Does healthy eating cost more for First Nation people living ...

Slide 1:Does healthy eating cost more for First Nation people living on reserve? 

Jacqueline Tetreault

Slide 2:Outline

Introduction Procedure & Methods Results Discussion Conclusion Acknowledgements Question Period Patrick Amos

Slide 3:Introduction

Lyle Campbell

Slide 4:Health Canada�s First Nation and Inuit Health

Work to improve health and to prevent chronic and contagious diseases Focus on nutrition programs to address the increased rates of obesity and type II diabetes Healthy eating initiatives Problems encountered = perception that healthy eating on First Nation reserves is more expensive than healthy eating works with organizations and communities to carry out activities aimed at improving health and preventing chronic and contagious diseases among this population with increased rates of obesity and type II diabetes amongst First Nation people (1-3) Health Canada focuses on various types of nutrition programs to solve this crisis one of the problems encountered in trying to implement these types of programs is the perception that healthy eating on First Nation reserves is expensive works with organizations and communities to carry out activities aimed at improving health and preventing chronic and contagious diseases among this population with increased rates of obesity and type II diabetes amongst First Nation people (1-3) Health Canada focuses on various types of nutrition programs to solve this crisis one of the problems encountered in trying to implement these types of programs is the perception that healthy eating on First Nation reserves is expensive

Slide 5:Food Security

�Food security exists when all people, at all times, have physical and economical access to sufficient safe and nutritious food to meet their dietary needs and food preferences for an active an health life.� Food and Agriculture Organization, 1996 Food Insecurity among First Nations 33.3% are food insecure 14.4% are severely food insecure Canadian Community Health Survey, 2004 in Canada, this is a major concern since many First Nation people living on reserve are faced with food security issues Note: CCHS data is for off reserve households in Canada, this is a major concern since many First Nation people living on reserve are faced with food security issues Note: CCHS data is for off reserve households

Slide 6:Food Insecurity

Factors that cause food insecurity among First Nation people Vulnerable population Low income Low education Remote isolated First Nation communities ? availability and access to fresh healthy food Food Mail Program they are considered a vulnerable population the low income and low education levels experienced in First Nation communities are other factors many reserves are affected by this (especially those that are in remote and isolated locations) because of decreased availability and accessibility to fresh healthy food the Department of Indian and Northern Affairs estimates that 57% of First Nations people live in reserve communities, and 12% of these communities are considered to be situated in remote locations in these isolated communities food is generally more expensive because of the increased transportation cost perishable foods tend to be lower in quality because of the increased transportation and time necessary to reach the final destination in an attempt to allow retailers in these communities to sell fresh food at lower prices, the Government of Canada and Canada Post are working together to provide Food Mail service the Food Mail program pays part of the cost of shipping nutritious, perishable food and other essential items by air to isolated northern communities However we know that this is still not enough to completely resolve the problems related to access to and availability of healthy food to these communities they are considered a vulnerable population the low income and low education levels experienced in First Nation communities are other factors many reserves are affected by this (especially those that are in remote and isolated locations) because of decreased availability and accessibility to fresh healthy food the Department of Indian and Northern Affairs estimates that 57% of First Nations people live in reserve communities, and 12% of these communities are considered to be situated in remote locations in these isolated communities food is generally more expensive because of the increased transportation cost perishable foods tend to be lower in quality because of the increased transportation and time necessary to reach the final destination in an attempt to allow retailers in these communities to sell fresh food at lower prices, the Government of Canada and Canada Post are working together to provide Food Mail service the Food Mail program pays part of the cost of shipping nutritious, perishable food and other essential items by air to isolated northern communities However we know that this is still not enough to completely resolve the problems related to access to and availability of healthy food to these communities

Slide 7:Diet of First Nation peoples

Changes in the last 60 years Traditional diet = based on hunting and fishing, diet was high in protein, mod. in fat, low in CHO 24-hour dietary recalls from a Northern Ontario First Nation reserve = diet was high in saturated fat and simple sugars, low in dietary fibre, high glycemic index value Gittelsohn et.al Journal of Nutrition 1998 vol128 in addition to food security issues, there has recently been a shift in the diet of First Nation peoples which affects their food choices since the increase in permanent reserves in the last 60 years, there has been a growing reliance on store-bought food and a decrease in traditional activities (both cooking and physical activity) at this time there were high energy demands in this time because of extreme cold temperatures and the strenuous physical activity of daily living this rapid cultural change has had a negative impact on dietary intakes among this population These dietary habits appear to play a major role in the development of type II diabetes among this population and its main risk factor, obesity in addition to food security issues, there has recently been a shift in the diet of First Nation peoples which affects their food choices since the increase in permanent reserves in the last 60 years, there has been a growing reliance on store-bought food and a decrease in traditional activities (both cooking and physical activity) at this time there were high energy demands in this time because of extreme cold temperatures and the strenuous physical activity of daily living this rapid cultural change has had a negative impact on dietary intakes among this population These dietary habits appear to play a major role in the development of type II diabetes among this population and its main risk factor, obesity

Slide 8:Assessing the cost of food

Nutritious Food Basket Food costing tool created by the Ontario Ministry of Health and Long Term Care Calculates the weekly cost of a fixed basket of food items for various age/sex groups Was created in 1998 and was based on the old Canada�s Food Guide to Healthy Eating Monitoring the Cost of a Nutritious Food Basket Protocol, 1998

Slide 9:Objectives of the project

Assess the cost of eating nutritious food on First Nation reserves because of the perception that healthy eating is more expensive Compare the cost of a nutritious meal plan to the cost of a less nutritious meal plan in four different reserve locations across Ontario Evaluate the geographical impact on the cost of eating nutritious food

Slide 10:Procedure & Methods

Norval Morrisseau

Slide 11:Selection of Communities

Convenience sample Urban south = Chippewas of the Thames Urban north = Fort William First Nation Rural = Sioux Lookout Remote locations = Fort Severn On-reserve or nearest off-reserve grocery stores were contacted Permission to enter the store and conduct the food costing survey was obtained

Slide 13:Creation of Meal Plans

Two 5-day meal plans � including 4 week days and 1 weekend day Food consumption patterns of a child aged 9-13, an adult female and an adult male aged 19-50 Nutritious Meal Plan = new Eating Well with Canada�s Food Guide as a guide Less Nutritious Meal Plan = food consumption patterns that were considered to be unhealthy Plans were reviewed by 5 registered dietitians

Slide 15:Child 9-13y

Slide 16:Costing of Meal Plans

Locations were visited to survey the cost of selected foods in the local grocery stores Food prices were collected according to: The Ministry of Health�s Monitoring the Cost of a Nutritious Food Basket Protocol The total cost of food planned for each of the five days was calculated for each individual and for both meal plans for each individual and for both meal plans

Slide 17:Statistical Analyses

Performed separately for the three individuals as well as for the four locations First objective: Compare difference between the cost of eating nutritious foods and the cost of less nutritious foods Independent t-tests Second objective: Evaluate geographical impact on the cost of eating nutritious food ANOVA with Post-hoc test for multiple comparisons

Slide 18:Results

Carl Ray

Slide 19:The cost of eating nutritious food compared to the cost of eating less nutritious food

Slide 20:The difference in the daily cost of the nutritious meal plan between locations

* Mean difference is significant at the p<0.00 level.

Slide 21:Discussion

Norval Morrisseau

Slide 22:Can First Nation people living on reserve consume healthy food for less than unhealthy food ?

Results suggest that it is possible to consume healthy foods at a lower cost than unhealthy foods This information will help by: Encouraging healthy eating among this population Reducing the barriers related to the consumption of healthy food Reduction of the prevalence of diet related diseases in this population may be possible Holds true in First Nation reserves across Ontario Holds true in First Nation reserves across Ontario

Slide 23:Is there a geographical impact on the cost of eating nutritious food?

In Fort Severn the cost of nutritious food was significantly (p<0.00) more expensive This raises problems as individuals and families living in remote locations typically: Are the most food insecure Struggle with low income Programs may need to expand to be able to provide better prices on healthy food

Slide 24:Limitations

Meal plans were created exclusively for this project and are not validated tools No evaluation was completed to determine if the meal plans were representative of actual eating habits More research is required to: Evaluate meal plans with a nutrient analysis system Evaluate actual food intake of healthy and unhealthy eaters Repeat project a different times of the year

Slide 25:Conclusion

Norval Morrisseau

Slide 26:Healthy eating does not cost more for First Nation people living on reserve

Important implications for health professionals and community workers: Address food security issues Improve food choices More action needs to be taken to lower the cost of nutritious foods in remote locations Additional research is necessary to evaluate the meal plan tools developed for this project

Slide 27:Acknowledgements

I would like to thank Ren�e C. Crompton for her guidance and support, Sharmaline Fernando, Jane Hammingh, Sara Ch�nevert and Julie Bernard for reviewing the food basket tools and Louise Gariepy for providing direction with the data analysis. This research project was supported by Health Canada�s First Nation and Inuit Health who provided funds for travel and accommodation expenses for the four day excursion to Northern Ontario.

Slide 28:Questions?

Joane Cardinal-Schubert

Slide 29:References

Young TK, McIntyre LL, Dooley J, Rodriguez J. Epidemiologic features of diabetes mellitus among Indians in northwestern Ontario and northeastern Manitoba. CMAJ 1985:132:793-797. Evers S, McCracken E, Antone I, Deagle G. Prevalence of diabetes in Indians and Caucasians living in southwestern Ontario. Can J Public Health 1987:78:240-243. Montour LT, Macaulay AC, Adelson N. Diabetes mellitus in Mohawks of Kahnawake, PQ: a clinical and epidemiological description. CMAJ 1989:141:549-552. Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) - Income-Related Household Food Security in Canada. Ottawa: Health Canada Publications Office, 2007. Indian and Northern Affairs Canada. 2004 Basic Departmental Data. Ottawa: First Nations and Northern Statistics Section, 2006. Canada Post. Food mail program. Ottawa: Canada Post Corporation, 2007. Ritenbaugh C, Goodby CS. Beyond the thrifty gene: metabolic implications of prehistoric migration into the New World. Med. Anthropol. 198911:227-236. Young TK. Are Subartic Indians undergoing the epidemiologic transition? Soc. Sci. Med. 1988:26:659-671.

Slide 30:References

Gittelsohn J, Wolever TMS, Harris SB, Harris-Giraldo R, Hanley AJG, Zinman B. Specific patterns of food consumption and preparation are associated with diabetes and obesity in a native Canadian community. J Nutr. 1998:128:541-547. Ontario Ministry of Health, Public Health Branch. Monitoring the Cost of a Nutritious Food Basket Protocol. Toronto: Ministry of Health, 1998. Health Canada. Eating well with Canada�s food guide. Ottawa: Health Canada Publications Office, 2007. Darmon N, Briend A, Drewnowski A. Energy-dense diets are associated with lower diet costs: A community study of French adults. Public Health Nutr. 2004:7:21-27 Monsivais P, Drewnowski A. The rising cost of low-energy-density foods. J Am Diet Assoc. 2007:107:2071-2076. Harrison GG, Ritenbaugh CK. Obesity among North American Indians. Philadelphia: Lippencotte Company, 1992. Wolever TMS, Hamad S, Gittelsohn J, Hanley AJG, Logan A, Harris SB, Kinman B. Nutrient intake and food use in an Ojibwa-Cree community in northern Ontario assessed by 24h dietary recall. Health Canada. Aboriginal Diabetes Initiative Evaluation Framework. Ottawa: Health Canada Publications Office, 2002. Maynard M, Ness AR, Abraham L, Blane D, Bates C, Gunnell DJ. Selecting a healthy diet score: Lessons from a study of diet and health in early old age. Public Health Nutr. 2005:8:321-326.