Indigenous Identity and Household Food Insecurity are Associated with Poor Health Outcomes in Canada

Purpose: To examine whether Indigenous identity and food insecurity combined were associated with self-reported poor health.Methods: Data from the 2015-2016 Canadian Community Health Survey and multiple logistic regression were employed to evaluate the association between Indigenous identity, household food insecurity, and health outcomes, adjusted for individual and household covariates. The Alexander Research Committee in Alexander First Nation (Treaty 6) reviewed the manuscript and commented on the interpretation of study findings.Results: Data were from 59082 adults (3756 Indigenous). The prevalence of household food insecurity was 26.3% for Indigenous adults and 9.8% for non-Indigenous adults (weighted to the Canadian population). Food-secure Indigenous adults, food-insecure non-Indigenous adults, and food-insecure Indigenous adults had significantly (p < 0.001) greater odds of poor health outcomes than food-secure non-Indigenous adults (referent group). Food-insecure Indigenous adults had 1.96 [95% CI:1.53,2.52], 3.73 [95% CI: 2.95,4.72], 3.00 [95% CI:2.37,3.79], and 3.94 [95% CI:3.02,5.14] greater odds of a chronic health condition, a chronic mental health disorder, poor general health, and poor mental health, respectively, compared to food-secure non-Indigenous adults.Conclusions: Health policy decisions and programs should focus on food security initiatives for all Canadians, including addressing the unique challenges of Indigenous communities, irrespective of their food security status.

"It's huge in First Nation culture for us, as a school, to be a role model": Facilitators and Barriers Affecting School Nutrition Policy Implementation in Alexander First Nation

This mixed-methods community-based participatory research generated knowledge of school staff perceptions of the facilitators of and barriers to implementation of a Canadian First Nation school’s healthy nutrition policy. Themes derived from seven qualitative staff interviews were integrated with quantitative data derived from 28 staff surveys. The Medicine Wheel was used to describe results, as it provided a non-hierarchical and relational way to categorize all components and stakeholders of nutrition policy implementation. Factors that facilitated policy implementation were associated with the school environment, including the nutritional quality of foods sold or offered at school, administrative support, and foundational health programming prior to policy development. Staff identified the school as a role model for community members and as a key facilitator of policy implementation (for example, in leading health initiatives, providing a place for nutritious food and physical activity opportunities, and acting as a health resource for all community members). Barriers included inconsistency between staff members in policy implementation, uncertainty about staff members’ role in policy implementation, and lack of school communication with parents regarding the policy. One of the informative barriers from a First Nation perspective was the perceived misalignment of traditional foods, such as bannock or wild game, served at First Nation cultural events with federally derived nutrition standards that emphasize a low-fat diet. Results suggest strengthening school nutrition policy implementation by increasing staff nutrition education and certainty of their roles as policy facilitators, advocates, and enforcers; improving communication with families; having supportive school health programming; and ensuring the school, community, and home environment all reinforce healthy eating.