017 in Canada [ 3]. The impacts of climate change will vary across the country, as will demographic, socio-economic, infrastructural, institutional capacity, and health system resiliency. Thus, there will be regional variation in terms of the strength and severity of associated health impacts. Indirect and direct effects of climate change such as temperature extremes, extreme weather events, air pollution, infectious diseases transmitted by vectors, stratospheric ozone depletion, and contamination of food and water [ 4, 5] are associated with health risks that are of significant concern in Canada.

The impacts of a changing climate will have direct and indirect effects on global and domestic food systems [ 6, 7]. Recent scientific evidence has led to increased concern about the possible impacts of climate change on food security. In its fifth assessment report, the Intergovernmental Panel on Climate Change (IPCC) indicated that climate change would have significant effects on food in the near-to-medium term [ 8]. On a global level, it has been suggested that climate change impacts on undernutrition constitute this century's greatest threat to health [ 9]. An examination of 30 of the most vulnerable countries to climate change impacts on undernutrition found that the number of undernourished people increased by approximately 6%, from 398 million people in 1990 to 422 million people in 2016 [ 9]. The World Health Organization (WHO) estimates that without adaptation, climate change will result in 7.5 million more cases of stunted children by 2030 and 10.1 million by 2050 [ 10]. Furthermore, an additional 4.8 million cases of undernutrition in children under 5 years of age is projected by 2050 due to climate change [ 11]. Currently, world hunger is on the rise and climate-related shocks have exacerbated this trend [ 12]. Extreme weather events were a major driver of the drastic increase in the number of people facing crisis level food insecurity in 2015 (~80 million people) and 2016 (~108 million people) [ 13].

Evidence suggests that climate change is impacting food security in Canada, particularly in northern and Indigenous communities [ 4, 14]. Observed climate impacts related to reduced duration and thickness of sea and lake ice, thawing permafrost, more unpredictable weather, freezing rain and wildfires, shorter winter seasons, and hotter summers can threaten food safety and security, for example, by challenging hunting and gathering activities and traditional food storage practices [ 14, 15]. Climate change impacts are also contributing to a change in the abundance and geographic distribution of populations of traditionally harvested species, such as caribou [ 4, 14]. In Manitoba, many of the province's 25 northern communities have experienced supply shortages of healthy food products due to warming conditions resulting in deteriorating ice roads [ 16].

The pathways in which climate change impacts travel through the food system and affect the critical dimensions of food security to influence human health outcomes are complex. Some pathways are understood well, while others have many knowledge gaps. Climate-related disruptions in the food system can indirectly impact human health by diminishing food security, which is a key determinant of health. Human health may also be directly affected by the physical effects of climate change on the food system, primarily through pathways of food safety and nutrition.

In Canada, little attention has been paid to this relationship in climate change research, resulting in a number of knowledge gaps regarding components of the food system most vulnerable to climate change, current and future impacts in Canada from warming of the climate [ 4], and the most effective strategies for adapting. This lack of understanding of the key dynamics and possible future impacts challenges the ability of public health officials and partners in other sectors to prepare Canadians for future risks to health.

The relationship between climate change, the food system, food security, and human health is dynamic and multi-sectoral. This creates conceptualization difficulties in recognizing vulnerabilities. The factors leading to health outcomes interact in complex systems that need to be understood. Challenges therefore exist in describing, measuring, and projecting future health risks associated with climate change impacts on food security [ 17].

To address these challenges, this paper presents a novel analytical framework to study and respond to the climate change, food security, and human health nexus. Current levels of food insecurity in Canada are presented, along with evidence of impacts on health and wellbeing. The framework is then presented, highlighting the complex and multi-sectoral relationships between climate change, food security, and human health. Examples of the Canadian food system's components that may be vulnerable to disruption by climate change impacts are identified, followed by analysis of how key pathways of vulnerability can influence food security and human health.

A number of frameworks exist that demonstrate the relationships between climate change and food security or food systems [ 6, 15, 18, 19], and to some extent, health or nutrition [ 20, 21, 22]. However, to the best of our knowledge, there is no existing framework that conceptualizes the nexus of climate change, food security, and human health in Canada. The proposed framework is intended to help public health officials, researchers, and relevant stakeholders investigate and understand current and future risks to food security from climate change, to inform efforts to prepare Canadians and their communities for possible health impacts.

2. Background: Food Security in Canada

In 1996, Canada adopted the Rome Declaration on World Food Security and the World Food Summit Plan of Action. The declaration indicates that food security exists when "...all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food which meets their dietary needs and food preferences for an active and healthy life" [ 23]. Three primary dimensions must be met in order for food security to exist: availability, accessibility, and utilization of food [ 24].

Food availability concerns the "physical presence of food" [ 25] and includes the quantity, quality, and type of food available to individuals. Food production, food distribution, and the exchange of food are key elements of food availability [ 18, 19, 24, 26]. The ability of individuals to acquire the quantity, quality, and type of food necessary for an active and healthy life is captured in the dimension of food accessibility. Key elements of food accessibility include affordability, allocation, and preference [ 19, 24, 25]. Food utilization refers to the ability to effectively use, consume, and benefit from food. Food safety as well as the nutritional and social value of food, are considered to be key elements of food utilization [ 18, 19, 24].

The temporal stability of the three dimensions described above is also required to achieve food security [ 18]. Indeed, food insecurity refers to "both the inability to secure an adequate diet today and the risk of being unable to do so in the future" [ 14], indicating the importance of the long-term stability of food availability, accessibility, and utilization. Food insecurity exists when any of the primary dimensions are unmet.

In Canada, approximately 12.6% of households were considered to be food insecure in 2011-2012, representing 2.8 million adults and 1.5 million children under the age of 18 [ 27]. These rates are an underestimation given that people living on First Nations reserves, full time members of the Canadian Forces, individuals in prisons or care facilities, and the homeless population are not included in this data [ 27, 28]. As illustrated in Figure 1 , rates of food insecurity are significantly higher in the Canadian North.

There is much evidence that suggests linkages and associations between food security and health conditions. For example, issues related to birth outcomes and maternal health, child development, chronic diseases, mental health, and emotional wellbeing, and increases in health care costs may emerge in food insecure households ( Table 1 ) [ 29].

Table 1

Health Outcome Category

Health and Social Challenges Related to Food Insecurity

Birth Outcomes and Maternal Health

Negative health impacts on both the mother and baby due to inadequate nutrition during pregnancy
Increased risk of birth defects
Impacts on infant feeding behaviors and sustainability of breastfeeding

Child Development

Poorer general health among food insecure children
Impacts on growth and development in early life
Poorer academic outcomes and social skills compared to children who do not experience food insecurity
Iron deficiency anemia linked to the subsequent development of a variety of chronic conditions, including asthma and depression

Health Status and Chronic Disease

Impacts on the quality and quantity of women's food intake due to lower incomes
Higher levels of poor or fair self-rated health, diabetes, heart disease, high blood pressure, food allergies and mental health outcomes
Barriers to chronic disease management, increasing the likelihood of adverse outcomes

Mental Health and Emotional Well-being

Impacts on social and mental well-being that can increase the likelihood of depression, distress and social isolation
Child hunger leading to depression and suicidal symptoms in adolescence and early adulthood

Economic costs

Increased health care costs associated with food insecurity
In Ontario, the annual healthcare costs were 23% higher for adults in marginally food insecure households, 49% higher for those in moderately food insecure households and 121% higher for those in severely food insecure households ¹ [ 34]
Increased probability that adults will become high-cost users of health care

A nutritious diet, a key aspect of food security [ 30], plays a significant role in an individual's health and wellbeing. In Canada, an unhealthy diet is considered a leading risk for death and disability [ 31] and is associated with an economic burden of approximately 13.8 billion dollars a year in Canada [ 32]. Increased consumption of processed foods and beverages that contribute to excess intake of sodium, sugars, and saturated fats and insufficient intakes of whole grains, nuts and seeds, fruits, and vegetables are key drivers of unhealthy diets [ 31]. The Global Burden of Disease Study reported that in 2016, dietary risk factors resulted in more than 800,000 years of disability and the death of approximately 48,000 Canadians [ 33, 34].

3. Methods

An analytical framework was developed to illustrate the complex relationship between climate change impacts and the food system, and how this relationship influences food security and human health in Canada. In order to appropriately capture the breadth of the climate change, food security, human health nexus, and the nuances of the relationship, multiple literature searches were conducted. The databases Medline and Embase were searched via Ovid between 2007 and September 2017. To understand the possible impacts of climate change on the Canadian food system and the subsequent implications for human health, four search strategies were developed in consultation with a research librarian at Health Canada's Health Library: (1) climate change + food security + Canada, (2) climate change + food security + health, (3) food security + health + Canada, and (4) food systems + climate change + food security.

An additional literature search was conducted between 2000 and April 2019 to identify frameworks that conceptualize the relationship between climate change, food security, and human health. Embase and Medline were searched via Ovid. Another simplified keyword search was conducted in AGRICOLA, BIOSIS Previews, Food Science and Technology Abstracts, Global Health, PsycINFO, and Social Policy and Practice.

4. Results

4.1. The Climate Change, Food Security, and Human Health Nexus Framework

Few studies and frameworks exist to increase our understanding of the possible impacts of climate change on food security and human health. Commonly, researchers examine the impacts of climate change on food systems or food security, but rarely are implications for human health included in the analysis. Thus, there is no comprehensive or common approach to studying the climate change, food security, and human health nexus, resulting in important knowledge gaps that hinder effective adaptation efforts.

The linkages and drivers between climate change, food security, and human health are presented in a new framework ( Figure 2 ). The framework illustrates the nexus from a food system perspective, highlighting the direct and indirect pathways in which the physical impacts of climate change may work through the food system to influence food security and, subsequently, human health. By identifying the different sectors of the food system, the framework demonstrates that a multi-sectoral approach is necessary for effective adaptation and resiliency building in response to climate change.

The following text provides an explanation of the main components of the framework. Table 2 summarizes potential vulnerabilities to key food system components from climate change impacts. Given the limited literature available in a Canadian context, examples from international studies are used where relevant. Evidence indicates that every component of the food system-production, processing, distribution, preparation and consumption-is climate sensitive and can experience impacts from climate change effects. These impacts can cause disruption and challenges to critical activities of the food system.

Table 2

Food System Component

Climate Vulnerability

Production

Increasing temperature extremes and variability, and changes in precipitation patterns and extreme weather events can cause damage to agricultural crops, reduce productivity, and decrease yield [ 37, 38, 39, 47, 48]

In the Prairies, groundwater quality and quantity may be reduced as summer rainfall decreases, which can increase irrigation needs for agricultural crops [ 49]

Sea level rise could cause inundation of agricultural lands in coastal regions, damaging crops, and creating unsuitable conditions for agricultural production and result in salt water intrusion of aquifers, reducing the quality of irrigation water [ 38]

Increasing temperatures and changes in precipitation patterns may create more favorable conditions for pests, invasive species and plant diseases [ 36, 37, 48]

Rising temperatures and increased concentrations of atmospheric CO ₂ may decrease the effectiveness of some herbicides used for pest control [ 8]

Temperature extremes can adversely impact livestock health and decrease productivity [ 48]

Extreme weather events may reduce land available for livestock pasture and foraging [ 36]

Rising temperatures may create favorable conditions for aquatic disease and invasive species [ 51]

Increasing temperatures and changing precipitation patterns are changing the quality and distribution of populations of traditionally harvested species in Canada (i.e., Caribou) [ 14]

Processing

Increasing temperatures and extreme temperature events may increase the risk of food spoilage or contamination while in storage at processing facilities [ 40]

Traditional food storage and preparation practices may be at risk, for example, permafrost melt may have implications for the stability and safety of traditional in-ground freezers used by Indigenous communities in the Canadian North [ 14]

Reduced or variable water availability may challenge food processing operations, which require significant amounts of potable water [ 38]

The physical infrastructure of processing facilities may be damaged by extreme weather events (i.e., flooding) which can disrupt operations [ 40]

Extreme weather events may cause disruption to energy supplies, labor availability and technological infrastructure critical to processing operations [ 40]

Distribution

Extreme weather events can cause damage and disruption to transportation infrastructure including road, rail, marine, and air transport infrastructure as well as urban and public transportation systems [ 42]

Temperature extremes, permafrost melt, changes in precipitation patterns, and freeze-thaw cycles can compromise the integrity of road, rail, marine, and air transport infrastructure [ 42]

Preparation and Consumption

Increasing temperatures, changes in precipitation patterns, and extreme weather events can create favorable conditions for the transmission, survival, and growth of many common foodborne pathogens [ 40, 52, 53]

Extreme weather events may facilitate chemical contamination at food production sites (i.e., contaminated flood waters inundating agricultural crops) [ 40]

An increase in ocean temperature and changes in salinity may increase the risk of pathogens that are known to contaminate seafood (i.e., Vibrio) [ 40, 52, 55]

In the Canadian North, climate change may allow for the emergence of new pathogens, viruses, and parasites that affect wildlife harvested as part of traditional and country food systems [ 14]

A changing climate may increase the need for the use of pesticides which can lead to increased pesticide residues in the food supply [ 6]

Increasing concentrations of atmospheric CO ₂ can alter the nutritional content of some agricultural crops, with studies indicating decreased concentration of protein, iron, zinc, and key minerals [ 8, 40, 56, 57]

4.2. Food Production

Food production is an essential component of the food system, it encompasses commercial and non-commercial agriculture, livestock, fisheries and aquaculture sectors, as well as the hunting, fishing and harvesting of traditional Indigenous foods. The food production sector is the starting point of the food system, providing the raw ingredients for processing and consumption. Ultimately, if the productivity of the food production sector declines, the availability and supply of food may be challenged. This would have impacts on food security status and, subsequently, human health.

Climate conditions such as rainfall and temperature have a primary influence on food production through impacts on water yields and flows, which are often modulated by irrigation and other water management techniques [ 17]. Other climate-related factors that can affect food production, and hence food security, include impacts on freshwater, biodiversity, soil degradation, fisheries, and carbon dioxide fertilization, with attendant impacts on nutritional food quality [ 35]. Some research suggests that climate change may create opportunities for Canadian food production [ 8, 36]. For example, some regions in Canada may experience an increased growing season and lengthened outdoor feeding season for livestock, which could positively affect food production [ 36, 37]. However, climate projections suggest an increased risk of drought in some regions of Canada, including the Prairies and British Columbia. In addition, future impacts from invasive pests and diseases, and transportation disruptions could put pressures on Canadian food production [ 38]. On the global level, any positive effects resulting from a warming climate are expected to be significantly outweighed by their adverse effects on the food system [ 39].

4.3. Food Processing

Food processing involves the transformation of raw food inputs into food products that are used in the preparation of meals or directly consumed by individuals. The food processing sector has a direct link to human health as its operations include washing, sanitizing, and preparing food that is safe for human consumption. Limited research has been conducted on climate change impacts to the food processing sector, both globally and in the Canadian context. Existing evidence suggests that climate change impacts may cause disruption to the stable supply of necessary resources, and inputs for processing operations and extreme weather events can cause physical damage to processing facilities [ 7, 38, 40, 41]. This sector is an essential component of food security, supporting the key dimensions of availability, accessibility, and utilization.

4.4. Food Distribution

The distribution of food is a critical component of food security as it links food products to consumers, directly supporting the availability and accessibility dimensions of food security. Climate change can disrupt food distribution networks through acute shocks such as extreme weather events, as well as through creeping climatic changes [ 42]. A national climate change assessment conducted on Canada's transportation sector in 2016 concluded that climate change will affect all modes of transportation, across the country [ 42]. Challenges to transportation infrastructure can undermine food security, and regions that are rural or remote-with a low capacity to produce and/or store food products locally-may be particularly vulnerable. Urban transportation infrastructure and public transportation systems, which are relied upon by many Canadians to access food distribution sites, such as grocery stores and markets, are also vulnerable to climate change [ 42]. Individuals that reside in food deserts-neighborhoods that are characterized by low income households and are underserved in terms of food distribution sites and public transportation infrastructure [ 43]-are particularly impacted by such disruptions.

4.5. Food Preparation and Consumption

The food preparation and consumption component of the food system directly supports the utilization dimension of food security. Food utilization refers to the need for "available and accessible food to fulfill the cultural, religious, health and nutrition needs of the population" [ 43]. This suggests that food needs to be safe to consume, be prepared in a culturally appropriate manner, while also providing adequate nutritional value in order for food security to exist.

Food safety and nutrition may be the pathways through which climate change impacts have the most direct effect on human health [ 20]. Nutrition may be challenged as climate change can contribute to shifts in diet composition and diversity [ 14, 44]. For example, country and traditional foods provide important nutritional value and contribute to healthy diets for Indigenous populations [ 14, 45]. In northern Indigenous communities in Canada, there has been an observed diet shift from country and traditional foods, to market foods. Climate change impacts on the availability and quality of traditional foods may contribute to this shift [ 14]. Market foods are often prepared, processed, and/or frozen, while fresh foods such as fruits and vegetables are not always available [ 14, 46]. Foods purchased and consumed are often less nutritious and high in sodium, sugars, and fat, which may contribute to various forms of malnutrition.

As the framework suggests ( Figure 2 ), proper functioning of the food system is integral for food security by supporting the critical dimensions of availability, accessibility, and utilization of food [ 24, 26, 58]. Given this relationship, food security may become compromised should any component of the food system experience disruption or stress in such a way that limits the accessibility, availability, and or proper utilization of food [ 26, 46, 58]. Ericksen [ 19] identifies three primary elements for each of the dimensions of food security, demonstrating the relationship with the food system. The primary elements also have relevance for human health outcomes ( Table 3 ).

Table 3

Primary Elements of Food Security

Critical Dimensions

Food availability

Production: how much and which types of food are available

Distribution: how food is made available (physically moved), in what form, when, and to whom

Exchange: how much of the available food is obtained through exchange mechanisms such as barter, trade, purchases, or loans

Food accessibility

Affordability: the purchasing power of households or communities relative to the price of food

Allocation: the economic, social, and political mechanisms governing when, where, and how food can be accessed by consumers

Preference: social, religious, or cultural norms and values that influence consumer demand for certain types of food

Food utilization

Nutritional value: how much of the daily requirements of calories, vitamins, protein, and micronutrients are provided by the food people consume

Social value: the social, religious, and cultural functions and benefits food provides

Food safety: toxic contamination introduced during producing, processing, and packaging, distribution or marketing food; and foodborne diseases

Canada is part of a global food system, exporting and importing raw and prepared food products from other regions of the world [ 59]. Although the severity or magnitude of some risks caused by climate change to Canada's food system may be lower compared to other countries, the nature of the global food system suggests that climate change impacts and risks in other regions can have implications for Canadian food security, including food supply and food safety [ 6].

The framework highlights that the presence and strength of food security is influenced by a number of different factors, including social, political, environmental, and economic determinants [ 19]. Evidence suggests, however, that climate change is increasingly becoming a significant stressor and influence on food security, through its impact on the food system [ 58]. Furthermore, climate change is a threat multiplier and can have impacts on the other factors that contribute to and influence food security status.

The framework also acknowledges that the food system is a major source of greenhouse gas emissions, and thus, an important driver of climate change [ 30, 39]. It is estimated that a quarter of global emissions are from food system operations and activities [ 60]. Furthermore, food systems are resource intensive, requiring significant water and energy inputs to sustain operations and activities. Industrial food systems can also contribute to unsustainable land use and deforestation [ 30].

Traditional and country foods have long been established as an important "enabler of food security and health" [ 14] for Indigenous communities and provide both spiritual and nutritional value [ 14, 61]. There are unique food security considerations that have not traditionally been included in conceptualizations of western food systems and food security concepts [ 62]. While this framework does include traditional and country foods and related activities in the different components of the food system, it is recognized that it may be limited in the extent to which it can appropriately capture the exceptional elements and characteristics of Indigenous food security and food systems. The Council of Canadian Academies developed a food security and sovereignty conceptual framework that reflects the situation of Indigenous communities in Canada's North, in the context of climate change [ 14].

5. Discussion

Greater understanding of the current impacts climate change is having on food security and on health is needed along with projections of future risks to populations [ 4]. Much of the current climate change and food security literature focuses on low-income countries [ 6, 35]. Indeed, low-income countries will be disproportionately impacted by climate change effects, and will likely experience more severe impacts to their domestic food systems, resulting in the exacerbation of existing challenges of food insecurity and undernutrition. While high income countries like Canada generally have robust food systems, with threats such as insufficient food supply of minor concern, challenges, and stressors related to climate change impacts still exist, particularly for certain populations and regions [ 4, 6].

Despite the consensus that climate change will have significant implications for global food security, research to date has primarily concentrated on one aspect of food security: availability, with a heavy focus on agricultural food production [ 58]. As a result, there is limited understanding of the measurable impacts climate change will have on non-production components of the food system [ 8]. Thus, many important aspects of food security are being overlooked both in domestic and international climate change and health research, demonstrating the need for a comprehensive conceptual framework.

While much of the existing Canadian research on climate change impacts on food security and health is focused on communities north of 60 degrees latitude, knowledge gaps about impacts in this region continue to exist. Furthermore, very little is known about the impacts and implications for regions south of 60 degrees latitude, for Indigenous, rural, and remote communities, as well as urban centers. Given these knowledge gaps, information about health outcomes that might result from climate change impacts, and effective adaptations in the food system, is limited.

The framework demonstrates that the climate change, food security, and health nexus represent an interdisciplinary problem that requires cross-sectoral collaboration for development of effective adaptations-for example, stakeholders from transportation, agriculture, water, health, environmental conservation, natural resources, urban planning, trade, social programs, and policy and regulations all play a role in the food system. Food systems have many interdependent subsystems that operate over different time and spatial scales [ 22]. The disruption of one activity can impact other activities in the system. The majority of existing research ignores the interdependency of the food system [ 58], typically exploring subsectors of the food system in isolation from each other. The framework supports interdisciplinary and systems research, and collaboration by conceptualizing key aspects of interdependencies in the food system.

Increasingly, the public health sector is using climate change and health vulnerability and adaptation assessments (V&As) to collect information on health risks associated with climate change and develop adaptation and response strategies [ 63]. The possible impacts of climate change on food security have not been widely explored in V&As within or outside of Canada. One study in 2018 that examined 34 assessments, supported by the WHO since 2013, found that all countries included an examination of climate change impacts on vector-borne diseases, while 22 countries examined water-borne diseases and only 15 investigated impacts on malnutrition [ 64].

In Canada, the 1998 assessment of health impacts of climate change did not explore the effects of climate change on food security, nor did an assessment in 2004 [ 65], but the 1998 study did recognize this as a high priority knowledge gap [ 66]. Subsequent national climate change and health assessments included examination of climate change impacts on food safety with some discussion of food insecurity threats in northern Canadian communities [ 4, 5].

On the local and regional levels, risks to food security have been identified in few V&As [ 54, 67]. In 2018, a high-level vulnerability assessment of Toronto's food system was conducted which explored the impacts of three hypothetical extreme weather events. The assessment highlighted that extreme weather events could impact food accessibility, distribution, and food safety [ 68]. The report recommended developing neighborhood-level food system resiliency plans for urban centers to address the unique needs of neighborhoods that may experience increased vulnerability during extreme weather events. The findings of the assessment support the argument for a coordinated effort across the food system to address vulnerabilities.

A food system resiliency assessment for the city of Baltimore also identified food system vulnerabilities to climate change-related hazards, and the results of the report will inform the development of a Food System Resilience Plan for the city [ 43]. There has yet to be a comprehensive examination of climate change impacts on Canada's food system at the national or local levels. The proposed framework is scalable and could guide such studies, ensuring unique characteristics of Canada are considered and key vulnerabilities are not overlooked.

Adaptation can be effective in mitigating the impacts of climate change on health [ 69], and proven interventions exist that can enhance food security, for example, by improving food safety and by preventing or treating malnutrition [ 35]. However, actions taken by public health officials to prepare for climate change impacts through for example, food access or food safety programs, will have limited effectiveness in reducing poor health outcomes if other major drivers of food insecurity are not addressed. This could include appropriate measures by officials in other sectors, for example, increasing the resilience of food production facilities and transportation systems.

At the global level an adaptation gap exists in efforts to address impacts of climate change on food insecurity and nutrition. Further efforts to build the evidence base and to develop models that can assist in quantifying the burden of disease related to malnutrition associated with weather extremes are needed to ramp up efforts to protect health [ 35]. Watts et al. [ 9] suggest that human interventions play the predominant role in shaping the relationship between climate change, food insecurity, and health impacts. The relationship of people to infrastructures and markets, for example, is a greater driver of vulnerability to food insecurity than is exposure to climate-related hazards such as droughts and floods [ 9]. Adaptation is therefore essential to prepare for the impacts of climate change.

The proposed framework highlights a number of important avenues of investigation related to key climate drivers, factors mediated by human behavior that influence accessibility, utilization, and availability of food and other determinants of poor health outcomes. This can aid researchers in future studies of climate change impacts on food security and health, including the development of health models and of early monitoring and warning systems of climate impacts on the food system. Investigation of unique characteristics and differences in social, political, economic, and environmental factors among urban, rural, coastal, northern, and Indigenous communities can elucidate important vulnerabilities in food systems that can inform the development of effective adaptations by health sector decision makers and those in related sectors.

Consideration of social equity is also important when developing and implementing adaptation actions. For example, Inuit participants of a workshop that focused on developing a strategic plan for food security for the Inuvialuit Settlement Region, Northwest Territories, using the results of the 2007-2008 Inuit Health Survey, identified housing as a major concern and barrier to achieving food security [ 70]. In order to store and prepare healthy foods, access to affordable, adequate, and safe housing was considered critical by the participants. Housing was not initially identified by the researchers as an area of concern as it was not recognized in the health survey results [ 70]. Thus, signaling the importance of studying food security and human health using an interdisciplinary, comprehensive framework. Furthermore, engaging people most affected empowers them to contribute to robust responses and adaptation strategies. Future research on the climate change, food security, and human health nexus, should therefore include considerations of social equity as well as Indigenous knowledge, which contribute to the development of effective responses and adaptation action.

6. Conclusions

The impacts of climate change on the Canadian food system work through complex pathways to influence human health. There is a significant need for a conceptual framework that fully captures these relationships so that Canadians and their communities can prepare for future impacts.

The framework presented in this paper provides a comprehensive conceptualization of the climate change, food security, and human health nexus, illustrating pathways of vulnerabilities and identifying opportunities for intervention. Analyzing this nexus from a food system lens allows for a broad understanding of food security, capturing the critical dimensions and highlighting vulnerabilities that may be overlooked in the existing literature. The framework will be useful in guiding future research, and can aid in the completion of climate change and health vulnerability and adaptation assessments. It can also inform the development and implementation of adaptation and resiliency building actions.

As highlighted in the framework, the food system is an interdependent system that requires activities from numerous sectors in order to operate effectively. Thus, a collaborative, multi-sectoral response is critical in order to increase climate change resilience in the food system.

Acknowledgments

We thank Robyn Hocking, MLIS (Health Library, Health Canada) for conducting the literature searches.

Author Contributions

Conceptualization, R.S.; methodology, R.S.; writing-original draft preparation, R.S. and P.B.; writing-review and editing, R.S. and P.B.

Funding

This research received no external funding.

Conflicts of Interest

The authors declare no conflict of interest.

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The Climate Change, Food Security and Human Health Nexus in Canada: A Framework to Protect Population Health

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Climate change impacts on the Canadian food system pose risks to human health. Little attention has been paid to the climate change, food security, and human health nexus, resulting in a number of knowledge gaps regarding food system components that are ...

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The effects of climate change around the world are now clearly visible. In Saskatchewan the largest effects to date have been very heavy rainfall events with extensive flooding, severe forest and grassland fires, and migration of insect pests from further south.

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Food and Agriculture Organization of the United Nations

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Much has changed since 1974, when FAO first began reporting on the extent of hunger in the world. The world population is growing steadily and is increasingly urbanized. Technology is evolving incessantly and the economy is more and more globalized. At the same time, there are worrying global trends in malnutrition, including a rapid rise in overweight and obesity, even as forms of undernutrition persist. The way food is produced, distributed and consumed worldwide has also changed dramatically. This vastly different world calls for new ways of thinking about hunger and food insecurity.

As part of its mandate, FAO strives to eradicate hunger, food insecurity and all forms of malnutrition. Supporting the livelihoods of small-scale food producers, improving the resilience of food production systems and encouraging the sustainable use of natural resources are all key to fulfilling this mandate and achieving Sustainable Development Goal 2 (SDG2), a world without hunger, food insecurity and malnutrition.

What is hunger?

Hunger is an uncomfortable or painful physical sensation caused by insufficient consumption of dietary energy. It becomes chronic when the person does not consume a sufficient amount of calories (dietary energy) on a regular basis to lead a normal, active and healthy life. For decades, FAO has used the Prevalence of Undernourishment indicator to estimate the extent of hunger in the world, thus "hunger" may also be referred to as undernourishment.

What is food insecurity?

A person is food insecure when they lack regular access to enough safe and nutritious food for normal growth and development and an active and healthy life. This may be due to unavailability of food and/or lack of resources to obtain food. Food insecurity can be experienced at different levels of severity. FAO measures food insecurity using the Food Insecurity Experience Scale (FIES) shown below:

How are hunger and food insecurity related?

When someone is severely food insecure, they have run out of food and gone a day or more without eating. In other words, they have most likely experienced hunger.

Severe food insecurity is one extreme of the scale, but even moderate food insecurity is worrisome. For those who are moderately food insecure, access to food is uncertain. They might have to sacrifice other basic needs, just to be able to eat. When they do eat, it might be whatever is most readily available or cheapest, which might not be the most nutritious food. The rise in obesity and other forms of malnutrition is partly a result of this phenomenon. Highly processed foods that are energy-dense, high in saturated fats, sugars and salt are often cheaper and easier to come by than fresh fruits and vegetables. Eating those foods may mean your daily requirement of calories is met, but you are missing essential nutrients to keep your body healthy and functioning well. In addition, the stress of living with uncertain access to food and going periods without food can lead to physiological changes that can contribute to overweight and obesity. Children facing hunger, food insecurity and undernutrition today may have a higher risk of overweight, obesity and chronic diseases like diabetes later in life. In many countries, undernutrition and obesity coexist and both can be consequences of food insecurity.

Monitoring hunger and food insecurity in the world

FAO uses multiple indicators to monitor the various aspects of these complex issues.

Two of these indicators, the Prevalence of Undernourishment (PoU) and the Prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES), are being used to monitor the world's progress toward achieving SDG2.

The PoU and the prevalence of food insecurity based on the FIES give different perspectives and utilize very different methodologies and sources of data.

The Prevalence of Undernourishment (PoU) is FAO's traditional indicator used to monitor hunger at the global and regional level and is based on country data on food availability, food consumption and energy needs. It estimates the adequacy of a population's dietary energy intake. Historically, the number of hungry people in the world (between 702 and 828 million) has been derived using this approach. PoU estimates cannot be sufficiently disaggregated to be able to identify specific vulnerable populations within countries, which is a limitation for monitoring the very ambitious goal of Zero Hunger in an agenda that aims to leave no one behind.

The prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES) is an estimate of the percentage of a country's population that faces difficulties in accessing enough safe and nutritious food for normal growth and development and an active and healthy life. The data is collected through direct interviews by asking people about experiences associated with constrained access to food. The FIES is capable of providing measures of food insecurity at the individual or household level and at different levels of severity. Estimates can be compared across countries and sub-populations within countries. Rather than only national trends, this methodology can be used to highlight the "who" and "where" of the of food insecurity, answering the questions: which populations are the most food insecure, and where are they located?

In monitoring the progress toward SDG 2, this FAO indicator measures the proportion of the population that is experiencing moderate or severe food insecurity in a population.

People experiencing moderate food insecurity have reduced the quality and/or quantity of their food and are uncertain about their ability to obtain food due to lack of money or other resources. Moderate food insecurity can increase the risk of some forms of malnutrition, such as stunting in children, micronutrient deficiencies or obesity in adults.

People experiencing severe food insecurity have run out of food and, at the most extreme, have gone days without eating. This group of people are those we call the "hungry". The number of severely food insecure people derived from the FIES complements the number of hungry people determined based on the POU.

Global, regional and country-level estimates of the POU and of the prevalence of moderate or severe food insecurity are disseminated annually in the State of Food Security and Nutrition in the World flagship report as well as on and the UN Global SDG Indicators Data Platform. The objective is regular monitoring of chronic food insecurity in all countries. This differs from the Global Report on Food Crises which focuses on acute food insecurity in a limited number of countries and territories affected by food crises as assessed based on analytic approaches such as the Integrated Food Security Phase Classification/Cadre Harmonisé.

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Much has changed since 1974, when FAO first began reporting on the extent of hunger in the world. The world population is growing steadily and is increasingly urbanized. Technology is evolving incessantly and the economy is more and more globalized.

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The purpose of the Indigenous Community Development National Strategy is to guide Indigenous Services Canada (ISC) and Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC) in building and investing in effective and sustainable Indigenous communities, government and services. "Indigenous peoples have the right to determine and develop priorities and strategies for exercising their right to development.

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In the Reservation era, our ancestors were forced into an abrupt change of lifestyle and struggled to adjust to entirely foreign economic and governmental systems. Their traditional ways of hunting, fishing and harvesting were either outlawed or impossible to continue because of the environmental devastation which had already ensued. In a pathetic attempt to make up for treaty violations, the Government began distributing food, healthcare and education to Native peoples. These programs were initiated under the disguise of good-naturedness but in reality only further damaged our communities. Commodity food programs introduced heavily processed, fatty and starchy unnatural foods like fry bread into Native diets. The Federal government intentionally introduced these cheap and unhealthy foods in Native communities with hopes of systematically wreaking havoc on native minds and bodies. The attack on Native health and wellbeing was to further eradicate the power of the people so that there could be no resistance to the continuing theft of indigenous land and resources; an age old tactic that was used for centuries in ancient Europe.

In spite of their ill effects on our bodies, minds and spirits, these harmful foods have become a part of our cultures today. Consequently, Native peoples are suffering from the epidemic of obesity, further resulting in deadly diseases such as heart disease, diabetes, hypertension, infertility, cirrhosis, strokes, neurodegenerative diseases and malignant neoplasms. Euro-American culture has furthermore influenced our people to devalue our spiritual connection to food.

The presence of alcohol, drugs and other mind and mood altering substances are a direct negative result of colonization and have contributed greatly to not only the current state of poor health, but also to the mental, emotional and spiritual disconnection that many of our people are experiencing. All of this has disempowered us and if we don't act now, it will continue to hind our abilities to collectively heal to restore, preserve and evolve our indigenous nationhood.

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colonial impact on indigenous foods - WELLFORCULTURE

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In the Reservation era, our ancestors were forced into an abrupt change of lifestyle and struggled to adjust to entirely foreign economic and governmental systems. Their traditional ways of hunting, fishing and harvesting were either outlawed or impossible to continue because of the environmental devastation which had already ensued.

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Impacts of climate change in Northern Canada – The Health of Canada’s Children and Youth

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Climate Change Preparedness in the North Program

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The program works with Indigenous and northern communities, territorial and regional governments and other stakeholders to identify priorities for climate change adaptation in the North.

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Black - References & Legend
Orange - Social Determinants of Health
Blue - Concepts
Purple - Subconcepts
Green - Interventions

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Develop a communal food program (potlucks, food donations, etc.) with Northern communities that prepare a variety of foods, including traditional and cultural meals. Develop a communal hunting/fishing program to provide resources for community members.
(Pegg, & Canadian Electronic Library, 2016)

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Expand and Revise Nutrition North Funding Criteria:
Target costs to subsidize essential and healthy food types and cultural foods over transportation
expand eligibility by outreach rather than looking at geography--> survey communities for need
(Pegg, & Canadian Electronic Library, 2016).

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Abstract

Background

Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood. The purpose of this study was to explore the perceptions of food insecurity by FN adults living in a remote, on-reserve community in northern Ontario known to have a high prevalence of moderate to severe food insecurity.

Methods

A trained community research assistant conducted semi-directed interviews, and one adult from each household in the community was invited to participate. Questions addressed traditional food, coping strategies, and suggestions to improve community food security and were informed by the literature and a community advisory committee. Thematic data analyses were carried out and followed an inductive, data-driven approach.

Results

Fifty-one individuals participated, representing 67% of eligible households. The thematic analysis revealed that food sharing, especially with family, was regarded as one of the most significant ways to adapt to food shortages. The majority of participants reported consuming traditional food (wild meats) and suggested that hunting, preserving and storing traditional food has remained very important. However, numerous barriers to traditional food acquisition were mentioned. Other coping strategies included dietary change, rationing and changing food purchasing patterns. In order to improve access to healthy foods, improving income and food affordability, building community capacity and engagement, and community-level initiatives were suggested.

Conclusions

Findings point to the continued importance of traditional food acquisition and food sharing, as well as community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. Public health policies to improve food security for FN populations are urgently needed.

Peer Review reports

Background

Food insecurity is a serious public health issue for Canada's indigenous population [ 1, 2]. The term "Aboriginal people" describes the three groups that comprise Canada's indigenous population; First Nations [FN], Métis, and Inuit. First Nations are the largest of these three groups, making up nearly 60% of the Aboriginal population living in Canada with approximately 60% of FN people living off-reserve lands. Data on food security in off-reserve Aboriginal people are alarming; 24% of Aboriginal households had a compromised diet (reduced quality and/or quantity), and 33% experienced food insecurity compared to 8.4% and 9%, respectively across the rest of Canada [ 3- 5]. In on-reserve FN households and Inuit households in Arctic communities the prevalence of food insecurity appears to be even higher. The First Nations Regional Health Survey found just over half (54.2%) of households surveyed were food insecure, while the Inuit Health Survey conducted in 36 Arctic communities found a range of household food insecurity from 45-69% depending on region [ 6, 7]. Food insecurity in Aboriginal households in Canada has been associated with high levels of poverty, multi-child households, low levels of education attainment and labour force participation, reliance on social assistance/welfare, and female lone-parent households [ 5].

Food security challenges faced by Aboriginal people are unique [ 1, 8- 12], especially for Aboriginal people living in remote and isolated communities. Aboriginal food systems are primarily characterized by two avenues of food provision: the harvesting, sharing and consumption of traditional (or country) foods and the purchasing and consumption of market (or commercial or store-bought) foods [ 11, 12]. Food harvested from the wild by FN people is called "traditional food" while the Inuit call wild-harvested food "country food". Despite the combination of the traditional food system and market food system as being distinct from the non-Aboriginal food system, current conceptualizations of food security lack the context, food practices, and perspectives of Aboriginal people [ 1].

Regardless of evidence that food insecurity is prevalent in Aboriginal communities, little information is known about the characteristics of the individuals or households experiencing this problem [ 13]. While numerous food system studies have been published on Inuit people living in the Canadian Arctic in recent years [ 7, 14- 23], there are still few food system studies with on-reserve FN communities [ 12]. Many gaps remain about the nature and extent of food insecurity for FN people in Canada. Lead authors in this field [ 1, 2, 5] have recommended qualitative studies to better understand the food security situation for FN people. The knowledge gained can help to tailor food security programs and policies to the unique needs of these communities and population [ 1, 5].

In this study, we explored food insecurity from the perspective of FN adults living in a remote, on-reserve subarctic community in northern Ontario, Canada. Previous work by our group had identified a high prevalence of household food insecurity (70%) using the Household Food Security Survey Module [ 4, 24]. The intention of this study was to determine participants' perceptions of food security and the range of adaptive strategies they use at an individual and household level. The two research questions addressed by this study were: (1) "What are the coping strategies for food insecurity used by community members?"; and, (2) "What suggestions do they have to improve food security in their community?"

Community profile and study population

This study was conducted in Fort Albany First Nation which is situated on the west coast of James Bay in the Mushkegowuk Territory along the Albany River in northern Ontario, Canada. As described previously [ 25, 26], the Fort Albany reserve is home to approximately 850 people. Fort Albany is geographically remote (52° 15′ N; 81° 35′ W); it is accessible only by plane year-round, by boat and barge during the ice-free season, and by ice road after freeze-up. In Canada, a remote community is defined as being more than 350 kilometres from the nearest service centre (or city) having year-round road access. Fort Albany also is categorized as a community with "special access" which means that it is located in a zone where there is no year-round road access to a service centre. Timmins, Ontario is 769 kilometres from Fort Albany and is one of the closest cities with road access. Timmins is considered a main entry point for food distribution to Fort Albany as food is flown from there during most of the year with the exception of 6-8 weeks in the winter when the ice road allows for accessibility to closer communities. One of the communities accessible by ice road is Moosonee, which is 128 kilometres southeast of Fort Albany and has train access. As a result of being remote with special access, transportation of goods into the community of Fort Albany, including commercial food, is very expensive.

At the time of this study, the community had one main grocery store and two small convenience stores. Although traditional foods remain an important part of their diet, the majority of dietary intake is from store bought food. Community members participate in traditional harvesting activities (also referred to as traditional food acquisition) including hunting, fishing, and gathering food from the land. However, these activities have been declining in recent decades, especially for young people. As these endeavours are seasonal, are limited by financial constraints for harvesting transportation and equipment, and the yield varies greatly depending on the success of the harvest, there is much variability in the consumption of traditional foods between households and over the course of the year. Traditional foods commonly harvested and consumed include berries (e.g., ground berries - Gaultheria procumbens), fish (e.g., whitefish - Coregonus clupeaformis), large land-based animals (e.g., moose - Alces alces), game birds (e.g., goose - Branta canadensis interior and Anser caerulescens caerulescens), and small game (e.g., hare - Lepus americanus). Community members live in small houses and many households have extended family living together.

Fort Albany First Nation was an ideal location for this project for a number of reasons: we have established a community advisory committee with broad community representation; have good rapport with the community and school as we have been working on school programs for healthy eating and physical activity for many years; and community members have a keen interest in improving the dietary habits of their population [ 25- 28].

Methods

This study builds upon our previous work where community focus groups and individual interviews with Fort Albany community members identified food insecurity as a constraint to healthy eating in children and youth [ 25, 27]. This study was also part of a larger project to examine food security in the community. The theoretical framework for the larger project was based on systems thinking and a critical social theory perspective [ 29]. Critical social theory includes aspects of theories from feminism, postcolonialism, and Indigenist critical theory which better reflects Indigenous ways of knowing than a purely postcolonial approach [ 29]. This theory allows for a more holistic spiritual viewpoint and represents an Indigenous research paradigm that supports self-determination. The theory also focuses on specific language used by participants as a source of information about meaning [ 29].

Community advisory committee

A community advisory committee (CAC) of six community members representing local stakeholder organizations (e.g., Band Council, Health Centre, school) and parents and the community at large was established prior to the study. For this study, members of the CAC were involved in the design of data collection tools (e.g., qualitative questions and probes), helped to adapt approaches to decrease the cultural sensitivity of study methodologies, assisted in collecting data, provided input on the interpretation of results, and assisted with the dissemination of results. Although a trusting relationship between the investigators and members/organizations in the community has been previously established, the specific formation of a CAC was fundamental to this participatory research. Ethics approval for this study was obtained from the Office of Research Ethics at the University of Waterloo and permission to conduct this study was obtained from Fort Albany First Nation.

Question development

As part of the larger project, the first part of each interview began with having the participants respond to the 18-item US Household Food Security Survey Module (HFSSM). The HFSSM is a government questionnaire that was used by Health Canada in the 2004 Canadian Community Health Survey (Cycle 2.2) to determine the prevalence and severity of food insecurity in the off-reserve population [ 4]. The qualitative interviews for the current study were conducted following completion of the HFSSM, which is why the first interview question refers to the government questionnaire.

Lambden and colleagues [ 30] concluded that traditional food attributes must be included in studies of food security in the Arctic. Although this study was in the subarctic, it is apparent from previous work with Cree in the western James Bay region that questions related to traditional food are very important for studying food security in this community. These considerations were taken into account during the question development for the qualitative interviews.

A set of three questions and probes were developed using an iterative process: 1) Initially, nine questions were informed by the qualitative food security literature, including studies with Aboriginal populations in Canada (e.g., [ 15, 22, 31]); 2) During subsequent drafts, questions were reviewed to ensure they were more understandable, culturally appropriate and relevant to the food security issues in FN communities based on consultation with and input from members of the CAC (n = 3) and the investigators' (n = 3) personal experiences with the people and community of Fort Albany. The number of questions for the final draft (n = 3) was kept small to reduce the response burden for the participants. The final three questions were: (1) The government questionnaire we did seemed to ask mostly about store-bought foods. Can you tell me about traditional foods and your household?, (2) How do you adapt if there doesn't seem to be enough food (traditional or store-bought) for your household?, and (3) What do you think can be done to make it easier for people in Fort Albany to get enough (healthy) food (store-bought and/or traditional food)?. Table 1 displays the final three questions and probes.

Table 1 Interview questions and probes

Participant recruitment, consent, and data collection

A local community research assistant was hired to collect the data. He had been employed by our research team in the past and trained in proper protocols for data collection, including the administration of surveys and conducting interviews. He had an understanding of the project's aims, was instructed to provide probes when appropriate, and was familiar with the practice of active listening during interviews [ 32]. The community assistant spoke Cree, which was helpful if any of the participants requested Cree translation. The assistant was also a member of Fort Albany First Nation, had stature in the community, and has lived there for more than 25 years. Therefore, the assistant had full understanding of the language and culture of the respondents as well as established trust and rapport; all of which are important elements for conducting qualitative interviews [ 33]. The status of the interviewer was very important for the comfort of the participants in discussing the sensitive topics around food insecurity.

One adult in each of the on-reserve FN homes in Fort Albany was approached in-person by the community research assistant to participate in the study. Participants were provided with an information/recruitment letter and/or the study was explained orally. Participants were given the option to be interviewed in their language of choice and their location of choice. As in our previous studies, verbal consent was obtained from all participants, being culturally appropriate for the Western James Bay region for this type of project [ 27, 34]. Semi-directed, in-depth interviews were conducted with each willing participant from June 2009 to January 2011. Interviews were guided by the three open-ended questions and the probes were only used to prompt more discussion if the participant needed examples to stimulate the conversation. The CAC decided that due to the sensitive nature of the topic of food insecurity it was not appropriate to audio-record the interviews. The community research assistant took verbatim handwritten notes during interviews. Demographic characteristics of the respondent and household were also collected. Interviews were coded by number for anonymity and to maintain confidentiality of respondents. All willing respondents participated in the interview regardless of whether their household was classified as food secure or food insecure.

The university research team was in regular contact with the community assistant either in-person or by telephone to discuss progress on data collection and to answer any questions that might come up related to the data collection. Interview transcripts were periodically returned to the research team in batches as they were completed.

Data management and analysis

The handwritten interviews were transcribed verbatim. Organization and coding of the transcribed data for the qualitative analysis was conducted both by hand and using QSR NVivo® computer software (NVivo, version 8.0; Doncaster, Australia: Sage Publications Software, 2008). Thematic data analyses were carried out according to the stages and steps described by Boyatzis [ 35] and followed an inductive, data-driven approach [ 35]. Initially, the raw data were reduced into logical and meaningful segments on paper [ 36]. Subsequently, data were organized into groups, and "themes" [ 37] were identified within a subsample of data from ten randomly selected interviews. The themes were then compared across subsamples and codes were created. Creating the codes was an iterative process of the writing, editing, and reconstruction of statements from the preliminary themes into a set of revised themes using the qualitative techniques of the constant comparison method and searching for deviant cases [ 38]. The qualitative analysis continued until saturation was reached, where no new themes emerged from the data. This also was an indication that there were a sufficient number of interviews and the sample size was adequate [ 39]. During the process of analyses, the theme and subtheme labels were created based on an interpretation of the statements and phrases of the participants. Therefore, the thematic labels presented in the study findings are not a verbatim representation of the exact words spoken by the participants during the interviews. Memos were used to record thoughts and ideas about the codes during the process of code development [ 40]. The codes were then used to analyse the rest of the qualitative data from all of the interviews. Initially the three interview questions were coded separately. Then the analysis was opened and coded across the three questions as the analyst found that the questions asked "triangulated". The final codes were arranged into a hierarchical coding list.

Initial thematic analysis was conducted by the lead author. To determine the consistency of judgment of the coders and to establish inter-rater reliability [ 41, 42], the codes for the themes and subthemes were confirmed by a second independent analyst who had documented expertise with qualitative methods and analysis and expertise on the topic of food security [ 43, 44]. The second analyst applied the themes to a subset of the data which was a random selection of 50% (n = 25) of the interviews. The percent agreement between the two coders was 83%. The second coder also recommended the reorganization and addition of two subthemes and one main theme. The additions of these themes were discussed between the two coders and it was agreed that they should be included in the analysis. The final code included 10 themes and 39 subthemes.

Final emergent themes and subthemes were shared with a few of the interviewed participants (n = 5) by the lead author to confirm that they accurately reflected their perspectives. A listing of the themes and subthemes was discussed with members of the CAC and revisions to the wording of the final themes and subthemes were suggested. Sharing the themes with participants and the CAC was a form of member checking to verify results of the study [ 45].

Results

Of the 76 individuals approached to participate in this study, 10 declined participation in the larger study, and 15 refused to participate in the interviews, resulting in a response rate of 67%. A total of 51 respondents participated in the interviews, 27 male and 24 female with an average age of 43.7 years. The main reason 15 individuals chose not to participate in the interviews was respondent fatigue as they had already completed the HFSSM questionnaire. Just over half of the non-participants were male (n = 8, 53%) and lived in households categorized as food secure (n = 8, 53%) and their average age was 41.3 years. Personal and household characteristics of the participating study population are shown in Table 2. Although more than three-quarters of the 51 participants had a salary from employment as their main source of income, 75.5% lived in households that were classified by the HFSSM as food insecure.

Table 2 Personal and household characteristics of participants (n = 51)

The results section documents an interpretation of the findings based on the three interview questions that were asked and selected discussions that followed between participants and interviewer. Figure 1 illustrates the hierarchical coding list of themes and subthemes that represent the participant's perspectives on food insecurity. Although there was some overlap between the questions asked, the interviews generally fell into the three question categories: traditional food acquisition; coping strategies for food insecurity; and suggestions to improve food security. For the remaining Results section, the paragraph headings are the themes. The full list of themes and subthemes are depicted in Figure 1.

Themes and subthemes that emerged from the thematic analysis of participant perspectives on food insecurity. The themes are the darkly shaded boxes where the number in parentheses denotes the number of times each theme was represented by a quote. The subthemes under each theme are listed in order according to the number of participants with at least one quote for the subtheme.

"Can you tell me about traditional foods and your household"

Barriers to traditional food acquisition

When describing traditional food acquisition for their household, the majority of participants reported various barriers that prevented them from acquiring traditional food on a regular basis despite their desire to eat game meats more often. The two main barriers reported were the high cost of hunting and environmental change affecting their ability to hunt in specific areas and during specific times. The high costs were attributed primarily to the cost of fuel to travel to hunting sites and the financial means to own hunting equipment. Hunting equipment included vehicles for transportation, guns, and ammunition. A number of participants pointed out that even if money was spent to go out hunting, there was no guarantee that the hunt would be successful.

"It costs money to go hunting - gas, snow machine, and you need that money for everything else because everything is expensive." (Interview 4, female)

"Gas is expensive...$1.85 a litre. But you can spend all the money to go out hunting and come back with nothing. So you've spent your money, but still have no food." (Interview 25, male)

"Still go hunting, geese, moose, caribou but the seasons are changing and it gets harder to get wild food. For spring hunting - geese fly at odd times now. In April it is still too cold, snow and sometimes it gets too warm and snow melts too fast. Geese won't land where there is no snow. I guess we have to change our hunting season [May and June] and go hunting at the Bay instead of the muskeg [swamp]. We try to get 12 geese at least and cook one per month." (Interview 17, male)

Other categories of barriers mentioned included the loss of culture as a reason for no more hunting; less [personal] time for hunting, fishing and cooking traditional food due to employment, and concern about environmental contaminants in hunted food.

No barriers to traditional food acquisition

A few participants did express that they thought there were no barriers to traditional food acquisition. However most of these people also admitted that they did not hunt, did not prefer game meat, or consumed only store-bought food.

"How do you adapt if there doesn't seem to be enough food for your household"

Importance of hunting/fishing/gathering and traditional food practices

This importance of traditional food acquisition and traditional food practices was a prevalent discussion topic throughout the interviews and was the predominant theme across all three of the interview questions. In addition to describing their access of traditional food from hunting, fishing, and gathering for themselves, the participants also mentioned accessing food from other people and the importance of food practices such as storing and preserving traditional food for future consumption.

"As for me, I don't really eat traditional food only when family member gives me wild meat. Would be nice to eat traditional food every supper." (Interview 46, female)

Food sharing

When asked how they adapt when there wasn't enough food, the majority of participants mentioned food sharing. Food sharing with family was the most common, followed by food shared between community members and then food shared with friends. Food sharing with family included immediate family as well as relatives, even if the relatives lived in another community. Food sharing was seen as a normal part of daily life and occurred more often during hunting seasons when game meat was made available by hunters. Most of the participants described that the food shared was traditional game meats.

"We have get-togethers as family and we go to another family house and we share what we have in our homes and the other family does as well." (Interview 29, male)

"Our parents have a lot of wild meat and share with our family." (Interview 19, female)

"One way is to give food if other families can't afford to buy what they run out of." (Interview 45, female)

Dietary change, rationing, and food purchasing patterns

Participants explained how they would change their eating and food purchasing patterns in times where they didn't have enough food or when they couldn't afford to purchase certain foods. They described how they bought food in bulk from the south and stocked up their provisions of non-perishable food when the winter road was usable. Some mentioned reducing portion sizes and changing their consumption patterns. For example, buying dry goods like rice and pasta which were cheaper to purchase.

"We buy more in Moosonee during the winter months. Buy foods such as macaroni, rice, other dry food. " (Interview 2, male)

"What do you think can be done to make it easier for people in Fort Albany to get enough (healthy) food"

Improve income and food affordability

When participants were asked to suggest ways to make it easier for community members to get enough food, the majority pointed to the high prices of food at the local store and the low incomes of community residents. They thought that the store food should be reduced in price to become more affordable and that freight costs for shipping food should be decreased. Increasing income by increasing the amount of social assistance (welfare) payments or having more employment opportunities were also mentioned.

"Lower cost of food would be nice so all people can afford, especially welfare recipients. " (Interview 5, male)

Building community capacity and engagement

Many participants discussed the importance of increasing independence and self-sufficiency so that they didn't have to rely on food transported from the south. They wanted to advocate for food security initiatives and put some of the responsibility for improving food security towards community leaders. For example, the Band and Band council were frequently mentioned and were viewed to be in a position to make positive changes towards increasing food availability and affordability. Many participants said "the Band should do this...". The participants used terms that indicated a collective movement whereby community members could work together towards solutions. For example, many respondents used the words "we could..." or "we should..." or "we need...".

"As for the last part of the question, one method is to move back in the upper bush land (upriver) and not depend on the white society. But...we, the First Nations in the communities have already accepted everything from the start...like the signing of the treaty or letting our kids go in the residential school to get educated...we need to be independent and start doing things for ourselves." (Interview 52, female)

"[There should be] scheduled hunting trips where gas and supplies are paid [by the Band] and traditional food/meat caught given to lower income families - salary for the hunter. This would provide jobs and feed the lower income groups. Lots of great hunters and trappers in this community - utilize them." (Interview 49, female)

Community-level initiatives

Participants also pointed out a number of community-level initiatives that they thought could improve food security. The most common community initiative suggested was related to gardening or farming. Community members were reminiscent about times in the past when they gardened or remembered when there used to be farming activity in the community.

" Start a garden. You could grow things like rhubarb for jam or pies. We used to have a garden and we grew potatoes. We used the potatoes at the goose camp. We know that you can grow things here." (Interview 50, female)

Community members also were keen to continue and support the 'Farmer's Markets' that had been started by a few community food champions. The 'Farmer's Market' was an event initially held once every few months where food was purchased from a southern store and a plane was chartered to fly the food into the community. The food was then sold to community members at prices that covered the cost of the food and freight with no profit. These events were organized by a few people in the community who wanted to improve food access and affordability for community residents.

" Okay, as for me I think they should hold more Farmer's Markets." (Interview 47, female)

Another suggestion was to employ community hunters. This was seen as a way to increase the harvesting of traditional foods as well as income support for community members who were willing and keen to hunt, but might be unable to afford to hunt due to financial constraints.

"Get Band Council to get some hunters to go hunting for spring and fall. Supply the hunters with guns, shells, gas for their trip. Whatever game [meat] is killed, it should be shared within the community." (Interview 51, female)

Improving the built environment/infrastructure

Participants made recommendations for building physical structures to promote food security and these were categorized as improving the built environment or infrastructure. They primarily mentioned the building of an all-season road in the community. An all-season road could provide year-round access to southern stores and reduce the cost of transporting food into the community.

" Maybe an all-season road will help to have more food in cupboards, like winter time." (Interview 37, male)

Some participants also mentioned having a larger grocery store with more healthy food and that greenhouses should be built to grow local food in the community. The one main store in the community was regarded by residents as being too small for the size of Fort Albany, even when it was first built. In addition to housing groceries, the store also serves as the local bank and the only local business where residents can buy clothing, appliances, furniture, and electronics. Respondents expressed a desire to have better quality and more quantity of fresh fruits and vegetables as well as more fresh meat that had not been frozen. It is important to note that a small greenhouse was built at the community school over the summer and fall of 2010. The five by six meter greenhouse was partially funded through a university research grant as a case study of food security intervention strategies in the community. It was not clear from the interviews whether the respondents were motivated by the school greenhouse to suggest that more greenhouses be built or whether the idea of building greenhouses originated elsewhere.

Discussion

Over the past century, Aboriginal populations living in northern communities have become increasingly vulnerable to the transformation of local culture and society, including a significant shift from a primarily subsistence way of life [ 47]. They are no longer nomadic and do not experience extreme feast or famine situations as they had in the past; however in many communities the experience of food insecurity prevails. The introduction of store-bought foods and reduction in traditional food acquisition has been a detrimental nutrition transition resulting in considerable changes to their health and well-being [ 11]. As northern and remote populations in Canada are continuing to be exposed to external stressors, such as environmental change; they become increasingly reliant on coping mechanisms to maintain food access [ 14, 19]. Issues related to food security in Aboriginal populations that have not been studied in-depth include: how traditions of sharing and reciprocity of food contribute to food security; how families cope internally with food shortages; how individuals within families experience or cope with food shortages differently; how communities cope with widespread food insecurity; and what solutions or strategies have worked (or not worked) in the past and what new strategies are suggested by community members [ 1, 2, 12]. The goal of this study was to begin to explore some of these understudied issues from the perspectives of individuals living in a remote FN community. To our knowledge, this is the first study to examine coping strategies for food insecurity with a remote, subarctic FN population. The findings point to the continued importance of traditional food acquisition and food sharing as well as listening to proposed community solutions for food systems change.

Traditional food acquisition and coping strategies for food insecurity

Similar to findings from this study, the high cost of hunting and environmental change have been cited as barriers to traditional food acquisition and affecting food security for Aboriginal people living in Canada's north [ 15, 19, 48- 53]. In this study, hunting, fishing, gathering of traditional food and traditional food practices (e.g., traditional food preservation and storage) were important ways for community members to cope with food shortages. Subsistence harvesting for Cree of the western and eastern James Bay region remains an integral part of the culture [ 54- 59]. Outside of the clear nutritional value of wild food, the spring and fall harvesting periods constitute a cultural event which increases social and community cohesiveness. The extremely high cost of market food is prohibitive [ 60, 61]. Thus, the contribution of wild food to the Cree diet must be preserved for both economic and cultural reasons [ 56]. The importance of traditional food for northern populations has been well documented [ 18, 52, 53]. Traditional food storage has become modernized with the use of freezers to store game meat for future consumption. It was not clear from the interviews whether the preservation of food, such as smoking or drying, has decreased with the increased use of freezers.

Food sharing was expressed by 63% of participants as a means of coping with food shortage. This important part of Aboriginal culture and traditions has been documented widely in the literature [ 6, 15, 19, 55, 62- 66] including food sharing by the James Bay Cree [ 57, 58]. The First Nations Regional Health Survey [ 6] found that nearly nine of ten (85.5%) respondents had traditional food shared with their household in the past year prior to the survey. Fort Albany residents felt that food sharing between family, community members, and friends was a key coping strategy when their household did not have enough food. In contrast to a few recent studies reporting that food sharing has been decreasing in northern Aboriginal communities [ 14, 19, 66], the current study found that food sharing continues to be an important way for community members to adapt to food shortages and a weakening of food sharing was not mentioned during interviews. Other studies pointing to a decline in food sharing networks cite reasons including the high cost of hunting; an increasing number of households without a hunter; and stress on hunting yields due to environmental changes [ 14, 19, 62, 66]. The high costs of hunting and environmental change were both subthemes that emerged as barriers to traditional food acquisition in Fort Albany.

Dietary change, such as consuming less expensive food like rice and pasta, and rationing of food intake are coping mechanisms for food insecurity that emerged from the current interviews and are commonly cited in the literature [ 67- 70]. Less severe forms of food rationing include cutting portion sizes to more severe behaviours such as skipping meals completely [ 67, 71]. Participants of this study even mentioned drinking water to feel full, which indicates the severity of food insecurity for some Fort Albany residents. Specific food purchasing patterns, such as buying in bulk from more southern stores and using this practice to build up home food provisions may be unique to remote communities with seasonal road access. After freeze-up when the winter road can be safely travelled is a time of year with a great flurry of community activity as people try to buy supplies that they otherwise have difficulty accessing due to reduced availability and cost at their local store.

Suggestions to improve food security

It must not be overlooked that the key determinant of food insecurity is poverty [ 72, 73]. Income and food costs become more powerful determinants of food selection due to wide spread poverty and reliance on social assistance in many Aboriginal communities [ 2]. Suggestions to improve food security in Fort Albany reflect the reality of low incomes and high food costs in the community. However, it is positive that Fort Albany members are keen to start building community capacity and engagement and initiate community-level initiatives to improve their food security. Community-driven initiatives in FN communities tend to result in greater community buy-in and more successful outcomes.

Initiating and maintaining nonconventional agricultural initiatives have the potential for the community to increase self-sufficiency and reduce reliance on imported produce [ 74]. Likewise, hiring community hunters could reduce dependence on meat transported from the south and provide employment. While gardening and farming would require considerable commitment by community residents, it is already gaining momentum in the community and has benefitted from pilot-projects, including a provincially funded "Get Growing" community garden project [ 75] and a pilot agroforestry (local-substitution) project [ 74]. Community gardens have been suggested by other studies as a step towards greater food security and food sovereignty [ 66, 74]. Harvester support programs that subsidize the cost of hunting, fishing, and trapping have been carried out in the Arctic [ 16, 76] and subarctic [ 77] resulting in benefits at the community level.

In 2007 community food champions in Fort Albany began to organize a non-profit 'farmer's market' event every few months. A plane would be chartered to fly in fresh and healthy food to be sold at cost to local residents. This means the prices are at least 50% lower than the same foods sold at the local grocery store because there are no overhead costs. Fort Albany has now started to call their 'Farmer's Markets' an 'alternative market'. The concept of their alternative market has begun to receive attention from a broader audience, has grown into a bi-weekly event and is being supported by external agencies that are aiming to improve northern food systems [ 61]. Awareness by external groups of the alternative market increased after it was presented at a national food security conference in November 2012 [ 78, 79]. While the alternative food market does not move the community food system towards greater self-sufficiency, it can help the community take more control over food pricing of transported foods and may lead to feeling empowered for food system change.

Building an all-season road into the community was suggested by numerous participants, but is a contentious issue. On one hand, having an all-season road would mean the ability to travel by truck to other neighbouring communities - and a year-round land connection to more southerly communities - where food costs are lower even taking into account the added cost of transportation for foods imported into the community. However year-round land access could also have negative consequences, such as the greater ease of transporting drugs and alcohol. Thompson and colleagues [ 80] found that fly-in communities in northern Manitoba generally had more severe and higher rates of food insecurity than those with road or train access.

The participants in this study spoke about the need to increase independence and self-sufficiency with respect to accessing adequate food. They are not alone with this plea as the indigenous food sovereignty movement has been gaining momentum in Canada and has been documented through the People's Food Policy project. They state that the "tribal values of giving, sharing and trading are at the heart of land care and food sovereignty" and that "the core of food sovereignty is reclaiming public decision-making power in the food system." [ 81]. Fort Albany residents did not use the exact term food sovereignty during their interview dialogue, but food sovereignty was, in essence, what they were describing; they expressed a desire and suggested strategies to enhance their independence, self-sufficiency and acquisition of new skills, in addition to advocating for better food security. Food security is a precondition for, and outcome of, food sovereignty. The goal is to achieve food security concurrently with food sovereignty.

The strengths of this research include the large sample of community members that participated in the interviews and the willingness of the respondents in describing their experience of food insecurity despite the sensitivity of the topic. Participants were likely more willing to discuss their perceptions of being food insecure because of their comfort level and rapport with the local community research assistant who conducted the interviews. There were two main limitations of this study: the inability to audio-record the interviews and the generalizability of the results. First of all, although it was deemed inappropriate by the CAC to audio-record the interviews, audio-recording would have allowed the interviewer to focus all of his attention on questioning and listening during the conversation as well as capturing elements of tone and emphasis made by the participants. However, one advantage of the absence of a tape recorder is that it may have led to the relaxed nature of the interviews. Secondly, the findings in this study are not generalizable to individuals living in contexts that vary greatly in terms of food accessibility and availability. For example, those living off-reserve and in more accessible geographic locations where store bought food is considerably less expensive and where traditional food practices are not an integral and important part of the food system.

Conclusions

Aboriginal people in Canada like the remote community of Fort Albany experience staggering rates of food insecurity and it continues to be an urgent and pervasive public health issue. Findings from this study point to the continued importance of traditional food acquisition and food sharing as well as listening to proposed community solutions for food systems change. These data highlight that traditional and store-bought food are both part of the strategies and solutions participants suggested for coping with food insecurity. The findings can be used to inform assessment and program planning activities and to advocate for policies at the local, provincial and federal levels to strengthen community food security, specifically in remote Aboriginal communities. Public health policies to improve food security for FN populations are urgently needed. While short and medium term strategies (e.g., greater employment and building community gardens and greenhouses) are important for initiating food systems change, long term sustainable food systems require policy strategies and instruments to be effective in building and strengthening food security and community capacity. Thompson and colleagues [ 80, 82] have suggested that community economic development and supporting sustainable livelihoods through local food production and local food networks can improve food security and re-establish food sovereignty in northern FN communities.

Fort Albany was at the forefront of the Food Secure Canada conference in 2012 when the newly elected Chief of Fort Albany received a standing ovation for his emotional speech on food sovereignty in remote communities [ 79]. Community members in Fort Albany are speaking up about the need for food systems change, and it appears that their local leaders are listening and supporting their mission. It's time for the provincial and federal governments in Canada to pay attention and to work with remote communities towards greater food security and to support a vision for food sovereignty.

Abbreviations

FN:

First Nations

CAC:

Community Advisory Committee

HFSSM:

Household Food Security Survey Module

Acknowledgements

The authors are grateful to all the community members that participated, the Community Advisory Committee, the community research assistant who collected the data and for the support of Fort Albany First Nation. The lead author was supported by a Doctoral Research Award from the Canadian Institutes of Health Research and an Ontario Graduate Scholarship. This study was funded by the Canadian Institutes of Health Research, the Social Science and Humanities Research Council of Canada and the Canadian Foundation for Dietetic Research.

Author information

Affiliations

1. School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Kelly Skinner, Rhona M Hanning & Leonard JS Tsuji

2. Department of Geography and Environmental Management, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Ellen Desjardins

3. Department of Environment and Resource Studies, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada

Leonard JS Tsuji

Corresponding author

Correspondence to Kelly Skinner.

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Competing interests

The authors declare that they have no competing interests.

Authors' contributions

KS, RH and LT designed and coordinated the study. KS conducted the qualitative analysis and wrote the manuscript. ED assisted with analysis. All authors read and approved the final manuscript.

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Giving voice to food insecurity in a remote indigenous community in subarctic Ontario, Canada: traditional ways, ways to cope, ways forward - BMC Public Health

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Background Food insecurity is a serious public health issue for Aboriginal people (First Nations [FN], Métis, and Inuit) living in Canada. Food security challenges faced by FN people are unique, especially for those living in remote and isolated communities. Conceptualizations of food insecurity by FN people are poorly understood.

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Abstract

Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises. In 2015, the Canadian government affirmed their responsibility for indigenous inequalities following a historic report by the Truth and Reconciliation Commission of Canada. It has outlined intergenerational traumata imposed upon Aboriginals through decades of systemic discrimination in the form of the Residential School System and the Indian Act. As these policies have crossed multiple lifespans and generations, societal conceptualization of indigenous health inequities must include social determinants of health (SDOH) intersecting with the life course approach to health development to fully capture the causes of intergenerational maintenance of poor health outcomes. To provide culturally sensitive care for those who have experienced intergenerational trauma, health care providers should be aware of and understand two key SDOH inequity influencing the indigenous life course, including the residential school system and loss of socioeconomic status, over time due to colonialism.

Keywords: Aboriginal, Canada, colonialism, health equity, social determinants of health

Introduction

Compared to the general population, indigenous Canadians suffer from disproportionate increases in diabetes, hypertension, substance abuse, mental health concerns, and overall morbidity and mortality in addition to having significantly reduced life expectancy. To conceptualize the origins of these disparities, exploring the social determinants of health (SDOH) can provide a strong framework of understanding. Proximal SDOH are often relied upon to explain inequities on a social scale as they include direct health-related behaviors, physical environments, and socioeconomic status (SES). Systems level influencers such as the health care system, education system, community, environmental stewardship, and cultural continuity have been deemed intermediate SDOH, while colonialism, racism, and self determination have been identified as distal SDOH. Focus will be given to the most pertinent distal SDOH for indigenous Canadians, colonialism, and how it has shifted the trajectories of the intermediate and proximal SDOH to produce intergenerational health inequities.

For Aboriginal populations, health is an overarching concept through the stages of life that comprise physical and mental wellbeing, as well as spiritual and cultural cohesion. Thus, effective indigenous health policies must be culturally sensitive and not impose definitions of health from ethnocentric perspectives. By definition, colonial policies contained culturally insensitive agendas to promote assimilation. The residential school system promoted family separation and cultural dissociation during childhood and adolescence, critical stages in the life course approach to health development (LCHD) that determine cognitive and social capacity into early adulthood and beyond. By utilizing the LCHD, a theory that traces health problems back to specific stages of life and their associated SDOH, it is possible to understand how cumulative disadvantages imposed upon Aboriginals have not only caused health inequities but also intergenerational trauma.

Residential School System

The residential school system was a highly controversial policy which instigated the dissociation of spiritual and cultural cohesion within Aboriginal communities. It was one of the most compelling pieces of evidence illustrating the nature of colonialism and its deleterious policies that caused the decline of indigenous populations in not only their overall health but also their sociocultural functioning. When the Indian Act was passed in 1876, this provided the foundation for the residential school system until 1996 when the last federal residential school was closed. The Canadian government mandated this policy to facilitate the assimilation of Aboriginal children into Euro-Canadian culture. Childhood and adolescence are vital times of cognitive learning and relationship maturation, so it is important to consider the impact of the residential school system on indigenous health with respect to the LCHD. In childhood, access to quality education is a protective factor for future health status because it promotes academic and social skills development, increases health literacy, and enables positive interpersonal development. However, this is only possible if the educational setting is provisioned with caring instructors, support networks, and ample resources to maintain a rich learning environment. The residential school system was not designed to provide any of these essential resources. Children were taken from their families to attend residential schools by government officials, placing extreme emotional stress on indigenous parents and their children. Being forced to attend against their will, over 81.3% of students felt isolated from their families. Family separation in childhood has been shown to be a major risk factor for mental disorders such as depression. Indeed, the literature has shown that family stress can cause dysregulation in brain function later in life. These findings demonstrate how family disruption may have negatively influenced Aboriginal mental health at later stages in the LCHD due to colonial policies. In school, ethnocentric rules were mandated and children were banned from speaking their native language or practicing any cultural customs. A study found that 76.8% of students recognized a significant loss in cultural identity due to their residential school experience. While our society may not include cultural identity in the definition of health, Aboriginals consider cultural cohesion to be strongly related to their health. Therefore, loss in cultural identity was a loss of health due to the residential school system instigated through colonial perspectives. Instructors enforcing these policies further contributed to the problem by verbally, emotionally, and even physically abusing students. As a child, negative relationships with caregivers and teachers can have serious implications on behavior, adjustment, and attitudes in adolescence and early adulthood. Childhood abuse has also been linked to poor health status, leading to increased hospitalizations for physical and psychological illnesses in adulthood. In a 2012 study by Elias et al., 48.1% of residential school attendees reported an abuse history, and those who were abused experienced increased rates of suicidal thoughts and suicide attempts. An important aspect of the child-teacher relationship is closeness, which is positively correlated with success in school and personal initiative. The abuse experienced by these children eliminated any possible positive outcomes related to academic success and ambition that residential schools were supposed to promote which is evident today by more than half of the Canadian Aboriginal population without high school diplomas. For students who managed to graduate, ineffective education resulting from trauma, cultural inhibition, and racism by teachers led to reduced employment opportunities and decreased SES. Clearly, the residential school system was detrimental to the indigenous population and paved the way for dysfunctional social and cognitive development in countless generations of Aboriginal children even after residential school policies were removed. The LCHD views health on a continuum, and as such, the survivors of the residential school system were not the only ones affected. Attendees who experienced trauma may exhibit not only intragenerational reduced health status but they also pass on their competencies or perhaps, lack of competencies, to future generations. Being in an indigenous family with residential school history has been linked to increased stress and decreased overall wellbeing, supporting the finding that colonialism has resulted in cumulative health disadvantage for existing generations of Aboriginals even if they did not directly live through colonial policies. Nonattendees of parents who were residential school survivors experience increased abuse which appears to solidify the concept of intergenerational trauma. Personal interviews revealed that the attendees felt that their parenting abilities were inadequate due to the lack of practical education and overall trauma they lived through. These individuals who did not gain key competencies and developed negative relationships in their childhood and adolescence at residential schools were likely to reproduce such environments for their offspring, causing a vicious cycle of health disadvantage. This meant that their children would also be less able to cope with stressors in life, leading to negative health outcomes.

Loss of SES

The residential school system ultimately limited employment opportunities for Aboriginals, which led to reduced SES. This was exacerbated by the lack of economic development in indigenous communities because the Canadian government implemented economic policies that focused on development in new or unseated lands from Aboriginals. The reserve system was one of the colonial policies that mediated economic isolation in indigenous communities. By placing Aboriginals on reserves and providing them with minimal financial support and no sustainable economic opportunities, the government forced them to integrate into new settler communities or succumb to relative poverty. Today, we know that many people on reserves suffer from impoverished living conditions and report that the lack of resources contribute to their economic insecurity. SES has been strongly correlated with health outcomes which is known as the socioeconomic gradient in health. People with lower SES tend to have reduced health status compared to their higher SES counterparts. This is a global phenomenon and the indigenous population is no exception. The unemployment rate is over two times higher for Aboriginal people relative to the general population. Unemployment has been linked to increased physical and mental illness and mortality, further supporting low SES as a risk factor for poor Aboriginal health. The health consequences of poor economic development and SES in indigenous communities are aggravated by the lack of access to basic goods and services such as healthy foods and medical support. A significant number of Aboriginals cannot afford medical treatment or transportation to hospitals, illustrating the severity of relative poverty being experienced on reserves. Their ability to access appropriate medical attention is limited by their low SES, which is a direct causative relationship to the poor health seen in Aboriginal communities across the nation. Furthermore, the lack of healthy food options act in synergy with low SES. For example, women with low income tend to be more obese than women with high income, which is intensified when Aboriginals cannot access any healthy foods. Children are more likely to be obese if their parents are obese, indicating that behaviors related to health are learned directly from parents. As obesity is associated with morbidity and increased risk for disease, this poses evidence for negative health outcomes later in life due to low SES impacting early childhood behavioral development. With the prevalence of food insecurity caused by low SES in Aboriginal families, it is possible to conclude that poor diet plays a key role in the health inequities seen on reserves. Moreover, nutrition is tightly tied to academic success, and children with low SES are less likely to succeed in school resulting in higher unemployment. Therefore, indigenous children from low SES families may not be able to work to their full potential in school due to inadequate nutrition, leading to health disadvantage later in life. Poor nutrition is a cumulative process because the body relies heavily on the food resources available during childhood and adolescence to determine physical abilities, cognition, and health outcomes in adulthood and beyond. With a compromised diet, as seen in many indigenous communities with low SES, children can experience poor physical and mental growth and increased susceptibility to disease in adulthood.

Conclusion

The effects of colonialism on the Canadian Aboriginal population are far-reaching and evident in the health inequities seen today. The LCHD can be used to illustrate the impact of colonial policies on existing and future generations because it provides a platform to study the SDOH through the LCHD within the Aboriginal community and helps us define indigenous health in a culturally sensitive manner. While there have been many detrimental policies such as the residential school system and reserve system, we can study how the intentions and implementations of these policies can be changed for positive outcomes. Although the intergenerational impact of colonialism on Aboriginals has manifested itself in negative health outcomes, affirmative action can be taken to break the cycle of cumulative health disadvantages. Understanding and integrating historical knowledge into trauma informed care will also prove beneficial for this population and improve relationships between health care providers and indigenous patients. We can ensure that health at each life stage, particularly at sensitive stages such as childhood and adolescence, is addressed according to the needs of Aboriginals by directly working together with indigenous patients and communities.

Acknowledgments

The author has been privileged with life experiences from friends, family, and patients alike through his medical training to have contributed to perspectives seen in this article.

Abbreviations Used

Author Disclosure Statement

No competing financial interests exist.

Cite this article as: Kim PJ (2019) Social determinants of health inequities in indigenous canadians through a life course approach to colonialism and the residential school system, Health Equity 3:1, 378-381, DOI: 10.1089/heq.2019.0041.

References

# data[].attributes.attachment_link.title
Social Determinants of Health Inequities in Indigenous Canadians Through a Life Course Approach to Colonialism and the Residential School System

# data[].attributes.attachment_link.description
Indigenous populations in Canada have experienced social, economic, and political disadvantages through colonialism. The policies implemented to assimilate Aboriginal peoples have dissolved cultural continuity and unfavorably shaped their health outcomes. As a result, indigenous Canadians face health inequities such as chronic illness, food insecurity, and mental health crises.

# data[].attributes.attachment_link.readable_text
Introduction

Background

Socio-economic well-being of First Nations people

5.1 According to Indigenous Services Canada, in December 2017, there were almost one million (987,520) individuals registered under the Indian Act, belonging to one of 618 First Nations or unaffiliated with a specific First Nation. Slightly more than half of the registered population (509,016) live on reserve or Crown land. Unless otherwise specified, "First Nations people" in this report refers to First Nations people on reserves.

5.2 First Nations people tend to have significantly lower socio-economic well-being than other Canadians. Socio-economic well-being can be measured by tracking indicators in areas such as education, income, and health. Closing socio-economic gaps means improving the social well-being and economic prosperity of First Nations people living on reserves.

Data for gauging progress in improving lives

5.3 To close socio-economic gaps and improve lives on reserves, federal decision makers and First Nations need information about the socio-economic indicators of First Nations people that is reliable, relevant, and up to date.

5.4 Indigenous Services Canada requires First Nations to provide extensive data about their on-reserve members. The Department also obtains data from Statistics Canada, other federal government departments, Indigenous organizations, and other sources.

5.5 Improving the lives of First Nations people requires a long-term approach. The first step in improving the lives of First Nations people is knowing what the current socio-economic gaps are. The second step is to regularly measure the gaps: If the gaps are not smaller in future years, it will mean that progress has not been made, which would mean that federal programs need to change. The federal government has access to data that can be used to inform decisions on federal programs and support and that can help effect real change and improve lives.

Federal commitments and the Truth and Reconciliation Commission

5.6 The federal government has made numerous commitments to meet Canada's obligations to First Nations, Inuit, and Métis people. Indigenous and Northern Affairs Canada was the lead government department responsible for meeting such commitments. The Department's mandate was to support Indigenous and northern peoples in their efforts to

improve social well-being and economic prosperity;

develop healthier, more sustainable communities; and

participate more fully in Canada's political, social, and economic development.

5.7 In August 2017, the federal government announced the dissolution of Indigenous and Northern Affairs Canada and the creation of two departments: Indigenous Services Canada, and Crown-Indigenous Relations and Northern Affairs. We audited Indigenous and Northern Affairs Canada before August 2017 and, afterward, the newly formed Indigenous Services Canada, which is now the responsible department. Hereafter, this report refers only to Indigenous Services Canada.

5.8 The Truth and Reconciliation Commission of Canada, created in 2008, had a mandate to inform Canadians about what happened in Indian residential schools. The Commission's final 2015 report included 94 calls to action, many of which referred to the socio-economic factors discussed in this audit. In 2015, the government committed to implementing these calls to action, coordinated by Indigenous Services Canada, including commitments to

jointly develop strategies to eliminate education and employment gaps;

identify, measure, and close the gaps in health outcomes between First Nations and other Canadian communities; and

prepare and publish annual reports on these and other issues.

5.9 Also in 2015, the federal government committed to a renewed relationship with Indigenous people, based on rights, respect, cooperation, and partnership. The Department's 2017-18 Departmental Plan forecast that it would spend about $10 billion to carry out its mandate.

5.10 In his mandate letter of November 2015, the Prime Minister directed the Minister of Indigenous and Northern Affairs to make real progress on issues essential to Indigenous communities, such as housing, employment, health care, community safety, child welfare, and education.

5.11 In 2000 and 2004, the Office of the Auditor General of Canada released reports highlighting the significant education gap between First Nations people on reserves and the Canadian population as a whole. These reports included recommendations to Indigenous Services Canada to improve its education programs and support for Indigenous post-secondary students. In the 2011 June Status Report of the Auditor General of Canada, Chapter 4-Programs for First Nations on Reserves, the Office criticized the federal government's progress in improving the lives and well-being of people on reserves.

Focus of the audit

5.12 This audit focused on whether Indigenous Services Canada satisfactorily measured and reported on Canada's overall progress in closing the socio-economic gaps between on-reserve First Nations people and other Canadians. It also focused on whether the Department made adequate use of data to improve education programs to close the education gap and improve socio-economic well-being.

5.13 Our reasons for examining the Department's education programs include that

education is critical to improving well-being on reserves;

Indigenous Services Canada is the federal department responsible for providing education support for on-reserve First Nations students, and education has been the Department's largest program in terms of overall spending; and

Indigenous Services Canada collects significant amounts of education data from First Nations.

5.14 This audit is important because Indigenous Services Canada-the lead federal department responsible for managing federal support to improve quality of life for on-reserve First Nations people-needs to collect and analyze appropriate data to know whether its approach to improving lives on reserves is working.

5.15 We did not examine the performance of non-federal organizations, First Nations communities, or First Nations organizations. Nor did we assess whether the amount of money spent on programs and services on reserves was adequate.

5.16 More details about the audit objective, scope, approach, and criteria are in About the Audit at the end of this report.

Findings, Recommendations, and Responses

Measuring well-being on First Nations reserves

The Department did not have a comprehensive picture of the well-being of on-reserve First Nations people compared with other Canadians

5.20 Our analysis supporting this finding presents what we examined and discusses the following topics:

5.21 First published in 2004, the Department's Community Well-Being index is its only publicly available overall measure of the socio-economic well-being of First Nations communities in comparison with other Canadian communities. The index is based on 1981 to 2011 census program data collected every five years for all Canadian communities, including First Nations that have a population of at least 65. The index measures four components:

education (high school and post-secondary graduation),

labour force (participation and employment),

income (total per capita), and

housing (overcrowding and need for major repairs).

5.22 The issues contributing to the socio-economic gaps between First Nations people and other Canadians are complex and challenging, and solutions depend on collaboration among First Nations, the federal and provincial governments, and other parties.

5.23 Our recommendation in this area of examination appears at paragraph 5.37.

Analysis to support this finding

5.24 What we examined. To determine whether Indigenous Services Canada adequately measured and reported on overall progress in closing socio-economic gaps between First Nations communities and other Canadians, we examined the Community Well-Being index, departmental documentation, and selected publicly available information. We also interviewed Department officials and representatives from selected provinces, First Nations, and First Nations organizations. In addition, we calculated rates of on-reserve and overall Canadian high school graduation (or equivalent) from 2001 to 2016.

5.25 Inadequate measurement of well-being. We found that the Department did not adequately measure well-being for First Nations people on reserves. The Community Well-Being index measured only four components of well-being: education, employment, housing, and income. While these are important aspects of well-being, the index did not include critical variables such as health, environment, language, and culture. First Nations have identified language and culture, in particular, as critical to their well-being.

5.26 Although the Department recognized that the index was incomplete, it did not modify the index to make it more comprehensive or establish a more complete measure or set of measures for assessing the well-being of on-reserve First Nations people.

5.27 In 2015, all member countries of the United Nations General Assembly, including Canada, adopted the 2030 Agenda for Sustainable Development. The 2030 Agenda contains 17 sustainable development goals and 169 associated targets for achieving economic growth, social inclusion, and environmental protection. The 2030 Agenda is intended to mobilize global efforts to ensure healthy lives, end poverty, and fight climate change. In our opinion, Canada's results against those 17 goals for First Nations people would likely be significantly worse than those for the whole Canadian population. In fact, according to the 2011 Community Well-Being index, 98 of the 100 lowest-scoring Canadian communities were First Nations communities.

5.28 From 2001 to 2011, the Community Well-Being index showed that gaps for all four components had widened. According to Indigenous Services Canada, between 2006 and 2011, about one third of First Nations communities (compared with one fifth of other Canadian communities) experienced a decline in the index scores. As of December 2017, the Department had not yet updated the Community Well-Being index with 2016 Census data.

5.29 Limited use of available data. We found that the Department could have used the volumes of available data from multiple sources to more comprehensively compare well-being relative to other Canadians and across First Nations communities, but did not. The Department had data and access to data from public sources, other departments, and First Nations, but did not include it in either the Community Well-Being index or another comprehensive measure or set of measures. We identified numerous sources of potentially useful data:

The Department's internal First Nation Community Profiles contained a large amount of data, including information on housing needs and water quality.

Employment and Social Development Canada collected data about participation in skills training that Indigenous people received through the Aboriginal Skills and Employment Training Strategy and the Skills and Partnership Fund programs. These programs are intended to support Indigenous people in obtaining professional and industry certificates, diplomas, or degrees, as well as work experience and employment.

Health Canada collected information about First Nations health, including information about oral health services and benefits that it provided to First Nations, as noted in the 2017 Fall Reports of the Auditor General of Canada, Report 4-Oral Health Programs for First Nations and Inuit-Health Canada. The First Nations and Inuit Health Branch, which was responsible for that program at Health Canada, has since been transferred to the newly formed Indigenous Services Canada.

In 2015, the Provincial Health Officer of British Columbia and the First Nations Health Authority issued a joint report, entitled First Nations Health and Well-being: Interim Update. This report provided an update on progress made on seven indicators: life expectancy, mortality rate, youth suicide rate, infant mortality rate, diabetes prevalence, childhood obesity, and the number of practising certified First Nations health care professionals.

Provinces had data on how many Indigenous children were placed in the care of families with one or more Indigenous members, rather than in families with no Indigenous members. A different culture and language could make it more difficult for children to adjust to the new family environment.

The First Nations Regional Health Survey 2008-10, conducted by the First Nations Information Governance Centre, identified the prevalence of chronic health conditions reported by First Nations adults on reserves across Canada.

5.30 Department officials told us that it did not incorporate this additional data into the Community Well-Being index because comparative data for other Canadian communities was not available. In our view, the Department should make better use of such data to more comprehensively assess and understand First Nations well-being in comparison with that of other Canadian communities, and to measure whether progress is being made.

5.31 In 2000, Indigenous Services Canada committed to measuring and reporting on the education gap every two years. As of December 2017, we found that the Department had not met this commitment. The index included a score for each of its four components, including education, to produce an overall score of well-being every five years. For example, in 2011, the average education score for First Nations communities was 36, while for Canadian non-Indigenous communities, it was 53. In our view, these scores did not provide a meaningful picture of the education gap because they did not provide a clear way to measure and report on education results.

5.32 Using census program data, we calculated on-reserve and overall Canadian high school graduation (or equivalent) levels from 2001 to 2016 ( Exhibit 5.1). We found that, while results for First Nations had improved, the results for all Canadians had improved by a greater amount: The gap was 30 percentage points in 2001 and 33 percentage points in 2016. In our view, this is a clearer way to measure and report on education results and would help to provide a more meaningful picture of well-being.

5.33 Incomplete reporting on well-being. We found that Indigenous Services Canada did not issue a comprehensive report on the overall socio-economic well-being of First Nations people on reserves. In comparison, we noted that, since 2009, the Prime Minister of Australia has issued annual reports, called Closing the Gap, with progress on improving the socio-economic well-being of Australian Indigenous people. These reports outline where more work is needed ( Exhibit 5.2).

5.34 Lack of meaningful engagement. Indigenous Services Canada did not work with First Nations to develop the Community Well-Being index, first published in 2004. Since then, we found that the Department has not revised the index to include language and culture or developed another comprehensive set of measures to assess First Nations well-being.

5.35 In July 2016, the Department engaged with First Nations and the Assembly of First Nations in a national forum to discuss criteria to measure First Nations students' success. This work was targeted for completion by December 2017. We found that, in July 2017, the Chief's Committee on Education directed First Nations representatives to stop working with Indigenous Services Canada. The Committee was concerned that federal processes did not allow enough time to develop measurement frameworks to reflect the diversity, autonomy, and authority of First Nations communities and education systems.

5.36 The federal government recognizes that engaging meaningfully with First Nations is essential to its mission of working together to make Canada a better place for Indigenous and northern peoples and communities. Given this mission, it is our view that greater efforts needed to be made to measure and report on the overall well-being of on-reserve First Nations people compared with that of other Canadians.

5.37 Recommendation. Through engagement with First Nations and other partners, Indigenous Services Canada should use relevant data to comprehensively measure and report on the overall socio-economic well-being of First Nations people on reserves compared with that of other Canadians. The Department should also measure and report on those additional aspects of socio-economic well-being that First Nations have identified as unique priorities, such as language and culture, which might not be directly comparable with other Canadians.

The Department's response. Agreed. Indigenous Services Canada will build on the Community Well-Being index by co-developing, with First Nations and other partners, a broad dashboard of well-being outcomes that will reflect mutually agreed-upon metrics in measuring and reporting on closing socio-economic gaps. Much of this work is already under way with the Assembly of First Nations and other partners in the co-development of a new fiscal relationship. This includes a shared vision of mutual accountability and the co-development of a national outcome-based framework that leverages the United Nations' 2030 sustainable development goals. As a part of the co-development, the Department will continue to work closely with First Nations to ensure that the broader reporting of First Nations' well-being integrates other outcomes and measures that are important to them.

Collecting, using, and sharing First Nations' education data

5.40 The goal of Indigenous Services Canada's Elementary and Secondary Education Program is to help eligible students on reserves achieve levels of education that are comparable with those of other Canadian students. Through various funding arrangements with the Department, First Nations deliver education on reserves, buy education services from school boards, or combine these two approaches. There are also seven federally operated schools on reserves. In all cases, the Department requires First Nations to provide data about their education programs.

5.41 At the post-secondary level, Indigenous Services Canada aims to help First Nations students develop job skills by giving them financial support for education and skills development. The Department transfers funds to First Nations for eligible students, whether they live on or off reserves. All First Nations recipients are required to report the results and related spending information for funded post-secondary students.

5.42 The Office of the Auditor General reported on Indigenous Services Canada's education programs in 2000, 2004, and 2011. In response to our past recommendations, the Department made commitments to closing the education gap. In particular, 18 years ago (in 2000), the Department promised to

develop and use appropriate performance indicators,

develop and use comparative cost information, and

publish a report every two years on progress toward closing the education gap between on-reserve First Nations students and other Canadians.

The Department did not collect data needed to improve education results

5.44 We found that Indigenous Services Canada did not collect data it needed to improve education results. In particular, it did not collect

information about education, such as teachers' years of experience or student participation rates;

information about post-secondary graduation rates; and

information to compare First Nations students' education levels with those of other Canadians.

5.45 Furthermore, we found that the Department did not assess relevant data it did collect, to determine whether it was accurate and complete. For example, it did not know to what extent First Nations students were graduating from high school with diplomas recognized by post-secondary institutions, or with completion certificates, which the Department acknowledged might not be recognized by these institutions.

5.46 Our analysis supporting this finding presents what we examined and discusses the following topics:

5.47 This finding matters because reliable, relevant, and up-to-date data is essential to making evidence-based decisions for improving education levels for First Nations students. When First Nations students are unable to proceed to higher education, their socio-economic status is also likely to suffer over the long term.

5.48 Our recommendation in this area of examination appears at paragraph 5.83.

Analysis to support this finding

5.49 What we examined. We examined whether Indigenous Services Canada collected information to measure and report on First Nations' education results, such as graduation rates. We also analyzed this data for accuracy and completeness.

5.50 Not collecting relevant data. In 2010, Indigenous Services Canada developed the Education Performance Measurement Strategy to measure results for First Nations students and schools and to determine whether its students achieved education results comparable with those of other Canadian students.

5.51 We found that the Department did not collect the information needed to compare First Nations' education results with those of other Canadian students. For example, it did not collect provincial or national data on standardized test scores and student attendance rates to allow for comparisons. Without this information, the Department did not know whether its approach to managing programs to educate First Nations students was helping to close the education gap.

5.52 We also found that the Department did not collect important data from First Nations on primary and secondary education programs. For example, the Department did not collect data about teacher experience or student participation rates. Without this data, the Department did not have a complete picture of First Nations' education programs.

5.53 We also found that the Department did not have data about post-secondary graduation rates for on-reserve First Nations students. Nor did it collect complete data on the number of First Nations students who wanted to pursue post-secondary education but could not access the funds to do so. Despite commitments by the Department to review these issues in 2004, it was still unable to report on the extent to which its support for First Nations' post-secondary education improved student results or whether its delivery model ensured that eligible students had equitable access to post-secondary education funding.

5.54 Not assessing relevant data. We found that the Department did not distinguish between high school diplomas and high school completion certificates. According to the Department, the certificates might not be recognized by post-secondary institutions. We found that, for the 214 First Nations schools that offered Grade 12 in the 2016-17 fiscal year, the Department did not collect information on the type of diploma or completion certificate provided to First Nations students. Similarly, the Department did not collect this information about First Nations students attending provincially operated schools.

5.55 Using analysis that the First Nations Education Steering Committee conducted on data collected by the Ministry of Education in British Columbia, we calculated that between the 2012-13 and 2015-16 fiscal years, about 14.5% (380 of 2621) of on-reserve students who finished high school received completion certificates. In comparison, only 2% (2,365 of 118,250) of non-First Nations students in British Columbia received completion certificates over the same period. In our view, by not distinguishing between official diplomas and completion certificates, the Department and First Nations could not determine how many First Nations graduating students might not be eligible to attend post-secondary institutions.

The Department did not adequately use data to improve education results

5.56 We found that Indigenous Services Canada did not adequately use data to improve education results. We found data the Department had collected that could have been used to improve education programs, but was not. For instance, the Department did not analyze First Nations students' literacy levels to determine how they compared with those of other Canadians. Nor did it assess whether departmental support was achieving expected results, or how the support could be improved.

5.57 We also found that the Department had not adequately used data to determine education funding. We found that it was unclear to what extent funding decisions considered First Nations students' unique education needs and important factors affecting costs. We found that, despite its commitment to do so in 2000, the Department did not report on how federal funding for on-reserve education compared with funding in other Canadian education systems.

5.58 Our analysis supporting this finding presents what we examined and discusses the following topics:

5.59 These findings matter because low graduation and literacy rates have a negative impact on the lives of on-reserve First Nations people-in particular, through reduced employment opportunities. Because the education gaps are complex-varying by region, population, student age, and over time-closing the gap requires the use of data that is accurate, comprehensive, and up to date.

5.60 Our recommendation in this area of examination appears at paragraph 5.83.

Analysis to support this finding

5.61 What we examined. We examined whether Indigenous Services Canada used data to improve education program results relative to those of other Canadians. We also looked at whether it used data to inform funding decisions and whether it had reported on how federal funding for on-reserve education compared with funding in other Canadian education systems.

5.62 Inadequate use of data to improve education programs. In 2008, Indigenous Services Canada identified literacy as a national priority. According to the Department, research has shown that literacy has a strong impact on future potential careers, socio-economic stability, and decision-making abilities. As well, literacy improves education results and student retention during a student's entire educational career.

5.66 According to the Department's estimate, in one region, the cost of providing education to students over 21 was about $15 million in the 2011-12 fiscal year. Department officials told us that if students were in school when they turned 22, they would continue to be funded. However, older students requesting to return to school were denied funding. In our view, the Department could explore ways to help First Nations students over 21 years old complete secondary education.

5.67 Inadequate use of data to inform funding decisions. Through a combination of core and supplemental programs, Indigenous Services Canada funded eligible on-reserve First Nations students to attend First Nations-operated, federal, private, or provincial schools.

5.68 In 2000, the Department committed to developing and using comparative cost information. This information is important for ensuring that First Nations students receive education comparable to that of other Canadians. Knowing these costs is important for developing an effective education strategy, closing the education gap, and meeting the education needs of First Nations students living on reserves. However, we found that, as of 2017, this work was still not complete, and that the Department was still unable to report how federal funding for on-reserve education compared with funding levels for other education systems across Canada.

5.69 We also found that, in arriving at its core funding decisions, it was not clear to what extent the Department accounted for the unique needs of First Nations students. For example, education costs could increase or decrease, depending on important factors affecting costs, such as

geographic isolation of many First Nations communities;

small school populations, common in many First Nations communities;

the first language of First Nations students (English or French not being the first language for a significant number of First Nations); and

difficulty in attracting and retaining qualified educators.

According to the Department, its method of calculating core education funding for First Nations had not substantively changed since the late 1990s. The formula relied on historical and out-of-date population data and did not consistently account for the above important factors in costing.

5.70 To supplement its core education funding budget, the Department received an additional $2.6 billion over five fiscal years, from 2016-17 to 2020-21. We found that the Department's analysis to support this amount was insufficient. For example, included in this amount was $577.5 million, or $115.5 million annually, for the High-Cost Special Education Program. The only evidence the Department provided to substantiate the annual $115.5 million increase was that spending on this program had exceeded the budget by $22 million in the 2012-13 fiscal year. The Department also determined that about 4,400 of the 13,000 students in the program required a new or updated assessment, but it did not provide a cost estimate for doing the needed assessments.

The Department required considerable education data from First Nations but did not share the resulting analyses with them

5.72 We found that, although First Nations communities were required to supply extensive education data to Indigenous Services Canada, the Department did not provide the promised access to its Education Information System. Therefore, First Nations could not access the resulting information and analyses.

5.73 Our analysis supporting this finding presents what we examined and discusses the following topics:

5.74 This finding matters because without access to education data and related analyses, First Nations communities cannot meaningfully engage with Indigenous Services Canada to improve education results or identify initiatives that would contribute to student success.

5.75 Our recommendation in this area of examination appears at paragraph 5.83.

Analysis to support this finding

5.76 What we examined. We reviewed information on the Education Information System and the volume of information that First Nations were required to provide. We examined whether the Department shared useful analyses of this data with First Nations.

5.77 Limited access by First Nations to the Department's Education Information System. In 2008, the Department proposed that it would develop a system to capture First Nations' education program data, which First Nations could access as well.

5.78 In 2010, the Department again committed that the system would be a shared information resource with First Nations. The Department also identified the need to reduce the reporting burden to First Nations. First Nations were required to provide 20 annual reports, using data gathered from about 1,500 sources, including

119,000 elementary and high school students,

19,000 post-secondary students,

450 reports on proposal-based education initiatives, and

activities by 110 cultural education centres.

5.79 A December 2015 internal audit of the system found that First Nations had only limited access to reporting tools to compare, for example, how students in their communities were doing relative to those from other regions. Furthermore, First Nations received little training on how to use the system. The audit also found that some regions were using their own processes and tools to track and report on education data, which increased their workload.

5.81 High administrative burden for First Nations. First Nations told us that the reporting requirements related to education programs were burdensome. We found that, in the 2017-18 fiscal year, the Department's education reporting requirements included up to 13 forms with 920 data fields. Many of these fields had to be filled in for each student supported by the Department-about 107,000 elementary and secondary and an estimated 24,000 post-secondary students in the 2016-17 fiscal year.

5.82 We also found that the Department did not use much of the data it collected to improve education results (as detailed in paragraphs 5.62 to 5.66) or inform important funding decisions ( paragraphs 5.67 to 5.71). Furthermore, First Nations and their organizations did not have full access to the education information gathered, or to the related analyses ( paragraphs 5.77 to 5.80). In our view, not using this data created an unnecessary administrative burden for First Nations.

5.83 Recommendation. Through engagement with First Nations and other partners, Indigenous Services Canada should collect, use, and share data with First Nations appropriately to improve education results of First Nations people on reserves.

The Department's response. Agreed. Indigenous Services Canada has invested in relationships with First Nations to manage data related to education, including ongoing collaboration to identify meaningful education results that would replace the current approach. These renewed education goals, together with agreed-upon measures and a data collection strategy, will be developed as part of the upcoming education transformation for elementary, secondary, and post-secondary education. In the meantime, the Department is actively exchanging data with First Nations to support education transformation.

Reporting on First Nations' education results

The Department's reporting was incomplete and inaccurate

5.87 Our analysis supporting this finding presents what we examined and discusses the following topics:

5.88 Treasury Board policies require departments to develop valid and reliable indicators with measurable targets and to obtain reliable, regular, and accurate data to monitor and report on progress.

5.89 Our recommendation in this area of examination appears at paragraph 5.98.

Analysis to support this finding

5.90 What we examined. We examined whether Indigenous Services Canada publicly reported complete and accurate information on its overall progress on closing the education gap between on-reserve First Nations students and other Canadians. We also examined data from the Department's Education Information System to determine whether the high school graduation rate accounted for students who withdrew from school before starting Grade 12.

5.91 Incomplete reporting. In 2000, the Department committed to developing appropriate performance indicators and publishing a report every two years on closing the education gap between on-reserve First Nations students and other Canadians. In 2010 and 2014, Indigenous Services Canada developed Education Performance Measurement Strategies that committed to specific performance measures.

5.92 We found that the Department did not report results for most of the measures. In particular, its 2014 strategy contained 23 specific measures, but we found that the Department never reported on 17 of them. For example, it did not report on student attendance and First Nations' language instruction. We also found that, despite the ultimate objective of both strategies that First Nations achieve levels of education comparable to those of other Canadians, the Department did not compare First Nations results with the results of other Canadians for measures in either strategy. We noted that British Columbia published an annual report comparing the education results of Indigenous students with those of non-Indigenous students ( Exhibit 5.3). This type of report offered a good example of how the Department could report on education results.

5.93 We also found that Indigenous Services Canada did not report against consistent targets for the performance measures it had identified in its 2010 and 2014 strategies. Setting consistent and measurable targets helps to improve results and achieve systemic change. Yet, in the seven fiscal years from 2010-11 to 2016-17, the Department reported the First Nations' high school graduation rate for six years and the available literacy rates for four years. During this period, the Department's target for graduation rates changed four times, and it did not develop a specific target for literacy rates until the 2016-17 fiscal year.

5.94 Inaccurate reporting of graduation rates. We found that the Department's reported graduation rate for on-reserve First Nations students was inaccurate. It reported a graduation rate that included only students enrolled in their final year of high school. This meant that the reported graduation rate was overstated, because students who dropped out in grades 9, 10, and 11 were excluded from the Department's calculation. Using data only from a student's final year of high school is inconsistent with how most provincial governments and the Council of Ministers of Education calculate graduation rates. For example, Manitoba divides the total number of graduates by the total number of students who were enrolled in Grade 9 four years earlier.

5.95 Using departmental data from the 2011-12 to the 2015-16 fiscal years, we calculated a graduation or completion rate that accounted for all students who dropped out in grades 9, 10, and 11 ( Exhibit 5.4). We found that these rates were 10 to 29 percentage points lower than those reported by the Department. This means that the Department's reported data showed, on average, that about one in two (46%) First Nations students graduated. However, our calculations showed that, on average, only about one in four (24%) students who started Grade 9 actually completed high school within 4 years. In our view, anyone relying on departmental information would not be fully informed. For example, the Department reported that graduation rates between the 2014-15 and 2015-16 fiscal years had improved-while we found that they had worsened.

5.96 In addition, the Department's reported graduation rate (see Exhibit 5.4) included both students who graduated with provincially recognized high school diplomas (or their equivalents) and those who received high school completion certificates (or their equivalents). Yet students with completion certificates might not have been eligible for enrolment in post-secondary institutions. In our view, these different rates should be reported separately. We note that, because of this issue, our calculated rates in Exhibit 5.4 are also overstated, because the Department's data did not distinguish between high school graduation and completion.

5.98 Recommendation. Indigenous Services Canada's reporting on First Nations' education results should be complete and accurate.

The Department's response. Agreed. Indigenous Services Canada is actively working with First Nations to transform elementary and secondary education, and will be co-developing renewed education outcomes, measurements, and a related data strategy. Likewise, the Department is working with First Nations and other Indigenous partners to transform post-secondary education. Embedded in the approach to renewed education will be agreement on mutual accountability and practices promoting complete and accurate reporting.

Conclusion

5.99 We concluded that Indigenous Services Canada did not satisfactorily measure or report on Canada's progress in closing the socio-economic gaps between on-reserve First Nations people and other Canadians. We also concluded that the Department's use of data to improve education programs was inadequate.

This independent assurance report was prepared by the Office of the Auditor General of Canada on socio-economic gaps between on-reserve First Nations people and other Canadians. Our responsibility was to provide objective information, advice, and assurance to assist Parliament in its scrutiny of the government's management of resources and programs, and to conclude on whether the Department's use of data, including measuring and reporting, complied in all significant respects with the applicable criteria.

All work in this audit was performed to a reasonable level of assurance in accordance with the Canadian Standard on Assurance Engagements (CSAE) 3001-Direct Engagements set out by the Chartered Professional Accountants of Canada (CPA Canada) in the CPA Canada Handbook-Assurance.

The Office applies Canadian Standard on Quality Control 1 and, accordingly, maintains a comprehensive system of quality control, including documented policies and procedures regarding compliance with ethical requirements, professional standards, and applicable legal and regulatory requirements.

In conducting the audit work, we have complied with the independence and other ethical requirements of the relevant rules of professional conduct applicable to the practice of public accounting in Canada, which are founded on fundamental principles of integrity, objectivity, professional competence and due care, confidentiality, and professional behaviour.

In accordance with our regular audit process, we obtained the following from entity management:

The objective of this audit was to determine whether Indigenous Services Canada satisfactorily measured and reported on Canada's overall progress in closing the socio-economic gaps between on-reserve First Nations people and other Canadians, and whether the Department adequately used appropriate data to improve education programs to close education gaps.

We examined whether Indigenous Services Canada had engaged with First Nations to define what components should be used to measure the social well-being and economic prosperity of on-reserve First Nations people relative to other Canadians. We examined how the Department measured and reported on overall progress in closing socio-economic gaps.

We also examined whether Indigenous Services Canada engaged with First Nations to make adequate use of data to improve programs intended to close education gaps.

The audit scope did not include

In brief, the audit approach comprised

The audit covered the period between April 2015 and December 2017. This is the period to which the audit conclusion applies. However, to gain a more complete understanding of the subject matter of the audit, we also examined certain matters that preceded the starting date of this period.

We obtained sufficient and appropriate audit evidence on which to base our conclusion on 11 April 2018, in Ottawa, Canada.

Principal: Joe Martire
Director: Dawn Campbell

Alex Fontaine
Sean MacLennan
Joseph O'Brien
Jacqueline Warren

The following table lists the recommendations and responses found in this report. The paragraph number preceding the recommendation indicates the location of the recommendation in the report, and the numbers in parentheses indicate the location of the related discussion.

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Report 5-Socio-economic Gaps on First Nations Reserves-Indigenous Services Canada

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Socio-economic well-being of First Nations people 5.1 According to Indigenous Services Canada, in December 2017, there were almost one million (987,520) individuals registered under the Indian Act, belonging to one of 618 First Nations or unaffiliated with a specific First Nation. Slightly more than half of the registered population (509,016) live on reserve or Crown land.

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Indigenous Services Canada (ISC) & Crown-Indigenous Relations and Northern Affairs Canada (CIRNAC) are Indigenous Community Developmental strategies that aims to build and invest in effective and sustainable Indigenous communities, government, and services.
One of its strategies is to support community-driven, nation-based planning, and capacity building. Planning can include working towards fulfilling the community's vision (elements of economy, social, and physical environments). In addition, this will support communities as they develop their plans that will identify key priorities in the areas of health, culture, family, education, land and environment.
This will help the Indigenous community in the northern Canada to  regain their culture and as well as by promoting their health (food security, access to healthcare).

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Realistic regional basic income supplementation for low-income families rather than last-resort social assistance (Pegg, & Canadian Electronic Library, 2016).

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Raise Awareness and visibility of food insecurity by obtaining accurate regional data on affordability and access to food and publishing data (Pegg, & Canadian Electronic Library, 2016).
Increase knowledge of resources available and increase public outreach (Gendron et al., 2017).

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Climate Change Preparedness in the North Program. This program support and works with the Indigenous and northern communities to identify priorities for climate change adaptation. Adaptation plan includes developmental plans that takes climate change into account, implementing flood proof standards in areas that are at risk of flooding, and enhancement of food security to improve food safety by preventing and treating malnutrition.
Having these adaptations implemented in the north could help the people in the community have easier access to food.

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Food Security in a Northern First Nations Community - National ...

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Food Security in a Northern First Nations Community - National ...

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Abstract

Indigenous Peoples living in rural and remote regions of Canada, the United States, and Australia experience the highest food prices in each country. High food prices, low incomes, and limited access to nutritious perishable foods foster increased reliance on poor quality non-perishable foods. In northern Canada, Inuit experience food insecurity at over eight times the rate of the general Canadian population. This study aims to contribute to the evidence-base for informing food policy in remote northern communities by documenting food prices and investigating the economic dimensions of diet quality and nutrition in one region of Arctic Canada. A participatory food costing study was undertaken seasonally in six communities of the western Canadian Arctic during a 14-month period (late 2014 to early 2016). Community research assistants systematically collected food prices for a list of 106 market foods. Food prices in the region were markedly higher than the national average. The average cost of the Revised Northern Food Basket (to feed a family of four for one week) was CAD $410, over two times the equivalent cost of feeding a family of four in the capital city of Ottawa (CAD $192). Results from this study also provide evidence of significant price differentials between energy-dense nutrient-poor foods, and costlier nutrient-rich foods. Evidenced-based policy is needed to overcome the unique challenges of food retailing in remote northern environments. Such policies must be pursued with due recognition of community priorities and self-determination, and pursued in parallel to initiatives that enhance access to traditional (country) food.

Introduction

The cost of food in remote, predominantly Indigenous, communities of northern Canada is extremely high (Duhaime and Caron, 2012, Veeraraghavan et al., 2016), despite the existence of Nutrition North Canada (NNC), a federal subsidy program to offset the high cost of transporting food to remote locations (Galloway, 2017). Inuit spend an estimated CAD $19.7 per person per day on food (CAD $7217 annually) (Pakseresht et al., 2014), roughly three times the amount spent by the average Canadian (CAD $6.44/day) (based on the annual average household (2.5 persons per household) expenditure of CAD $5880 of food purchased in-store) (Statistics Canada, 2016a). For several decades, Inuit have indicated that they cannot afford to purchase sufficient food to meet their family's needs (Lambden et al., 2006). This is reflected in the very high rates of food insecurity, and the extreme disparity (over eight fold difference) in food security status among Inuit, relative to the general Canadian population (62.6% relative to 7.7%) (Egeland, 2011; Health Health Canada, 2012, Huet et al., 2012, Rosol et al., 2011).

Food insecurity among Inuit has been associated with disturbed eating patterns, reduced diet quality, and increased susceptibility to chronic and infectious disease (Egeland et al., 2011, Jamieson et al., 2012). Compounding the matter, Inuit face a dual burden of food insecurity and unhealthy body weight, with over 60% of Inuit men and 66% of Inuit women classified as overweight or obese (Zienczuk et al., 2012). High food prices may represent a barrier to the adoption of more healthful diets (particularly among low income consumers), and may be partly responsible for the higher prevalence of obesity and nutritional deficiencies documented among people of lower socioeconomic status (Darmon and Drewnowski, 2015, Darmon et al., 2002, Drewnowski and Darmon, 2005a, Drewnowski et al., 2004).

It is hypothesized that poverty and obesity are linked through habitual consumption of low-cost, energy-dense diets (Drewnowski, 2003). Low-cost foods of high energy density (e.g. foods high in sugar and fat), but low essential nutrient content, are often heavily relied upon by low-income and food insecure consumers who resort to low-cost diets to satisfy energy requirements within budgetary constraints (Agarwal et al., 2015, Drewnowski and Specter, 2004). The analysis of food price in relation to energy and nutrient density represents an established approach for research into the socioeconomic determinants of diet quality (Darmon et al., 2003, Drewnowski and Darmon, 2005b, Drewnowski et al., 2015) and bears important implications for food security and public health policy (Aaron et al., 2013, Jones and Monsivais, 2016, Monsivais et al., 2010). However, the economic dimensions of diet and nutrition among Inuit has received limited attention to date.

The objectives of this study are to document food prices and investigate the economics of diet quality and nutrition through a participatory food costing study (Williams et al., 2012) in communities of one Arctic region - the Inuvialuit Settlement Region (ISR), the westernmost Inuit region in Canada. Given the strong parallels with other Indigenous populations living in rural and remote communities in postcolonial states, such as the United States and Australia (Brimblecombe and O'Dea, 2009, Ferguson et al., 2016b), this research may contribute more broadly to the development of evidence-based food policy for Indigenous populations living in rural and remote areas around the world.

Worldwide, Indigenous Peoples, with few exceptions, systematically experience disparities in health status relative to national averages (Anderson et al., 2016, Valeggia and Snodgrass, 2015). Health inequities among Indigenous Peoples are associated with various economic, social, and political factors (e.g. poverty and poor living conditions), and generally embody the pervasive and enduring consequences of colonization, (Adelson, 2005, Gracey and King, 2009). This includes the disruption of Indigenous Peoples' ties to their ancestral territories (CSDH, 2007), and the adverse diet and lifestyle consequences of the nutrition transition - the erosion of subsistence-based lifestyles and the increased representation in the diet of nutrient-poor foods sourced from industrial and commercial processes (Albala et al., 2002, Hughes and Lawrence, 2005, Kuhnlein et al., 2004, Port Lourenço et al., 2008).

While globally the majority of Indigenous Peoples live in rural areas (United Nations, 2010), in postcolonial states such as Canada, the United States and Australia, the majority of the Indigenous population (52%, 71% and 79%, respectively) resides in urban areas (Australian Bureau of Statistics, 2017, Statistics Canada, 2017, U.S. Census Bureau, 2018). The degree of urbanization in such contexts, however, varies considerably across Indigenous groups. In Canada, for example, most Inuit (56%) reside in rural/remote areas across Inuit Nunangat, their traditional homeland (Aboriginal Affairs and Northern Development Canada, 2013). Furthermore, Indigenous people often comprise a greater proportion of the total population in remote areas (Baxter et al., 2011). Given their elevated presence in many rural and remote of communities in Canada, the United States and Australia, Indigenous Peoples pay some of the highest food prices, coupled with some of the lowest per capita incomes, in each respective nation (Duhaime and Caron, 2012, Ferguson et al., 2016b, First Nations Development Institute, 2016, Veeraraghavan et al., 2016). For example, food prices in Nunavik (northern Quebec, Canada) and in Northern Territory, Australia were on average 81% and 60% higher, respectively, relative to equivalent items in capital cities (Duhaime and Caron, 2012, Ferguson et al., 2016b). Similarly, higher average food prices have been documented in Native communities across the United States, relative to urban areas for most food items (First Nations Development Institute, 2016).

In addition to high food prices, the availability and quality of healthful foods in rural and remote food stores may be limited. Energy dense foods like cereal, grains, pulses, potato chips, and chocolate bars are typically dry, resist degradation during shipping, have stable shelf lives, and provide considerable dietary energy at low cost (Agarwal et al., 2015, Drewnowski and Darmon, 2005b). Conversely, naturally-hydrated, energy-dilute foods (e.g. fruits and vegetables) are generally more susceptible to degradation during shipment, have shorter shelf lives, and are generally more costly (Darmon et al., 2004). Given the challenging logistics and high cost of shipping perishable food to remote community stores, energy dense foods are likely to be favored in these retail environments. Indeed, the population-level diet of Indigenous people in remote regions of Australia and Canada is characterized by high consumption of sweets (e.g. sugar sweetened beverages, sweet snacks, and sugar added to coffee) and refined carbohydrates (e.g. potato chips, bread), coupled with low consumption of fruits and vegetables (Brimblecombe et al., 2013, Kenny et al., 2018a). To date, research on the economics of nutrition has largely favoured the general population of developed countries such as the United States and France, with limited research on rural and remote settings where the logistics and constraints of retail food environments differ markedly, and where in many regions, a higher percentage of the population is comprised of Indigenous people (Brimblecombe and O'Dea, 2009).

Conventional metrics of food security which emphasize economic access to market foods seldom embody nuances of Indigenous Peoples food systems that may also include the harvest, consumption, and sharing of locally harvested, culturally-valued, nutrient-dense traditional foods (Kuhnlein et al., 2009). Traditional foods (termed "country foods" in the Inuit context), for example, although a modest contribution to the total diet of contemporary Inuit, remain a critical source of many essential nutrients (Kenny et al., 2018a, Kuhnlein, 2003), contribute importantly to social relations and cultural identity (Borré, 1991, Condon et al., 1995), and are culturally-preferred (Lambden et al., 2007). Nevertheless, the majority of Inuit adults (74-80%, according to region) have reported a preference for a mixed diet of both country food, and, market food (Egeland, 2010a, Egeland, 2010b, Egeland, 2010c).

While the traditional economy in Indigenous communities across northern Canada has been documented for several decades (Harder and Wenzel, 2012, Usher and Wenzel, 1987, Wenzel, 2009), there is a paucity of research on the economics and dynamics of the market food system in this context. Despite the the existence of federally-administered food subsidy programs to promote the availability of and access to nutritious foods in northern remote communities (i.e. lack road access) for several decades (e.g. the federal Food Mail Program, 1999-2011) (Hill, 1998), food prices in the North remain "extremely high" (Enrg Research Group, 2016). The current NNC subsidy program has been critiqued for its level of effectiveness in meaningfully promoting access to nutritious foods, in addition to its administration and reporting structure and restrictive community eligibility criteria (Burnett et al., 2015, de Schutter, 2012, Galloway, 2014, Office of the Auditor General of Canada, 2014).

This article reports on a participatory food costing study in the ISR, and is part of a broader food security research program designed to address community and regional priorities identified through a comprehensive health and food security study (Egeland, 2010a) and a strategic planning process to promote food security and food safety in the ISR (Fillion et al., 2014). This community-engaged research, which takes a food systems approach (Kenny, 2017, Kuhnlein et al., 2009) and addresses issues related to country food and locally-produced food (e.g. northern greenhouses) in addition to store-bought food, is contributing to the evidence-base that will ultimately support the development of a regional food security strategy, similar to that developed in the Inuit region of Nunavut (Nunavut Food Security Coalition, 2014). The University of Ottawa Health Sciences and Health Research Ethics Board granted ethical approval (No. H01-14-10) and the Aurora Research Institute (Inuvik, NT) granted licenses (No. 15446; No. 15676) for this research.

Section snippets

The Inuvialuit Settlement region

This study was conducted in the Inuvialuit Settlement Region (ISR) (total population of 5800), a Land Claim Settlement area located in the western Canadian Arctic (Fig. 1). The region comprises six communities, ranging in population from 132 to 3265 people (Table 1). Inuvik, the largest community, serves as the administrative center for the western Canadian Arctic and is road-accessible, whereas the other five communities (Aklavik, Paulatuk, Sachs Harbour, Tuktoyaktuk

Food prices in the Inuvialuit Settlement region

Mean (SD) regional food prices in the ISR were compared with national average food prices for the study period (2014-2016) (Statistics Canada, 2016b) in Table 2. Only the subset of food items (37 of 106 items costed in this study) for which Statistics Canada publishes equivalent national average food prices (as part of the regular monthly Consumer Price Index survey) were included. Food prices in the ISR were markedly higher than national average retail prices for both perishable and

Discussion

The existence of economic barriers to meeting federal dietary recommendations raises significant concerns regarding equitable access to health (Marmot et al., 2008) for Inuit. Given the existing health and socioeconomic disparities among Indigenous Peoples in postcolonial nations, strategies to promote access to healthy diets, particularly in remote communities where the greatest food security disparities often exist, constitute an important policy priority (Ferguson et al., 2016b, National

Making food more affordable in remote communities

Higher food prices in remote retail environments derive from factors such as geographic isolation, small community size, high operating costs (e.g. high transportation, storage, electricity and other costs), store management practices, and limited retail competition (Burnett et al., 2017, Ferguson et al., 2016a, Galloway, 2017, Socha et al., 2011). Ferguson et al. (2016a) highlight three pathways to improved food affordability in remote stores, including: (i) generating savings at the retailer

Conclusion

Nutrient-poor foods are increasingly selected as alternatives to traditional foods by Inuit in Arctic Canada (indeed, by Indigenous Peoples elsewhere across the globe (Damman et al., 2008, Port Lourenço et al., 2008, Thaman, 1982, van Vliet et al., 2015)), while the consumption of healthful fruit and vegetables in the remains limited (Kenny et al., 2018a, Kuhnlein et al., 1996). Given strong parallels in the retail food environment, the nutrition transition experienced by Indigenous Peoples in

Acknowledgments

We wish foremost to recognize and extend our appreciation to the community research assistants whose diligent work was instrumental to the realization of this project. We also thank the Inuvialuit Regional Corporation (Community Development Division) for their logistical and in-kind support. This manuscript has been substantively improved by the helpful feedback provided by the two anonymous reviewers - thank you. Finally, we thank Dr. Nicole Darmon and Dr. Matthieu Maillot for their seminal

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Calories are cheap, nutrients are expensive - The challenge of healthy living in Arctic communities

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Indigenous Peoples living in rural and remote regions of Canada, the United States, and Australia experience the highest food prices in each country. High food prices, low incomes, and limited access to nutritious perishable foods foster increased reliance on poor quality non-perishable foods.

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Household Food Insecurity in Canada - PROOF

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Household Food Insecurity in Canada This section is a starting point for those looking to learn more about household food insecurity in Canada. We address key questions for understanding this serious problem and how to effectively address it. Understanding Household Food Insecurity Food insecurity is the

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Calories are cheap, nutrients are expensive – The challenge of healthy living in Arctic communities

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Calories are cheap, nutrients are expensive – The challenge of healthy living in Arctic communities

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About the fund

The health, safety and well-being of all people in Canada, including First Nations, Inuit and Métis is and will remain a top priority for all.

Canada recognizes that First Nations, Inuit and Métis are among the most at-risk and that during this crisis, in particular, those in remote and fly-in only parts of the country are uniquely vulnerable. Communities are incredibly resilient and full of solutions and innovative ideas. This is why we must support distinctions-based measures to improve public health response for Indigenous communities and provide them with the flexibility they need to address the specific needs identified by communities and their members.

This fund provides Indigenous leadership and organizations with the flexibility needed to design and implement community-based solutions to prevent, prepare and respond to the spread of COVID-19 within their communities. These funds can be used for measures including, but not limited to:

support for Elders and vulnerable community members

measures to address food insecurity

educational and other support for children

mental health assistance and emergency response services

preparedness measures to prevent the spread of COVID-19

Although the fund was created to prevent, prepare and respond to COVID-19, we recommend communities speak with their regional First Nations and Inuit Health Branch contacts, or First Nations Health Authority contacts (in British-Columbia), for the most up-to-date information about COVID-19 vaccine distribution and support for the rollout on reserve and in Inuit Nunangat.

How it works

Needs-based funding

Needs-based funding is currently available through the following request process, to:

all First Nations, Inuit and Métis communities and organizations

Indigenous communities and organizations serving Indigenous peoples, including those living in urban centres and First Nations living off reserve.

First Nations

On-reserve and self-governing First Nations communities received formula-based funding directly from Indigenous Services Canada (ISC).

The amount provided to each community took into account a base amount per community, the total population residing in community (based on 2016 Census population) and was adjusted for remoteness and Community Well-Being Index scores.

Landless bands received $50,000, as their amounts are not able to be adjusted based on population residing in community, remoteness and Community Well-Being Index scores. A landless band is defined as a band with no corresponding land on the Indian Lands Registry System.

Additional funding announced on August 12, 2020, November 30, 2020 and April 19, 2021 followed the same methodology, but the base amount was $25,000 per community.

Inuit

Inuit Nunangat regions received formula-based funding directly from ISC. Distribution of all funding among the Inuit land claims and representative organizations of Inuit Nunangat was in accordance with the general regional allocation funding formula determined by the Inuit Tapiriit Kanatami Board of Directors.

Métis Nation

Métis Nation governing members received formula-based funding through existing mechanisms to facilitate funding distribution. A standard model was applied to decide how much each region received, consistent with governing members historical application to federal funding.

Urban and off-reserve Indigenous organizations and communities

Approximately $235 million was allocated in 2020-2021 to Indigenous organizations serving urban Indigenous peoples and First Nations living off reserve.

$150 million of the funding proposed on April 19, 2021 is supporting urban and off-reserve Indigenous organizations and communities. These funds are available through the needs-based funding request process.

How the fund developed during the pandemic

On March 18, 2020, the Government of Canada announced $305 million for a new, distinctions-based Indigenous Community Support Fund (ICSF) through its COVID-19 Economic Response Plan to address immediate needs in First Nations, Inuit and Métis communities. $290 million was allocated directly to First Nations, Inuit and Métis communities and $15 million was allocated to urban and off-reserve Indigenous organizations through a call for requests.

On May 21, 2020, $75 million was announced for urban and off-reserve Indigenous organizations, bringing the total to $90 million.

On August 12, 2020, an additional $305 million was announced. This included:

approximately $145.2 million in direct allocations to First Nations, Inuit and Métis communities

a further $159.8 million in needs-based COVID-19 support for Indigenous communities and organizations serving Indigenous peoples, including those living in urban centres and First Nations living off reserve

The needs-based request process was launched on October 30, 2020 and closed on November 30, 2020.

On November 30, 2020, an additional $380 million was announced for the fund through the Fall Economic Statement. This includes:

approximately $145.2 million in direct allocations to First Nations, Inuit and Métis communities

a further $234.8 million in needs-based COVID-19 support for Indigenous communities and organizations, including $75 million to support Indigenous peoples living in urban centres and members of First Nations living off reserve

On December 18, 2020, the government announced that $30 million of the $100 million Emergency Food Security Fund is being transferred to ISC from Agriculture and Agri-Food Canada to help improve access to food and increase food supply for Indigenous communities, and was distributed through the Indigenous Community Support Fund.

On April 19, 2021, Budget 2021 committed an additional $760.8 million for the ICSF. This includes:

approximately $200 million in direct allocations to First Nations, Inuit and Métis communities delivered in June 2021

approximately $200 million in direct allocations to First Nations, Inuit and Métis communities delivered in October 2021

a further $360 million in needs-based COVID-19 support for Indigenous communities and organizations, including $150 million to support Indigenous peoples living in urban centres and members of First Nations living off reserve

the remaining $800,000 has been set aside for administration to ensure the swift delivery of funds

The request process for needs-based funding is open and requests are currently being accepted.

A list of Indigenous Community Support Fund allocations is available.

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The health, safety and well-being of all people in Canada, including First Nations, Inuit and Métis is and will remain a top priority for all. Canada recognizes that First Nations, Inuit and Métis are among the most at-risk and that during this crisis, in particular, those in remote and fly-in only parts of the country are uniquely vulnerable.

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Abstract

Introduction:

This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada.

Methods:

We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences.

Results:

Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%), Saskatchewan (83%) and Manitoba (72%). Respondents to the survey (n = 92) expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods.

Conclusion:

There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.

Keywords: food environments, retail, food quality, provincial Norths, northern Canada

Highlights

Communities without access to allseason roads face extremely high rates of food insecurity.

Northern retail environments are unique and differ from southern and urban locales.

The North West Company operates within an oligopoly in the provincial Norths.

Limited retail competition may be a contributing factor to food insecurity in northern Canada.

The greatest concern northern participants expressed about food purchasing fell within three main areas: the high cost of food, the quality of food available (e.g. whether fresh or expired), and the availability, selection and variety of specific foods (e.g. fresh produce and dairy products).

Introduction

Northern retail environments are unique and differ from southern and urban locales, thereby posing meaningful challenges to food security. 1 Significantly, conflating the provincial Norths and Far North (the Northwest Territories, the Yukon, and Nunavut) fails to capture the unique contexts and challenges that characterize food retailing in these locales. An in-depth examination of the retail environment in the provincial North reveals several things: that the lack of retail competition and choice, as well as extremely long supply chains and their attendant costs, result in exceptionally high food costs and serious concerns about food quality, availability and selection/variety. 2- 5 The termination of the federal Food Mail Program (a transportation subsidy applied to select foods and goods) and its replacement by Nutrition North Canada (NNC) (a subsidy for select foods paid directly to retailers) in 2011 brought the high cost of food to light. 6

Grassroots Indigenous movements and organizations responding to the changes in the subsidy program have brought the extremely high rates of food insecurity in the Canadian North to the attention of the broader Canadian public through social media campaigns and on Facebook pages such as Feeding My Family. 7 Such community responses have been echoed by academics and international organizations. In 2014, for example, the Council of Canadian Academies published Aboriginal Food Security in Northern Canada: An Assessment of the State of Knowledge, which reported that food insecurity in northern Canada is a pressing and immediate issue demanding urgent attention. 8 This analysis was preceded in 2012 by the report of Olivier De Schutter, then the United Nations' Special Rapporteur on the right to food, on his visit to Canada, which revealed that 60% of on-reserve Indigenous households in northern Manitoba were food insecure, as were 70% of Inuit adults in Nunavut. 9 De Schutter further noted that these rates of food insecurity were six times higher than the national average and "represent[ed] the highest documented food insecurity rate for any aboriginal population in a developed country." 9 While the situation in the Far North is extremely important, discussions of food insecurity have remained focussed on that region (specifically, Nunavut). And while Nunavut (and the NWT and Yukon) needs access to NNC (and to better, more effective programs designed to lower the cost of food and increase access to land- and waterbased foods), the focus of this research is on the retail food environments of First Nations communities in the provincial Norths.

The all-encompassing use of the term northern has created confusion as to what constitutes the "North." We are concerned about the conflation of the provincial Norths and Far North and the reduction of the experiences of what are two different regions undergoing food crises to one representative experience. Canada's "North" represents 96% of the country's landmass and includes widely disparate geographic and culturally diverse peoples situated within different economic, political and social environments. Notably, the one continuity between these regions is the disproportionate rates of food insecurity among Indigenous peoples living in rural and northern communities, and the presence of corporate oligopolies.

In this article, we focus on the provincial Norths, often referred to as "Canada's forgotten North." 10,p.312 Frequently, the provincial Norths are absent from conversations about the "North," which generally refers to the Far North (Nunavut, Northwest Territories and the Yukon). 11 While the provincial Norths tend to have more in common with the Far North than the urban south, conflating the regions does them a disservice and fails to adequately account for their distinctive features. Such totalized discourse concerning northern Indigenous populations also does the colonial work of homogenizing First Nations and Inuit peoples and removing them from the specific contexts, geographies and histories in which they are situated.

Background

Over the past decade, a growing body of scholarship that examines food insecurity and environments in First Nations and Inuit communities has developed. However, the majority of this literature remains focussed on the Far North and the landand water-based practices of the Inuit. Discrete studies exist on the provincial Norths, focussing on specific communities but concentrating primarily on measuring rates of food insecurity. For instance, a 2012 study of 14 communities in northern Manitoba found that three out of every four households (75%) were food insecure. The incidence and severity of food insecurity varied, with fly-in communities generally having more severe and higher rates of food insecurity than those with road or train access. 12 Similarly, a 2013 study in Fort Albany First Nation, located along the James Bay coast in present-day northern Ontario, found that 70% of households suffered from food insecurity. 13 Both works note that the retail environments of fly-in First Nations have limited options, and that lack of access to all-weather roads has an enormous impact on food security. 12 The largest and most common retailer in First Nations communities in the provincial Norths is the North West Company (NWC). Also known as the Northern Store, the NWC has a long history in these communities as the former Northern Department of the Hudson's Bay Company (HBC). In 1987, executives of the HBC and private investors purchased the Northern Department and opened the NWC with an increased focus on retail food sales. 14, 15

Within a market environment of restricted retail options, retailers have an enormous opportunity to shape local food environments and peoples' access to foods. Academics such as Teresa Socha and her colleagues noted that community members regarded the profit-driven model adopted by retailers as a significant barrier to affordable food. 3, 4 These researchers posed an important question in relation to the high cost of food: that is, "food or profitability?" 3,p.58 Their 2011 study compared the prices of food between grocery retailers in Thunder Bay and a remote First Nation located in northwestern Ontario, arguing that resolving food insecurity in the provincial North was premised on "solving problems related to the food chain, including transportation, food accessibility, and food availability." 3,p.58

Solutions to food insecurity include increasing Indigenous peoples' access to land- and water-based foods through supporting community food sharing networks, harvester and hunter support programs and community freezers. 4, 12, 16 In other words, Indigenous food sovereignty is essential to decolonizing local food environments. However, Indigenous food sovereignty has focussed primarily on control over land- and water-based foods, and while this is extremely important, such a focus can obscure the fact that market-based food systems remain prohibitive in terms of costs and negligent regarding food selection and quality. While food sovereignty is imperative in First Nations communities, it does not preclude the need to have equitable market- based foods systems in operation and under local control as well. Indeed, the need to address the existing market-based food system and the oligopolies that have facilitated the current conditions present in most northern communities is urgent. A comprehensive solution is required that includes both land-and-water-based and market-based food systems and that places a critical focus on the profit-producing operations of retailers in the region.

Historical context

Hunger and food insecurity in First Nations communities located in the provincial Norths are not recent phenomena; they have their roots in settler colonialism and the erosion of Indigenous peoples' access to their foodways. 2, 8, 9 The establishment of reserves failed to draw on the knowledge and preferences of Indigenous peoples who had lived on and managed their territories and resources since time immemorial. Nor were reserves established with consideration for proximity to food, clean water, medicines or suitability for long-term settlement. In direct violation of the treaties, provincial hunting laws criminalized Indigenous hunting practices by making it illegal to hunt certain animals, thereby preventing Indigenous peoples from hunting during specific seasons, and created bag limits (restrictions on the number of animals within a particular species that hunters may kill and keep). 17- 20 For example, in the First Nations Food, Nutrition, and Environment Study, 65% of participants in on-reserve communities in British Columbia reported that government restrictions affected or limited where they could hunt, fish or collect berries. Indeed, government restrictions were identified as the biggest barrier to harvesting activities. 21

Under Canada's residential school system, hundreds of thousands of Indigenous children were forcibly removed from their families and communities and confined to schools that were designed to assimilate them. These schools had, and continue to have, a profound impact on the intergenerational transmission of the knowledge required to harvest and prepare wild foods. 22 Climate change has also altered animal migration patterns and reduced the ability of people to continue to hunt and fish. 8 Nevertheless, the harvesting, preparation and consumption of traditional foods remains deeply embedded in the familial, cultural and social fabric of communities and is an essential component of both the social and physical wellbeing of First Nations. 8, 22

After the Second World War, the federal government undertook a series of social welfare and food subsidy programs as well as education initiatives that had the effect of undermining Indigenous foodways and resulted in Indigenous people becoming increasingly reliant on southern market-based food systems. For instance, in the late 1960s, the federal government instituted a transportation subsidy for a select list of foods to be run through Canada Post, called the Food Mail Program. This subsidy existed until April 2011, when it was replaced by Nutrition North Canada. NNC is a retail-based program intended to subsidize the high cost of perishable, nutritious foods in the North. Retailers receive a subsidy on certain foods that are flown into eligible northern communities. The subsidy is applied on two levels (high or low) for perishable and nutritious foods, and is based on destination and weight. Registered retailers receive the subsidy directly and are responsible for passing along the full savings to their customers with little to no oversight. Until 01 October, 2016, in northern Ontario there were 32 fly-in communities and only eight fully eligible communities, 23 although all were desperately in need of the food subsidy. 6

The program came under serious criticism in the Auditor General's report in 2014 24, which found that community eligibility was not based on need and Indigenous and Northern Affairs Canada had not verified whether the NNC subsidy was passed onto consumers in full. Following the election of the Liberal government in fall of 2015, another 37 communities were made eligible for the NNC subsidy after October 1, 2016; 19 of these new communities are located in northern Ontario. 23 Consultations have recently been conducted with NNC stakeholders to determine how the program might be improved. 25 What the Auditor General's report 24 did not address was the lack of retail competition in many First Nations communities located in the provincial Norths. Many Indigenous on-reserve communities in the provincial Norths are accessible only by plane or sea barge, and briefly by seasonal ice roads. As a result of long transportation routes, the cost of food is prohibitively high, food selection and quality is limited and communities are usually serviced by a single grocery store. One of the major factors contributing to food insecurity in northern First Nations populations is the relative cost of accessing food, whether from increasing dependence on the market (imported) food system or the rising costs of participating in land- and water-based food-harvesting activities. 26

Objectives

The objective of this research was to examine the retail food environment in northern Canada in two ways: (1) by considering whether the NWC has market competition for grocery retailing in communities without year-round road access; and (2) by inviting people living in semiremote and remote communities to share their experiences of the retail food environment in the North. It is very challenging to recruit people living in semi-remote and remote communities to participate in surveys and obtain their perspectives on northern issues. While we acknowledge that there are some methodological limitations to the approaches we were able to use, including a small sample size, this paper presents an important contribution to a very scant body of literature on the topic of retail environments in northern Canada.

Methods

We employed two approaches to assess northern retail food environments. The first was designed to determine whether the NWC faces substantive competition in the North, since the NWC is the major grocery retailer across northern Canada. To accomplish this, we initially created a list of all the northern communities in Canada without year-round road access. We then checked these communities to determine whether they had a NWC store, based on the list of stores on the NWC website (http://www.northwest.ca) in December 2016. From this list, we ascertained whether that store faced any retail competition by searching and listing other stores in the same community that had a full-service grocery store. Thus, small, locally owned convenience stores were not counted as competitors to NWC stores.

We included a community in our study if it met any of the following criteria: it was located in the provincial Norths, Yukon, Northwest Territories, Nunavut, Nunavik, or Labrador; it was part of the NNC program; it was included in the article "From Food Mail to Nutrition North Canada: Reconsidering Federal Food Subsidy Programs for Northern Ontario," published in Canadian Food Studies in May of 2015; 6 or, finally, it was listed on the NWC website. In northern Ontario, we also included the municipality of Moosonee because it serves as an important entry point for northern First Nations in the Mushkegowuk territories for services (food, general goods and health care) and is only accessible year-round by rail (as all-season roads are not yet operational). Any store that sold food as a general store or grocery store was included in the study. We counted those stores that had more than one operation in the community (i.e. the NWC often operates a grocery store in addition to a gas station or "Quick-Stop"), which are often contained in more than one building, as one store despite the multiple locations and different retail focusses. While further breaking down these smaller categories may offer additional insight into the breadth and scope of the oligopolies operating in northern communities, such an inquiry is not within the scope of this article.

The second approach was to collect data from community members living in northern Canada using an online survey tool that was developed in consultation with community members and Elders. The Ontario-based Northern Food Sovereignty Advisory Group (FSAG) comprises seven food activists and community members, including one Elder, who live in communities in northern Ontario and have formed an advocacy group engaging with issues of food sovereignty and addressing current relationships of power and inequality through various activities. We worked with the FSAG over the course of two years, and during our discussions it became clear that there were serious concerns around best-before and expiry dates, food quality, food preference and retail practices, as well as a desire for more information about these issues. We drafted a survey to try and address these concerns, using a scale from one to five and comment boxes to encourage participants to further elaborate on those issues about which they felt most strongly. The failure of people to understand best-before dates is a frequent critique offered by retailers, and so, after a lengthy discussion with community members, we chose to use the term "expired foods." "Expired" is the term most commonly used by community members and the perception that "best before" and "expired" are synonymous is relevant when considering what informs people's purchasing decisions (packaged foods that are being sold after the best-before date). The survey went through a revision process of four drafts in consultation with five of the FSAG community members and the Elder.

The survey was launched using the online survey tool FluidSurveys (Fluidware, Ottawa, ON, CAN) on November 12, 2014, and closed December 31, 2014. We invited northern residents in Canada to share their experiences and concerns about food purchasing experiences with local retailers. To promote the survey and encourage northern residents to participate, postcards explaining the study were distributed at the 2014 Food Secure Canada conference and to our community partners to share with their own social networks. Northern media and social media outlets (e.g. the Feeding My Family Facebook group) were widely contacted as well as northern organizations engaged with food security issues and health and well-being concerns more generally. Due to the significant constraints of conducting survey research in remote communities, we were limited to a convenience sample of participants. Incentives were not provided to survey participants.

Results

Store competition

Across Canada, there are 120 NWC stores (or various iterations of the store: North Mart, Northern) located in either the provincial Norths or Far North that do not have year-round road access, and are briefly accessible in the winter by seasonal ice roads or rail. The NWC operates the sole grocery store in 65 of the 120 communities (or 54%). An additional 55 communities have a second full-service grocery store. In other words, the NWC is the only full-service grocery store in 54% of the communities in which it operates in Canada.

This picture is further complicated if we break down the number of NWC stores according to province and territory. Table 1 shows the number of NWC stores that face competition from at least one non- NWC full-service grocery store in each province or territory. Those provinces that have the highest number of NWC stores are Manitoba, Ontario and Saskatchewan, where the company faces almost no competition. Proportionately, NWC stores located in northern First Nations in Ontario face the least competition; 91% of their stores face absolutely no retail competition. Eighty-three percent and 72% of the communities in northern Saskatchewan and Manitoba, respectively, are serviced only by an NWC store.

Retail experiences

The second element of this work was to assess the retail environment through individual experiences and perceptions of the high cost of food; the quality of the food available to purchase (e.g. whether fresh or expired); and availability and selection or variety of specific foods (e.g. fresh produce and dairy products). Of the 113 people who started the survey, we excluded those who only completed the first few questions of the survey (n = 20) and one person who was living in the United States. The following descriptive analyses were conducted using data from the remaining respondents (n = 92).

The majority of people who responded to the survey were women (71.7%); 27.2% of all respondents were aged 35 to 44 years; 25.0% were aged 25 to 34 years, and 21.7% were aged 45 to 54 years. Twentyone percent of respondents had 5 or more people living in their household, with an average of 3.4 people per home. Approximately one-third of our respondents (32.6%) resided in northern Ontario; the next highest number of respondents were from Northwest Territories (21.7%), Manitoba (18.5%) and Nunavut (12.0%). Eight of the provinces and territories were represented ( Figure 1 ).

Eighty-nine percent of respondents identified themselves as currently residing in a remote or semi-remote community. All of the people who did not currently live in a remote or semi-remote community but had lived in one previously were asked to provide their perspective from when they had lived there.

About half (51.1%) of respondents lived in a community with year-round road access. Of the respondents who mentioned the cost of gasoline (n = 74, 80.4%), the average cost was $1.59 per litre and ranged from $1.00 to $3.00 per litre.

The majority of respondents reported doing most of the food shopping for their household (84.7%). The store that respondents indicated they used most often as their primary retailer was the NWC (49.5%), followed by private, locally owned stores (18.9%), a community-owned store (15.8%) and Arctic Co-operatives (6.3%). When asked, "Does the store sell expired food?" with the response options of "Often," "Sometimes," "Never" or "I don't know," 82% of respondents stated that their store often or sometimes sold expired food. When asked, "Is the perishable food usually in good condition?" with the response options of "Yes" or "No," more than half (57%) of the respondents said perishable food was not usually in good condition. Those respondents who said that perishable food was not usually in good condition were able to provide comments about the condition of this food in their store. Their comments described foods that were not fresh; shopping practices that involved paying great attention to checking food quality prior to purchasing perishables; and difficulties related to food freshness and quality that arose from long transportation routes. ("More often than not, they are close to rotten or rotten when they arrive," wrote a participant from a remote community in northern Manitoba). Some described the food as having variable quality (e.g. a participant from a remote community in Yukon commented "Highly variable-sometimes arrive in good condition, bananas and cucumbers regularly frozen/soggy"). Some reported having to make sure to consume it quickly after purchase (e.g. a participant from a remote community in the Northwest Territories defined her fresh food purchases as "rotten, or so ripe [they] must be consumed immediately," and another participant from a semi-remote community in northern Ontario wrote, "Usually have to use the day you buy it.") Several people described the winter months as a time when perishable food was of poorer quality, while others explained it was an issue all year round ("They don't last longer than a day or two once purchased.... Winter months are worse than summer months," offered one participant from a remote community in Nunavut).

When asked, "What is your biggest concern when shopping at your primary retailer?", the greatest concerns participants expressed regarding food purchasing fell within three main areas: the high cost of food; the quality of the food available to purchase (e.g. whether fresh or expired); and the availability and selection or variety of specific foods (e.g. fresh produce and dairy products). When asked, "What are the top five food items you purchase most often?" the food purchased most often was milk. When participants were asked, "Name the top three fresh or perishable healthy foods that you think should be made more affordable," they chose produce (i.e. fresh fruit and vegetables), followed closely by milk and meat.

At the end of the survey, participants were asked if they had any additional concerns or if there were questions that they had not been asked. Twenty-seven people (29.3%) provided additional comments. Some of the comments included possible reasons for the lack of variety and quality of products available to them, such as this from a member of a remote community in Nunavut:

The lack of variety comes from the Head Office as the employees are only limited to what they can order in the order guide. Also they have get in a lot of their own brand which is horrible because they make more money on selling their own brand. Also we have notice even the groceries coming in on the barge which should be cheaper because it is barged in, is at the same price as the groceries coming in on the planes. Also all this non food items all seem to be cheap stuff but they sell it at huge prices ... crap we can buy in dollar stores down south but they mark it up so much. Now we know why The North West Company always makes a profit because the prices are out of this world.

Others were very focussed on the high cost of specific staple foods compared to those that were less healthy, such as this from a remote community in northern Manitoba:

Why isn't the price of milk, eggs, bread, etc the staples of a household not regulated across the country? I have never seen any of the above go on sale. Cost of 4 litres of milk is over $8.50, in the northern town where I live. Yet 2 litres of Pepsi & coke products can go on sale for $1.00, potato chips go on sale. Alcohol is regulated, but milk is not, something has to be done about that.

Comments also provided details about some of the challenges to food access during specific times of the year and how that impacted prices: "During spring break-up and fall freeze up we chopper groceries across. I see food prices go up during this time, but they never go back down" (from a member of a remote community in Northwest Territories). Several respondents also described the cost of food in comparison to the cost of living: "How are you supposed to make a living when milk is 15 dollars? I know that's not even the worst in Canada, but seriously. People have to feed their families and all they can afford is the terrible and unhealthy pre packaged food" (from a remote community in northern Ontario). Finally, a number of respondents questioned the profits made by retailers and referenced government subsidy programs, including the NNC subsidy: "I believe that there needs to be more transparency with how much the food costs, how much the retailer profits, and how much the government is subsidizing the rates by" (from a remote community in the Northwest Territories).

Discussion

In this paper, we highlight the scope of the NWC's food retailing operations in the provincial North, and describe the context of the food retail environment in the Far North and provincial Norths by drawing on the perspectives of people living in those communities. Reducing the experiences and contexts of many different communities and locales within a vast area to one described as simply the "North" does not adequately address the nature of the retail and food environments of northern Indigenous communities. There are significant differences between the Far North and the provincial Norths, as well as within those regions and communities. Our objective was to address and illustrate some of the unique challenges that many First Nations communities in the provincial Norths face in acquiring market-based foods, both in terms of the lack of competition, the existence of oligopolies, and general retail experiences.

Our analysis of retail competition in northern Canada demonstrated that the NWC holds market dominance in the provincial Norths especially when it comes to the sale of food. Between 1987 (when the Northern Department of the Hudson's Bay Company was sold to executives of the Northern Store and private investors) and 2015, the portion of those profits from the sale of food has more than doubled from just over 30% to 79.3%. 27 Indeed, participation in a retail food market has proven so profitable to the NWC that the company expanded in 2007 through the Cost- U-Less initiative to the South Pacific and Caribbean, citing "a leading competitive position that's supported by high barriers to entry." 27 The market dominance of the NWC in the North is facilitated by the company's ability to access government subsidy programs such as Nutrition North Canada and its predecessor, the Food Mail Program. During the 2014/15 fiscal year, the NWC received the majority (50%) of the NNC subsidy from the federal government, while the recipient of the next highest amount was the Arctic Co-operatives, located primarily in Nunavut, Northwest Terroties and Yukon, at only 19%. 28

The regions that contained the highest number of NWC stores in Canada were northern Manitoba and Ontario (with 25 and 22 stores respectively). Very few of our sample communities contained a second full-service grocery store: in northern Ontario there is one First Nation that has a second full-service grocer, and in Manitoba there are seven. While the challenging retail environment has limited retail competition and precluded the establishment of more than one grocery store in many communities, those retailers that do operate in northern First Nations continue to make a significant profit. A 2014 report on NNC, entitled "Northern Food Retail Data Collection and Analysis," commissioned and released by the federal government said that while "retailers were unwilling to provide specific financial information regarding the profitability of their northern retailing operations," it nonetheless concluded that "northern grocery retailers are making a profit from their activities in northern communities and therefore profit is a factor contributing to the overall cost of groceries." 29

The online survey we conducted in northern Canada provides texture to the description of the retail environments and brings into sharper focus a number of the issues highlighted in the November 2014 Auditor General's report on NNC, 24 the recently released Government of Canada report about the NNC public community engagement process, 25, 30 and an external program evaluation. 31 The government report summarized general observations from community members about the public engagement process as follows:

Northerners feel that everything in the North is expensive, with a number of participants stating that, as Southerners, it is difficult to understand those struggles, which is then further intensified with many people living off a fixed income. Even with the subsidy provided through NNC, for which they generally expressed an appreciation, many families are not able to afford healthy food. There were significant concerns regarding the overall quality and availability of nutritious perishable food in the North. 30

Our findings from surveying the experiences of northerners with retail food access generally aligned with these observations. People living in northern and rural First Nations that are accessible briefly by seasonal ice roads demand access to a wider selection of food that is in good condition at affordable prices. The quality of perishable foods poses a significant concern and often serves as a barrier to the purchase of fresh foods. The fear of spending money on inedible food may prevent people from taking the risk of buying new types of food, or make them decide to purchase ready-made or fast foods that they can be fairly sure they will be able to eat. Indeed, quality consistently remains one of the principal concerns expressed by community members but continues to be considered the least important factor when it comes to research design or assessing the success of the NNC program, both of which to date have focussed on collecting the prices of a select list of foods from the Revised Northern Food Basket (RNFB).* A failure to understand the dynamic between food quality and food purchasing practices in the North adds to the misconception that people in First Nations communities in the provincial Norths choose to purchase unhealthy, prepackaged and processed foods rather than healthier fresh produce and perishable items; in fact, food purchasing decisions are often influenced by past experiences of purchasing rotten, mouldy or less-than-fresh food that is inedible.

Finally, while all community members have questioned the current terrain of the retail environment that exists in fly-in and northern First Nations located in the provincial Norths, there is a real and marked failure on the part of government agencies to pose those same questions. The 2014 Auditor General's report on NNC noted that some communities in northern Ontario were eligible for NNC and others were not. It made no mention, however, of the dominance of the market-based food system by one company and that company's influence on and access to the decisionmaking processes that affected Indigenous communities. For instance, when consultations on the Food Mail Program were undertaken in 2007 to 2008, the NWC's consultation with Dargo and Associates (the consulting firm) was either on par with that of communities and First Nations or even, in some cases, exceeded the access given to community members. 33 What is more, this report argued that the relationship between the federal government and food retailers "encourages market disruption and is at odds with the Minister's mandate of supporting northern economic development." 33,p.17

Drawing on data collected by NNC, Galloway 31 studied whether or not the existence of the subsidy program made a meaningful difference in the cost of food in northern communities. She found that the lack of retail competition in small communities, even those subsidized by NNC, resulted in extremely high food costs. She provided examples from the Far North, noting that communities with a second retailer still could not be considered a competitive food retail environment, and those communities with a single food retailer exhibited the highest cost of food in Canada. 31 In our research, we found that there is a shortage of competition for food retailers in the provincial Norths. We suggest that limited retail competition plays a significant role in food insecurity in northern Canada. Further research is required to obtain data on the oligopoly of the retail food environment in northern Canada and to provide more evidence as to whether a lack of retail competition makes food costs considerably higher in these communities. 31 Quantifying the differences in food costs for communities with multiple food retail competitors versus those with oligopolies or monopolies, along with an examination of food quality and further investigation of the perspectives of people living in northern Canada, is warranted.

Strengths and limitations

This paper addresses a relatively unexamined topic in regards to food security in First Nations communities located in the provincial Norths. The paper only examined retail competition in the 120 communities that had NWC stores and did not have year-round road access. The online survey was informed by community members from the FSAG and reflects their concerns about their shopping experiences, and cannot be representative of everyone. The number of survey respondents was limited by several factors: the need for access to the Internet in order to complete the survey, language barriers, and the fact that the most marginal members of the community were unlikely to respond. The result was a small sample size (n = 92) representing eight provinces and territories and not presenting a complete picture of food retail experiences across northern Canada. However, due to the challenging nature of collecting this type of data in remote regions, along with the absence of other data on shopping experiences from residents in northern locales, this study is a first step in building new information on this topic.

*The RNFB is a survey tool created by Indigenous and Northern Affairs Canada in consultation with Health Canada to monitor the cost of food in remote northern communities. The RNFB is based on average overall consumption for a sample population and contains 67 items (as revised in 2008) and their purchase sizes. 32

Conclusion

Food insecurity in northern Canada, especially among First Nations and Inuit people, is a pressing public health problem. Limited retail food competition have exacerbated this issue enormously. In northern Ontario, there is only one full-service grocery store in 91% (20 of 22) of the fly-in First Nations communities that are only accessible by seasonal ice roads. Limited retail choices also affect the range and quality of foods that people are able to purchase. Efforts to support Indigenous food sovereignty must address all elements of local food economies, including retail and land and water harvesting activities.

Acknowledgements

We would like to acknowledge the kindness, generosity and patience shown to us by the community members who worked with us on this project. We also thank Robert Thivierge, who did the legwork of identifying grocery stores in northern Canada, and James Jung, who helped us with some last-minute fact checking. The research was funded by SSHRC.

Conflicts of interest

The authors do not have an affiliation with or involvement in any organization or entity with any financial interest or non-financial interests in the subject matter or materials discussed in this article.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

Authors' contributions

KB and KS were involved in the conceptualization of the work; distribution of the survey; acquisition, analysis and interpretation of data; and drafting and revising the manuscript. TH was involved in the distribution of the survey; analysis of the data and drafting the manuscript. JL was involved in the conceptualization of the work and the drafting of the online survey and its distribution among community members. LC was involved in the conceptualization of the work and revising the manuscript.

References

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Articles from Health Promotion and Chronic Disease Prevention in Canada : Research, Policy and Practice are provided here courtesy of Public Health Agency of Canada

# data[].attributes.attachment_link.title
Retail food environments, shopping experiences, First Nations and the provincial Norths

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This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of ...

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specific food purchasing patterns, such as buying in bulk from more southern stores to build up home food provisions may be unique to remote communities with seasonal road access. Therefore after freeze-up when the road can be safely travelled, people try to buy supplies that they otherwise have difficulty accessing due to reduced availability and cost at their local store (Skinner, 2013).

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Understanding and integrating historical knowledge into trauma-informed care will prove beneficial for this population and improve relationships between healthcare providers and Indigenous patients. We can ensure that health at each life stage, particularly at sensitive stages such as childhood and adolescence, is addressed according to the needs of the Indigenous population by directly working together with indigenous patients and communities (Kim, 2019).

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Unhealthy food choices which could increase the chances of consumption of processed food

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Unhealthy food choices which could increase the chances of consumption of processed food

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Exclusion of indigenous individuals from the economy, and from resources

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Percentage of resources going towards food.

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Some roads in North West Canada do not have all-season roads contributing to food insecurity.

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Nutrition North Canada (NNC) is a Government of Canada subsidy program to provide Northerners in isolated communities with improved access to perishable nutritious food. NNC is part of the Government of Canada's Northern Strategy.

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This publication was prepared as part of the Library of Parliament's research publications program, which includes a set of publications, introduced in March 2020, addressing the COVID‑19 pandemic. Please note that, because of the pandemic, all Library of Parliament publications will be released as time and resources permit.
Executive Summary

Food insecurity is generally defined as a situation that exists when people lack secure access to sufficient amounts of safe and nutritious food. In 2017⁠-⁠2018, 12.7% of Canadian households were food insecure, representing at least 4.4 million individuals. Food insecurity is disproportionately worse in the North than elsewhere in the country, with rates of household food insecurity reaching 16.9%, 21.6% and 57% in the Yukon, the Northwest Territories and Nunavut respectively.

Among Northerners, Indigenous peoples are particularly at risk of being food insecure. The high rates of food insecurity among northern and Indigenous populations can be explained by several factors, such as the relative remoteness and isolation of their communities, financial hardship and socioeconomic inequities, the legacy of colonial policies, climate change and environmental dispossession and contamination. Food insecurity has severe consequences on health and well‑being; it has, for instance, been linked to malnutrition, infections, chronic diseases, obesity, distress, social exclusion, depression and suicidal ideation.

By providing a subsidy to eligible retailers in remote and isolated communities, Nutrition North Canada, a federal program, targets one of the causes of food insecurity: the high cost of perishable and nutritious food in the North. Introduced in 2011, the program has been criticized for several reasons over the years, with critics noting that the cost of perishable and nutritious food in the North remains too high for too many families. As of March 2019, the average cost to feed a healthy diet to a family of four in the North was $422.07 per week.

Regional and local initiatives have been implemented to address food insecurity in the North. These include a wide range of measures, from culturally appropriate food guides to comprehensive poverty‑reduction initiatives. Communities have their own solutions, from food banks and soup kitchens to hunting and harvesting support programs.

Food insecurity is a serious public health issue that risks worsening in coming years. To reduce food insecurity in the North, the government will need to address its social, economic and environmental roots.

1 Introduction

2 Context

2.1 Scope of Food Insecurity

Since 2004, data on food security has been collected through the Household Food Security Survey Module of the Canadian Community Health Survey. 8 The most recent results, collected in 2017⁠-⁠2018, indicate an increase in food insecurity in the North, with rates of household food insecurity reaching:

57% in Nunavut (compared to 52.3% in 2015⁠-⁠2016);

21.6% in the Northwest Territories (compared to 20.3% in 2015⁠-⁠2016); and

16.9% in Yukon (where data were not collected in 2015⁠-⁠2016).

Similarly, rates of food insecurity are higher in First Nations communities, compared with the rest of Canada. According to the First Nations Food, Nutrition and Environment Study, which collected data from 2008 to 2016 in 92 randomly selected First Nations south of the 60 th parallel, "[t]he prevalence of food insecurity is very high in First Nations communities (48%)" with "rates [being] also significantly higher in remote communities with no year‑round road access to a service centre (58%)." 15

It is more difficult to be precise about the situation of the Métis population, as peer‑reviewed data about its experience of food insecurity in the North are limited. 16

2.2 Causes of Food Insecurity

2.3 Consequences of Food Insecurity

Finally, Inuit Tapiriit Kanatami notes that food insecurity is not only a threat to public health, but also to the "overall social and cultural stability in Inuit communities." 27

3 Current Initiatives

At the provincial/territorial, regional and local levels, there have been efforts to address the causes of food insecurity and mitigate its consequences. For its part, the federal government is playing a role through the Nutrition North Canada (NNC) program, 28 which provides retail subsidies to improve access to perishable, nutritious and traditional food in certain communities. It should be noted, however, that reducing food insecurity is not part of NNC 's mandate. Rather, the program targets one of its causes: the high cost of perishable and nutritious food in the North.

3.1 Federal Initiatives

3.1.1 Nutrition North Canada

In place since 2011, NNC aims to improve access to perishable and nutritious food in northern communities lacking year‑round ground or marine access (see Appendix A for a map of eligible communities). 32 "Perishable" refers to "food that spoils quickly especially if it is not stored at the proper temperature," while the notion of "nutritious food" refers to the items and quantities prescribed by the Revised Northern Food Basket 33 (see Appendix B). NNC subsidizes the cost of traditional food at a single subsidy rate (which varies by location) and other types of nutritious food coming from the South at three subsidy rates, according to a scale of importance:

a lower subsidy rate for staples;

a higher subsidy rate for nutritious food; and

a targeted (highest) subsidy rate for frozen vegetables and fruits, fresh milk and infant food and formula.

NNC also provides funding for nutrition education initiatives, though these activities only account for a small portion of the program's annual budget. The program's main objective is to offset the "inherent disadvantage faced by isolated northern communities which have no other option but to fly in perishable foods." 35 By offering a subsidy to eligible food retailers, NNC replaced the Food Mail Program (also known as the Northern Air Stage Program), which had subsidized the cost of shipping food to eligible northern and isolated communities since the 1960s.

3.1.1.1 Program Spending

To contain costs, NNC's annual budget was initially fixed at $60 million in 2011. However, in subsequent years, the federal government committed to enhancing the program and increased its funding. An annual compound escalator of 5% was also added to the food subsidy budget in 2014 to account for growing demand and population growth. 36 As such, planned program spending increased steadily over time (see Figure 1). Program spending should reach $109.2 million in 2020⁠-⁠2021. 37 Changes to the program in 2019⁠-⁠2020 include a revised list of subsidized products, increased subsidy rates and the creation of a new Harvesters Support Grant "to help lower the high costs associated with traditional hunting and harvesting activities." 38
Show Text Version
Sources: Figure prepared by the author using data obtained from Indigenous and Northern Affairs Canada, Departmental Plans and Results Reports; and Government of Canada, Departmental Plans for Crown‑Indigenous Relations and Northern Affairs Canada.

At first, NNC went over its budget by 12.9% in 2012⁠-⁠2013 and 14.6% in 2013⁠-⁠2014. These variances were attributed "to growth in demand for subsidized food" and changes to the subsidy rate in the program's first year. 39 According to the Office of the Auditor General of Canada (OAG), the department responsible for NNC (then Aboriginal Affairs and Northern Development Canada [AANDC]) had to transfer funds away from other programs and activities to cover these variances. 40 The trend gradually reversed and the program spent 12.4% less ($12.2 million) than planned in 2018⁠-⁠2019. Crown‑Indigenous Relations and Northern Affairs Canada, which succeeded AANDC as the lead department for NNC, explained that the variance between planned and actual spending in 2018⁠-⁠2019 was "due to a late implementation of program updates announced in December 2018." 41 Notwithstanding these variances, actual program spending grew by 27% (or $18.4 million) from 2012⁠-⁠2013 to 2018⁠-⁠2019.

3.1.1.2 Concerns and Criticisms

In 2014, the OAG concluded that AANDC "ha[d] not managed the Program to meet its objective of making healthy foods more accessible to residents of isolated northern communities" and "that the Department ha[d] not done the work necessary to verify that the northern retailers are passing on the full subsidy to consumers." 42 The NNC's Advisory Board, tasked with providing Northerners with a direct voice in the program, noted similar concerns. 43

NNC has also been criticized for its inadequate evidence base and accountability structure, its lack of responsiveness to concerns by community members and experts, and its failure to address inequities in food availability and affordability between regions and communities. 44 Furthermore, a 2019 assessment of NNC "suggests that food insecurity has worsened in Nunavut communities after the introduction of the program." 45 According to the researchers who conducted it, their study "raises serious concerns about the federal government's continued focus on food‑subsidy initiatives to improve food access in the North." 46

3.1.2 Food Policy for Canada

On 17 June 2019, the Minister of Agriculture and Agri‑Food announced the Food Policy for Canada. With a commitment of more than $134 million by the federal government, the policy's stated aim is to "shape a healthier and more prosperous future for Canadian families and communities." 49 The policy is the result of consultations held in 2017, which outlined several priorities, including the need to:

increase food security in northern communities;

support community-based food security initiatives;

recognize food as a significant determinant of health; and

acknowledge the impacts of climate change on hunting, harvesting and access to traditional foods.

The policy also confirms the commitment made in Budget 2019 to allocate $15 million over five years to create the Northern Isolated Community Initiatives Fund to support community‑led food production projects. 51 The Canadian Northern Economic Development Agency will be responsible for this initiative.

3.2 Provincial/Territorial, Regional and Local Initiatives

Examples of provincial/territorial and regional initiatives include the strategies and action plans developed by organizations such as the Nunavut Food Security Coalition; 54 the culturally appropriate food guides prepared by the Nunavik Regional Board of Health and Social Services and the Department of Health of Nunavut; 55 and comprehensive poverty‑reduction initiatives, such as the Makimaniq Plan. 56 Local community initiatives also offer short‑term (e.g., food banks and soup kitchens) and medium‑term (e.g., nutrition education and knowledge‑sharing programs, and hunting and harvesting support programs) solutions. 57

Given that each northern and Indigenous community has its own needs and circumstances, any sustainable solution to food insecurity must build on local knowledge and existing initiatives.

4 Conclusion

Food insecurity remains a severe public health and human rights issue in northern communities and among Indigenous peoples. To date, the federal government has yet to develop and implement a strategy to address the social, environmental and economic determinants of northern food insecurity in a holistic way. The phenomenon is rooted in complex issues, such as socio‑economic gaps, climate change and the long‑lasting and ongoing effects of colonialism. Addressing food insecurity in northern Canada will thus require a comprehensive, multi‑faceted and coordinated approach that fully takes into account these issues.

Notes

*  This background paper is largely based on Olivier Leblanc‑Laurendeau, Food Insecurity in Northern Canada: An Overview, Publication no. 2019‑18‑E, Parliamentary Information and Research Service, Library of Parliament, Ottawa, 5 July 2019.

†  Library of Parliament Background Papers provide in depth studies of policy issues. They feature historical background, current information and references, and many anticipate the emergence of the issues they examine. They are prepared by the Parliamentary Information and Research Service, which carries out research for and provides information and analysis to parliamentarians and Senate and House of Commons committees and parliamentary associations in an objective, impartial manner.

Appendix A - Communities Eligible for Nutrition North Canada as of 1 April 2019
Show Text Version
Source: Government of Canada, " Map of community eligibility as of April 1, 2019," Eligible communities.

Appendix B - Revised Northern Food Basket

The Revised Northern Food Basket (RNFB) is a tool developed by the federal government that lists 67 food items and the quantities required to nutritiously feed a family of four for one week. The government uses the RNFB to monitor food prices in northern communities. The RNFB was introduced in 2007 and replaced the Northern Food Basket of 1990.

Not all items in the RNFB are eligible to the Nutrition North Canada subsidies.

Dairy products (Total: 15.35 L)

2% milk, fresh or UHT (4.76 L)

Mozzarella cheese (485 g)

Processed cheese slices (385 g)

Yogurt (1.67 kg)

Evaporated milk, 2% (1.58 L)

Skim milk powder (90 g)

Meat, poultry, fish (Total: 6.7 kg)

Chicken drumsticks (2.68 kg)

Pork chops, loin (1.21 kg)

Ground beef, lean (1.34 kg)

T‑bone steak (470 g)

Sliced ham (135 g)

Frozen fish sticks (135 g)

Canned pink salmon (270 g)

Sardines in soya oil (270 g)

Canned ham (200 g)

Meat alternatives and meat preparations (Total: 1 kg)

Canned pork‑based luncheon meat (50 g)

Canned corned beef (40 g)

Canned beans with pork (290 mL)

Canned beef stew (180 g)

Canned spaghetti sauce with meat (155 mL)

Grain products (Total: 5.5 kg)

Bread, enriched white (660 g)

Bread, 100% whole wheat (660 g)

Flour, all purpose (1.92 kg)

Pilot biscuits (275 g)

Macaroni or spaghetti (385 g)

Rice, long‑grain parboiled white (330 g)

Rolled oats (275 g)

Corn flakes (440 g)

Macaroni and cheese dinner (550 g)

Citrus fruit and tomatoes (Total: 4.4 kg)

Oranges (1.23 kg)

Apple juice, frozen (130 mL)

Orange juice, frozen (1.13 L)

Apple juice, TetraPakc (880 mL)

Orange juice, TetraPakc (375 mL)

Canned whole tomatoes (215 mL)

Canned tomato sauce (300 mL)

Other fruit (Total: 9.95 kg)

Canned fruit cocktail in juice (855 mL)

Canned peaches in juice (285 mL)

Canned pineapple in juice (285 mL)

Potatoes (Total: 3.7 kg)

Fresh potatoes (3 kg)

Frozen French fries (480 g)

Instant potato flakes (220 g)

Other vegetables (Total: 8.7 kg)

Carrots (2 kg)

Onions (695 g)

Cabbage (520 g)

Turnips (350 g)

Frozen broccoli (695 g)

Frozen carrots (260 g)

Frozen corn (260 g)

Frozen mixed vegetables (1.74 kg)

Canned green peas (900 mL)

Canned kernel corn (1.09 L)

Canned green beans (315 mL)

Canned carrots (325 mL)

Canned mixed vegetables (545 mL)

Sugar (Total: 600 g)

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Food Insecurity in Northern Canada: An Overview

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This publication was prepared as part of the Library of Parliament's research publications program, which includes a set of publications, introduced in March 2020, addressing the COVID‑19 pandemic. Please note that, because of the pandemic, all Library of Parliament publications will be released as time and resources permit.

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First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada - Canadian Journal of Public Health

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First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada - Canadian Journal of Public Health

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Introduction

Food security is achieved "... when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life" (Food and Agriculture Organization 2008). Most household food security measures assess the inadequate or insecure access to store-bought foods as a result of financial constraints. A common tool to measure food security in Canada is the Household Food Security Survey Module (HFSSM) used in the national Canadian Community Health Survey (CCHS) (Health Canada 2007; PROOF Food Insecurity Policy Research 2018).

Because food security is largely looked at through the lens of economics and physical access, broader concepts are required to capture the distinct food systems of Indigenous Peoples and to honour their unique world views and perspectives. Stated as a precondition for food security, Indigenous Food Sovereignty emphasizes the close connection Indigenous Peoples have with their environment, the work being done by Indigenous communities to revitalize their food systems, the transmission of cultural knowledge about their lands, and the harvesting of traditional food (TF) (i.e., hunting, fishing, gathering, cultivating) (Coté 2016; Indigenous Peoples in Route to the Rio +20 Conference 2011). This concept is often used to exemplify the struggles First Nations Peoples encounter in harvesting TF and restoring/revitalizing their Indigenous food systems (Morrison 2006, 2011).

Food security and food sovereignty are inexorably linked for Indigenous Peoples because the harvest of TF is a key element in the achievement of both these constructs (Centre for Indigenous Conservation and Development Alternatives 2017; Morrison 2006, 2011). Much of the difficulties in harvesting TF stem from the ongoing long-standing colonial policies that have led to a loss of governance over Indigenous lands, and the breakdown of social systems from the intergenerational trauma of the residential school system that saw the removal of children from their families and other institutions that separated them from their culture. Land privatization, government regulations, and overexploitation of resources from industrialization (e.g., hydro-electricity, mining, forestry, and roadways) along with climate change have led to substantive environmental degradation, including increased contaminant risk from pollution, biodiversity losses, and the inability to access sufficient amounts of TF (Coté 2016; Laberge Gaudin et al. 2015; Turner et al. 2013b). Other inhibiting factors include the time and resources needed to access distant harvest areas, changes in knowledge and skills related to harvesting and preparation of TF, and avoidance of areas and food due to concerns for contaminants (Chan et al. 2006; Delormier and Marquis 2018; Kuhnlein et al. 2013; Laberge Gaudin et al. 2015). The multiple threats impacting First Nations Peoples' ability to maintain reliance on the TF systems combined with inadequate support from existing health systems are accompanied by the socio-demographic risk factors for food insecurity (Tarasuk et al. 2016, 2019).

A higher proportion of First Nations individuals live in poverty as compared with other Canadians and they more often live in poorly constructed, over-crowded houses headed by single parents (Statistics Canada 2015; Tarasuk et al. 2016). Using CCHS data, Tarasuk et al. ( 2019) found that the probability and severity of food insecurity are more than 50% (or between 34% and 78%) higher in off-reserve Indigenous households than in the general population of Canada. The First Nations Regional Health Survey reported that food insecurity was experienced by 54% of First Nations individuals living on-reserve (First Nations Information Governance Centre 2012).

Because food security in an Indigenous context cannot be separated from issues of food sovereignty and access to the preferred TF, in this article, in addition to reporting food security prevalence and analyzing factors contributing to it, we will investigate drivers of food sovereignty by identifying barriers and enablers of TF as expressed by on-reserve First Nations adults across Canada.

Methods

The First Nations Food, Nutrition and Environment Study (FNFNES) is a cross-Canada participatory study of First Nations adults living on-reserve south of the 60 th parallel. Recruitment and sampling occurred from 2008 to 2016 and these have been described elsewhere (Chan et al. 2021). Data collection began in British Columbia in 2008-2009, followed by Manitoba (2010), Ontario (2011-2012), Alberta (2013), the Atlantic region (New Brunswick, Nova Scotia, Prince Edward Island and Newfoundland (excluding Labrador)) (2014), Saskatchewan (2015), and Quebec/Labrador (2016). Methods were presented for approval to participating First Nations communities in each region before the onset of data collection in a regional methodology workshop and adjustments were made to the methods to respond to communities' needs. The required adjustments did not affect the survey tools used to assess food security and TF access, both discussed in the present article. As a result, the same tools were used in the 92 participating communities. Community-level results were presented to each participating First Nations community's leadership and members, and reactions were obtained to the findings for each section of the study and incorporated in the final community report. Anonymized regional results were subsequently presented at regional workshops to obtain reactions from regional First Nations representatives before any results were published. Each Nation's data were returned to the First Nation's leaders and members and community representatives were trained in data analysis.

Interviews to assess food security were conducted by trained First Nations workers under the guidance of a trained dietitian using the HFSSM. The HFSSM module focuses on self-reports of uncertain, insufficient, or inadequate food access, availability and utilization due to limited financial resources, and the compromised eating patterns and food consumption that may result among members of a household (Health Canada 2012; PROOF Food Insecurity Policy Research 2018). The questionnaire contained 18 questions (10 questions for adults and 8 additional questions for households with children) (PROOF Food Insecurity Policy Research 2018). Households were classified as food secure if no item was answered positively, or as marginally, moderately, or severely food insecure, using the thresholds adopted by PROOF (PROOF Food Insecurity Policy Research 2018).

In the third year of the FNFNES (after data collection was completed in British Columbia), food costs in participating First Nations communities and in one or more major urban centres in each region were estimated using the National Nutritious Food Basket tool (Health Canada 2009). The total costs of the items in the food basket as recorded by the field research staff were used to calculate the weekly cost of a food basket for a family of four consisting of two adults (a woman and a man, aged 31-50 years) and two children (one boy aged 14-18 years and one girl aged 4-8 years).

Prevalence of food insecurity was compared geographically by region (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, the Atlantic region, and Quebec and Labrador). Food insecurity was also compared by the Indigenous and Northern Affairs Canada Remoteness Index Zone (INACRIZ) classification (Alasia et al. 2017): Zone 1 (year-round road access and within 50 km to the nearest service centre); Zone 2 (year-round road access and between 50 and 350 km to the nearest service centre); Zone 3 (year-round road access and >350 km to the nearest service centre); Zone 4 (no year-round road access to a service centre, i.e., fly-in First Nations communities) (Alasia et al. 2017).

Other information collected by interviewers included information on diet, lifestyle, environmental concerns, and health. Information on household socio-demographic characteristics (gender, age group, income source, number of adults with full-time employment, education) and health (self-reported health, BMI, smoking status) were also collected. Although income was not collected, education and source of income were used as proxies. Because the HFSSM does not measure TF access, FNFNES measured indicators related to Indigenous Food Sovereignty using additional questions that addressed the barriers and enablers to obtaining TF and the control over access and sufficiency of TF. Two questions ("We worried whether our traditional food would run out before we could get more" and "The traditional food that we got just didn't last, and we couldn't get any more.") were posed to assess a household's adequacy of and the ability to replenish TF supplies. Additional questions, some open-ended, investigating perceptions of the impact of climate change on TF consumption and barriers to greater use of TF, plus another close-ended question listing possible impediments to TF harvesting, were administered. Answers to the open-ended questions were categorized by an analyst into at least one of the main themes that emerged (financial, household, personal constraints, climate change, etc.) and analyzed as a percentage of mentions of each theme over the total number of responses.

Food insecurity prevalence was the dependent variable in a multivariable logistic regression. Individuals with 'severe', 'moderate', or 'marginal' food insecurity were grouped together and compared to food secure individuals. The independent variables included the region in which the respondent resided; whether the First Nations community had year-round road access; the number of individuals in the house with full-time work (0, 1, or 2 or more); the main source of income (wages, salary, or self-employment vs. all other sources); age group (19-30, 31-50, 51-70, 71 years or over); the individual's BMI category (less than 25, 25 to less than 30, or 30 and above); the individual's formal education level (8 years or less, 9 to 12 years, 13 years or more); gender; and self-reported health (good (combined 'excellent', 'very good' and 'good') and poor (combined 'fair' and 'poor')).

Data were entered into a study database using Epi Info 3.5.4 (Centers for Disease Control and Prevention, Atlanta, GA, USA). Data analysis used SAS/STAT version 9.4 (SAS, Cary, NC, USA, 2013). All analyses were weighted by the First Nations community, household, and individual for non-response and to ensure they represented this population. Weights were adjusted for changes in population from 2008 to 2017. For the multivariable analysis, replicate weights were generated by randomly selecting 500 bootstrap subsamples of the full sample. Using PROC SURVEYLOGISTIC in SAS, the balanced repeated replication (BRR) option for variance estimation was employed ('VARMETHOD=BRR').

Results

The final sample size was 5176 after removing all missing data in the multivariable analysis. Almost half (47.1%) of all participating households were food insecure, while regional prevalence ranged from 38.0% to 57.2% (Fig. 1). Household food insecurity prevalence was higher in British Columbia and Alberta as compared with that in the Atlantic region.

Household food insecurity prevalence by region for First Nations households in Canada from the First Nations Food, Nutrition and Environment Study (FNFNES), 2008-2018, compared with the previously reported national prevalence for Canada. National food insecurity rate for Canada presented here for comparison taken from Household food insecurity in Canada, 2012 (Tarasuk et al. 2014). The researchers calculated rates from CCHS data gathered in 2011 among Canadian households. Household food insecurity among Indigenous households located off-reserve was 27.1%

First Nations household food insecurity prevalence among households with and without children is presented in Table 1. Forty-eight to 74% of households had children under the age of 18 years depending on the region. First Nations households with children experienced greater food insecurity than those without children (54% vs. 36%) and 29% of these households reported food insecurity at the child level, i.e., the children themselves experienced food insecurity (Table 1). In most regions, more than 5% of households with children exhibited severe food insecurity. The prevalence of food insecurity in households without children in Alberta was higher when compared with the Atlantic region, Ontario, and Saskatchewan but not different from British Columbia, Manitoba, and Quebec/Labrador. More adults in households with children experienced severe food insecurity than children (9% of adults with severe food insecurity vs. 3% of children) (Table 1).

Table 1 Income-related household food security status for First Nations households with and without children in Canada from the First Nations Food, Nutrition and Environment Study (FNFNES), 2008-2018a

In all regions, food costs were lower in major urban cities (Fig. 2). Cost differences between the urban centre and First Nations communities were lowest in the Atlantic region. Weekly food basket costs were $112-$140 higher in remote First Nations communities without road access vs. non-remote communities.

Comparison of average cost of healthy food basket to the community with the highest cost and a main urban centre in each region. Food basket costing was not undertaken in BC

Most adults said that they would like to have more TF in their diet. Although two thirds of First Nations households were actively engaged in harvesting (67%), over half of all adults reported that industrial activities (i.e., mining, hydro-electricity, forestry, farming) affected their harvesting in addition to other factors including climate change, financial (money and equipment or transportation), and household constraints (no hunter, time, traditional knowledge, and health). Overall, 47% indicated that they had experienced TF shortages while 43% were concerned that they could not get more in a timely fashion (Fig. 3).

The percentage of First Nations households who experienced a traditional food shortage and worried about the status of their traditional food supply in the last 12 months in Canada from the FNFNES, 2008-2018

Results of multivariable analyses are summarized in Table 2. The Atlantic region reported less food insecurity than Alberta and British Columbia. Women vs. men, households with children vs. those without, and individuals on social assistance, workers' compensation, and employment insurance vs. those receiving wages reported greater food insecurity. Participants with poor perceived health vs. those reporting good health and smokers vs. non-smokers reported food insecurity. Those households reporting TF activities were more food insecure than those not reporting it. Age, body mass index, and food basket cost did not influence prevalence of food insecurity.

Table 2 Multivariable predictors of food insecurity among First Nations households in Canada from the FNFNES, 2008-2018

Discussion

As a result of the challenges facing them, there continues to be an inequitable distribution of the economic resources and other social determinants of health between First Nations Peoples and others in Canada (Egeland and Harrison 2013; Turner et al. 2013a; United Nations 2007; Whyte 2015). Policy decisions impacting environmental determinants of health and well-being are often made for the benefit of external entities to First Nations communities, such as for industrial development and other territorial considerations that often do not consider First Nations right to self-determination (Turner et al. 2013a; Whyte 2015). The outcome is a dire situation where a majority of First Nations households are not able to achieve a healthy diet either from the TF systems within their territory due to these external considerations now compounded by the climate crisis, or from the market food system due to financial constraints that limit access to diverse and high-quality market foods (Kuhnlein et al. 2009; Lambden et al. 2006; Willows et al. 2019). As a result, income-related food insecurity prevalence is four times higher among First Nations households on-reserve than among non-Indigenous Canadian households (48% vs. 12%) and greater than that among off-reserve Indigenous households (27%) (Tarasuk et al. 2019).

When household TF activities were reported, they were associated with higher food insecurity, indicating that the costs associated with these activities (owning and the use of equipment) (Pal et al. 2013) may contribute to an increased food insecurity or, alternatively, these foods were resorted to in case of food insecurity (Schuster et al. 2011). Our cross-sectional data cannot establish, however, the reason for the observed association; careful qualitative research is needed to better understand the relationship between food security and TF harvesting.

Household food security has previously been associated with income-related issues such as low revenue and lower formal education attainment (Tarasuk et al. 2016). FNFNES measured education level and income source of respondent (i.e., employment and social assistance), along with employment status of household members but not individual or household income level. Although First Nations households located off-reserve with lower levels of formal education report four times higher risk of food insecurity (Tarasuk et al. 2019), FNFNES found no such reduction of risk in on-reserve First Nations households who reported higher education level. We observed that a combination of insufficient employment at the household level (less than 2 adults working full-time) and the respondent's source of income appeared to be income-related contributing factors to the high levels of food insecurity in on-reserve First Nations households.

As in other studies (Egeland et al. 2010; Tarasuk et al. 2016; Willows et al. 2011), our results clearly showed that households with children experience higher prevalence of food insecurity than those without children. As with other studies, to mitigate this, children in FNFNES households tended to be protected from food insecurity, and particularly so from its most severe form, by the adults sacrificing their food security on behalf of their offspring (9% of adults with severe food insecurity vs. 3% of children) (Power 2008; Tarasuk et al. 2016). In contrast, earlier studies in Indigenous Peoples in Canada report that children's reported food insecurity is worse than that of adults (Power 2008). It is possible, however, that some severe food insecurity figures were underestimated in this study, particularly in households with children; several community representatives mentioned, during the return of community results, that some parents, for fear of being stigmatized or having social workers interfere with their raising of their children, might be underreporting food insecurity (personal correspondence to the first author).

Unlike in Tarasuk et al. ( 2019), the probability of household food insecurity was higher for First Nations Peoples in Alberta than for those in the Atlantic region. The high levels of income-related food insecurity across most regions and the challenges of including more TF in the diet largely explain the less desirable dietary patterns (characterized by low intakes of grains, dairy, fruits and vegetables, and high intakes of sugar and sources of saturated fat and salt such as processed meats) and inadequate intake of several nutrients that we have found previously (Batal et al. 2018; Batal et al. 2021a; Willows et al. 2019). Household financial constraints play a key role in the quality and quantity of the household food supplies and dietary intake (Tarasuk et al. 2007). With a limited food budget, many First Nations families rely on lower priced foods which are often lower in nutritional value and are ultra-processed (Batal et al. 2018).

The strengths of this study include measuring food security using the HFSSM validated tool (PROOF Food Insecurity Policy Research 2018) and having a large sample with weighting of results at the First Nations community and regional levels, while accounting for population growth within these First Nations communities. Because the diet of First Nations individuals is a mix of both TF and store-bought food and the HFSSM only captures the latter, additional questions explored the barriers and concerns related to the harvesting, sharing, preparation, and consumption of TF, as TF practices are central to First Nations culture, health, and survival (Power 2008). Bias may have been introduced due to self-reported data that tend to over-report items viewed as positive such as the increased consumption of TF and under-report items interpreted as negative such as the intake of unhealthy market foods (Skinner et al. 2013).

Another strength was that this study provided new insight into the large variation in food costs between urban and rural First Nations communities. Food cost estimates, however, may underestimate the true costs of food as they did not include transportation costs involved in obtaining the food. In our study, food costs were restricted to items in the Healthy Food Basket (Health Canada 2009), a tool with a limited amount of foods, developed to help comparisons across regions but not estimating the real cost of foods consumed by First Nations Peoples. This basket only contains market foods and may not reflect foods culturally important to First Nations individuals. Interestingly, after adjusting for other factors, First Nations community food costs were not associated with food insecurity in our data.

Like Tarasuk et al. ( 2016), we included the marginally food insecure households in our analyses (those who are worried about having enough money to buy food). Because of this approach, our estimates would be higher than those reported by Statistics Canada and Health Canada as they only include the moderate and severe classifications in food insecurity (Health Canada 2017; Statistics Canada 2018). Severely food insecure households experience regular disruptions to eating patterns and food shortages, and moderately food insecure may be purchasing lower quality foods (Tarasuk et al. 2016).

Despite the introduction of the 'Nutrition North Canada' subsidy program since 2011 (Nutrition North Canada 2018), a high prevalence of food insecurity remains entrenched in remote Indigenous communities in Canada. Measured food insecurity in Nunavut at 41% (north of the 60 th parallel) was the highest in Canada in 2014 (Tarasuk et al. 2016, 2019), similar to the prevalence in remote First Nations communities in our sample south of the 60 th parallel at 43-58%. The Office of the Auditor General report in 2014 identified three main problems with 'Nutrition North' that may explain its failure to abate food insecurity in remote Indigenous communities: Indigenous community eligibility was not based on need; it is unclear whether subsidies were passed on to consumers; and insufficient information was collected to manage the program or monitor its success (Auditor General of Canada 2014).

First Nations Peoples are seeking greater control over their food systems through self-determination in order to achieve better food sovereignty (Coté 2016; Kepkiewicz and Dale 2019). Governments need to continue to encourage and build upon current First Nations Peoples efforts at all levels (i.e., First Nations community, regional, provincial, and national) to improve the food security and sovereignty of First Nations Peoples and provide adequate funding for programs developed by First Nations to improve access to TF (Solar and Irwin 2010). Future research/monitoring efforts need to supplement data at the individual level with higher level environmental data for both the market and Indigenous Food Systems (including market food availability, access, pricing, marketing, the ability of First Nations Peoples to influence food grown and sold within the community, TF access, distribution channels, and evaluation of success of interventions).

New mechanisms and governance models, co-developed with First Nations Peoples, are needed to address weaknesses in current policy and program approaches. This may range from increasing local food production and reducing food price differences to improving families' financial ability to obtain healthy food choices. Additionally, to address environmental threats to TF systems, efforts are needed that strengthen First Nations Peoples' self-determination and connection to the land, and their stewardship of the environment (Lee et al. 2019). Indigenous priorities and values need to be meaningfully recognized and included within relevant federal, provincial, and municipal decisions with respect to land use, development, conservation, and habitat protection, with an intention to maintain or enhance access to and availability of high-quality TF, as has been recognized in the United Nations Declaration on the Rights of Indigenous Peoples (United Nations 2007). Support is needed by all levels of government, including First Nations Peoples themselves, to monitor, protect, and ensure that local ecosystems are healthy and can support First Nations Peoples' ability to access TF.

Some First Nations communities have allied to implement programs to improve their food sovereignty, such as reintroducing and promoting salmon in the Okanagan (Syilx Okanagan Nation Alliance 2017), paying individuals who hunt and fish full-time (Cree Hunters and Trappers Income Security Board 2017), and championing ongoing efforts for knowledge transfer to future generations, e.g., culture camps and school curricula. Studies investigating the holistic evaluation of the feasibility of increasing traditional foods from an Indigenous perspective are required to monitor the health, social, and economic benefits of TF and food sovereignty strategies.

Acknowledgements

The authors would like to acknowledge the efforts of these individuals in the collection of the data used in this study: Olivier Receveur, Harold Schwartz, William David, Laverne Gervais, Lisa Wabegijig, Judy Mitchell, Kathleen Lindhorst, Constantine Tikhonov, and Lynn Barwin. The authors would like to thank all the members of the First Nations communities who participated and worked on the study.

Funding

The data used in this article originate from the First Nations Food, Nutrition and Environment Study (FNFNES) funded by the First Nations and Inuit Health Branch of Indigenous Services Canada. Part of knowledge translation activities were funded by the Canadian Institutes of Health Research; HMC and MB are funded by the Canada Research Chair Program.

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Authors and Affiliations

1. Département de nutrition, Faculté de Médecine, Université de Montréal, Pavillon Liliane de Stewart, CP 6128 succ. Centre-Ville, Montréal, QC, H3T 1A8, Canada

Malek Batal, Amy Ing, Genevieve Mercille & Louise Johnson-Down

2. Centre de recherche en santé publique de l'Université de Montréal et du CIUSS du Centre-sud-de-l'Île-de-Montréal (CReSP), 7101 Avenue du Parc, Montréal, QC, H3N 1X7, Canada

Malek Batal & Genevieve Mercille

3. Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada

Hing Man Chan

4. First Nations Food, Nutrition and Environment Study, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada

Hing Man Chan & Karen Fediuk

5. HealthBridge Foundation of Canada, 1 Nicholas Street, Suite 1004, Ottawa, ON, K1N 7B7, Canada

Peter R. Berti

6. Assembly of First Nations, 55 Metcalfe Street, Suite 1600, Ottawa, ON, K1P 6L5, Canada

Tonio Sadik

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Malek Batal, Amy Ing, Karen Fediuk, Tonio Sadik, and Hing Man Chan. Peter Berti was involved in the data analysis. The first draft of the manuscript was written by Louise Johnson-Down and reviewed by Genevieve Mercille, and all authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Malek Batal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards and approved by the institutional and/or national research committee (Ethical Review Boards at Health Canada, the University of Northern British Columbia, the University of Ottawa and the Université de Montréal) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The FNFNES also follows the First Nations principles of Ownership, Control, Access and Possession (OCAP®) of data (Schnarch 2004). Informed written consent was obtained from all participants.

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Informed written consent was obtained from all participants.

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Not applicable.

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Batal, M., Chan, H.M., Fediuk, K. et al. First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada. Can J Public Health 112 (Suppl 1), 52-63 (2021). https://doi.org/10.17269/s41997-021-00491-x
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DOI: https://doi.org/10.17269/s41997-021-00491-x

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Keywords

Indigenous

First Nations

Food security

Food insecurity

Food sovereignty

Traditional food

Mots-clés

Autochtones

Premières Nations

sécurité alimentaire

insécurité alimentaire

souveraineté alimentaire

aliments traditionnels

# data[].attributes.attachment_link.title
First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada - Canadian Journal of Public Health

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Objective To describe the prevalence of food insecurity in First Nations households across Canada while identifying barriers and enablers to traditional food (TF) consumption. Methods The First Nations Food, Nutrition and Environment Study is a cross-Canada participatory study of on-reserve First Nations from 2008 to 2018.

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Inflated food costs are a contributing factor to food insecurity in isolated communities of Canada's North. To increase the affordability and accessibility of healthy food in Northern communities, a federal government program Nutrition North Canada (NNC) offers retail-based subsidies on select nutritious foods shipped by air. In this paper, I integrate methods of process evaluation to determine whether or not the program components of NNC, such as the defined target population and subsidy design, are sufficient to achieve the intended program outcomes of increased affordability and accessibility of nutritious foods. A literature review drawing on government documents and journal articles outlines the setting of northern food insecurity and defines an inventory of NNC program components. Media articles published between 2011 and 2015 provide context and draw focus to specific implementation issues drawn from the NNC program. The process evaluation for this paper examines these documents for examples of inconsistency within the NNC program's target, design, and structure that will affect successful program implementation and delivery. My results focus on inadequacies in the structure of the community eligibility target, subsidy design, and compliance reports. I conclude with recommendations on revising and strengthening these components, to ensure that the Nutrition North Canada program can reach its key goal of increasing the affordability and accessibility of healthy foods in isolated northern communities that do not have year-round marine and/or ground transport.

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Addressing a Northern Food Crisis: Process Evaluation of Nutrition North Canada

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Inflated food costs are a contributing factor to food insecurity in isolated communities of Canada's North. To increase the affordability and accessibility of healthy food in Northern communities, a federal government program Nutrition North Canada (NNC) offers retail-based subsidies on select nutritious foods shipped by air.

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Due to its connection to multiple concepts, residents of Northan Reserve communities have difficulties in their working life conditions. Therefore, this social determinant of health is affecting the population's daily life.

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-Affected are aware and unaffected don't realize it is an issue
-Affected not aware of resources /education to improve conditions
-Not widely posted on news outlets and media
-Visible only in urban centres
-Partnerships not widely available in remote communities

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Retail food environments, shopping experiences, first nations and the provincial North

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Retail food environments, shopping experiences, first nations and the provincial North

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Health Promotion and Chronic Disease Prevention in Canada
https://doi.org/10.24095/hpcdp.37.10.03
This article has been peer reviewed.

Correspondence: Kristin Burnett, Department of Indigenous Learning, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1; Tel: 807-346-7721; Email: kburnett@lakeheadu.ca

Abstract

Introduction: This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada.

Methods: We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences.

Results: Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%), Saskatchewan (83%) and Manitoba (72%). Respondents to the survey (n = 92) expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods.

Conclusion: There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.

Keywords: food environments, retail, food quality, provincial Norths, northern Canada

Introduction

Grassroots Indigenous movements and organizations responding to the changes in the subsidy program have brought the extremely high rates of food insecurity in the Canadian North to the attention of the broader Canadian public through social media campaigns and on Facebook pages such as Feeding My Family. Such community responses have been echoed by academics and international organizations. In 2014, for example, the Council of Canadian Academies published Aboriginal Food Security in Northern Canada: An Assessment of the State of Knowledge, which reported that food insecurity in northern Canada is a pressing and immediate issue demanding urgent attention. This analysis was preceded in 2012 by the report of Olivier De Schutter, then the United Nations' Special Rapporteur on the right to food, on his visit to Canada, which revealed that 60% of on-reserve Indigenous households in northern Manitoba were food insecure, as were 70% of Inuit adults in Nunavut. De Schutter further noted that these rates of food insecurity were six times higher than the national average and "represent[ed] the highest documented food insecurity rate for any aboriginal population in a developed country." While the situation in the Far North is extremely important, discussions of food insecurity have remained focussed on that region (specifically, Nunavut). And while Nunavut (and the NWT and Yukon) needs access to NNC (and to better, more effective programs designed to lower the cost of food and increase access to land- and water-based foods), the focus of this research is on the retail food environments of First Nations communities in the provincial Norths.

The all-encompassing use of the term northern has created confusion as to what constitutes the "North." We are concerned about the conflation of the provincial Norths and Far North and the reduction of the experiences of what are two different regions undergoing food crises to one representative experience. Canada's "North" represents 96% of the country's landmass and includes widely disparate geographic and culturally diverse peoples situated within different economic, political and social environments. Notably, the one continuity between these regions is the disproportionate rates of food insecurity among Indigenous peoples living in rural and northern communities, and the presence of corporate oligopolies.

In this article, we focus on the provincial Norths, often referred to as "Canada's forgotten North.",p.312 Frequently, the provincial Norths are absent from conversations about the "North," which generally refers to the Far North (Nunavut, Northwest Territories and the Yukon). While the provincial Norths tend to have more in common with the Far North than the urban south, conflating the regions does them a disservice and fails to adequately account for their distinctive features. Such totalized discourse concerning northern Indigenous populations also does the colonial work of homogenizing First Nations and Inuit peoples and removing them from the specific contexts, geographies and histories in which they are situated.

Background

Within a market environment of restricted retail options, retailers have an enormous opportunity to shape local food environments and peoples' access to foods. Academics such as Teresa Socha and her colleagues noted that community members regarded the profit-driven model adopted by retailers as a significant barrier to affordable food., These researchers posed an important question in relation to the high cost of food: that is, "food or profitability?",p.58 Their 2011 study compared the prices of food between grocery retailers in Thunder Bay and a remote First Nation located in northwestern Ontario, arguing that resolving food insecurity in the provincial North was premised on "solving problems related to the food chain, including transportation, food accessibility, and food availability.",p.58

Solutions to food insecurity include increasing Indigenous peoples' access to land- and water-based foods through supporting community food sharing networks, harvester and hunter support programs and community freezers.,, In other words, Indigenous food sovereignty is essential to decolonizing local food environments. However, Indigenous food sovereignty has focussed primarily on control over land- and water-based foods, and while this is extremely important, such a focus can obscure the fact that market-based food systems remain prohibitive in terms of costs and negligent regarding food selection and quality. While food sovereignty is imperative in First Nations communities, it does not preclude the need to have equitable market-based foods systems in operation and under local control as well. Indeed, the need to address the existing market-based food system and the oligopolies that have facilitated the current conditions present in most northern communities is urgent. A comprehensive solution is required that includes both land-and-water-based and market-based food systems and that places a critical focus on the profit-producing operations of retailers in the region.

Historical context

Under Canada's residential school system, hundreds of thousands of Indigenous children were forcibly removed from their families and communities and confined to schools that were designed to assimilate them. These schools had, and continue to have, a profound impact on the intergenerational transmission of the knowledge required to harvest and prepare wild foods. Climate change has also altered animal migration patterns and reduced the ability of people to continue to hunt and fish. Nevertheless, the harvesting, preparation and consumption of traditional foods remains deeply embedded in the familial, cultural and social fabric of communities and is an essential component of both the social and physical well-being of First Nations.,

After the Second World War, the federal government undertook a series of social welfare and food subsidy programs as well as education initiatives that had the effect of undermining Indigenous foodways and resulted in Indigenous people becoming increasingly reliant on southern market-based food systems. For instance, in the late 1960s, the federal government instituted a transportation subsidy for a select list of foods to be run through Canada Post, called the Food Mail Program. This subsidy existed until April 2011, when it was replaced by Nutrition North Canada. NNC is a retail-based program intended to subsidize the high cost of perishable, nutritious foods in the North. Retailers receive a subsidy on certain foods that are flown into eligible northern communities. The subsidy is applied on two levels (high or low) for perishable and nutritious foods, and is based on destination and weight. Registered retailers receive the subsidy directly and are responsible for passing along the full savings to their customers with little to no oversight. Until 01 October, 2016, in northern Ontario there were 32 fly-in communities and only eight fully eligible communities, although all were desperately in need of the food subsidy.

Objectives

The objective of this research was to examine the retail food environment in northern Canada in two ways: (1) by considering whether the NWC has market competition for grocery retailing in communities without year-round road access; and (2) by inviting people living in semi-remote and remote communities to share their experiences of the retail food environment in the North. It is very challenging to recruit people living in semi-remote and remote communities to participate in surveys and obtain their perspectives on northern issues. While we acknowledge that there are some methodological limitations to the approaches we were able to use, including a small sample size, this paper presents an important contribution to a very scant body of literature on the topic of retail environments in northern Canada.

Methods

We employed two approaches to assess northern retail food environments. The first was designed to determine whether the NWC faces substantive competition in the North, since the NWC is the major grocery retailer across northern Canada. To accomplish this, we initially created a list of all the northern communities in Canada without year-round road access. We then checked these communities to determine whether they had a NWC store, based on the list of stores on the NWC website in December 2016. From this list, we ascertained whether that store faced any retail competition by searching and listing other stores in the same community that had a full-service grocery store. Thus, small, locally owned convenience stores were not counted as competitors to NWC stores.

We included a community in our study if it met any of the following criteria: it was located in the provincial Norths, Yukon, Northwest Territories, Nunavut, Nunavik, or Labrador; it was part of the NNC program; it was included in the article "From Food Mail to Nutrition North Canada: Reconsidering Federal Food Subsidy Programs for Northern Ontario," published in Canadian Food Studies in May of 2015; or, finally, it was listed on the NWC website. In northern Ontario, we also included the municipality of Moosonee because it serves as an important entry point for northern First Nations in the Mushkegowuk territories for services (food, general goods and health care) and is only accessible year-round by rail (as all-season roads are not yet operational). Any store that sold food as a general store or grocery store was included in the study. We counted those stores that had more than one operation in the community (i.e. the NWC often operates a grocery store in addition to a gas station or "Quick-Stop"), which are often contained in more than one building, as one store despite the multiple locations and different retail focusses. While further breaking down these smaller categories may offer additional insight into the breadth and scope of the oligopolies operating in northern communities, such an inquiry is not within the scope of this article.

The second approach was to collect data from community members living in northern Canada using an online survey tool that was developed in consultation with community members and Elders. The Ontario-based Northern Food Sovereignty Advisory Group (FSAG) comprises seven food activists and community members, including one Elder, who live in communities in northern Ontario and have formed an advocacy group engaging with issues of food sovereignty and addressing current relationships of power and inequality through various activities. We worked with the FSAG over the course of two years, and during our discussions it became clear that there were serious concerns around best-before and expiry dates, food quality, food preference and retail practices, as well as a desire for more information about these issues. We drafted a survey to try and address these concerns, using a scale from one to five and comment boxes to encourage participants to further elaborate on those issues about which they felt most strongly. The failure of people to understand best-before dates is a frequent critique offered by retailers, and so, after a lengthy discussion with community members, we chose to use the term "expired foods." "Expired" is the term most commonly used by community members and the perception that "best before" and "expired" are synonymous is relevant when considering what informs people's purchasing decisions (packaged foods that are being sold after the best-before date). The survey went through a revision process of four drafts in consultation with five of the FSAG community members and the Elder.

The survey was launched using the online survey tool FluidSurveys (Fluidware, Ottawa, ON, CAN) on November 12, 2014, and closed December 31, 2014. We invited northern residents in Canada to share their experiences and concerns about food purchasing experiences with local retailers. To promote the survey and encourage northern residents to participate, postcards explaining the study were distributed at the 2014 Food Secure Canada conference and to our community partners to share with their own social networks. Northern media and social media outlets (e.g. the Feeding My Family Facebook group) were widely contacted as well as northern organizations engaged with food security issues and health and well-being concerns more generally. Due to the significant constraints of conducting survey research in remote communities, we were limited to a convenience sample of participants. Incentives were not provided to survey participants.

Results

Store competition

Across Canada, there are 120 NWC stores (or various iterations of the store: North Mart, Northern) located in either the provincial Norths or Far North that do not have year-round road access, and are briefly accessible in the winter by seasonal ice roads or rail. The NWC operates the sole grocery store in 65 of the 120 communities (or 54%). An additional 55 communities have a second full-service grocery store. In other words, the NWC is the only full-service grocery store in 54% of the communities in which it operates in Canada.

This picture is further complicated if we break down the number of NWC stores according to province and territory. Table 1 shows the number of NWC stores that face competition from at least one non-NWC full-service grocery store in each province or territory. Those provinces that have the highest number of NWC stores are Manitoba, Ontario and Saskatchewan, where the company faces almost no competition. Proportionately, NWC stores located in northern First Nations in Ontario face the least competition; 91% of their stores face absolutely no retail competition. Eighty-three percent and 72% of the communities in northern Saskatchewan and Manitoba, respectively, are serviced only by an NWC store.

Province/territory

Number of communities with an NWC

Number of communities with only an NWC

Number of communities with a grocery store in addition to NWC

Abbreviation: NWC, North West Company.

Table 1 - Footnote a

This sample to determine competition with the NWC was limited to the 120 communities without year-round road access that had a NWC store.
Return to Table 1 - Footnote a referrer

Table 1 - Footnote b

This number was determined by counting the NWC stores listed on the NWC website in December 2016 in communities in each of these provinces/territories that did not have year-round road access and that sold food as a general/grocery store.
Return to Table 1 - Footnote b referrer

Retail experiences

The second element of this work was to assess the retail environment through individual experiences and perceptions of the high cost of food; the quality of the food available to purchase (e.g. whether fresh or expired); and availability and selection or variety of specific foods (e.g. fresh produce and dairy products). Of the 113 people who started the survey, we excluded those who only completed the first few questions of the survey (n = 20) and one person who was living in the United States. The following descriptive analyses were conducted using data from the remaining respondents (n = 92).

The majority of people who responded to the survey were women (71.7%); 27.2% of all respondents were aged 35 to 44 years; 25.0% were aged 25 to 34 years, and 21.7% were aged 45 to 54 years. Twenty-one percent of respondents had 5 or more people living in their household, with an average of 3.4 people per home. Approximately one-third of our respondents (32.6%) resided in northern Ontario; the next highest number of respondents were from Northwest Territories (21.7%), Manitoba (18.5%) and Nunavut (12.0%). Eight of the provinces and territories were represented ( Figure 1).

Figure 1: Geographic representation and percentage of survey respondents from each province and territory

Figure 1 - Text Description

In Figure 1, we can see that approximately one-third of the survey respondents (32.6%) resided in northern Ontario; the next highest number of respondents were from Northwest Territories (21.7%), Manitoba (18.5%) and Nunavut (12.0%). Eight of the provinces and territories were represented.

Eighty-nine percent of respondents identified themselves as currently residing in a remote or semi-remote community. All of the people who did not currently live in a remote or semi-remote community but had lived in one previously were asked to provide their perspective from when they had lived there.

About half (51.1%) of respondents lived in a community with year-round road access. Of the respondents who mentioned the cost of gasoline (n = 74, 80.4%), the average cost was $1.59 per litre and ranged from $1.00 to $3.00 per litre.

The majority of respondents reported doing most of the food shopping for their household (84.7%). The store that respondents indicated they used most often as their primary retailer was the NWC (49.5%), followed by private, locally owned stores (18.9%), a community-owned store (15.8%) and Arctic Co-operatives (6.3%). When asked, "Does the store sell expired food?" with the response options of "Often," "Sometimes," "Never" or "I don't know," 82% of respondents stated that their store often or sometimes sold expired food. When asked, "Is the perishable food usually in good condition?" with the response options of "Yes" or "No," more than half (57%) of the respondents said perishable food was not usually in good condition. Those respondents who said that perishable food was not usually in good condition were able to provide comments about the condition of this food in their store. Their comments described foods that were not fresh; shopping practices that involved paying great attention to checking food quality prior to purchasing perishables; and difficulties related to food freshness and quality that arose from long transportation routes. ("More often than not, they are close to rotten or rotten when they arrive," wrote a participant from a remote community in northern Manitoba). Some described the food as having variable quality (e.g. a participant from a remote community in Yukon commented "Highly variable-sometimes arrive in good condition, bananas and cucumbers regularly frozen/soggy"). Some reported having to make sure to consume it quickly after purchase (e.g. a participant from a remote community in the Northwest Territories defined her fresh food purchases as "rotten, or so ripe [they] must be consumed immediately," and another participant from a semi-remote community in northern Ontario wrote, "Usually have to use the day you buy it.") Several people described the winter months as a time when perishable food was of poorer quality, while others explained it was an issue all year round ("They don't last longer than a day or two once purchased.... Winter months are worse than summer months," offered one participant from a remote community in Nunavut).

When asked, "What is your biggest concern when shopping at your primary retailer?", the greatest concerns participants expressed regarding food purchasing fell within three main areas: the high cost of food; the quality of the food available to purchase (e.g. whether fresh or expired); and the availability and selection or variety of specific foods (e.g. fresh produce and dairy products). When asked, "What are the top five food items you purchase most often?" the food purchased most often was milk. When participants were asked, "Name the top three fresh or perishable healthy foods that you think should be made more affordable," they chose produce (i.e. fresh fruit and vegetables), followed closely by milk and meat.

At the end of the survey, participants were asked if they had any additional concerns or if there were questions that they had not been asked. Twenty-seven people (29.3%) provided additional comments. Some of the comments included possible reasons for the lack of variety and quality of products available to them, such as this from a member of a remote community in Nunavut:

The lack of variety comes from the Head Office as the employees are only limited to what they can order in the order guide. Also they have get in a lot of their own brand which is horrible because they make more money on selling their own brand. Also we have notice even the groceries coming in on the barge which should be cheaper because it is barged in, is at the same price as the groceries coming in on the planes. Also all this non food items all seem to be cheap stuff but they sell it at huge prices ... crap we can buy in dollar stores down south but they mark it up so much. Now we know why The North West Company always makes a profit because the prices are out of this world.

Others were very focussed on the high cost of specific staple foods compared to those that were less healthy, such as this from a remote community in northern Manitoba:

Why isn't the price of milk, eggs, bread, etc the staples of a household not regulated across the country? I have never seen any of the above go on sale. Cost of 4 litres of milk is over $8.50, in the northern town where I live. Yet 2 litres of Pepsi & coke products can go on sale for $1.00, potato chips go on sale. Alcohol is regulated, but milk is not, something has to be done about that.

Comments also provided details about some of the challenges to food access during specific times of the year and how that impacted prices: "During spring break-up and fall freeze up we chopper groceries across. I see food prices go up during this time, but they never go back down" (from a member of a remote community in Northwest Territories). Several respondents also described the cost of food in comparison to the cost of living: "How are you supposed to make a living when milk is 15 dollars? I know that's not even the worst in Canada, but seriously. People have to feed their families and all they can afford is the terrible and unhealthy pre packaged food" (from a remote community in northern Ontario). Finally, a number of respondents questioned the profits made by retailers and referenced government subsidy programs, including the NNC subsidy: "I believe that there needs to be more transparency with how much the food costs, how much the retailer profits, and how much the government is subsidizing the rates by" (from a remote community in the Northwest Territories).

Discussion

In this paper, we highlight the scope of the NWC's food retailing operations in the provincial North, and describe the context of the food retail environment in the Far North and provincial Norths by drawing on the perspectives of people living in those communities. Reducing the experiences and contexts of many different communities and locales within a vast area to one described as simply the "North" does not adequately address the nature of the retail and food environments of northern Indigenous communities. There are significant differences between the Far North and the provincial Norths, as well as within those regions and communities. Our objective was to address and illustrate some of the unique challenges that many First Nations communities in the provincial Norths face in acquiring market-based foods, both in terms of the lack of competition, the existence of oligopolies, and general retail experiences.

Our analysis of retail competition in northern Canada demonstrated that the NWC holds market dominance in the provincial Norths especially when it comes to the sale of food. Between 1987 (when the Northern Department of the Hudson's Bay Company was sold to executives of the Northern Store and private investors) and 2015, the portion of those profits from the sale of food has more than doubled from just over 30% to 79.3%. Indeed, participation in a retail food market has proven so profitable to the NWC that the company expanded in 2007 through the Cost-U-Less initiative to the South Pacific and Caribbean, citing "a leading competitive position that's supported by high barriers to entry." The market dominance of the NWC in the North is facilitated by the company's ability to access government subsidy programs such as Nutrition North Canada and its predecessor, the Food Mail Program. During the 2014/15 fiscal year, the NWC received the majority (50%) of the NNC subsidy from the federal government, while the recipient of the next highest amount was the Arctic Co-operatives, located primarily in Nunavut, Northwest Territories and Yukon, at only 19%.

The regions that contained the highest number of NWC stores in Canada were northern Manitoba and Ontario (with 25 and 22 stores respectively). Very few of our sample communities contained a second full-service grocery store: in northern Ontario there is one First Nation that has a second full-service grocer, and in Manitoba there are seven. While the challenging retail environment has limited retail competition and precluded the establishment of more than one grocery store in many communities, those retailers that do operate in northern First Nations continue to make a significant profit. A 2014 report on NNC, entitled "Northern Food Retail Data Collection and Analysis," commissioned and released by the federal government said that while "retailers were unwilling to provide specific financial information regarding the profitability of their northern retailing operations," it nonetheless concluded that "northern grocery retailers are making a profit from their activities in northern communities and therefore profit is a factor contributing to the overall cost of groceries."

The online survey we conducted in northern Canada provides texture to the description of the retail environments and brings into sharper focus a number of the issues highlighted in the November 2014 Auditor General's report on NNC, the recently released Government of Canada report about the NNC public community engagement process,, and an external program evaluation. The government report summarized general observations from community members about the public engagement process as follows:

Northerners feel that everything in the North is expensive, with a number of participants stating that, as Southerners, it is difficult to understand those struggles, which is then further intensified with many people living off a fixed income. Even with the subsidy provided through NNC, for which they generally expressed an appreciation, many families are not able to afford healthy food. There were significant concerns regarding the overall quality and availability of nutritious perishable food in the North.

Our findings from surveying the experiences of northerners with retail food access generally aligned with these observations. People living in northern and rural First Nations that are accessible briefly by seasonal ice roads demand access to a wider selection of food that is in good condition at affordable prices. The quality of perishable foods poses a significant concern and often serves as a barrier to the purchase of fresh foods. The fear of spending money on inedible food may prevent people from taking the risk of buying new types of food, or make them decide to purchase ready-made or fast foods that they can be fairly sure they will be able to eat. Indeed, quality consistently remains one of the principal concerns expressed by community members but continues to be considered the least important factor when it comes to research design or assessing the success of the NNC program, both of which to date have focussed on collecting the prices of a select list of foods from the Revised Northern Food Basket (RNFB). A failure to understand the dynamic between food quality and food purchasing practices in the North adds to the misconception that people in First Nations communities in the provincial Norths choose to purchase unhealthy, prepackaged and processed foods rather than healthier fresh produce and perishable items; in fact, food purchasing decisions are often influenced by past experiences of purchasing rotten, mouldy or less-than-fresh food that is inedible.

Finally, while all community members have questioned the current terrain of the retail environment that exists in fly-in and northern First Nations located in the provincial Norths, there is a real and marked failure on the part of government agencies to pose those same questions. The 2014 Auditor General's report on NNC noted that some communities in northern Ontario were eligible for NNC and others were not. It made no mention, however, of the dominance of the market-based food system by one company and that company's influence on and access to the decision-making processes that affected Indigenous communities. For instance, when consultations on the Food Mail Program were undertaken in 2007 to 2008, the NWC's consultation with Dargo and Associates (the consulting firm) was either on par with that of communities and First Nations or even, in some cases, exceeded the access given to community members. What is more, this report argued that the relationship between the federal government and food retailers "encourages market disruption and is at odds with the Minister's mandate of supporting northern economic development.",p.17

Drawing on data collected by NNC, Galloway studied whether or not the existence of the subsidy program made a meaningful difference in the cost of food in northern communities. She found that the lack of retail competition in small communities, even those subsidized by NNC, resulted in extremely high food costs. She provided examples from the Far North, noting that communities with a second retailer still could not be considered a competitive food retail environment, and those communities with a single food retailer exhibited the highest cost of food in Canada. In our research, we found that there is a shortage of competition for food retailers in the provincial Norths. We suggest that limited retail competition plays a significant role in food insecurity in northern Canada. Further research is required to obtain data on the oligopoly of the retail food environment in northern Canada and to provide more evidence as to whether a lack of retail competition makes food costs considerably higher in these communities. Quantifying the differences in food costs for communities with multiple food retail competitors versus those with oligopolies or monopolies, along with an examination of food quality and further investigation of the perspectives of people living in northern Canada, is warranted.

Strengths and limitations

This paper addresses a relatively unexamined topic in regards to food security in First Nations communities located in the provincial Norths. The paper only examined retail competition in the 120 communities that had NWC stores and did not have year-round road access. The online survey was informed by community members from the FSAG and reflects their concerns about their shopping experiences, and cannot be representative of everyone. The number of survey respondents was limited by several factors: the need for access to the Internet in order to complete the survey, language barriers, and the fact that the most marginal members of the community were unlikely to respond. The result was a small sample size (n = 92) representing eight provinces and territories and not presenting a complete picture of food retail experiences across northern Canada. However, due to the challenging nature of collecting this type of data in remote regions, along with the absence of other data on shopping experiences from residents in northern locales, this study is a first step in building new information on this topic.

Conclusion

Food insecurity in northern Canada, especially among First Nations and Inuit people, is a pressing public health problem. Limited retail food competition have exacerbated this issue enormously. In northern Ontario, there is only one full-service grocery store in 91% (20 of 22) of the fly-in First Nations communities that are only accessible by seasonal ice roads. Limited retail choices also affect the range and quality of foods that people are able to purchase. Efforts to support Indigenous food sovereignty must address all elements of local food economies, including retail and land and water harvesting activities.

Acknowledgements

We would like to acknowledge the kindness, generosity and patience shown to us by the community members who worked with us on this project. We also thank Robert Thivierge, who did the legwork of identifying grocery stores in northern Canada, and James Jung, who helped us with some last-minute fact checking. The research was funded by SSHRC.

Conflicts of interest

The authors do not have an affiliation with or involvement in any organization or entity with any financial interest or non-financial interests in the subject matter or materials discussed in this article.

Authors' contributions

KB and KS were involved in the conceptualization of the work; distribution of the survey; acquisition, analysis and interpretation of data; and drafting and revising the manuscript. TH was involved in the distribution of the survey; analysis of the data and drafting the manuscript. JL was involved in the conceptualization of the work and the drafting of the online survey and its distribution among community members. LC was involved in the conceptualization of the work and revising the manuscript.

The content and views expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

References

Footnote 1

The RNFB is a survey tool created by Indigenous and Northern Affairs Canada in consultation with Health Canada to monitor the cost of food in remote northern communities. The RNFB is based on average overall consumption for a sample population and contains 67 items (as revised in 2008) and their purchase sizes.

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Galloway T. Canada's northern food subsidy Nutrition North Canada: a comprehensive program evaluation. Int J Circumpolar Health [Internet]. 2017 [cited 2017 Mar 22];76(1):1279451. Available from: http://dx.doi.org/10.1080/22423982.2017.1279451

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# data[].attributes.attachment_link.title
Retail food environments, shopping experiences, First Nations and the provincial Norths

# data[].attributes.attachment_link.description
Health Promotion and Chronic Disease Prevention in Canada https://doi.org/10.24095/hpcdp.37.10.03 This article has been peer reviewed. Correspondence: Kristin Burnett, Department of Indigenous Learning, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1; Tel: 807-346-7721; Email: kburnett@lakeheadu.ca Introduction: This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada.

# data[].attributes.body
Due to the geographical location and the weather conditions in the Northern Canada, there are typically smaller populations with:
Limited access to resources
Limited stores
Limited opportunity
Limited ability to travel (ice roads 4mon/yr)

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Due to multiple social determinants of health throughout the years, including intergenerational trauma, racism, and systematic discrimination, there is a significant decline in socioeconomic status.

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Colonization affected the Indigenous people's food system by introducing foreign and invasive plant and animal species. This further led to environmental disruption which continuously resulted in disruption of the Indigenous culture.
The Indigenous people were forced to change their lifestyle. Hunting, fishing and harvesting were their traditional food source but it stopped due environmental disruption.

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There is increased in temperatures in northern Canada where it has warmed about twice than the global average. This would significantly affect the environment in the north including changes in agriculture distribution and altered migration of wildlife.
Climate change would affect the health of the people in northern communities of Canada due to climate change due to decreased access to food. Furthermore, due to climate change, communities in northern SK has been experiencing heavy rainfalls that results in   extensive flooding, severe forest and grass fires, and migration of pests from the south.

In addition, climate change can affect the roadway's integrity. With continuous extreme weather changes, road erosion or snow build up can affect the people's access to food in the northern community.

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Nutrition North Program
- Food Security Research Grant
-Food that is eligible for subsidy: Fruit and veg, Bread, Dairy, Formula, Deli Meats.
-But only a 1% decrease in the overall cost of groceries from the NNC food subsidy program
Indigenous Community Support Fund
Reliance on wages and social assistance
***Band members/Treaty members do not pay tax on groceries which may help alleviate some costs

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-"To date, the federal government has yet to develop and implement a strategy to address the social, environmental and economic determinants of northern food insecurity in a holistic way."
-Nutrition North Canada (a federally funded program) is highly criticized, and makes little difference in grocery costs. (1% reduction)
-There are several programs available in urban centres but they not accessible in northern communities
-Food security programs partnerships with community resources such as food banks, but these are not available in northern communities

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Nutrition North Canada Program
Increased prices relate to the expenses of the resources required to transport these goods and services to these locations. Some communities do not have all-season roads, so more expensive transportation methods are needed. The socioeconomic status of these locations (employment, education, etc.) results in more cost of food with low wages/salaries. The economic, political, and social conditions within these communities are different compared to the Southern parts of Western Canada. This impacts food prices for these populations.
"Food purchasing fell within three main areas: the high cost of food, the quality of food available (e.g. whether fresh or expired), and the availability, selection and variety of specific foods (e.g. fresh produce and dairy products)."
https://doi.org/10.24095/hpcdp.37.10.03

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Disturbed eating patterns and reduced diet quality due to low cost, energy-dense diet can result in chronic and infectious disease. High-cost of food may be a result of the development of unhealthy food practices. Low variety of food/lack of cultural variety can impact health practices.
https://doi.org/10.1016/j.foodpol.2018.08.006

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Low competitiveness and choices due to restricted numbers of retail markets in these communities.
North West Company executes an oligopoly market.

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Access to Transportation to and from Healthy and Affordable Food - SDOH

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Access to Transportation to and from Healthy and Affordable Food - SDOH

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Expensive to ship and store healthy food in these areas of Canada. Not having access to healthy food can result in malnutrition, infections, chronic disease, obesity, distress, social exclusion, depression, suicidal ideation and suicide.

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Access to affordable, quality health services 

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Access to affordable, quality health services 

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 Food Insecurity and Malnutrition in Residents of Northern Reserve Communities in Western Canada

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 Food Insecurity and Malnutrition in Residents of Northern Reserve Communities in Western Canada

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How colonialism affected their way of living – due to forced relocation, ongoing residential school trauma, and disruption of their relation to their land, and their traditional food systems.

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Affordable Housing, Basic Amenities and Safety - SDOH

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Affordable Housing, Basic Amenities and Safety - SDOH

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Access to Affordable and Healthy Food - SDOH

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Access to Affordable and Healthy Food - SDOH

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Statistics for most affordable food include four product categories over time: fresh produce, snacks (including candy, chocolate, potato chips, and other salty snacks and meat snacks), sweetened beverages, and cigarettes.

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Sale prices in stores increase at the end of the month associated with the social assistance payments; sales of transit passes, cigarettes, and lottery tickets account for highest