The Nutritional Health of First Nations and Métis of the Northwest Territories

THE NUTRITIONAL HEALTH OF THE FIRST NATIONS AND MÉTIS OF THE NORTHWEST TERRITORIES: A review of current knowledge and gaps

Regine Halseth

EMERGING PRIORITIES © 2015 National Collaborating Centre This publication is available for Citation: Halseth,R. (2015). The for Aboriginal Health (NCCAH). This download at: www.nccah-ccnsa.ca. All nutritional health of the First Nations and publication was funded by the NCCAH and NCCAH materials are available free Métis of the Northwest Territories: A review of made possible through a financial contribution and can be reproduced in whole or in current knowledge and gaps. Prince George, from the Public Health Agency of Canada. part with appropriate attribution and BC: National Collaborating Centre for The views expressed herein do not necessarily citation. All NCCAH materials are Aboriginal Health. represent the views of the Public Health Agency to be used solely for non-commercial of Canada. purposes. To measure the impact of For further information or to obtain these materials, please inform us of their additional copies, please contact: Acknowledgements use. National Collaborating Centre for The NCCAH uses an external blind Une version française est également Aboriginal Health review process for documents that publiée sur le site www.nccah-ccnsa. 3333 University Way are research based, involve literature ca, sous le titre La santé nutritionnelle des Prince George, BC, V2N 4Z9 reviews or knowledge synthesis, or Premières Nations et des Métis des Territoires Tel: 250 960 5250 undertake an assessment of knowledge du Nord-Ouest : un examen des connaissances Fax: 250 960 5644 gaps. We would like to acknowledge et des lacunes actuelles. Email: [email protected] our reviewers for their generous Web: www.nccah-ccnsa.ca contributions of time and expertise to this manuscript.

Outer Cover Photo © Credit: iStockPhoto.com, ID 2442437 Inner Cover Photo © Credit: iStockPhoto.com, ID 29984010 CONTENTS

EXECUTIVE SUMMARY ------6 1.0 INTRODUCTION ------14 2.0 BACKGROUND ------16 3.0 METHODOLOGY ------19 4.0 REVIEW OF THE LITERATURE ------21 4.1 Peer- and non-peer reviewed publications over time ------22 4.2 Population group under study ------22 4.3 Research topics ------24 4.4 Summary of literature findings ------25 Download this publication at www.nccah-ccnsa.ca/34/ 5.0 CURRENT KNOWLEDGE ------27 Publications.nccah 5.1 The nutrition transition ------27 5.2 Importance of traditional foods in First Nations and Métis diets ----- 30 5.3 Assessment of nutrient intakes and deficiencies------32 5.4 Food security ------35 5.5 Summary ------45

6.0 HEALTH IMPACTS OF THE NUTRITION TRANSITION ------47

La version française est 7.0 HEALTH PROMOTION ------53 également disponible au www.nccah-ccnsa.ca/193/ 7.1 Programs or initiatives to increase the affordability and publications.nccah availability of healthy market foods ------54 7.2 Health and education programs ------54 7.3 Community wellness and intergenerational knowledge sharing ----- 56 7.4 Harvester support and sustainable wildlife management ------58 7.5 Poverty reduction and community economic development ------58 7.6 Innovation in infrastructure, transportation and local food production ------59 7.7 Youth engagement ------60 7.8 Summary ------61

8.0 CONCLUSION ------63 REFERENCES ------65 List of Figures & Tables

FIGURE 1: Aboriginal language groups in the NWT ------16 TABLE 1: Dene population in the Northwest Territories ------17 TABLE 2: Publications by year of publication, five year intervals ------22 TABLE 3: Publications by population group ------22 TABLE 4: Publications by main topics ------24 TABLE 5: Nutrient deficiencies identified in the literature for First Nations and Métis people of the NWT ------33 TABLE 6: Socio-economic indicators in the Northwest Territories (2006 Census) ------36 TABLE 7: Contaminants found in TFs ------39 TABLE 8: Prevalence (crude) of self-reported diabetes among First Nations, Inuit and Métis individuals in Canada ------48 TABLE 9: Communities involved in the Small Scale Foods Program, by region ------59 © Credit: iStockPhoto.com, ID 11672101 © Credit: iStockPhoto.com, List of Acronyms & Abbreviations

AANDC ...... Aboriginal Affairs and Northern Development Canada BCC...... Breastfeeding Committee of Canada BFI...... Baby Friendly Initiative BMI...... Body Mass Index Cbz...... Carboxybenzyl CCHS...... Canadian Community Health Survey CDC...... Centers for Disease Control and Prevention CFP...... Community Food Program CINE ...... Centre for Indigenous Peoples’ Nutrition and Environment CO2 ...... Carbon dioxide CPNP...... Canada Prenatal Nutrition Program CWD...... Chronic Wasting Disease DDE (pp-DDE)..... Dichlorodiphenyldichloroethylene DDT...... Dichlorodiphenyltrichloroethane DHSS...... Department of Health and Social Services DNA...... Deoxyribonucleic acid GM...... Geometric Mean HC ...... Health Canada HCH...... Hexachlorocyclohexane MF...... Market Food NAHO ...... National Aboriginal Health Organization NCCAH ...... National Collaborating Centre for Aboriginal Health NIDDM...... Non-insulin Dependent Diabetes Mellitus NU...... Nunavut NWT...... Northwest Territories NWT ECE...... Northwest Territories Education, Culture and Employment NWT HSS...... Northwest Territories Health and Social Services OC...... Organic Contaminants PCB...... Polychlorinated biphenyl PHAC ...... Public Health Agency of Canada POPs...... Persistent Organic Pollutants TF...... Traditional Food EXECUTIVE SUMMARY

Aboriginal peoples have been a summary of the relevant literature, related to the nutritional health of experiencing a nutrition transition that including publication trends over First Nations and Métis in the NWT has resulted in a greater proportion of time, and the priority topics and sub- involved a search of academic databases their diet being comprised of nutrient populations of interest. The next section and Google Scholar. Combinations poor market foods. This has led to will provide an overview of current of the following search terms were a growing crisis linked to unhealthy knowledge about the nutritional health used: food/diet/nutrition/nutritional weights. Socio-economic, cultural and of First Nations and Métis in the NWT, status/health promotion/obesity/ environmental factors are contributing drawing on the relevant literature as well cardiovascular/diabetes/food security to this transition. Nevertheless, as broader sources, including research & Dene/First Nation/Aboriginal & harvesting and consumption of related to all Aboriginal populations Northwest Territories. In addition, the traditional foods remains important for residing in the NWT, the North and bibliographies of relevant literature were Aboriginal peoples, providing numerous nationally where this research has perused to identify additional sources. cultural, economic, social and health relevance for the nutritional health of All literature published between 1980 benefits. First Nations and Métis in the NWT. and August 2014 was included if it met the search criteria. Relevancy was This report is meant to engage First Aboriginal people comprise more than determined based on the population of Nations and Métis peoples residing half of the population of the NWT interest (whether it provided a specific in the Northwest Territories (NWT) (Statistics Canada, 2013a). The largest focus on either or all of First Nations, in conversations about healthy food, Aboriginal group is First Nations, Dene or Métis populations); the topic of nutrition and eating, with the overall representing 63.1% of the Aboriginal interest (extent of nutrition transition, aim of supporting them in achieving population. This Aboriginal group is dietary intakes, traditional and market optimal health and well-being. While primarily comprised of the Dene, a food consumption, food security, health there has been considerable research linguistic group speaking Athapaskan impacts, health promotion, etc.); and the on the nutritional health of the Inuit languages who live collectively in a type of publication (letters-to-the editor, population or on Aboriginal people region referred to as ‘Denendeh’ (Dene news items, editorials, and draft/not for in the NWT collectively, less is Nation, n.d.). The Dene are comprised circulation documents were excluded). known about the nutritional health of of five groups each with their own First Nations and Métis populations territory and language: the South Slavey Review of the literature specifically. The report aims to Chipewyan, Dogrib/ Tłı̨chǫ Sahtu, summarize current knowledge about the and Gwich’in. The Métis represent This section of the report focused nutritional health of this population and approximately 15.4% of the Aboriginal exclusively on the literature deemed highlight any knowledge gaps. population (Statistics Canada, 2013d). relevant to the nutritional health of First They live throughout the NWT but are Nations and Métis in the NWT that was The report begins by providing a concentrated largely in the communities identified in the literature search. The demographic profile of the Aboriginal of Fort Resolution, Fort Smith, Hay search resulted in the identification of population in the NWT. It then outlines River and Yellowknife (Métis Nation 103 pieces of relevant literature. Many the methodology used to identify NWT, n.d.). of these were produced by colleagues literature relevant to the nutritional associated with the Centre for health of First Nations and Métis in The methodology used to identify Indigenous Peoples’ Nutrition (CINE) the NWT. This will be followed by relevant literature and research and Environment at McGill University.

6 Their work made groundbreaking most predominant topic related to food while others describe it as involving the contributions to the literature and insecurity, including prevalence and consumption of fewer types and smaller generated large databases of information the socio-economic and environmental quantities of traditional food species which informed later studies. factors that affect food insecurity. This and a greater quantity and diversity of was followed by nutrient assessments market foods (Batal, 2001; Kuhnlein The relevant literature spanned and food consumption patterns, benefits & Chan, 2000; Kuhnlein, Receveur, from 1983 to 2014. Based on five- of a traditional diet, determinants of Soueida, & Berti, 2007). While the year publication intervals, a steadily food use, and the health impacts of nutrition transition has resulted in increasing trend in publications is the nutrition transition. Most of these significant changes in the collection, use revealed; however it is not known publications focused on identifying and consumption of traditional food whether this reflects increasing interest nutritional health issues and the sources and attitudes towards them, in research related to the nutritional underlying factors that affect them. To consumption of them continues to health of First Nations and Métis in the date, there has been very little research remain high among Aboriginal people NWT or whether it reflects changes on health promotion initiatives and in the NWT (Kuhnlein & Souieda, in the research priorities and funding their effectiveness. This is a noticeable 1992; Condon, Collings, & Wenzel, levels of funding agencies. research gap that must be addressed 1995). so that effective strategies can be put There was a tendency of the relevant in place to address the looming public A wide variety of factors (social, literature to focus on broad population health crisis arising from the nutrition economic and environmental) influence groups, be they all northern residents, transition. food choices and preferences. Kuhnlein all Aboriginal peoples collectively, or and Receveur (1996) identify a number all Dene/Métis people. Proportionally, Current knowledge about of factors related to ecology and very few studies focused on differences culture that have contributed to less in the nutritional health of specific the nutritional health of First engagement in traditional subsistence sub-populations, be they linguistic- Nations and Métis in the activities. Sharma (2010) adds the role based, age-based or geography-based. of social changes such as settlement There were also no studies that NWT into stationary communities and forced examined differences based on socio- attendance at residential schools in economic status. As a result, the diverse This section draws on some of the eroding Indigenous culture with respect experiences of Aboriginal peoples key findings from the 103 pieces of to traditional harvesting practices. with respect to their nutritional health relevant literature on the nutritional Perceptions about the positive and continue to be largely ignored, making health of First Nations and Métis in the negative attributes of traditional and it difficult to implement effective health NWT, as well as on broader sources market foods; the cultural, social promotion activities in such a broad of information, including literature and spiritual contributions that food context. There may be significant focused on Inuit or general northern harvesting and gathering activities can differences in the experiences of various populations, to the extent that this provide to the health and well-being First Nations and Métis communities broader literature has relevance for First of individuals and communities; and based on geography, including access Nations and Métis in the NWT. The the health and safety of food choices to country food, the affordability of purpose of this section is to identify can affect food choice as well. These store bought food, household income, what is currently known about the perceptions are not static but can be and cost of living. Most of the current nutritional health of this population as changed through education and media literature and research on the nutritional well as any specific gaps in knowledge. influences. In addition, variables like health of First Nations and Métis in the age, gender, seasonality and geographic NWT is also focused on adults rather The nutrition transition location can also influence food than on infants, children and youth. consumption patterns. Older people Addressing the nutritional deficiencies There have been varying thoughts consume more traditional foods than in young people is a key component of about how the nutrition transition has younger ones, men consume more than stemming an emerging public health manifested in First Nations and Métis women, and communities in closer crisis. populations of the NWT. Szathmary, proximity to urban locales and in more Ritenbaugh and Goodby (1987) southern latitudes consume less than The relevant literature was coded for conclude that dietary acculturation those in remote locales or northern main topics of interest based on the manifested as the addition of new foods latitudes. Seasonal variations affect the criteria that at least one paragraph was to a stable traditional diet rather than quantities of traditional foods being devoted to discussing that topic. The a replacement of traditional foods; consumed, and there are variations in

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 7 © Credit: iStockPhoto.com, ID 3430216 © Credit: iStockPhoto.com,

preference of traditional foods based on on what is known about the importance consumption than children. Of the age, gender, and geographic location. of traditional foods in the diets of types of TFs consumed, animal species Finally, for many Aboriginal people these populations, including the types far outweigh plant species. Caribou and residing in the NWT, socio-economic of TFs consumed, frequency of TF moose are the leading TFs consumed barriers may exacerbate dietary change consumption, the proportion that TFs across northern communities, and not towards less healthy food choices, comprise in daily diets, and changes in surprisingly, in some communities, First particularly when these are combined TF consumption patterns over time. Nations and Métis exceed the Canada with the high cost, poor quality and Food Guide’s daily recommended limited variety and availability of healthy The majority of the diets of First servings of protein (Kuhnlein et al., market foods in northern and remote Nations and Métis people in the NWT is 2013). There is very little research regions. comprised of market foods (MFs), with focused on the contribution of TF consumption ranging from a low traditional plant species to the diets of Importance of traditional foods in First of 5% of dietary energy intake (Berti, First Nations and Métis in the NWT. Nation and Métis diets Soueida, & Kuhnlein, 2008) to a high The research seems to indicate that of 33% (Kim, Chan, & Receveur, 1998; while the consumption of TFs continues There are few longitudinal studies that Berti, Receveur, Chan, & Kuhnlein, to remain important in the diets of First track traditional food (TF) consumption 1998b). Northern communities had Nations and Métis in the NWT, the patterns over time, leaving an unclear higher TF consumption compared diversity of TFs being consumed has picture of the extent of the dietary to southern communities, men had been declining (Kuhnlein et al., 2004). transition in First Nation and Métis higher consumption of TFs than diets in the NWT. This section focuses women, and adults had higher TF 8 While a number of studies examined the track food consumption patterns of nutrient densities for iron, B vitamins, most frequently consumed traditional children as they become adults are vitamin D, dietary fibre, zinc, copper, foods, fewer studies examined the needed to provide a clearer picture of and magnesium. First Nations and most frequently consumed market the extent of the nutrition transition. Métis diets were generally considered foods. The limited research in this area deficient in vitamin A, D, and calcium; seems to indicate that daily servings Other gaps were also identified in the this is attributed to a lack of access to for fruits and vegetables, as well as for literature on patterns of traditional or availability of market foods that milk and alternatives, fall below the and market food consumption among are considered high in these nutrients. portions recommended in Canada’s First Nations and Métis in the NWT. Nutritional deficiencies vary across Food Guide; and that more than half Gates et al. (2014) noted that most genders, ages, communities and seasons of the energy intake of First Nations literature on the diets of Aboriginal (Doolan, 1991; Egeland et al., 2004; and Métis in the NWT comes from less youth was focused on isolated or Kuhnlein et al., 2006; Curren, Davis, & nutrient dense foods that are highly remote communities. Research on Van Oostdam, 2014). processed, low cost, and high in sugar food consumption patterns of off- and carbohydrates (Kuhnlein et al., reserve First Nations and Métis living A body of literature also examines the 2013). This is especially concerning for in or near urban locales and on the potential of TFs to address specific children who derive a high proportion impacts of poverty on food choice nutrient deficiencies in First Nations of their dietary energy from fats and are required to address these gaps in and Métis populations. Specifically, sea sweet foods. knowledge. Gates et al. also noted mammal fats and organ meats were high that for health promotion efforts to be in vitamin A, D, and E (Kuhnlein et Few studies report changes in TF effective, barriers to healthier diets must al., 2006); rabbit liver, loche liver, and consumption over time. These studies be overcome; this requires a greater Canada goose meat was high in Vitamin seem to indicate significant declines understanding of why individuals eat A (Simoneau, 1997); connie eggs, rabbit in some harvesting activities, though what they do and what constitutes flesh, and caribou were generally high in the evidence has been contradictory. a healthy diet. In addition, despite calcium (Simoneau, 1997); and raw fish While some studies show reduced widespread recognition of the impact eggs, raw whale skin, kelp, caribou liver, harvesting of traditional animal species of poverty on nutritional health, there ringed seal liver, and blueberries are rich (for example Tracy and Kramer, was a gap in knowledge with respect to in vitamin C (Fediuk et al., 2002). Given 2000; McDonald, 2009); others seem the impact of poverty on food choices that many of these traditional food to indicate shifting preference for and on the motivations and influences sources are organ meats, where high harvesting certain animal species behind individual food choices. levels of environmental contaminants over time (see for example, Sahtú can often accumulate, addressing issues Renewable Resources Board, 2004), Assessment of nutrient intakes and related to the food security of these such as replacing caribou with deficiencies foods and communicating the safety moose. Still others show considerable of them to Aboriginal people will be increases in the consumption of TFs Dietary assessments have been a paramount to any health promotion (see for example, Armstrong et al., strong focus of investigations into the strategy involving the promotion of 2007; Van Oostdam et al., 2009 which nutritional health of First Nations and traditional foods as a way of addressing show increases in the consumption Métis in the NWT. Most of the research nutritional deficiencies. of fish amongst pregnant women). in this area has been undertaken by Nevertheless, these studies provide a researchers associated with the CINE. The research clearly highlights the snapshot of TF consumption patterns Their findings generally reveal that nutritional benefits of traditional foods over selected periods of time; they are TFs have high nutrient densities for and their potential to address nutrient generally short in duration and rarely a number of nutrients and as a result, deficiencies in First Nations and Métis track individuals’ food consumption would serve as suitable alternatives in the NWT. However, substantive patterns over time. We therefore have for addressing some of the nutritional evidence is generally lacking for why an unclear picture of the extent of the deficiencies they identified in the diets certain nutrients are deficient in the nutrition transition within First Nations of First Nations and Métis people in the diets of First Nations and Métis and and Métis. It is not simply enough to NWT. more research is needed with respect to acknowledge that TF consumption is differences in the adequacy of nutrients low among children and that this will TFs were found to have numerous in the diets of First Nations and Métis translate into permanent poor eating nutritional benefits. These include sub-populations, including socio- habits as adults which will result in lower fat content and polyunsaturated economic and geographic differences. poorer health outcomes. Studies that to saturated fatty acids ratio; and high

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 9 Food security higher rates of poverty, First Nations primarily consumed by Inuit rather than and Métis peoples of the NWT are at First Nations and Métis people. They Definitions of food security typically increased risk of vulnerability to food tend to be higher in organ meats, marine emphasize the access, availability and insecurity. Food expenditures in the animals, fish, and fish-eating birds. utilization dimensions of food security. NWT are the second highest in the The evidence also highlights the need These definitions are often developed country behind only Nunavut, and to address the high rates of smoking in non-Aboriginal contexts and fail while food subsidy programs exist, only among Aboriginal people in the NWT, to take into consideration the unique four Dene communities were eligible for as smoking contributes high levels of cultural dimensions of food security full subsidy in 2013 (Nutrition North, cadmium into the blood stream. related to the harvesting, sharing and 2013). First Nations and Métis people consumption of country or traditional have a higher prevalence of socio- Given the potential health risks foods. In conceptualizing and economic risk factors for household associated with chemical contaminants measuring food security in the context food insecurity, including reliance on in fetuses and newborns, there is a of Aboriginal peoples, both market social assistance for income, having considerable body of research focused and traditional food systems must larger families, being below the Low one exploring levels of exposure to be considered (Lambden et al., 2007; Income Cut-off, having lower levels organochlorine and metal contaminants Power, 2008). This section provides of education, not owning their own in Aboriginal mothers and their a summary of current knowledge on homes, or being lone-parent households. newborns in the NWT and in northern the prevalence of food security in First The high price of hunting equipment, Canada. The research evidence suggests Nations and Métis of the NWT, and gas and lack of access to a vehicle also that while health risks are not as high the socio-economic and environmental impact First Nations and Métis peoples’ for First Nations and Métis mothers and factors that affect food security for this ability to access traditional food sources. newborns as they are for Inuit, levels population. Women were more likely to report of some contaminants are sufficiently food insecurity compared with men, high to warrant concern, especially No single study captures the prevalence and older individuals were less able to methylmercury, lead, and cadmium. of food insecurity among First afford fishing and hunting equipment Nevertheless, several studies noted an Nations and Métis peoples of the and engage in traditional harvesting encouraging trend of decreasing levels NWT. To draw our conclusions we activities. of contaminants in northern Aboriginal must utilize information from a few populations and in traditional food local community studies, studies on Several recommendations were made sources. Aboriginal people in the NWT based for addressing food insecurity in on Canadian Community Health northern Aboriginal communities, The central theme that emerged from Survey (CCHS) data which exclude including First Nation and Métis. the literature is that First Nations and the on-reserve population, or studies These recommendations emphasized Métis people in the NWT are not of the general population of the NWT that solutions aimed at reducing food continually consuming dangerous levels (including both Aboriginal and non- insecurity must address the broader of chemical contaminants and that TFs Aboriginal populations). The data seem issues of poverty and the negative should not be avoided out of fear of to suggest that the prevalence of food aspects of acculturation, which affect chemical contamination. While some insecurity for Aboriginal residents of many Aboriginal people’s ability to hold individuals may consumer higher than the NWT is considerably higher than down jobs and deal with addictions. tolerable levels of contaminants from the national average, and that it would certain foods during certain times of be even higher for First Nations living The safety of traditional or country the year, these levels are generally not on-reserve. However, food insecurity foods through the bioaccumulation considered usual intake levels. The seems to vary considerably across of chemical contaminants also has an benefits of consuming traditional foods regions. There are numerous barriers to impact on food security. There is a far outweigh the risks. There is therefore accessing both traditional and market general perception among Canadian a need for effectively communicating foods, including socio-economic and Aboriginal people that there is a health risks associated with consuming environmental challenges. considerable health risk associated with TFs, including consideration of seasonal eating TFs because of concerns over use and portion size, so as to avoid Living in northern and remote regions levels of contaminants. The research confusion over food safety. However, has negative impacts on the cost, evidence suggests that high levels of this requires additional research on availability, and quality of healthy contaminants are found only in select the health consequences of eating market foods. When coupled with TF sources and that these sources are contaminated TFs (an area of research

10 © Credit: iStockPhoto.com, ID 25635063 © Credit: iStockPhoto.com,

that is generally lacking), continued populations rather than First Nations There is a dearth of literature and monitoring of contaminant levels in TFs and Métis populations. A strong research focused on the impacts of and in Aboriginal populations, and on focus of the research and literature climate change on food security and on how to effectively communicate risk. has been on community adaptation the health implications of a warmer and to climate change, with a lesser focus more unpredictable climate, especially Climate change is another on documented impacts as they relate in the context of First Nations and environmental factor that affects food to food security in the NWT. Only Métis populations in the NWT. Clearly security. There is general agreement three studies focused on documenting more research is required in this that climate change has been occurring impacts of climate change on the area, especially more location specific in the Canadian Arctic and that it will acquisition of TFs by First Nations assessments of climate change impacts have greater impacts on the North, and Métis people in the NWT. These (Ford & Pearce, 2010). particularly for Aboriginal peoples who impacts include changes to distribution have a close connection to the land and and health of animal species, and Health impacts of the nutrition limited resources to adapt to changing effects to land, water and ice that transition conditions. These changes have the have implications for traditional food potential to increase uncertainty harvesting activities. Several studies Researchers have noted that changing with respect to the availability and tracked the population of animal species diets and lifestyles within Indigenous predictability of the range of TFs as over time, explored the impacts of communities have contributed to well as the quality of these foods (Paci a decline in animal species for food increased prevalence of many diseases et al., 2004). Most of the emphasis security, and/or offered suggestions for and illnesses, including diabetes, certain to date has been on impacts to Inuit adapting to species decline. cancers, dental disease, cardiovascular

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 11 disease, fetal alcohol syndrome, and promotion programs and initiatives, intergenerational knowledge sharing a wide range of illnesses associated which are generally targeted at broader programs include: food sharing and with mental health and poor cultural populations in the NWT rather than community food programs, as well morale (Kuhnlein, 1995, p. 766). focused specifically on First Nations as health promotion initiatives aimed Despite these assertions, few studies or Métis populations in the territory. at reducing the prevalence of chronic have explored the impacts of the This information was primarily derived disease, including the Aboriginal nutrition transition on the health of from a search of Google rather than Diabetes Initiative, the Chronic Disease First Nations and Métis people living in from the research literature, as only five Management Model, the Diabetes the Northwest Territories. Most of the of the 103 relevant articles explored Self-Management Pilot Program and current information is focused on the health promotion initiatives. While Diabetes Capacity Building Project, general NWT population, on Aboriginal some offered suggestions for health and the Government of the NWT’s people in the NWT, or on the northern promotion initiatives, none undertook Health Promotion Strategy Fund. territories combined. This leaves us evaluations on the effectiveness of There are several programs that with an unclear picture of the impacts initiatives. Such research is essential provide harvester support and focus of the nutrition transition on the health so that knowledge can be shared and on sustainable wildlife management of First Nations and Métis people in the communities can learn from what works including the: Commercial Harvest NWT. well in other places. Program, Traditional Harvest Program, Western Harvester’s Assistance The limited evidence seems to suggest A diverse range of health promotion Program, community organized hunts, that the prevalence of chronic illnesses initiatives was identified using Google’s and wildlife monitoring programs. Only associated with diet and nutrition is search engine. These initiatives one program could be identified that rising and they may be emerging as were multi-level and multi-sectoral would fall under the ‘poverty reduction health concerns for First Nations and approaches, targeting either the general and community economic development Métis peoples in the NWT. While population or the Aboriginal population category; Arctic co-operatives provide prevalence of diabetes, cardiovascular in the NWT, and specific age groups a mechanism for building capacity diseases, and hypertension have (infants, children, youth or adults) or among Aboriginal people as well as traditionally been considered low for all generations. Some of the initiatives helping to reduce the cost of foods. Aboriginal people living in the NWT, are short-term, temporary solutions Programs or initiatives that could when one considers that the current while others involve organizational be categorized as ‘Innovation in research evidence largely excludes on- change or policy response. Although infrastructure, transportation and local reserve First Nations populations and initiatives could be organized into food production’ include the Growing that there is evidence that First Nations multiple categories, for the purposes Forward Initiative which is comprised and Métis in the NWT are at greater of this report they are organized into of the Small-Scale Food Program and risk of diabetes and cardiovascular the seven categories utilized in the the Northern Agri-Food Program, disease because they have higher rates Expert Panel on the State of Knowledge of as well as the harvester’s assistance of many of the risk factors for these Food Security in Northern Canada’s (2014) programs identified earlier for their goal diseases, including rates of obesity framework. Programs or initiatives of improving food security through the and overweight (which are especially aimed at improving the availability promotion of traditional harvesting. alarming in children), there is a and affordability of high quality foods Programs and initiatives aimed at reasonable expectation that prevalence include: the Healthy Foods North building capacity and empowering rates of these chronic diseases will Initiative and Nutritious North Canada. youth with knowledge related to food increase into the future. In order to gain Health and education programs security include: Drop the Pop, Sip an understanding about the extent of include the: Canada Prenatal Nutrition Smart, Healthy Food for Learning, Kids health impacts associated with diet and Program, Brighter Futures program, in the Kitchen, Jump Rope for Heart, nutrition in these populations, further Baby Friendly Initiative, Healthy and Take a Kid Trapping. research is required. Children Initiative, Aboriginal Head Start, and a fact sheet series on the types Health promotion of traditional foods and what vitamins they are rich in. Kuhnlein et al. (2013) There is a noticeable gap in knowledge also show that individual communities with respect to health promotion. Most are engaged in developing their own of the information on this topic focuses culturally relevant health promotion on identifying and describing health initiatives. Community wellness and

12 Conclusion

Improving the nutritional health of First Nations and Métis in the NWT has been a health priority and research focus for decades. The research clearly shows a trend towards increasingly substituting traditional foods with market foods by younger generations, and highlights the role that age, gender, geography, socio-economic status and individual food preferences play in this. It shows the existence of some nutritional deficiencies in First Nations and Métis, and the nature and extent of food insecurity. Nevertheless, there remains a considerable gap in knowledge related to patterns of traditional and market food consumption, determinants of nutrient deficiencies, levels of contaminants in traditional food sources over time and across space, the impact of climate change on the quality and availability of specific traditional foods, the prevalence of chronic diseases associated with diet and nutrition, and the effectiveness of various health promotion programs and initiatives. In particular, the research needs to more clearly respond to the diversity of Aboriginal peoples, including the impact of socio-economic status and location of residence, so that more targeted and effective health promotion programs and initiatives can be implemented.

© Credit: iStockPhoto.com, ID 5665127 1.0 INTRODUCTION

There is a growing crisis of chronic in which families live” (Kuhnlein, First Nations and Métis people in the diseases associated with unhealthy Receveur, Soueida, & Egeland, 2004, p. NWT. Most of the research focuses weights resulting from low levels of 1452). Promoting the consumption of on Inuit and Inuvialuit2 populations physical activity and poor nutrition traditional foods should therefore be an rather than First Nations and Métis, in children and adults. In Canada, important component of any strategy especially research on the impacts of the prevalence of chronic diseases, to improve the health and well-being of climate change and environmental especially obesity and diabetes, has Aboriginal peoples. contamination on traditional food reached epidemic proportions in some systems, on food security, and on Aboriginal1 communities (Liu et al., This report is meant to engage First health. Other research related to the 2006; Young, Reading, Elias, & O’Neil, Nations and Métis people residing impacts of diet and nutrition on health 2000). Much of this public health crisis in the Northwest Territories (NWT) and well-being tends to be more can be attributed to the rapid social, in conversations about healthy food, broadly focused on the general NWT cultural and environmental changes nutrition and eating, with an overall population (including Aboriginal and Aboriginal peoples have undergone intent to support them in achieving non-Aboriginal populations), or on through colonization. While traditional optimal health and well-being. The First Indigenous populations in either the foods continue to be an important Nations and Métis, despite comprising NWT or the North. This research part of their diets, Aboriginal people the majority of the Aboriginal thus fails to capture the unique have been undergoing a nutrition population in the NWT, are often circumstances and conditions of the transition whereby a greater proportion overlooked in research related to diet, First Nations and Métis people. of their daily diets is being comprised nutrition, and their association with of market foods, many of which are health and well-being. While a group of This report aims to summarize current nutrient poor. The factors contributing researchers associated with the Centre knowledge about the nutritional health to this transition are wide-ranging for Indigenous Peoples’ Nutrition of First Nations and Métis people in and include socio-economic, cultural, and Environment (CINE) at McGill the NWT and identify knowledge gaps. and environmental dimensions. The University have undertaken fairly The report will begin in Section 2 by research evidence shows that traditional extensive research related to nutritional providing a demographic profile of the foods are not only more nutritious deficiencies, the extent of traditional Aboriginal population of the NWT. than market foods, they also provide and market food (MF) consumption, Section 3 will provide an overview of numerous cultural, economic, social and levels of contaminants found the methodology used to identify the and health benefits. In fact, “[f]or all in traditional food (TF) sources in peer and non-peer reviewed literature Indigenous peoples, food is at the heart Arctic Indigenous peoples, there published up to August 2014 on the of culture and health, and is considered remain considerable gaps in knowledge nutritional health of First Nations to be part of the environmental whole pertaining to the nutritional health of and Métis in the NWT. Section 4 will

1 The term ‘Aboriginal’ will be used to denote the Indigenous peoples of Canada as defined by the Constitution Act of Canada 1982, Section 35, 2 as First Nations (including status/non-status Indians, and on/off reserve Indians), Inuit and Métis peoples. 2 The Inuvialuit people are Western Canadian Inuit living primarily in their homeland, the Inuvialuit Settlement Region, which extends along the Arctic Ocean coastline from the Alaskan border east through to Beaufort Sea, and includes the Mackenzie River delta, the northern portion of the Yukon, the northwest portion of the Northwest Territories, and the western Canadian Arctic Islands (Wikipedia, http://en.wikipedia.org/wiki/Inuvialuit).

14 summarize the relevant literature on the nutritional health of this population. Specifically, it will identify publication trends over time, as well as the priority topics and sub-populations that are of interest. This will be followed in Section 5 by a summary of current knowledge about the nutritional health of the First Nations and Métis population, including the importance of TFs, food preferences, factors that impact the types and quantities of TFs consumed, the extent of the nutrition transition among this population, nutritional deficiencies, issues related to food security, the impacts of diet and nutrition on health, and health promotion programs and initiatives aimed at improving the nutritional health of First Nations and Métis people in the NWT. This section will draw on the relevant literature identified in the literature search, as well as information from broader sources, including research related to all Aboriginal populations in the NWT, the North and nationally, where it has relevance for First Nations and Métis people residing in the NWT. This will allow us to gain a better understanding about what is currently known about their nutritional health and where there may be research gaps.

© Credit: GettyImages.ca, ID 105774386 2.0 BACKGROUND

Aboriginal people comprise much of the FIGURE 1: ABORIGINAL LANGUAGE GROUPS IN THE NWT population of the NWT. According to the National Household Survey3, 51.9% of the approximately 21,160 residents are Aboriginal (Statistics Canada, 2013a). The largest Aboriginal group is First Nations, representing about 63.1% of the Aboriginal population, followed by Inuit4 (15.6%) and Métis (15.4%). With the exception of the Cree who live close to the Alberta border, the First Nations population consists primarily of the Dene, inhabitants of an area that stretches from Hudson’s Bay through the NWT and the Yukon to the interior of Alaska, and from northern Alberta to the Arctic Ocean.

The Dene speak northern Athapaskan languages and live collectively in a region referred to as ‘Denendeh’ (Dene Nation, n.d.). They are comprised of five groups, each with their own Source: DOBES: Documentation of Endangered Languages (n.d.), http://dobes.mpi.nl/ territory and dialect (Figure 1). The five wp-content/uploads/2013/02/map-1.jpg groups are the Gwich’in (Mackenzie Delta Region), North Slavey (Sahtu Region), South Slavey (Dehcho Region), followed by the Chipewyan (24.5%), the living within each of these communities Chipewyan (South Slave Region), and Dogrib/T ł ı̨ c h ǫ (21.2%), the Sahtu Dene is readily available, at present, according Dogrib/T ł ı̨ c h ǫ (North Slave Region). (15.3%), and the Gwich’in (14.1%). to Statistics Canada 2011 National Table 1 shows the main First Nations Household Survey, 3250 people in the bands within each group and the The Métis live throughout the NWT NWT self-identified as Métis (Statistics approximate proportion that each group but can be found in large concentrations Canada, 2013d). They represent comprises of the total Dene population. in the communities of Fort Resolution, approximately 15.4% of the total The largest group, as calculated by the Fort Smith, Hay River, and Yellowknife population (Statistics Canada, 2013c). author, is the South Slavey (comprising (Métis Nation NWT, n.d.). While no approx. 24.9% of the Dene population), information on the number of Métis

3 The 2011 National Household Survey (NHS) replaced the 2006 long-form census and has raised concerns for quality and comparability over time (Sheikh, 2013). Statistics Canada has identified potential limitations to the NHS data due to incomplete enumeration of 36 Indian reserves and low response rates among certain populations (Statistics Canada, 2013b). Due to the limited data available from the 2011 NHS, this report relies heavily on data obtained from the 2006 Canadian Census. 4 Usually described as the Inuvialuit.

16 TABLE 1: DENE POPULATION IN THE NORTHWEST TERRITORIES5

Language Approx. Approx. First Nations Tribal Group Group 2013 percentage Affiliation Statistics of NWT’s Canada First Nation population population6

South 4531 24.9 Acho Dene Koe First Nation, Deh Gah Deh Cho Tribal Council Slavey Gotie Dene First Nation, Jean Marie River First Nation, Ka’a’gee Tu First Nation, K’atlodeeche First Nation, Liidlii K’ue First Nation, Nahanni Butte First Nation, Pehdzeh Ki First Nation, Sambaa K’e Dene First Nation, West Point First Nation

Chipewyan 4450 24.5 Deninu K’ue First Nation, Lutsel K’e Akaitcho Territory Dene First Nation, Salt River First Nation, Yellowknives Dene First Nation

Dogrib/ 3848 21.2 Dogrib Rae First Nation, Wha Ti First Dogrib Tribal Council and Tłı̨chǫ Nation, Gameti First Nation, Dechi Laot’I the Tłı̨chǫ Self-Government First Nation

Sahtu 2785 15.3 Behdzi Ahda First Nation, Deline First Sahtu Dene Dene Nation, Fort Good Hope First Nation, Tulita Dene First Nation

Gwich’in 2569 14.1 Aklavik, Gwichya Gwich’in, Inuvik Native, Gwich’in Tribal Council Tetlit Gwich’in

Total First Nations Population: 18,183

Source: Aboriginal Affairs and Northern Development Canada, 2014.

5 Caution must be exercised in interpreting this data given that language group boundaries may not correspond absolutely with tribal group affiliations. 6 Percentages were calculated by the author using primarily data derived from Aboriginal Affairs and Northern Development Canada (2014). Two South Slavey communities did not identify the number of registered First Nations – K’atlodeeche and West Point. Populations from these two communities were derived from community websites, www.katlodeeche.com/kfn-community\kfn-reserve and http://www.dehcho.org/members/west_point.htm, using band membership numbers.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 17 © Credit: iStockPhoto.com, ID 20227233 3.0 METHODOLOGY

The methodology described here relates in comparison to First Nations. Second, to diet and nutrition such as obesity, to the search strategy utilized in Section they differ considerably from First cardiovascular disease and diabetes; 4 to identify relevant literature related Nations from a cultural perspective and health promotion initiatives. Given to the nutritional health of First Nations (ie. the types of traditional foods the importance of TFs in the diets of and Métis people of the NWT. The consumed and the extent of the Aboriginal populations throughout the literature was derived from a search of nutrition transition). Third, they also NWT, any general literature related to academic databases, including Academic differ significantly from First Nations food security and environmental health Search Premier, Medline, PubMed, in terms of the impacts of the nutrition (i.e. climate change or environmental and Social Sciences indexes, as well as transition on their health. However, contamination) in northern Canada from Google and Google Scholar. The studies that included Inuit in addition (including the Yukon, NWT, and following combinations of search terms to First Nations and/or Métis were Nunavut) was included as long as this were utilized: food/diet/nutrition/ included if they provided disaggregated literature discussed impacts on the food nutritional status/health promotion/ data and analysis for First Nations and/ security of Aboriginal populations. obesity/cardiovascular/diabetes/ or Métis populations in the NWT. These topics have relevancy in the food security & Dene/First Nation/ While the majority of the Aboriginal context of First Nations and Métis Aboriginal & Northwest Territories. population in the Territory is comprised populations in the NWT. In addition, the bibliographies of of Dene people, the Métis are included relevant literature were also perused to in this report because they share many Relevancy was also determined based on identify additional sources. All literature common cultural practices and values the nature of the publication. Letters- published up to August 2014 was related to food and nutrition, and to-the-editor, news items, editorials, and included if it met the relevancy criteria. because in the literature they are often documents marked ‘not for circulation’ considered collectively with the Dene. or ‘draft’ were excluded, while reviews The first relevancy criterion was the of the literature were included for their population of interest. Literature was The second relevancy criterion was utility in helping to identify research considered relevant if it included a topic of interest. The topics considered gaps. To capture the widest range of specific focus on either or all of First relevant included: the extent of the publications, no publication start date Nations, Dene or Métis populations in nutrition transition; the importance was imposed and all publications up to the NWT. Studies focusing exclusively of traditional harvesting activities and August 2014 were assessed for relevancy. on Inuit or Inuvialuit populations foods; dietary intake from either TFs were excluded for three primary or MFs; nutrient assessments in either It is important to note that while fairly reasons. First, while a significant Inuit TFs or MFs, food preferences and comprehensive, this scan was not population resides primarily in the factors affecting food choice; food systematic. As a result, some relevant northern part of the Territory, they security from either a socio-economic literature may not have been identified comprise a relatively small proportion or environmental perspective; the through the methodology used. of the Territory’s Aboriginal population prevalence of chronic illnesses related

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 19 © Credit: iStockPhoto.com, ID 12390182 4.0 REVIEW OF THE LITERATURE

This section of the report provides seven studies may be included in later in food sources) in the NWT since the a review of the literature published discussions (Section 5) where current 1990s. Their early body of research up to August 2014 on the nutritional knowledge is summarized. This section made groundbreaking contributions health of First Nations and Métis in the examines the nature of only the 103 to the literature in terms of identifying NWT. Using the search terms noted relevant publications identified in the the factors that impact traditional food in the methodology section, the search literature search. Specifically, it assesses consumption (age, seasonality, location, resulted in the identification of 103 the number of studies published over etc.); the benefits and risks of traditional relevant publications. An additional time, the population group that is of food consumption (nutrient content, seven publications were excluded from interest to the study, and the main quality, etc.); threats to traditional food this review because they related to topics of interest covered in the study. systems; and the extent of the nutrition chronic diseases among residents of For those who are interested, these transition occurring among Aboriginal the NWT generally, without providing publications can be identified in the people in the NWT and in northern disaggregated data or analysis for First Reference List (at the end of this report) regions7 generally. Large databases of Nations and/or Métis populations through the use of an asterisk. information were generated from this specifically. Given the prevalence of early body of work, much of which has chronic diseases associated with diet It is interesting to note that many informed later studies. and nutrition on Aboriginal people in of the publications identified in this Canada noted in the literature, the lack literature search were produced by of disaggregated data makes it difficult colleagues associated with the Centre to assess any health impacts of diet for Indigenous Peoples’ Nutrition and nutrition on First Nations and/ and Environment (CINE) at McGill or Métis in the NWT. Nevertheless, University who have undertaken several given that more than 50% of the phases of research on diet and nutrition NWT’s population is Aboriginal, some (levels of food consumption, nutritional of the relevant findings from these assessments, and levels of contaminants

7 They have undertaken studies in Canada’s three territories (Nunavut, Yukon, and Northwest Territories), the northern regions of provinces like Quebec, as well as Arctic regions internationally.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 21 4.1 Peer- and non-peer TABLE 2: PUBLICATIONS BY YEAR OF PUBLICATION, FIVE YEAR INTERVALS reviewed publications over time Interval Number of publications

The relevant literature spanned from 1983 to 2014. Table 2 shows the number 1980s 4 of relevant publications identified by five year intervals. No literature published 1990-1994 12 prior to 1983 and only a few items of literature published prior to 1990 could 1995-1999 18 be identified through the methodology utilized. It is not known whether this 2000-2004 22 reflects a lack of published literature prior to the 1990s or a lack of updating 2005-2009 23 electronic databases to include older publications prior to the rapid expansion 2010-August 2014 24 of the electronic technology age. Of the publications identified in this search, there is a temporal trend of a steadily increasing volume of publications TABLE 3: PUBLICATIONS BY POPULATION GROUP related to the nutritional health of First Nations and Métis in the NWT over * successive five-year intervals. It cannot Population Group Number of publications be ascertained, however, whether this increase reflects greater interest Dene/Métis collectively 33 by researchers in topics related to the nutritional health of this population General northern population (incl. both Aboriginal/non-Aboriginal or whether it reflects changes in the 17 research priorities and funding levels of people in the North generally or the funding agencies. NWT specifically) Northern or Arctic Aboriginal 11 4.2 Population group under study Dene only (within a specific 10 community or across the NWT) Table 3 summarizes the population group that is the focus of the literature General Aboriginal 10 identified in this search. These 7 categories have been developed on the Sahtu/Métis (across the NWT or basis of whether there was separate within a specific community) analysis and discussion for specific Dogrib 9 population groups. For example, all literature that focused exclusively on Gwich’in 8 Dene populations was categorized as Dene. However, all literature with a Chipewyan 3 northern Aboriginal population focus that provided separate and distinct Sahtu only 3 analysis or discussion about the Dene population (in addition to other Deh Cho 2 population groups like the Inuit) were also categorized as “Dene” rather than * Since several publications provided data disaggregation for multiple language groups, n does not equal 103. as “General Northern Aboriginal”, a

22 © Credit: iStockPhoto.com, ID 2868199 © Credit: iStockPhoto.com,

TABLE 3: PUBLICATIONS BY POPULATION GROUP category reserved for those publications Aboriginal people in northern Canada. examined differences in the nutritional that never deviated from a general focus The remainder of the publications health of Aboriginal communities near on the general Aboriginal population. focused on single Dene language to and remote from urban centres, none groups. None of the studies included a examined the nutritional health of First Most of the relevant publications specific focus on only Métis people. Nations and/or Métis living in urban were focused on broad populations locales. Health promotion initiatives rather than specific sub-populations. In addition, most studies focused are more effective in changing health Publications focused on combined broadly on all ages, genders and behaviors when they are tailored to Dene/Métis populations, either geographies. Of the 103 relevant specific audiences (Kreuter & Wray, in a specific community or across publications, more than half (53.4%) 2003; Kreuter, Oswald, Bull, & Clark, the NWT generally, comprised the focused on the general population, 2000; Noar, Benac, & Harris, 2007), and largest proportion of the relevant regardless of age or gender. Of the this requires accurate information for literature (32%). The second largest publications that focused on the sub-sections of the population. population group of interest was the nutritional health of a specific segment general northern population, including of the population, the focus was Overall, the data reveals a tendency both Aboriginal and non-Aboriginal more often on females compared to to focus on broad population groups, people living in either the northern males (79% compared with 60.4% be they all northern residents, all territories (Nunavut, Yukon and NWT) respectively), and adults (72.9%) Aboriginal peoples collectively, or all collectively or in the NWT specifically compared with children (20.8%), infants Dene/Métis people. Proportionally, (nearly 17% of the literature). Eleven (10.4%), or youth (6.3%). Further very few studies focused on differences publications (10.7%) were focused on research is needed with respect to First in the nutritional health of specific northern or Arctic Aboriginal people Nations and Métis young people as sub-sections of the population, be in Canada. Ten percent of the literature addressing their nutritional deficiencies they linguistic-based, age-based or focused on the Dene population is critical to stemming an emerging geography-based. As a result, the diverse exclusively, and a further 10% focused public health crisis. Further research experiences of Aboriginal peoples on the general Aboriginal population is also needed to capture the diverse with respect to their nutritional health (across Canada or internationally). This experiences of First Nations and Métis continue to be largely ignored, which latter category was included despite communities based on geography. There will make it difficult to implement its general focus because the literature may be considerable differences based effective health promotion activities in focused primarily on food security on where one lives, including the ability such a broad context. issues resulting from climate change or to access country food, the affordability environmental contamination, issues of store bought food, household income, that are of particular importance to the and cost of living. While several studies

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 23 4.3 Research topics 66% were focused on the impact of studies typically involve assessing how environmental contaminants on food frequently certain foods (be they market This section focuses on the main security; 26% addressed socio-economic or traditional) are consumed or the research topics discussed in the relevant and cultural factors, including the proportion of the diet that is comprised literature. Since publications can include impact of household status, age, poverty, of traditional/market foods, which discussion on multiple topics, they may and traditional sharing practices among is often expressed as a percentage of be categorized into more than one topic others, on food security; and 25% total energy intake. The benefits of a area. As a result, the totals will not add addressed climate change impacts on traditional diet, determinants of food up to 103. In order for a publication to food security. The next most prevalent use (including season, age, gender, be categorized under a specific topic, topics were nutrient assessments geography, etc.), and the health impacts there must be at least one paragraph and patterns of food (traditional of the nutrition transition (obesity, devoted to discussion of that topic. and/or market) consumption, each cardiovascular disease, hypertension, Passing mentions were excluded. Table comprising approximately 28% of etc.) are the next most common topics, 4 summarizes the predominant topics all relevant publications. Nutrient comprising 22.3%, 21.4%, and 18.4% of found in the relevant publications. assessment studies typically involve relevant publications respectively. Given analyzing nutrients found in particular the prevalence of literature focusing The most predominant topic found in food sources (be they traditional or on the impact of environmental the literature related to food security, market-based foods) and determining contaminants on food security, it is addressed by nearly 60% of all relevant whether any nutrients are inadequate somewhat surprising that only 16.5% literature. Of these publications, nearly in diets. Food consumption pattern of the literature focused on analyzing

TABLE 4: PUBLICATIONS BY MAIN TOPICS

Research themes Number of publications

Food security 61 • Environmental contamination 40 • Socio-economic and cultural aspects 16 • Climate change 15

Nutrient assessments 29

Food consumption patterns 29

Benefits of traditional diet 23

Determinants of food use 22

Health impacts of nutrition transition 19

Food preferences 17

Analysis of contaminants in food 17

Seasonal changes in diet 11

Food/health beliefs 8

Health promotion 5

24 © Credit: iStockPhoto.com, ID 4495772 © Credit: iStockPhoto.com,

levels of contaminants in food sources. 4.4 Summary of literature The literature identified in this search These studies could involve assessing also showed that while there has been a contaminant levels in traditional food findings fairly balanced coverage of topics related sources or assessing the levels of to the nutritional health of First Nations contaminants found in populations. From the relevant literature, we can see and Métis people in the NWT, the focus Seasonal changes in diet, food/health a clear trend of increasing publications of these topics has primarily been on beliefs, and health promotion were over time on topics related to the identifying nutritional health issues and topics of lesser concern. nutritional health of First Nations and the underlying factors that affect them. Métis people in the NWT and in the To date, there has been little research The main topics covered in the literature north generally. However, much of this on health promotion activities and their focused primarily on identifying issues research encompasses broad population effectiveness. The sharing of lessons related to the nutritional health of First groups (northern residents, Aboriginal learned from public health initiatives Nations and Métis in the NWT and people in the NWT, all Dene/Métis implemented in particular contexts the factors that affect their nutritional people), with little research examining would be tremendously beneficial as health. Given that diet and nutrition differences between specific population Aboriginal people work to address have been identified as contributing groups (be they differences among this public health issue in their own to the rising rates of obesity and language groups, between genders, communities. diabetes in Aboriginal populations, it across age groups, and geographies). is surprising that only five publications As a result, the current research fails focused on health promotion as a topic. to adequately capture the diverse This is a noticeable gap in the research experiences of specific First Nations and that must be addressed so that viable Métis groups in the NWT. These are and effective strategies can be put in research gaps that must be addressed place to address this emerging public so that health promotion activities can health crisis. be implemented effectively and lead to positive changes in diets.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 25 © Credit: iStockPhoto.com, ID 18051616 5.0 CURRENT KNOWLEDGE

This section will summarize some of NWT. This section will conclude with Changes resulting from a transition the key findings from the literature an examination of the health impacts away from a traditional lifestyle have with respect to the nutritional health of resulting from this nutrition transition, been associated with the emergence of First Nations and Métis people in the including obesity, diabetes, and previously unknown chronic diseases NWT. However, while Section 4 drew cardiovascular disease, and a discussion such as hyperglycemia and diabetes from only the 103 relevant publications on health promotion activities geared at (Ritenbaugh, Szathmary, Goodby, & identified in the literature search, this addressing these health impacts. Feldman, 1995), obesity and anemia section will draw on broader sources (Kuhnlein & Receveur, 1996), and a of information, including literature 5.1 The nutrition transition higher prevalence of teeth deterioration focused on Inuit or general northern (Kuhnlein et al., 2004). populations, to the extent that this There are varying definitions of broader literature has relevance for First ‘nutrition transition’ in the literature. There have been several thoughts Nations and Métis people in the NWT. It has been defined by Damman, about how this nutrition transition The purpose of this summary is to Eide, and Kuhnlein (2008) as has manifested. In 1987, Szathmary, identify what is currently known about “changes in diets, patterns of work Ritenbaugh, and Goodby examined the nutritional health of this population and leisure, accompanied by and dietary change among adult Dogrib and any specific gaps in knowledge. resulting from industrialization, Dene. They found stability in urbanization, economic development the traditional food base across This section begins with a discussion and globalization of markets” (p. communities but differences in the on how the nutrition transition is 135). Sharma (2010) characterizes quantity and variety of consumed defined and manifested, and the factors the nutrition transition as a shift market foods, leading them to conclude that underlie dietary change for First from traditional eating patterns to that dietary acculturation manifested Nations and Métis people in the NWT. processed, shop-bought foods. In the as the addition of new foods to a This will be followed by an examination case of Aboriginal communities in stable traditional diet rather than a of how frequently they consume the NWT, most have undergone some replacement of traditional foods. As a traditional and market foods, and a level of nutrition transition over the result, total energy intake has increased. comparison of the nutrients contained past 60 years (Damman et al., 2008; Others describe it as involving the in both traditional and market food Sharma, 2010). This process has been consumption of fewer types and smaller sources. This should provide the reader gradual and generally involves a shift quantities of traditional food species, with an overview of how adequate diets towards a less healthy diet resulting while the diversity and quantities of are for this population. The section will from decreased reliance on traditional commercially produced market foods then move to a focus on food insecurity foods (TFs) and increased reliance have increased (Batal, 2001; Kuhnlein among First Nations and Métis people, on market-based foods (MFs) that & Chan, 2000; Kuhnlein, Receveur, including discussion on the prevalence are often preprocessed and high in Soueida, & Berti, 2007). The nutrition of food insecurity and the socio- refined carbohydrates and saturated fat transition has seen significant changes economic and environmental challenges (Kuhnlein et al., 2004; Popkin, 2006; in the collection, use and consumption to improving the nutritional health of Popkin & Gordon-Larsen, 2004). of traditional food sources, and in First Nations and Métis people in the attitudes towards them (Kuhnlein &

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 27 Souieda, 1992; Condon, Collings, & available, other factors such as taste, patience and other personal qualities. Wenzel, 1995). Despite this dietary quality, and convenience affect food Harvesting activities can contribute to shift, consumption of traditional choice and preference. Kuhnlein and the maintenance of sharing networks, foods continues to remain high among Receveur (1996) suggest that the flavor, which provide a means for elders and Aboriginal people in the NWT. color, texture and aroma of foods play individuals in need to access traditional an important role in defining food foods when they would otherwise A wide variety of factors (social, preferences culturally. Traditional be unable to (Condon, Collings, & economic, and environmental) influence meats are generally preferred over Wenzel, 1995; McMillan & Parlee, 2013; food consumption preferences and store-bought meats because they are McMillan, 2012). Food preferences patterns. Kuhnlein and Receveur considered healthier, inexpensive, are also affected by other social and (1996) identify a number of factors natural, clean, free from chemicals, personal elements such as whether the related to culture and ecology that and superior in taste (Nakano, 2004). food will be shared, whether it is for a have contributed to less engagement Wien et al. (1989) also show a higher personal event, or whether it is used to in traditional subsistence activities, rating for traditional snack foods express individual, family, and group including the number of plant and like dried meat and fish over modern identity with a culture (Kuhnlein & animal species, the transfer of cultural snack foods, a finding reinforced by Receveur, 1996). knowledge to youth, the time and Batal, Gray-Donald, Kuhnlein, and energy for harvesting due to wage- Receveur’s (2005) study showing that Perceptions about the health and based employment, environmental one-third of the land animal meat being safety of food sources also affect food contamination, climate change, the consumed in the winter and summer choice. In their study assessing the density of species, and land use and was being dried. The consumption of benefits of traditional foods among harvesting practices. They argue that the animal organs is noted as likely subject three cultural groups of women in quality of the environment for plant and to cultural preferences and restrictions the Arctic, Lambden, Receveur, and animal wildlife foods has decreased and (taboos) (Simoneau & Receveur, 2000; Kuhnlein’s (2007) survey among Dene/ with an increased emphasis on a wage- Simoneau, 1997). On the other hand, Métis women revealed a concern by based economy, there has been less time market foods are generally valued for many about the health and safety of and interest in traditional food pursuits fresh produce, the provision of staples, TFs. Women were asked whether they (Kuhnlein & Receveur, 1996; Kuhnlein, and for their convenience, ease of noticed any recent changes in the 1995). Simoneau and Receveur (2000) preparation, availability, accessibility, quality or health of traditional plants note that lack of equipment and having and variety (Nakano, 2004). or meats of land animals, birds or fish. no hunter/fisher in the household Approximately 38% noticed changes are attributes that limit the intake of Perceptions about the cultural, social that included physical deformities, traditional foods. These factors have and spiritual contributions that food decreased accessibility, contamination resulted in diminishing knowledge harvesting and gathering activities can of TFs, reduced animal size, taste about traditional foods and traditional provide to the health and well-being and other sensory changes. When food systems. Sharma (2010) also adds of individuals and communities can asked whether there were any TFs the role that social changes, such as lead to increases in the consumption they thought were especially good settlement into stationary communities of TFs. Nakano (2004) notes that for their health, the women identified and the residential school system, have obtaining TFs contributes to many caribou, fish, moose, and meat among played in eroding Indigenous culture aspects of life such as physical fitness, the TFs considered especially healthy with respect to traditional harvesting saving money, and providing education (Lambden et al., 2007). Negative practices. on the natural environment and perceptions about the appearance of survival skills. Kuhnlein, McDonald, traditional foods like the ones identified Perceptions about the positive and Spigelski, Vittrekwa & Erasmus (2013) by Lambden et al. may inhibit people negative attributes of traditional and add additional benefits including from consuming them. Some of these market foods may play a role in food opportunities for outdoor recreation, negative perceptions may be attributed choice and preference. The costs keeping people ‘in tune with’ nature, to the ways in which human health associated with MFs and the availability maintaining culture, providing a means risks associated with environmental of TFs play a major role in food choice for adults to display responsibility for contaminants in traditional food and preference (Wein, Henderson Sabry, children, bringing respect from others, systems are communicated to the and Evers, 1989, 1991a; Kuhnlein, building pride and confidence, gaining public (Furgal, Powell, & Myers, 2005; Dickson, Armstrong, & Paci, 2003a). survival and food preparation skills, Bocking, 2001). When there is a diversity of foods and providing opportunities to learn

28 Food perceptions are not static; they Park who note that for each additional Receveur, Boulay, and Kuhnlein (1997) can be changed through education year, the frequency of country food8 show some correspondence between and media influences (Kuhnlein & consumption increased by a factor of latitude and the consumption of MFs, Chan, 2000). These influences likely 0.1, while being female accounted for a with those living in communities played a role in the nutrition transition decrease of 43.80 grams of country food further south and closer to food away from TFs. Indigenous peoples per day. Age and gender also appear to distribution networks consuming more have been introduced to new foods influence food preferences, with youth MFs. Kuhnlein and Receveur (2007) such as sugar, refined grain flour and consuming more milk, fruits and fruit found that consumption of TFs varied bread, and they have been exposed juices compared with their elders (Wein from 6%-40% of daily dietary energy to nutrition education programs and et al., 1991a); men consuming greater depending on the remoteness of the advertisements that emphasize the food quantities of bird flesh compared to community from commercial centres. of the dominant culture rather than the women (Batal et al., 2005); women Ritenbaugh et al. (1995) note that among nutritional and cultural benefits of TFs consuming more rabbit compared to Dogrib Dene, those living in the main (Kuhnlein & Receveur, 1996). Such men; and younger women being more village were more likely to include non- messages are particularly influential likely to prefer fish over moose than traditional foods in their diet compared among children and youth (Neumark- older women (Lambden et al., 2007). with those living in smaller, more Sztainer, Story, Perry, & Casey, 1999; dispersed communities. Geography Larson, & Story, 2009; Taylor, Evers, A number of studies note seasonal also affects food availability, which in & McKenna, 2005) and can contribute variations in traditional food turn affects the extent that food sources to unhealthy food choices. However, consumption. The accessibility of TFs might be consumed in particular regions educational and media influences can during certain times of the year is an (Kuhnlein & Receveur, 1996; Receveur also change perceptions back in favour important determining factor (Kuhnlein et al., 1997). Traditional foods that are of TFs. Van Oostdam, Donaldson, & Chan, 2000). In their study of two available in large quantities (which for Feeley, & Tihonov’s (2009) finding that Sahtu Dene/Métis communities, the Dene include caribou and whitefish) Dene/Métis pregnant women in Inuvik Morrison, et al. (1995) reveal that tend to be preferentially used (Batal, had doubled their fish consumption fish and berries are more commonly 2001; Kuhnlein et al., 2013). over an 8 year period seems to suggest consumed in the summer, land animals that public health messages about the are more commonly consumed in the Socio-economic barriers (such as low nutritional benefits of consuming fish winter, and birds are more commonly income/education) may exacerbate and the general safety of most fish consumed in the spring (see also Wien dietary change towards less healthy species are being heard. et al., 1991a). Doolan (1991) highlights food choices, particularly when these differences between two Dene are combined with the high cost, In addition to food preferences and communities in terms of the variety of poor quality, and limited variety and perceptions, variables like age, gender, TFs consumed in each season and the availability of healthy MF choices. seasonality and geographic location proportion of TFs consumed. Kuhnlein, In northern latitudes and remote can also influence food consumption et al.’s (1995a) study also reveals seasonal regions, the costs of shipping food can patterns (Batal et al., 2005, Kuhnlein variations in TF consumption, with be considerably higher than in other & Chan, 2000; Kuhnlein & Receveur, some TFs being consumed in only 30% regions (Slater et al., 2013). Under these 2007; Kuhnlein et al., 2004). Older of the days in summer but 90% of the circumstances, many Aboriginal people Dene/Métis consume more TFs than days in winter. may turn to cheap and filling MFs that younger ones, and men consume are low in mineral and vitamin content more than women (Kuhnlein, 1995; Several geographic variables also impact (Kuhnlein, et al., 2004; Batal, 2001). Kuhnlein & Receveur, 1996; Ritenbaugh levels of TF and MF consumption, Kuhnlein and Receveur (1996) note that et al., 1995; Kuhnlein & Receveur, including proximity to urban areas, the delocalization of the food supply 2007; Kuhnlein et al., 2004). These accessibility to roads, and northern (the processes by which food species differences are highlighted by Wein latitudes. Sharma (2010) highlights the and varieties, production techniques, et al. (1991a) in their study of Dene/ role of transportation improvements in and use patterns disseminate throughout Métis near Wood Buffalo National increasing the availability of MFs, while the globe) can benefit those who can

8 The terms ‘country foods’ and ‘traditional foods’ will be used interchangeably throughout this report, based on the terms utilized in the source literature.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 29 afford to purchase foods brought in high of 33% (Receveur et al., 1997), with inconnu, loche and trout are among from distant locations, providing them approximately 63-65% of the population the most commonly consumed fish with greater diversity of food products. consuming these foods on a daily basis (Kuhnlein & Receveur, 2007; Kuhnlein For Aboriginal people, many of whom (Kim, Chan, & Receveur, 1998; Berti, et al., 2013). Given the importance live in poverty or reside in rural areas Receveur, Chan, & Kuhnlein, 1998b). of traditional meats in diets, it is not where they may lack access to these Of the 16 Dene/Métis communities that surprising then that some studies show foods, this delocalization of the food the CINE has been studying since the First Nations and Métis people in the supply may in fact have the opposite 1990s, northern communities have been NWT exceeding the daily servings effect of decreasing the diversity of found to have higher TF consumption of protein recommended in Canada’s foods consumed as individuals rely compared with southern (Kuhnlein Food Guide (Kuhnlein et al., 2013). less on traditionally harvested foods et al., 2013; Nakano, 2004; Nakano, Only one study could be found that and more on limited kinds of market Fediuk, Kassi, Egeland, & Kuhnlein, focused specifically on traditional plant foods. Socio-economic disparities may 2005a, 2005b). TF consumption has use among First Nations and Métis also prevent many from taking up or also been found to be higher among in the NWT. This study revealed that continuing hunting because of the high men compared with women, and adults wild berries, including cloudberries, costs of purchasing equipment like compared to children (Kuhnlein et al., cranberries and blueberries, as well snowmobiles, firearms, ammunition and 2013; Nakano et al., 2005a, 2005b). The as Labrador tea leaves, were the most fuel (Lambden, Receveur, Marshall, & highest community average of TF use frequently collected plant products Kuhnlein, 2006; Condon, Collings, & for Dene/Métis children was found in (Murray et al., 2005). The literature also Wenzel, 1995; Chan, et al., 2006; Chiu, the northern Gwich’in community of seems to indicate that while TFs remain 2013). Tetlit Zheh at 5.9% (Kuhnlein et al., important in the diets of First Nations 2013). and Métis people, the diversity of TFs 5.2 Importance of traditional being consumed has been declining In terms of the types of TFs consumed, (Kuhnlein et al., 2004). foods in First Nations and animal species far outweigh plant foods Métis diets (Morrison et al., 1995; Murray, Boxall, While a number of studies identified the & Wien, 2005). There are numerous most frequently consumed TFs, fewer While most researchers believe that a examples in the literature that highlight studies examined the most frequently dietary transition has been taking place, the importance of animal species in the consumed MFs. Kuhnlein and Receveur there are few longitudinal studies that diets of First Nations and Métis people. (2007) identified tea, sugar, white track TF consumption patterns over For example, Batal (2001) found that bread, biscuits, lard, crystal powdered time, leaving an unclear picture of the approximately 92% of Dene/Métis drinks, instant coffee, evaporated milk, extent of the dietary transition. What women and 95% of the men consumed corn flakes, soft drinks, butter and is clear in the literature, however, is traditional land animal meat on any eggs as the most commonly consumed that TFs continue to remain important given day, while Kuhnlein et al. (2013) MFs. Healthier MFs such as fruits and in the diets of First Nations and Métis found that 60% of households in the vegetables, milk and alternatives are people. This section summarizes what is Gwich’in community of Tetlit Zheh often lacking in variety, quality and known about the importance of TFs in consume most or all of their meat or availability in northern and remote the diets of First Nations and Métis in fish as traditional food (Kuhnlein et communities, and they generally cost the NWT. Specifically, it will provide an al., 2013). Morrison et al. (1995) found considerably more than they do in overview of the types of TFs consumed, that land mammals and fish comprised southern communities (Kuhnlein et al., how often they are consumed in a given 68% of the TFs consumed by Dene/ 2013). Not surprisingly then, several period of time, the proportion that Métis adults, while Nakano (2004) studies have shown that for many TFs comprise in daily diets, usually found that for children, 87% of TFs First Nations and Métis people, daily expressed as a percentage of total was derived from land animals, 9% servings of fruits and vegetables, as energy intake, and any changes in TF from fish, 2% from birds, and another well as milk and alternatives, fall well consumption over time. 2% from berries. Caribou and moose below the portions recommended in are the leading TFs consumed across Canada’s Food Guide (Kuhnlein et al., In recent years, market foods have northern communities, in terms of 2013). Nakano et al. (2005a/b) found comprised the majority of the diets of quantities consumed daily and in terms that more than half of the energy intake First Nations and Métis people in the of their contributions to total energy, from MFs came from less nutrient dense NWT. TF consumption has ranged fat, and nutrient intakes (Chiu, 2013; food items, while Kuhnlein et al. (2013) from a low of 5% of daily energy intake McMillan, 2012; Kuhnlein & Receveur, note that of the top 20 market foods (Berti, Soueida, & Kuhnlein, 2008) to a 2007). Whitefish, salmon, char, consumed, most were highly processed

30 While most researchers believe that a dietary transition has been taking place, there are few longitudinal studies that track TF consumption patterns over time... ID 11206572 © Credit: iStockPhoto.com,

and least-cost foods containing a lot of to be the most significant TF for First in their systematic review of the sugar and carbohydrates. The decreased Nations and Métis people in the NWT. literature related to diet and nutrition nutrient density from MFs is especially The CINE has been assessing dietary of Aboriginal youth identified only concerning for children who have been intake from numerous Aboriginal three studies focusing on the NWT shown to derive a high proportion of communities in three cultural areas and noted they were primarily from their dietary energy from fats and sweet of Canada, including in the NWT, isolated or remote communities. Little foods (Kuhnlein et al., 2013; Nakano et for more than 20 years. Their studies research has been conducted to date on al., 2005a/b). highlight the success of public health Métis populations or on those living messages regarding the safety of some off-reserve or in urban centres like Few studies report on changes in TF species which in the past had Whitehorse. Gates et al. also note that TF consumption over time. Nakano been considered by many as unsafe eating healthier foods is not always a (2004) reports that 60% of Dene/Métis for consumption. In particular, these feasible option given the barriers to respondents from 16 communities in studies showed relative stability in accessing these foods. These barriers the NWT consumed less TFs compared consumption levels by pregnant women must be overcome before health to five years ago, while 18% consumed and mothers for most TF sources over promotion efforts can be effective, and more and 22% remained the same. the study period, but considerable overcoming them requires a greater Tracy and Kramer (2000) found a increases in the consumption of understanding of why individuals two- to four-fold decrease in caribou fish (Armstrong, Tofflemire, Myles, eat what they do, including parental consumption over a period of 20 Receveur, & Chan, 2007; Van Oostdam influences on the diets of children and years. Several studies estimated total et al., 2009). Nevertheless, while these youth, and perceptions about health harvest of animals, birds, and fish for studies provide a snapshot of TF and nutritious diets, the importance Dene and Métis hunters, trappers, and consumption patterns over selected of traditional foods, body weight and fishers in order to provide support for periods of time, these periods are obesity, and what constitutes a healthy Comprehensive Land Claim processes, generally short in duration and rarely diet. Improving this knowledge would including the Sahtú Settlement Harvest track individuals’ food consumption allow for more culturally relevant and Gwich’in Harvest studies (Sahtú patterns over time. initiatives to promote dietary adequacy. Renewable Resources Board, 2004; In addition, despite widespread McDonald, 2009). These studies show Several gaps in knowledge were recognition of the impact of poverty some significant declines in some identified in the literature regarding on nutritional health, there was also a harvesting activities, especially for the consumption of TFs and MFs. gap in knowledge with respect to the caribou which is generally considered Gates, Skinner, & Gates (2014) impacts of poverty on food choices.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 31 5.3 Assessment of nutrient Numerous nutritional benefits have al., 2004; and Kuhnlein & Receveur, been found in TF sources. Appavoo, 1996), consumption of these foods intakes and deficiencies Kubow and Kuhnlein’s (1991) analysis may vary widely due to the high cost of fat and fatty acids in TFs consumed of hunting and fishing, and concerns Given the trend towards increasingly by the Sahtu Dene/Métis revealed about environmental contamination of substituting TFs with MFs, coupled that these foods were generally TFs. Inadequate calcium consumption with the poor selection and availability healthier, with lower fat content and can be attributed to the fact that it is of quality MFs in remote and northern polyunsaturated to saturated fatty acids lacking in many TF sources9 (Wein, locales, dietary assessments have been ratio, making them very beneficial for Henderson Sabry, & Evers, 1991b) a strong focus of investigations into maintaining cardiovascular health. The and must therefore be largely obtained the nutritional health of First Nations consumption of traditional meats also through higher cost and less available and Métis of the NWT, as well as other provides many essential vitamins and market-based foods. Nevertheless, northern Aboriginal populations. minerals, including iron, B vitamins, substantive evidence for why certain Dietary assessments have inherent and vitamin D, as well as dietary nutrients are lacking in the diets of First limitations, including the fact that fibre, protein and essential fatty acids Nations and Métis people is generally there is no means of obtaining ‘usual’ (Kuhnlein, et al., 2004; Hidiroglou, lacking and much more research is intake data; that preparation techniques, Peace, Jee, Leggee, & Kuhnlein, 2008; needed to determine the motivations storage conditions, and seasonal and Doolan, 1991; Receveur & Kuhnlein, and influences behind individual food biological variations can influence the 1998a). Traditional foods are seen as choices. nutrient composition of food items; being extremely important for ensuring and that nutrient requirements vary high dietary quality for both adults It must be noted that nutritional among individuals (Doolan, 1991). Most and children (Kuhnlein & Receveur, deficiencies are not uniform across of the research in this area has been 2007; Nakano, Fediuk, Kassi, Egeland, all genders, ages, communities, undertaken by researchers associated & Kuhnlein, 2005a; Hidiriglou et al., or seasons. Receveur et al. (1997) with the CINE who have compiled data 2008). highlighted generational and gender from 44 communities (involving three differences in nutrient intakes that are cultural groups, including the Dene/ Nutrient deficiencies can be attributed pronounced during periods of peak Métis) into a vast nutrient database partially to the “extent of market food TF consumption. Doolan (1991) found (Kuhnlein et al., 2004; Kuhnlein, consumption, and food choice patterns that Vitamin A intakes were lower for Egeland, Receveur, & Berti, 2003b). dependent on cost and availability of women aged 50 years and older in both Their work began early in the 1990s good food sources” (Kuhnlein et al., of her study communities, as well as and has continued through to the 2006, p. 504). Some of the nutrient for women between the ages of 19- current decade, with studies focused on deficiencies noted in the literature 49 in one community. Egeland et al. determining the nutritional content of are identified in Table 5. Vitamin A (2004) found variations in Vitamin A both TFs and MFs to assess nutritional deficiencies are attributed by Kuhnlein intake by gender and age group, with benefits and deficiencies within diets. et al. (2006) to the high cost and low younger women having lower intakes Their findings generally reveal that availability of foods such as fortified of Vitamin A. Kuhnlein et al. (2006) TFs have high nutrient densities for milk and dark coloured vegetables. found that older Dene/Métis adults, a number of nutrients, that there are Vitamin D deficiencies are attributed who generally consume more TFs, some nutritional deficiencies in the to the long dark periods of winter and had greater adequacy for Vitamin A. diets of First Nations and Métis people, the lack of and purchase of Vitamin D Intakes of fibre, folate, vitamin A, C, and that some TFs would be suitable rich foods (Calvo and Whiting, 2003; D and calcium have been found to be a alternatives for high-cost market-foods Slater et al., 2013). Slater et al. (2013) concern for Aboriginal youth, especially as the primary source of some of these also note that while some TFs are good for those living in remote or isolated deficient nutrients. sources of Vitamin D (see for example communities (Curren, Davis, & Van Receveur et al., 1997; Kuhnlein et Oostdam, 2014).

9 Batal et al. (2005), however, note that animal organs can be important sources of nutrients such as calcium.

32 TABLE 5: NUTRIENT DEFICIENCIES IDENTIFIED IN THE LITERATURE FOR FIRST NATIONS AND MÉTIS PEOPLE OF THE NWT

Nutrient Population Source deficiency

Vitamin A Children Nakano et al., 2005a; Nakano, 2004

Adults Kuhnlein et al., 1995a; Kuhnlein, Soueida, & Receveur, 1996; Wein & Wein, 1995; Wein et al., 1991a/b; Receveur, Boulay & Kuhnlein, 1997; Receveur & Kuhnlein, 1998a; Kuhnlein, et al., 2007; Kuhnlein et al.., 2006; Simoneau, & Receveur, 2000; Simoneau, 1997

Women (including pregnant and Doolan, 1991; Berti et al., 2008 lactating women)

Men Kuhnlein, 1995

Vitamin C Adults Kuhnlein et al., 2007; Simoneau, 1997; Calvo & Whiting, 2003; Wein et al., 1991a/b

Women (including pregnant and Berti et al., 2008 lactating women)

Vitamin D Children Nakano et al., 2005a; Nakano, 2004; Kuhnlein & Receveur, 2007

Adults Kuhnlein et al., 2006; Wein et al., 1991a/b; Receveur et al., 1997

Women (prenatal) Waiters et al. (1998)

Vitamin E Children Nakano et al., 2005a; Nakano, 2004

Adults Kuhnlein et al., 2007; Kuhnlein et al., 2006; Receveur et al., 1997

Women (including pregnant and Berti et al., 2008 lactating women)

Omega 3 Children Nakano et al., 2005a; Nakano, 2004 fatty acids

Omega 6 Children Nakano et al., 2005a; Nakano, 2004 fatty acids Adults Kuhnlein et al., 2007

Calcium Children Nakano et al., 2005a; Nakano, 2004

Adults Receveur et al., 1997; Wein et al., 1991a/b; Kuhnlein et al., 2007; Kuhnlein et al., 1995a; Receveur & Kuhnlein, 1998a; Kuhnlein et al., 2004

Women (including pregnant and Berti et al., 2008; Waiters, Godel, & Basu, 1998 lactating women; & new mothers)

Men Kuhnlein, 1995

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 33 TABLE 5: NUTRIENT DEFICIENCIES IDENTIFIED IN THE LITERATURE FOR FIRST NATIONS AND MÉTIS PEOPLE OF THE NWT (CONTINUED)

Nutrient Population Source deficiency

Folate Adults Kuhnlein et al., 2007; Wein et al., 1991a/b

Women (including pregnant and Berti et al., 2008 lactating women)

Folic acid Adults Receveur et al., 1997

Iron Adults Wein et al., 1991a/b

Magnesium Children Nakano et al., 2005a; Nakano, 2004; Kuhnlein & Receveur, 2007

Adults Kuhnlein et al., 2007

Women Berti et al., 2008

Phosphorous Children Nakano et al., 2005a; Nakano, 2004

Zinc Women (including pregnant and Berti et al., 2008 lactating women)

Dietary fibre Children Nakano et al., 2005a; Nakano, 2004

Adults Receveur et al., 1997; Wein et al., 1991a/b; Kuhnlein et al., 2007

Women Waiters et al., 1998

The literature search also revealed a of TF sources are rich in these and liver, ringed seal liver and blueberries body of research which highlights the other vitamins and promoting them are rich in Vitamin C. Given that potential of TFs to address specific would be one way of addressing these many of these traditional food sources nutrient deficiencies in the First Nation nutrient deficiencies in the diets of First are organ meats, where high levels of and Métis populations. This research Nations and Métis people. For example, environmental contaminants can often identified the food sources that specific Kuhnlein et al. (2006) found that sea accumulate, addressing issues related to nutrients are primarily derived from mammal fats and organ meats are levels of contaminants in food sources (be they traditional or market foods), excellent sources of Vitamins A, D and and how to communicate the safety of and explored alternative sources for E. Simoneau (1997) found that rabbit these foods to Aboriginal people will these nutrients. The nutrient assessment liver, loche liver, and either smoked or be paramount to any health promotion studies revealed that calcium, Vitamin dried Canada goose meat are generally strategy which involves encouraging A, and Vitamin C are primarily derived high in Vitamin A, while connie eggs, traditional food consumption as from market-based foods (Doolan, rabbit flesh, woodland and barrenland a means of addressing nutritional 1991; Kuhnlein, 1995; Receveur et al., caribou are generally high in calcium. deficiencies. 1997; Fediuk, Hidiroglou, Madère, & Fediuk et al. (2002) also found that raw Kuhnlein, 2002). However, a number fish eggs, raw whale skin, kelp, caribou

34 The research highlights the considerable security. Within this definition, food non-Aboriginal populations. No single nutritional benefits of traditional foods and nutrition security exists “when all study captures the prevalence of food and their potential to address nutrient people at all times have physical, social insecurity among the First Nations and deficiencies in First Nations and Métis and economic access to food, which is Métis population of the NWT, and we populations in the NWT. However, gaps safe and consumed in sufficient quantity are left to draw our own conclusions in knowledge remain about the impact and quality to meet their dietary needs based on these more general studies. that living in poverty or living in urban and food preferences, and is supported compared to rural or remote locales by an environment of adequate Food insecurity is considered to be have on the adequacy of nutrient intake sanitation, health services and care, generally high for residents of the in First Nations and Métis people in the allowing for a healthy and active life’” NWT and for Aboriginal populations. NWT. (Kuhnlein et al., 2014, p. xiv). Ledrou and Gervais’ (2005) analysis of 2000/01 CCHS data showed that 5.4 Food security Both market and traditional food 28% of NWT residents reported systems must be considered in food insecurity compared with 15% In 1996, the World Food Summit conceptualizing and measuring food nationally. Tarasuk et al. (2014) analyzed defined food security as existing “when security in the context of Aboriginal CCHS 2011 data and reported similarly peoples (Lambden et al., 2007; Power, high rates of food insecurity in the people at all times can acquire safe, 10 nutritionally adequate, and culturally 2008). For traditional food systems to NWT at 20.4%. They also noted an acceptable foods in a manner that be secure, “there must be a patterned overall increase in food insecurity in maintains human dignity” (as cited and predictable supply and reserve of a the Territory since 2005. Willows, in Beaumier & Ford, 2010, p. 196). range of foods” (Kuhnlein et al., 2003 Veugelers, Raine, & Kuhle (2008) This definition emphasizes the access, as cited in Paci, Dickson, Nickels, Chan, utilized 2004 CCHS data to identify availability and utilization dimensions of & Furgal, 2004, p. 5). This includes factors associated with food insecurity food security. However, such definitions considering access to food on the basis and found a strong association with of food insecurity are developed in non- of levels of traditional food knowledge, Aboriginal status. Nationally, 33% of Aboriginal contexts and are generally access to traditional food systems, and Aboriginal households were found to be based on the assessment of monetary safety of traditional/country food, in food insecure compared with only 9% access to MFs (Egeland & Harrison, addition to socio-economic factors of non-Aboriginal households. While 2013; Power, 2008). As Power (2008) like poverty. This section provides a all three of these reports identified argues, “they do not take Aboriginal summary of current knowledge on the Aboriginal people as being at-risk for food practices into full account, nor do prevalence of food insecurity among food insecurity, none of them focus they reflect Aboriginal perspectives” First Nations and Métis people of the directly on First Nations and Métis (p. 95). Power argues that there are NWT, and on the socio-economic and in the NWT. Other factors found to unique food security considerations for environmental factors that affect food be associated with food insecurity Aboriginal people related to harvesting, security for this population. include number of children in the sharing and consuming country or household, lone-parent households, not traditional food, and that because Prevalence of food insecurity having home ownership, educational food obtained from traditional food attainment of secondary school or less, systems is key to cultural identity, health Food insecurity has been measured gender (females), being middle-aged and survival, this cultural dimension consistently since 2005 (Tarasuk, (35-64), unemployment, income from must be considered in Aboriginal Mitchell, & Dachner, 2014). To date, sources other than wages or salaries, public health. A more recent definition the primary source of data on food and low income (Tarasuk et al., 2014; proposed by the FAO Committee on insecurity has been the Canadian Rosol et al., 2011; Willows et al., 2008; World Food Security in 2013 better Community Health Survey (CCHS). Kuhnlein et al., 2013). Food insecurity encompasses some of these unique This data has been analyzed at the has also been found to be slightly more considerations and emphasizes the regional/territorial level and at the prevalent in urban rather than rural importance of nutrition in food national level comparing Aboriginal and areas (Tarasuk et al., 2014). In all three

10 Differences in the methodology used to calculate food insecurity between these two surveys prevent any direct comparisons from being made. The Ledrou & Gervais (2005) study reported on food insecurity among those aged 12 and older, while Tarasuk et al. (2014) reported on all members of a household. In addition, Tarasuk et al. included marginally food insecure households in their calculations while Ledrou & Gervais (2005) utilized only those who lived in moderate or severely food insecure households.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 35 of these studies, a significant proportion Socio-economic and demographic expected to be considerably higher of the Aboriginal population has been factors affecting food security than this. The Canadian government excluded from the analysis as CCHS has worked to offset some of the high data does not include people living on There are a range of socio-economic costs of food expenditures in these First Nations reserves. and demographic factors that affect communities through the Nutrition food security for First Nations and North Canada Program. Only four Aside from these general studies, only Métis residing in the NWT. Some of Dene communities were eligible for full two studies could be identified that these affect all northern residents, subsidy through this program in 2013, reported on food insecurity among such as the higher cost of living and including Deline, Fort Good Hope, First Nations in the NWT specifically. lack of availability of affordable quality Norman Wells, and Tulita (Nutrition These studies do not assess food MFs, and some are factors that are North Canada, 2013). The cost of a insecurity using CCHS data, but more acute for First Nations and Métis Northern Food Basket (what it costs to rather draw on information collected people specifically, such as higher feed a family of four on a healthy diet using the researchers’ own survey rates of poverty which contribute to for one week) in these communities tools. Kuhnlein et al. (2013) found the increased rates of food insecurity11 ranged from $386.28 in Deline to that 55% of households in Tetlit Zheh (NCCAH, 2012; Kuhnlein & Receveur, $427.16 in Fort Good Hope. were considered food insecure, with 1996). As noted earlier, the cost, 6% reporting severe food insecurity. availability, and quality of healthy Aboriginal people have a higher This food insecurity extended to both MFs are negatively impacted by the prevalence of socio-economic risk traditional and market foods, with distance and accessibility of getting factors for household food insecurity, 28% of women in the community foods to market in northern and remote including reliance on social assistance reporting difficulty accessing their communities. In 2009, the NWT had for income, having larger families, favorite TFs and 43% reporting the second highest food expenditures being below the Low Income Cut-off difficulties accessing their favorite MFs. in the country behind only Nunavut, determining poverty, having lower The study also identified barriers to with an annual household average of levels of education, not owning their accessing traditional and market foods. $9,509 compared to a national average own homes, or being lone-parent Barriers to accessing TFs included of $7,262 (Statistics Canada, 2010). households, especially those headed lack of transportation, equipment, Food expenditures in more remote by females (NCCAH, 2012). Table 6 and/or storage; lack of a hunter in the communities in the NWT would be presents several selected socio-economic household; reliance on others to provide TFs; and time constraints. Barriers to accessing MFs were primarily lack of TABLE 6: SOCIO-ECONOMIC INDICATORS IN THE NORTHWEST TERRITORIES (2006 CENSUS) affordability and availability. Lambden et al. (2006) examined food insecurity Indicator First Métis Non- among women in Yukon, Dene/Métis Nations Aboriginal and Inuit communities across Arctic Canada and found considerable regional Unemployment variation. Inuit women were the least 23.2% 10.1% 4.0% likely to report being able to afford rate adequate amounts of food, while Dene/ Education Métis women were most likely to report • No high school 58.86% 35.81% 14.07% being able to afford adequate amounts • Bachelor’s degree 1.81% 5.52% 18.5% of food. Seventy percent of Dene/Métis women aged 20-40 years and 65.4% of Average Dene/Métis women aged 41-60 years employment $51,242 $64,954 $71,137 reported their families were able to income – full time afford to buy all the food they need full-year from the store. Source: Statistics Canada (2006). Data products – topic based tabulations, catalogue #97-564-XCB2006002, Northwest Territories

11 For more information on the impact of social determinants on poverty, please refer to the NCCAH’s fact sheet series on social determinants.

36 indicators for First Nations and Métis others in the community (a finding also only households with children were people in the NWT. First Nations noted by McMillan & Parlee, 2013 and considered. Household food insecurity people in the NWT are more likely to McMillan, 2012). They also suggest was also associated with housing be unemployed compared to Métis, that this predominance of middle-aged insecurity. In Ford et al.’s (2013) study and both groups are significantly more food program users may be associated examining characteristics of community likely to be unemployed compared to with residential school experience and food program (CFP) users in Inuvik their non-Aboriginal counterparts. trauma, which has resulted in addictive and Iqaluit, homelessness was found First Nations are also more likely behaviours and an inability to hold to be a contributing factor in food to have lower levels of education, down a job, thus creating challenges in insecurity, especially in Inuvik where which translates as well into a lower accessing sufficient food. Lambden et CFP users were twice as likely to report average employment income for those al. (2006) found that older Aboriginal being homeless compared with those who worked full time for the full women and their families from Yukon, in Iqaluit. Willows et al. (2008) and preceding year. However, the diversity Dene/Métis, and Inuit communities in Tarasuk et al. (2014) also note that of Aboriginal peoples in Canada the Arctic were less able to afford to buy those who rent homes are more likely complicates an understanding of what all the food they needed from the store. to report being food insecure compared food security means even further, since Age was found to also play a significant with those who own their own homes. there may be differences by age, gender, role in the ability of Dene/Métis women Pardhan-Ali et al. (2013) also highlight and geographic location. and their families to afford and access the role that socio-economic status fishing and hunting equipment, with can play in ensuring the safety of Given the high costs of food in Elders having less ability to engage in foods in that poor housing conditions northern communities, access to safe, these activities (Lambden et al., 2006). can facilitate exposure to and spread accessible and affordable TFs is even of salmonella and other pathogens, more important. However, Ford et al. Several other socio-economic and including inadequate food storage and (2013), in their study of community demographic variables were associated preparation, poor water supply and food program use in Inuvik and with household food insecurity. sanitation, all of which can impact food Iqaluit, found that there was a lack Women are more likely to report food security. of availability of TFs and the costs of insecurity in the household compared obtaining them were high, despite the to men (Ford et al., 2013; Tarasuk et Given the multitude of socio-economic fact that approximately 50% of survey al., 2014). Matheson & McIntyre (2013) and demographic factors impacting participants had a hunter in the family suggest this may be because female food security, several recommendations and 87% reported having a hunter in survey respondents are more likely were made in the literature for the extended family through which to report having more children and addressing food security in northern some access to TFs could be obtained. lower household income, “suggesting Aboriginal communities, including Ford et al. noted the high price of insufficient material resources to feed First Nations and Métis. The high rate hunting equipment, gas, and lack of the family” (p. 45). They also argue of poverty in these communities is a access to a vehicle or snowmobile as that women have more information significant barrier to accessing both factors limiting the availability of TFs about household food needs and nutritious traditional and market foods. for chronic food program users. In may experience inequitable access to Access to both types of foods must be addition, some food program users household resources, and thus have made more affordable. One approach indicated a loss of knowledge on how different perceptions from their male is to subsidize the cost of certain to prepare TFs as a barrier to accessing partners about food security in the foods, such as milk, to levels found in them. household. Lone-parent households are southern communities (Slater et al., more likely to be food insecure and, 2013). Programs such as Healthy Foods Several studies found associations as noted by Willows et al. (2008) and North and Canada’s Food Mail aim to between age and food insecurity. Ford Tarasuk et al. (2014), these households increase the affordability, availability, et al. (2013) found that there was a are more likely to be headed by women. and quality of MFs; however, Kuhnlein predominance of middle aged (35-64 Tarasuk et al. (2014) found that et al. (2013) note that such programs years) people who were chronic food households with children under the have been inactive in some Dene/ program users, which they attribute age of 18 were at greater risk of food Métis communities, like the Tetlit to the fact that most general food insecurity than those without children Zheh community, for several years. programs are targeted towards children (15.6% compared with 11.4%). In fact, Ford et al. (2013) remind us that given and pregnant women and that Elders household insecurity increased from the financial constraints of procuring are more often supplied with food by 20.4% to 31.6% in the NWT when TFs, “health messages focusing on TF

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 37 consumption are of little value to those on the health impacts of exposure to sources are more likely to be consumed who do not have access to these foods chemicals in traditional food systems is by Inuit rather than First Nations and and are at times a source of frustration” generally lacking. Métis people. They also tend to be (p. 11). Harvesters’ assistance programs higher in organ meats, marine animals, (described in greater detail later) are one There is a general perception among fish, and in fish-eating birds. tool for making the costs of traditional Canadian Aboriginal people that there harvesting more affordable. Ford et al. is considerable health risk associated A second category of research on (2013) also argue that food policy must with eating TFs because of concerns environmental contaminants in TFs be more broadly integrated into wellness over levels of contaminants (Berti involves studies which assess dietary initiatives so that the challenges many et al., 1998a/b). This perception is exposure to selected organochlorines, Aboriginal people face in holding reinforced by findings of higher levels heavy metals or other contaminants. down jobs and dealing with addictions of organochlorines in blood and The research seems to indicate that can be overcome. Solutions aimed at breast milk among consumers of large while exposure to contaminants is encouraging a more nutritious diet must amounts of fish, marine mammals, and generally elevated for First Nations and therefore address the broader issues fish-eating birds, TF sources that have Métis in the NWT, they are at much of poverty and the negative aspects of been shown to have high concentrations lower health risk from consuming acculturation (Slater et al., 2013; Ford et of contaminants (Dewailly et al., 1993; TFs than Inuit because of differences al., 2013; Pakseresht et al., 2014). Dewailly et al., 1996; Dewailly, Nantel, in their traditional diets. Kuhnlein’s Weber, & Meyer, 1989). Yet the reality (1995) study of the dietary intakes of Environmental contamination is that the evidence of substantial health contaminants by Inuit and Sahtu Dene/ risks associated with consumption Métis men in the NWT highlighted The safety of traditional or country of contaminants is as yet unproven considerable individual variability in foods through the bioaccumulation (Kuhnlein & Chan, 2000) and as TF use and contaminant intakes. She of contaminants such as cadmium, such, must be weighed against the found that on average, while many Inuit lead and mercury in the food chain sociocultural, nutritional, economic, and men exceeded tolerances for toxaphene, has been a major concern in the spiritual benefits they can provide (Van PCBs, s-cBZ , chlordanes, and dieldrin, Canadian North and a focus of Oostdam et al., 1999; Van Oostdam, only chlordane tolerances were likely research for decades. It has been Donaldson, Feeley, & Tremblay, 2003). exceeded by some Sahtu Dene/Métis proven that measurable pesticides, men. She attributes this finding to the heavy metals and radionuclides have This section will examine what greater consumption of fats (where been brought to the north by wind is known about the impacts of contaminants often accumulate) from and ocean currents, where they have environmental contamination of TFs TFs by Inuit men compared with accumulated in Arctic biota and are on the food security of First Nations Sahtu Dene/Métis men. Wheatley and magnifying as they move up the food and Métis people in the NWT. The colleagues found that 20% of Dene chain (Furgal et al., 2005). Use of lead literature reviewed in this section will men and women exceeded Health bullets in harvesting TFs may also be be organized into two categories. The Canada’s 20 μg/L guideline for blood a factor contributing to environmental first category summarizes studies that methylmercury levels compared to 57% contamination of TFs (Tsuji et al., undertake assessments of the level of of Inuit men and women (Wheatley et 2008a/2008b; Tsuji, & Nieboer, 2008; contaminants found in TF sources al., 1979; Wheatley and Paradis, 1995). Johansen, Asmund, & Riget, 2004; without assessing the degree to which They found sea mammals contributed Tsuki, Nieboer, Karagatzides, Hanning, these contaminants are being consumed. the highest mean blood Hg levels, & Katapatuk, 2001). The consumption This information is summarized followed by fish. Kuhnlein, Receveur, of contaminants can have deleterious in Table 7. Information about the Muir, Chan, & Soueida’s (1995b) study effects on human health, particularly contaminants found in TFs consumed assessing the exposure of Sahtu Dene/ during early development (Ayotte, Roy, by Inuit in the NWT are included Métis women to polychlorinated Belles-Isles, Wagner, & Bailey, 2003; here as well, as it is assumed that First biphenyls and organochlorine pesticides Bailey et al., 2003; Chu et al. 2003). Nations and Métis people living in the found that the foods that contributed For example, Kuhnlein and Chan same regions might also be consuming the most organochlorine contaminants (2000) highlight studies that identified these food sources. were caribou, whitefish, inconnu, trout neurobehavioral deficits, developmental and duck. Berti et al. (1998b) also found delays, and endocrine disruption on The research appears to suggest that that arctic char, beluga mattack, loche children exposed to PCBs and other high levels of contaminants are found liver, and cisco flesh contributed high organochlorines. However, the research only in select TF sources and that these concentrations of contaminants.

38 TABLE 7: CONTAMINANTS FOUND IN TFS

Description of study Contaminants identified Study

Analysis of cadmium, lead Relatively high concentrations of cadmium and lead found in Chan, Kim, Khoday, Receveur, & and mercury in TF sources ringed seal liver, mussels, and kelp. Elevated concentrations of Kuhnlein, 1995 of the Inuit on Eastern mercury found in ringed seal liver, narwhal mattak, beluga meat, Baffin Island and beluga mattak

Assessment of dietary Foods with concentrations of contaminants high enough to Berti et al., 1998b exposure to selected exceed tolerable levels if consumed regularly included arctic organochlorines in 16 char, loche liver, trout flesh, and cisco flesh Dene/Métis communities

Risk assessment of arsenic Levels of arsenic found in produce grown in Yellowknife Koch, Ollson, Potten & Reimer, levels near Yellowknife residential gardens found not to exceed the provisional 2003; Galloway et al., 2012; Koch, maximum daily intakes, but that grown in the former gold Wang, Ollson, Cullen, & Reimer, mining area would exceed safe levels 2000

Bioaccessibility of arsenic Arsenic concentrations ranged from 0.06 to 21 mg/kg in berries, Koch et al., 2013 in hares, plants, edible 1.9 mg/kg in Labrador tea, 46 mg/kg in mushrooms, but only mushrooms and wild 0.007 to 0.6 mg/kg in hare muscle tissue; toxic forms of arsenic berries from Yellowknife in in country foods vary widely, with lowest bioaccessibilities12 2000, 2004 and 2010 observed from plants and berries

Analysis of mercury, Positive and significant correlations of mercury content Smith & Armstrong, 1978 methyl mercury and associated with age and body weight, with larger and older selenium in TF sources for mammals and fish having higher levels Inuit in Holman, NWT

Assessment of PCBs in TFs Levels of contaminants generally below the maximum residue Doolan, 1991 limit with the exception of beaver flesh, caribou and moose liver, moose flesh, and ptarmigan flesh

Analysis of cadmium in TF In general, mean cadmium concentrations in traditional foods Kim et al., 1998 sources in Fort Resolution; were found to be comparable with market foods. Highest level compared against of cadmium concentrations found in moose kidney and other equivalent market foods animal organs

12 Bioaccessibility refers to "the amount of contaminant that is absorbed into the body where it can cause toxic effects" (Koch et al., 2013, p.2).

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 39 TABLE 7: CONTAMINANTS FOUND IN TFS (CONTINUED)

Description of study Contaminants identified Study

Exposure to Foods important to Sahtu-Dene/Métis that contributed Kuhnlein, Receveur, Muir, Chan polychlorinated biphenyls organochlorine contaminant were caribou, whitefish, inconnu, & Soueida, 1995b and organochlorine trout and duck pesticides for Indigenous women

Organic contaminants Toxaphene the predominant OC in fish tish, followed by PCBs, Evans, Stern, & Muir, 2003 (OC) and metals in fish DDT, CBz and HCH. Highest OC concentrations found in Burbot species in the Great Slave liver Lake and Slave River ecosystem

Perfluorinated Perfluorooctane sulfunate concentrations high in polar bear liver; Martin, Mabury, & Muir, 2003 compounds in the also detected in mink, arctic fox, and lake trout Canadian Arctic

Persistent organic Significant declines in mercury and other POPs in ringed seal Muir & Kwan, 2003 pollutants and metals in samples collected from 7 of 9 locations over the 1970-1990s ringed seals period; shows regional differences in POPs

Lead and mercury in Decline in mercury deposition in the Arctic Muir, Jackson, Halliwell, & Arctic lakes in a number of Cheam, 2003 regions across the north

Organochlorines and Levels of PCBs, DDT and chlordane very low and well below Snowshoe, 2003 heavy metals in beaver available guideline levels. Levels of cadmium found in beaver and muskrats livers and kidneys but consistent with other terrestrial wildlife levels.

Organochlorine Increase in mean mercury concentrations in burbot muscle Stern & Ikonomou, 2003 contaminants, mercury, over 16 year time period; muscle mercury levels below the selenium and arsenic in recommended guideline level for commercial sale but above the burbot near Fort Good guideline level for fish used for subsistence; levels of most major Hope OC groups in burbot liver has declined over a 13 year period

Organochlorine Mercury found in muscle of fish from Arctic freshwaters up to 0.5 Lockhard, Wagemann, Tracey, concentrations in ppm; radionuclides widespread at levels below those acceptable Sutherland, & Thomas, 1992 freshwaters of the Arctic, in food including toxaphene, PCBs and chlordane, mercury; radionuclides

40 The literature reveals considerable Provisional Tolerable Weekly Intake to reduce the movement of global variability in TF use and contaminant of 400-5500 µ/week as defined by the contaminants into the North” (Butler intakes among First Nations and World Health Organization. However, Walker et al., 2003, p. 50). In 2003, Métis people and that, in general, cadmium levels increase in correlation Butler Walker et al. established a few are at increased risk of exposure with tobacco use (Butler Walker et al., baseline for exposure to organochlorine to environmental contaminants. 2006). and metal contaminants for Dene/ Differences in levels of environmental Métis, Inuit and Caucasian mothers contamination depend on a variety of In addition to assessing dietary and their newborns in the NWT and factors including: 1) local mineralogy intakes of Dene/Métis for nutrient Nunavut and found PCBs and pp-DDE and mining, military radar sites, and inadequacies, the CINE also compiled to be present in all cord samples, and proximity to heavy industrialization a database for environmental HCB in almost all samples. Like similar in different regions; 2) the ages and contaminants in TFs (Chan, 1998). This studies in the adult population, levels genders of animals; 3) the type of database includes results from a review of contaminants were higher in Inuit species and where it fits within the of the levels of four major contaminants samples compared with Dene/Métis and food chain (biomagnification results in (chlordane, mercury, polychlorinated Caucasian samples. Butler Walker et al. higher concentrations of contaminants); biphenyls, and toxaphene) in 81 (2006) continued their investigation of and 4) food preparation techniques (ie. species of marine mammals, terrestrial chemical contaminants in maternal and reducing levels of fat will help reduce mammals, birds, fish and plants umbilical cord blood. They reported organochlorine contaminant levels) consumed by northern Indigenous that 5% of Dene/Métis cord samples (Kuhnlein and Chan, 2000). They also populations. Chan (1998) utilized exceeded the US Environmental depend on taste preferences and the this data to determine whether these Protection Agency’s benchmark dose availability of certain foods at certain contaminants were a concern for Dene of 5.8 μg/L for mercury concentrations times of the year. Berti et al. (1998b) and Inuit populations. He found that compared with 56% of Inuit, and that undertook an assessment of dietary once data from northern Quebec (where the Geometric mean (GM) for lead exposure to selected organochlorines mercury levels are high) was excluded, (Pb) was significantly higher in Dene/ and heavy metals at the request of 16 only 2% of the fish data exceeded Métis (30.9 μg/L) and Inuit (31.6 μg/L) Dene/Métis communities who were Health Canada’s guidelines for mercury, participants compared with Caucasian concerned about food contamination while marine mammal blubber had the participants (20.6 μg/L). They also from heavy metals. They noted highest levels of PCBs, chlordane and expressed concern for the high levels considerable variation in contaminant toxaphene. He then estimated the intake of cadmium among smokers; 48% intake levels between seasons, genders, level of PCBs and mercury in Dene and of Dene/Métis participants reported ages and communities. They concluded Inuit diets using previous dietary intake being a smoker, and GM blood Cd that the intake of almost all individuals data and concluded that the intake levels in moderate and heavy smokers was was less than the tolerable/acceptable for all contaminants, with the exception found to be 7.4- and 12.5-fold higher levels for DDT, HCH, Die, Cbz, of toxaphene, were within the tolerable respectively than in nonsmokers. and PCBs, with some individuals intake levels for the Dene diet but Van Oostdam et al. (2009) explored occasionally exceeding tolerable levels exceeded the tolerable intake levels for the presence of POPs and metals in of certain contaminants on certain the Inuit diet (Chan, 1998). Indigenous mothers in the Arctic and days (depending on whether they found that none of the Dene/Métis consumed marine based foods such as Given the potential health risks mothers from Inuvik exceeded Health beluga mattack, arctic char, loche liver, associated with chemical contaminants Canada’s level of concern for PCBs trout flesh, and cisco flesh which are in fetuses and newborns, there is a or mercury, while 6% of Dene/Métis considered to have large concentrations considerable body of research exploring mothers exceeded the Tolerable Daily of contaminants). In addition, Koch levels of exposure to organochlorine Intake for one or both of chlordane et al. (2003) noted that while arsenic and metal contaminants in Aboriginal and toxaphene. They also found that levels were 10 times higher in residential mothers and newborns in the NWT 4.8% of Dene/Métis mothers exceeded gardens near Yellowknife compared to and in northern Canada. This body the lead guidelines for intervention of than the national average, produce from of research seems to indicate that 100 microg/L compared with 3.2% of these gardens was safe to eat, while while health risks are not as high for Inuvialuit mothers. They argue that produce from lake and mine gardens First Nations and Métis people in the some individuals will need to reduce should not be consumed. Kim et al. NWT as they are for Inuit, levels of their intakes of the most contaminated (1998) found that the average weekly some contaminants are sufficiently food items to reduce exposure to OCs. cadmium intakes from TF for both men high to warrant ongoing monitoring Armstrong et al. (2007) correlated and women were much lower than the and continued “international efforts food intake levels with maternal blood

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 41 levels of contaminants and found avoiding only certain species are being et al., 2005). It is clear that much more moderate to strong correlations for a heard by this population (Van Oostdam research is needed to determine the broad range of contaminants in Dene/ et al., 2009). Despite these declines, levels of organochlorines and metals Métis and Inuvialuit mothers in Inuvik, Donaldson et al. (2013) argue for the in TFs, human dietary exposure to with mercury showing the strongest continued need for biomonitoring of contaminants across regions, changes correlation. While Armstrong et al. note POPs and metals, and indeed, expansion in consumption patterns of TF, the that most contaminants were present in of monitoring to include new emerging impacts of exposure to chemicals higher levels in Inuvialuit compared to chemicals. on health, and how to effectively Dene/Métis mothers, the mean levels of communicate risk. lead were similar in both groups, with The central theme that emerges from 4.8% of Dene/Métis mothers exceeding the literature is that in general, First Impacts of climate change the lead guidelines for intervention of Nations and Métis people in the 100 microg/L. Despite these somewhat NWT are not continually consuming Climate change refers to the “most high rates of exposure to environmental dangerous levels of chemical recent period of warming, precipitated contaminants in Dene/Métis mothers contaminants and therefore should not by increased emissions of greenhouse and newborns, Van Oostdam et al. avoid consuming TFs out of fear of gases, namely carbon dioxide (CO2), (2009) found a positive trend of a chemical contamination. While some resulting from industrial development” decreasing level of contaminants over individuals may consume higher than (Paci et al., 2004, p. 3). There is general the period 1998-2006. In Dene/Métis tolerable levels of contaminants from agreement that climate change has mothers, all the contaminants tested certain foods during certain times of been occurring in the Canadian Arctic during this period showed decreases the year, these levels are generally not and that it will have greater impacts on with the exception of cadmium, considered usual intake levels, either the North, particularly on Aboriginal reflecting increased smoking rates because these foods are consumed peoples who have a close connection to among this population. Lead showed in large quantities for only a short the land and limited resources to adapt the greatest decrease, from 35 to 13 period during the year or because the to changing conditions (Ford et al., microg/L. foods containing the highest levels of 2008; Simeon, 2008; Prowse & Furgal, contaminants are typically consumed 2009; Duerden, 2004). Evidence that it This encouraging trend in decreasing by only a few individuals (Berti et al., has been occurring includes “significant levels of contaminants in northern 1998b). Kuhnlein and Chan (2000) warming, increased precipitation, Aboriginal populations over time was argue that advisories should take into alterations in sea-ice dynamics, and a found in other studies as well. Curren et account seasonal use and portion size. change in climatic variability and the al.’s (2014) temporal and spatial analysis There are also ways of reducing the occurrence of extremes” (Ford et al., of two previous northern biomonitoring levels of lead consumed from game 2008, p. 45). These changes have the studies noted evidence of declining meat by removing and discarding the potential to create greater uncertainty concentrations of POPs in Arctic tissue immediately surrounding lead with respect to the availability and biota and “contaminant concentration bullets (Tsuji, Wainman, Jayashinghe, predictability of the range of TFs, as decreases in the range of 20 to 50%, VanSpronsen, & Liberda, 2009). well the quality of these foods (Paci depending on the chemical” in blood Nevertheless, research on the health et al., 2004). For northern Aboriginal concentrations of POPs (p. 3). Wheatley consequences of eating contaminated peoples, whose culture and livelihoods and Paradis (1995) noted a downward TFs is generally lacking and there are deeply interconnected with the trend in Hg levels in community continues to be confusion about the land, food security may be seriously residents over a 20 year period from safety of TFs. Consumption of TFs impacted. However, “the extent of these 1972 to 1992, but undertook no research is a key component of food security impacts on the nutritional well-being of to determine whether this decline and healthy lifestyles for northern individuals and communities is not yet was the result of falling Hg levels in Indigenous peoples. It is also very well understood” (Guyot, Dickson, Paci, fish or because less fish was being important to their cultural and Furgal, & Chan, 2006., p. 404). eaten by people. A more recent study spiritual life (Myers, Fast, Kislalioglu indicated that at least among pregnant Berkes, & Berkes, 2005). Given this A strong focus of the current literature Dene/Métis women in Inuvik, fish importance, the confusion about the has been on community adaptation consumption had in fact doubled over safety of TFs must be resolved to to climate change. The ability of the 1998 to 2006 period, indicating prevent unnecessary shifts in food communities and individuals to adapt that public health messages about the consumption patterns towards more varies. While it is beyond the scope of health benefits of consuming fish and market based foods (Berti, 1998b; Myers this paper to summarize the literature

42 © Credit: iStockPhoto.com, ID 56061350 © Credit: iStockPhoto.com,

related to climate change adaptation, The current body of research highlights and vegetation has been shown to understanding how climate change a number of documented impacts of detrimentally affect goose populations impacts food security and health is climate as they relate to food security (Fast & Berkes, 1998). In addition, necessary so that communities can in the NWT. These include changing changes in water temperature and develop health-related adaptation distribution and health of animal circulation patterns are expected to plans and communication strategies species, and effects to land, water and affect fish populations, with coldwater (McClymont Peace & Myers, 2012). ice that have implications for traditional fish species (such as arctic char) Health Canada’s Climate Change food harvesting (Guyot et al., 2006; expected to decline in population, while and Health Adaptation Program has Guyot, 2006; Krcmar, van Kooten, & arctic cisco and marine mammals such played an important role in this process Chan-McLeod, 2010). While some of as beluga, bowhead whales, harbor and by funding climate change research these impacts are positive, others are harp seals and walrus are expected to related to northern First Nation and detrimental. Warming temperatures are increase in numbers (Fast & Berkes, Inuit communities. During the period expected to produce a longer growing 1998). Climate change is also making 2008-2011, the program funded 36 season, leading to the potential for harvesting more dangerous and access projects on a range of topics, including expanded agriculture and shifts in to hunting areas more difficult and “loss of traditional foods; water quality natural plant and animal distributions unequal (Ford, Smit & Wandel, 2006; and safety; erosion/loss of permafrost, further north (White, Gerlach, Loring, Ford et al., 2008). Impacts to the changes in traditional medicines; Tidwell, & Chambers, 2007). Larger timing of freeze-up and breakup, and relationship with ice through ice periods of open water over extensive the creation of more weather extremes, monitoring; landslides; and numerous areas are constraining the movement are placing the safety of hunters at risk climate change and health research and of land animals such as caribou, and reducing their access to certain education projects” (McClymont Peace moose, arctic fox and wolves, while hunting areas (Ford et al., 2008; & Myers, 2012, p. 3). These projects drier conditions are contributing to a Furgal, & Seguin, 2006). As well, have resulted in the development of decrease in the habitat for polar bear, climate change can impact Arctic food a wide range of knowledge tools that ringed and bearded seal populations, chain contamination, with increases communities can use to assist them as well as mink, otter and likely beaver in temperature possibly resulting in in understanding climate change and populations (Fast & Berkes, 1998). an increased degree of revolatization health issues. The destabilization of permafrost of contaminants presently stored in

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 43 For those living in poverty, financial constraints may prove insurmountable barriers to participating in traditional harvesting activities... © Credit: iStockPhoto.com, ID 47920378 © Credit: iStockPhoto.com,

soils and oceans (Fast & Berkes, 1998). species such as eagles; a later arrival of for moose, as well as changes to the Rising temperatures can also increase geese which shortens the spring goose migration of moose which brought the frequency of food poisoning hunt; the presence of spruce needles in them closer to the community. These by altering meat fermentation for the stomachs of ducks suggesting a later changes were described as gradual, specialized dishes (Ford, 2009). spring thaw affecting their normal food allowing people from the community sources; and the arrival of new plant to easily adapt. Overcoming such Three studies could be identified that species. In addition, participants noted changes in access to or availability of focused on documenting the impacts more pronounced water fluctuations TF resources is “significantly influenced of climate change on the acquisition of that were having an effect on food by an individual’s access to economic TFs by First Nations and Métis people availability and accessibility, such as resources and technology” since there in the NWT. The first study by Guyot higher levels of precipitation in the will need to be investment in additional et al. (2006) explored the effects of spring resulting in floods and unusual tools and equipment (Furgal & Seguin, climate change on the diet of people weather changes, with more extreme 2006, p. 1968). Community participants living in two northern Aboriginal weather events and a trend of warmer in this study also identified a need for communities, the Deh Gah Got’ie winters and strong storms in summer. additional funding and enhancements First Nation from Fort Providence These issues raised community concerns to existing initiatives to support hunters and the community of Beaver Creek about the availability of berries later and trappers. For those living in in the Yukon. They documented local in the summer, the ability of fish to poverty, financial constraints may prove traditional knowledge and observations spawn, safe travel to hunting and insurmountable barriers to participating of change in the local environment gathering areas, and impacts on food in traditional harvesting activities that and traditional food harvest, as well preservation methods. However, may make a vulnerable population as current adaptive strategies. The community participants also noted even more vulnerable to poor diet and documented changes to the accessibility some benefits from drier conditions nutrition. of TF sources identified by Deh Gah overall, including changes in the mode Got’ie participants included increases in of transportation towards more land- The second study by Parlee, Goddard, some existing animal species like deer based transportation which allowed and Lutsël K’é Dene First Nation and beaver; introduction of new bird for easier travel to harvesting areas (2014) draw on traditional knowledge

44 from the Łutsël K’é Dene First Nation of caribou over time, but increases in been focused on the impacts of climate to explore the health of caribou and the harvesting of other species like change on Inuit peoples specifically and moose populations. They compared moose. Chie (2013) outlines some on their ability to adapt. Of this body data from research in 1998-2002 with negative impacts of a decline in caribou of literature, the dominant focus has data from interviews conducted in populations, which she states will been on biophysical systems, followed 2010 and noted that while few changes particularly impact communities with by vulnerabilities, socio-economic were observed in the condition of these older populations, those with lower impacts of climate change, and the two animal species, there were some employment rates, those with lower health impacts of climate change (Ford changes to their distribution. Caribou incomes, and those who lack access to & Pearce, 2010). Clearly, more research were observed moving further east community stores. She argues that a is required in this area. In particular, from key hunting areas and declining in decline in caribou population will result Ford and Pearce highlight the need for population, while moose were observed in higher ‘caribou prices’ (the costs of location specific assessments of climate expanding their range and increasing procuring caribou when it is scarce), change impacts, and for studies on the in abundance. Using data triangulated which will result in further substitution effectiveness, durability, and long-term from multiple sources, including harvest of a traditional meat source with high viability of adaptations. and consumption data, the researchers priced MFs and further consequences suggest these changes are indicative of for those who are already food insecure. 5.5 Summary ecological change. Finally, McMillan (2012) and McMillan & Parlee (2013) examine how hunting The benefits of consuming traditional The third study was undertaken by strategies and food sharing networks foods extend far beyond simply higher Kuhnlein et al. (2013) with Gwich’in contribute to social-ecological resilience nutrient density and the availability of survey participants. They found that the towards decreased availability of TF key essential nutrients. They also include majority of survey respondents (68%) sources. They highlight the potential “physical activity during harvesting, felt that climate change had affected of community organized hunts as a lower food costs, the prevention of their intake of TFs. Changes observed means of allowing communities to adapt chronic disease by consumption of by survey respondents included: changes to the socio-economic and ecological more nutritious food, and multiple in the appearance and availability of challenges arising from declining sociocultural values that contribute fish species, changes in the temperature caribou populations. to mental health and cultural morale” and cleanliness of water; declines in the (Kuhnlein & Chan, 2000, p. 615). As numbers of caribou and moose which McClymont Peace and Myers (2012) well, fishing, hunting, and gathering they attributed to “climate-related note that the “health implications of traditional foods can provide changes in migration patterns caused resulting from a warmer and more educational value, economic benefits by warming temperatures, increased unpredictable climate are not distributed and a place in the social fabric of forest fires, and reduced access to evenly: current health status, age, community life (Kuhnlein & Receveur, food sources” (p. 116); and changes in genetics, gender, geography, and 1996; Kuhnlein & Chan, 2000). weather conditions which affected the economics, are all key variables ability of hunters to travel to and access affecting the ability of individuals and Given these benefits, it is essential that harvesting areas. As a result of these communities to adapt and reduce the traditional food sources be promoted changes, 36% of respondents felt they effects of climate change” (pp. 1-2). Yet, to improve the health and well-being did not eat as much TF as they wanted there is currently a dearth of literature of Aboriginal peoples generally, and to and that access to these foods was focusing on the impacts of climate the First Nations and Métis peoples made more difficult because of the change on food security and on the of the NWT specifically. This will impediments of rising fuel costs and health implications of a warmer and entail effective communication about lack of time. more unpredictable climate. This dearth the safety of traditional food sources of literature is even more pronounced and the implementation of additional Several additional studies track the when the focus is specifically on the supports to overcome the impacts of population of animal species over time, First Nations and Métis populations of climate change on the accessibility and explore the impacts of a decline in the NWT. Given that the circumpolar availability of traditional food sources. animal species for food security, and/ north is a region where global processes In addition, further research is required or offer some strategies for adapting and changes in atmospheric gases to assess the safety of specific traditional to species decline. Harvest studies or temperatures are more acutely food sources and the impacts of climate like McDonald (2009) and McMillan experienced (Paci et al., 2004), not change on food security and on health. (2012) show declines in the harvesting surprisingly, most literature to date has

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 45 © Credit: iStockPhoto.com, ID 35581974 6.0 HEALTH IMPACTS OF THE NUTRITION TRANSITION

Researchers have noted that changing NWT population (Aboriginal and diets and lifestyles within Indigenous non-Aboriginal populations combined), communities have contributed to or compares Aboriginal people with increased prevalence of many diseases non-Aboriginal people in either the and illnesses, including diabetes, certain NWT or in the northern territories cancers, dental disease, cardiovascular combined, leaving an unclear picture of disease, fetal alcohol syndrome, and a the health impacts on First Nations and wide range of illnesses associated with Métis people specifically. One reason mental health and poor cultural morale for the lack of data may be the small (Kuhnlein, 1995, p. 766). However, sample sizes for these chronic diseases, few studies have explored the health given the relatively small proportion of impacts of the nutrition transition on the Canadian population living in the First Nations and Métis people living in NWT and previous findings that show the Northwest Territories. This section lower rates of cardiovascular diseases will summarize what is currently known and diabetes among people living in about chronic illnesses associated with northern latitudes compared with diet and nutrition in First Nations southern latitudes (Filate, Johansen, and Métis, specifically obesity, Type 2 Kennedy, & Tu, 2003; Hu et al., 2006; diabetes, cardiovascular and other heart- Young, 1993, Young, Szathmary, Evers related chronic diseases. and Wheatley, 1990). Nevertheless, the evidence, albeit limited, suggests The literature and data related to that the prevalence of chronic illnesses the prevalence of obesity, diabetes, associated with diet and nutrition is cardiovascular disease and other heart- on the rise and these illnesses may be related chronic illnesses among First emerging as health concerns for First Nations and Métis peoples in the NWT Nations and Métis people in the NWT. is extremely limited. Most of the current Further research specific to these information focuses on the general populations is required.

47 In Canada, rates of diabetes have Research on diabetes within First is an innate trait in the Dogrib, it been rising rapidly and are considered Nations and Métis people living in the did demonstrate that genetic factors to have reached epidemic levels in NWT is more limited; nevertheless, played a role in carbohydrate and lipid some communities (PHAC, 2011b). there is evidence of an increasing trend metabolism (Szathmary, 1993). In 1987, However, there is a considerable degree in prevalence and some association using National Survey data for known of diversity within and between First between diabetes and acculturation. In cases of diabetes, Young (1993) noted Nations, Métis, and Inuit communities. the past, diabetes diagnoses were very that Aboriginal people living in the Diabetes has been found to be highest rare within the First Nations and Métis NWT had the second lowest number among First Nations living on-reserve people in the NWT. Early studies by of diabetes cases in Canada, with only and lowest among Inuit (Table 8). One Szathmary and colleagues focused on Inuit living in the NWT having lower of the common explanations for the the effects of acculturation and dietary rates (p. 26). high rates of diabetes found among change in the Dogrib population Aboriginal peoples is the thrifty (Szathmary, 1989, 1990, 1994; Szathmary Szathmary and colleagues also explored gene hypothesis. This hypothesis & Holt, 1983; Szathmary, Ritenbaugh, whether there were any associations stipulates that Aboriginal peoples & Goodby, 1987). They reported that between dietary factors and the have an inherited susceptibility for no cases of diabetes existed until about prevalence of diabetes in the Dene/ “a biological incapacity to adapt to 1981 when oral glucose tests revealed Métis population of the NWT. In a modern sedentary lifestyle with a that approximately 10% had glucose 1987, Szathmary et al. investigated consistent supply of energy” (Egeland levels exceeding the international differences in the mean glucose & Harrison, 2013, p. 14). However, criteria for diabetes (Szathmary & Holt, levels in four Dogrib settlements to this explanation is considered to be 1983). However, when the test was determine whether there were any generally too simplistic. Emerging data repeated in 1985, only approximately associations between more acculturated suggests there are possible epigenetic 2% of the same Dogrib population had or less acculturated settlements effects whereby there are changes in glucose levels exceeding the criteria and the prevalence of non-insulin gene expression that can be transmitted for diabetes. These studies highlight dependent diabetes mellitus (NIDDM). intergenerationally but do not involve the occurrence of a shift in the glucose They found very low prevalence of the alteration of DNA base sequences tolerance of normal adults (Szathmary, diabetes and no association between (Ibid., p. 15). 1993). While the evidence derived acculturation and NIDDM, despite from these studies did not support the significant differences in the intake notion that fasting hyperinsulinemia components derived from non-

TABLE 8: PREVALENCE (CRUDE) OF SELF-REPORTED DIABETES AMONG FIRST NATIONS, INUIT AND MÉTIS INDIVIDUALS IN CANADA

Source Age Age-standardized prevalence

Non-Aboriginal 2009-2010 CCHS 12+ 6.0

First Nations (on-reserve) 2008-2010 Regional Health Survey 18+ 15.3

First Nations (off reserve) 2009-2010 CCHS 12+ 8.7

Inuit 2006 Aboriginal Peoples Survey 15+ 4.0

Métis 2009-2010 CCHS 12+ 7.3

Source: PHAC, 2011b

48 © Credit: ThinkStockPhotos.ca, ID 81334112 © Credit: ThinkStockPhotos.ca,

traditional foods by community and for Aboriginal people in the NWT, infrequent physical activity. This data by age. However, in 1990, Szathmary especially for First Nations. This data suggest that the prevalence of chronic and Ferrell (1990) found significant shows age-standardized prevalence of diseases may increase in the future. elevations in centripetal obesity diagnosed diabetes for the NWT as and significantly higher long-term a whole to be between 5.5 and 6.0%, The evidence seems to suggest that circulating plasma glucose levels and which is mid-range when compared First Nations and Métis in the NWT fasting triglyceride levels in the most with all other provinces and territories are at greater risk of diabetes and acculturated Dogrib community. (PHAC, 2011b). When coupled with the cardiovascular illness because they have data from CCHS which excludes on- higher rates of many of the risk factors More recent data suggests that rates reserve First Nations people, these rates for these illnesses. Rates of obesity and of diabetes in First Nations and Métis seem to indicate that the prevalence of overweight are generally higher in the in the NWT may be rising. Data diabetes may in fact be much higher NWT compared to the national average from Statistics Canada’s Canadian for on-reserve populations. The fact (PHAC, 2011a; Vanasse, Demers, Community Health Survey (CCHS) that Aboriginal Canadians are being Hemiari & Coureau, 2006; Pouliou & reveals that between 2007 and 2010, diagnosed with diabetes at a younger Elliott, 2009; Freeman, King, Briand, the age-standardized rate of diabetes age than non-Aboriginal individuals & Pickett, 2012), and they are also among Aboriginal people living in the (PHAC, 2011b) further hints at an generally higher among First Nations NWT was 2.9% compared with 6.1% emerging public health crisis. Sarkar, and Métis people in the NWT compared of Aboriginal people in Canada, 3.6% Lix, Bruce & Kue Young (2010) also with non-Aboriginal people (Kimery, of non-Aboriginal people living in the noted some negative shifts over time Amirkhalkhali, & Amirkhalkhali, 2013; NWT and 4.5% of non-Aboriginal in their comparison of self-report data Kuhnlein et al., 2013, 2014; Nakano et people in Canada generally (Statistics for Aboriginal and non-Aboriginal al., 2005). The Public Health Agency Canada, 2013b, 2013c). However, this respondents living in northern Canada of Canada (2011b) examined four risk data excludes First Nations people living across two cycles of the CCHS, factors for diabetes and found that on reserve. Diabetes data collected by including increases in the number prevalence rates for three of these the Public Health Agency of Canada of Aboriginal respondents reporting factors (self-reported overweight and (which includes both Aboriginal and obesity, as well as increasing prevalence obesity, inadequate vegetable and non-Aboriginal populations) seems to of a number of risk factors for chronic fruit consumption, and daily tobacco indicate warning signs that diabetes is disease among Aboriginal respondents, smoking) were very high in the NWT emerging as a public health concern including odds of daily smoking and (as well as in Nunavut) compared

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with other provinces and territories in adults compared with younger adults with little reliance on market economies Canada.13 In particular, the NWT had (Ibid.). Kuhnlein et al. (2013) expressed tend to be of normal weight” (p. 12). the second highest prevalence of self- considerable concern about the extent reported inadequate vegetable and fruit of obesity among women, noting that The rates of obesity and overweight consumption, which again highlights 46% of the Dene women in their sample among First Nations and Métis children the role that scarcity of fresh foods in were considered obese based on body are particularly alarming. Kuhnlein northern latitudes plays in maintaining mass index (BMI), 57% were considered et al. (2013) found that 24% of First good health. obese based on waist circumference, and Nations youth were above the 85th 88% were at substantially increased risk percentile for BMI and 20% and 18% Researchers associated with the CINE of obesity-related health complications. were above the 85th percentile for examined the prevalence of obesity They attributed these high rates largely waist circumference and body fat, among Indigenous people from 44 to low physical activity expenditures. respectively. Nakano et al. (2005) communities in the Canadian Arctic Nevertheless, this study found that examined overweight among Dene/ (including Yukon First Nations and hypertension was non-existent and pre- Métis (and Yukon) children aged 10-12 both Dene/Métis and Inuit in the hypertension was present in only a small years, finding excessive prevalence, NWT). They found that overall the rate proportion of youth and young women. with 32% of children above the 85th of obesity for Arctic adults exceeded all Geography is also a contributing percentile for BMI. The author noted Canadian rates (Kuhnlein et al., 2004). factor in the prevalence of obesity. As that prevalence of obesity varied by Furthermore, prevalence of obesity noted by Egeland and Harrison (2013), region and gender, with rates 30% lower was higher for women compared with “Indigenous peoples who live in remote for boys compared with girls, and rates men, for Inuit compared with other areas with considerable biodiversity and considerably higher in southern regions Indigenous groups, and for older who are engaged in traditional activities compared with central and northern

13 The fourth, physical inactivity, was in the mid-range.

50 regions. She warns, however, that they identified four risk factors (of a There is a need for additional research caution should be exercised in using the total of 6) that were above Canadian related to chronic diseases associated CDC Growth Charts to assess obesity averages including percentage of survey with diet and nutrition within First because of built-in assumptions about respondents who were current smokers, Nations and Métis in the NWT, in differences among racial and ethnic who were obese (BMI equal to or order to identify the prevalence of these groups resulting from environmental greater than 30.0), who were physically diseases and the extent to which these factors such as socioeconomic status, inactive, and who were considered to be populations are at risk of developing poverty and the availability of health low income. Despite these risk factors, these chronic diseases. What limited and nutrition services rather than the percentage of NWT respondents data is available seems to suggest genetic factors. Vanasse et al. (2006) who were hypertensive was considerably that the risk factors for diabetes and suggest that the higher rates of obesity below the national average. This same cardiovascular disease (including in the NWT are likely attributed more methodology and data was used by tobacco use, inadequate fruit and to low fruit and vegetable consumption Filate et al. (2003) and Chow et al. vegetable intakes, inadequate physical rather than to physical inactivity by (2005) to assess regional variations in activity, and obesity and overweight) the substantial Aboriginal population cardiovascular disease. In these studies, are generally high among First Nations living in the territory. Panagiotopoulos, Filate et al. found that rates of mortality and Métis, and that prevalence rates for Nyguyen, & Smith (2014) found that from cardiovascular disease were lowest these diseases will continue to increase. nearly 50% of Aboriginal children from in the NWT, while rates of mortality It is imperative that health promotion the Beaufort-Delta region of the NWT from ischemic heart disease were second programs and initiatives target these were obese or overweight, highlighting lowest. Similarly, Chow et al. noted that risk factors in order to stave off this the need to address the barriers self-reported prevalence of heart disease, emerging public health threat. The Aboriginal populations face in rural myocardial infarction, angina and/or following section will discuss current and remote regions in accessing high- congestive heart failure was also the health promotion programs and quality nutritious foods and recreational lowest in the Yukon/NWT/Nunavut initiatives. programs. collectively. While these data do not disaggregate Aboriginal from non- The only literature related to Aboriginal populations (and in some cardiovascular or other heart-related cases include all northern residents), it is illnesses in the NWT focused on likely that cardiovascular disease is not the general population rather than yet a public health issue among the First on First Nations and Métis. A study Nations and Métis of the NWT. by Tanuseputro et al. (2003) utilized 2000/01 CCHS data to assess risk factors for cardiovascular disease in Canada across provinces and territories. For the general population of the NWT,

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 51 © Credit: iStockPhoto.com, ID 24556757 7.0 HEALTH PROMOTION

This section will examine what is known health promotion initiatives. Several examples involve multi-level and multi- about health promotion initiatives in suggestions are offered in the literature sectoral approaches. Some target the the NWT. Since the population of the pertaining to public health strategies. general population of the NWT, while NWT is almost evenly split between Given that many traditional foods others target Aboriginal populations Aboriginal and non-Aboriginal people, are high in several essential nutrients, specifically. The target population may this section will include information Kuhnlein et al. (2006) argue that these include all ages or focus specifically pertaining to both populations. It will types of TFs should be promoted in on infants, children, youth or adults. also draw on information gathered not public health initiatives. Others posit Some of the initiatives are short- only from the five articles identified in strategies aimed at overcoming some of term, temporary solutions aimed at the literature search that focused on this the barriers to accessing healthy market addressing food insecurity, some aim to topic, but also on information collected foods, including increasing levels of build capacity and develop skills, and from a search of the Internet for health Vitamin D and calcium, especially for some involve organizational change or promotion initiatives in the NWT. new mothers and their infants, through policy responses. All of the initiatives This search involved using Google’s vitamin supplementation (Waiters et convey the importance of community search engine with the search terms al., 1998), and subsidizing the cost of consultation and participation in health “health promotion” and “Northwest milk in northern communities to bring promotion initiatives (Kuhnlein et Territories.” However, not all programs cost down to the levels of southern al., 2014). The examples found will be or initiatives will be found on communities (Slater, et al., 2013). Some categorized according to a framework Google, especially those that are more examples of current health promotion utilized by the Expert Panel on the community-based. Funding and time initiatives in the NWT show an effort to State of Knowledge of Food Security in constraints prevented contacting various incorporate elements of these strategies. Northern Canada (Ibid.): 1) programs to government staff directly to determine increase the affordability and availability the availability of specific programs or Kuhnlein et al. (2014) argue that of healthy food; 2) health and education initiatives. As a result, it is likely that “because food insecurity is experienced programs; 3) community wellness some programs and initiatives will be differently at individual, household, and intergenerational knowledge missed. Nevertheless, the examples of community, and regional levels, it sharing; 4) harvester support and programs and initiatives are diverse and follows that strategies to mitigate food sustainable wildlife management; 5) should be considered representative of insecurity must be similarly diverse” poverty reduction and community the programs and initiatives that are (p. xxi). The diversity of these health economic development; 6) innovation available in the NWT. promotion initiatives identified in in infrastructure, transportation and the literature and from a search of local food production; and 7) youth Of the five articles that discuss health the Internet is evident in terms of engagement. These categories are not promotion initiatives, none provide the partners involved in funding mutually exclusive. an evaluation of the effectiveness of and administering the initiative, the initiatives. Instead, the focus is generally population targeted by the initiative, on identifying and describing various and the nature of the initiative. The

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 53 © Credit: iStockPhoto.com, ID 29229988 © Credit: iStockPhoto.com,

7.1 Programs or initiatives to foods and activities, improves peoples’ the exception of those communities diets, increases physical activity, and without marine service). This includes increase the affordability and reduces the risk of obesity and chronic fruits, vegetables, bread, fresh meats, availability of healthy market disease (PHAC, 2012). The program milk and eggs, all of which receive the has been expanded to other northern highest rate of subsidy. The expectation foods communities, including Ulukhaktok, is that these subsidies will then be NWT. Several evaluations have been passed from retailers to consumers, Programs or initiatives aimed at undertaken of this program; however, making healthy market foods more improving the availability and the focus has been on the effectiveness affordable. The program also aims affordability of high quality foods help of this program on improving diet to improve access to commercially- counteract the high costs of bringing among Inuit and Inuvialuit populations produced traditional, northern foods, nutritious foods to market, which when rather than First Nations and Métis and provides funding for communities, coupled with the lower socio-economic populations. These evaluations highlight working in partnership with Health status of many Aboriginal people, act the effectiveness of the program in Canada, to offer culturally-appropriate as significant barriers to accessing improving the intakes of vitamin A nutrition and health promotion nutritious market foods in the NWT and D among women of childbearing activities, including information on and the north generally. Two programs age, decreasing significantly the the use, marketing and preparation were identified through a search of the consumption of de-promoted of nutritious foods to support healthy Internet which aimed to improve the foods, such as high fat meats and eating (AANDC, 2010). accessibility and affordability of market dairy products, and using healthier foods. preparation methods (Bains et al., 2013; 7.2 Health and education Kolahdooz, et al., 2014). The Healthy Foods North Initiative programs is an intervention program aimed Nutritious North Canada is a northern at improving diets and reducing the food retail subsidy program initiated Most health promotion programs risk of chronic disease in Aboriginal in 2010 to replace the previous Food and initiatives can be categorized as populations (Kuhnlein et al., 2014). The Mail Program. The program, funded being health education programs. initiative was part of the Pan-Canadian by the federal government, is designed These programs are primarily aimed Healthy Living Strategy. It was first to make healthy foods more accessible at improving maternal and infant introduced in 2008 by the Government and affordable to all residents of nutritional health, or at improving the of the NWT, Department of Health isolated northern communities. Unlike health of children and youth, through and Social Services (DHSS) with the the previous Food Mail Program, educating individuals about healthier Canadian Public Health Association which also subsidized non-food diets and lifestyle choices. They are as a pilot project in Inuvik and items, most non-perishable foods, often funded by Health Canada and Tuktoyaktuk to make nutritious food and some perishable foods with little managed by the territorial government, more affordable (Epp, 2009). Working nutritional value, the current program though there are also some community- closely with local Inuit and Inuvialuit only subsidizes northern retailers based initiatives. community groups, program leaders and wholesalers of large volumes of developed a multi-level intervention nutritious and perishable foods (with program that promotes traditional

54 The Public Health Agency of Canada about breastfeeding and the importance (HSS) departments collaborate on implemented the Canada Prenatal of healthy eating. The Initiative is this initiative. Two different types of Nutrition Program (CPNP) in the administered by the Territory’s Health funding are available: Community Northwest Territories in 1994 (PHAC, and Social Services Department. Initiatives and Supporting Child 2011b). This community-based program Services. Of interest to this review is the provides funding for the promotion of The Baby Friendly Initiative (BFI) first type of funding, which provides public health and support to improve was initiated in Canada in 1991 as an aid to existing programs or services the health and well-being of pregnant integrated initiative for hospitals and that improve the development of early women, new mothers and babies community health services to provide childhood intervention programs for facing challenging life circumstances. optimal support for maternal-child children 0-6 years old and their families, Currently, there are 28 programs in health (Breastfeeding Committee of including promotion and prevention the NWT, supported by two regional Canada, 2012). It was implemented and programs that enable families and CPNP dieticians based in Yellowknife is administered by the Breastfeeding communities to make healthy choices. and Inuvik (NWT Prenatal Nutrition Committee for Canada (BCC), a This might include enhancing Program, n.d.-a). A separate stream of volunteer not-for-profit volunteer community level parenting courses the program is administered through organization established by Health which assist parents in providing quality Health Canada and serves Inuit and Canada to protect, promote and support care for their children (NWT, ECE & First Nations women living on-reserve. breastfeeding as the normal method HSS, n.d.). Main program activities include of infant feeding. In recognition that nutrition screening, education and the degree to which the BFI can be The federal government provides counseling (for example, information implemented across Canada varies funding for Aboriginal Head Start sessions on nutrition, pregnancy and that it may be more difficult to programs (for both on- and off-reserve and health, grocery store tours, baby implement in more rural, isolated and populations) which focus on early food making activities, and physical First Nations communities, a new work child development and education. activities); maternal nourishment (for group with the BCC, the Provincial/ Among other things, these programs example, cooking classes, healthy food Territorial BFI Committee, was incorporate a health promotion hampers, meal bags, Good Food Boxes, initiated to explore ways for the BCC component designed to “empower food vouchers, healthy snacks provided to assist and support the BFI in these parents, guardians, caregivers and those during CPNP activities, food access communities (Ibid.). To date, there involved with Aboriginal Head Start activities and bulk food buying); and have been few activities related to the to increase control over and improve breastfeeding promotion, education BFI undertaken in the NWT with their health” (NWT, Aboriginal Head and support (NWT Prenatal Program, the exception of making an Online Start, n.d.). Aboriginal Head Start n.d.-b). Breastfeeding Course available to centres encourage practices for self- health care professionals, the hosting care, working together to address health The Brighter Futures program was of the ‘NWT Supports Breastfeeding concerns, and the creation of formal introduced by the federal government in website’ by the NWT Health and Social and informal social support networks the early 1990s to “assist First Nations Services Department, and sending a to facilitate actions that contribute and Inuit communities to develop representative to attend the BCC P/T to holistic health. Specific actions community-based approaches to better committee meetings (Ibid., p. 23). undertaken within these centres include health” (Health Canada, 2007, para. developing and undertaking physical 1). Brighter Futures offers funding Another federally funded but activities and games that promote the for health promotion and ill-health territorially administered initiative is development of gross motor skills and prevention projects that offer learning- the Healthy Children Initiative. This participation in an active lifestyle in related activities focused on increasing initiative was implemented to 1997 children, and encouraging parents to awareness, changing attitudes, building to support people, organizations and participate in activities that promote a knowledge and enhancing skills. The communities that create programs healthy and active lifestyle (Ibid.). The program consists of five components: and services aimed at having “healthy program is administered by the DHSS. mental health, child development, children of healthy parents grow parenting, healthy babies and injury up in strong supported families in The Government of the NWT has prevention. The Child Development caring communities” (NWT, ECE promoted traditional foods in health and Healthy Babies components can & HSS, n.d., p. 1). In the NWT, the promotion initiatives for at least a include nutrition projects such as school Education, Culture and Employment decade. In 2002, the HSS created a based breakfast programs and education (ECE) and Health and Social Services fact sheet series on traditional food

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 55 which continues to be available on acceptable to all ages and genders. decreased availability of traditional the Internet. There are two fact sheet She attributes the success of these food sources (in this case caribou) and series for Dene/Métis traditional foods interventions to the fact that they limitations on beneficiaries. McMillan and two for Inuit traditional foods. combined Western scientific principles & Parlee (2013) note that meat sharing Each series includes one fact sheet that of good nutrition with traditional comprises a substantial portion of identifies the types of traditional food knowledge, and they built trust and the total harvest for community and sources consumed by each population commitment among community household organized hunts. However, group, the parts consumed, some residents and their leaders. since there are more requests for meat optimal food preparation techniques from elders and those in need after for that food source, and the nutritional 7.3 Community wellness and a community harvest compared to benefits of that food source (ie. whether individual household organized hunts, it has high or low fat content); and one intergenerational knowledge the portions of meat being shared tend fact sheet that provides information sharing to be smaller. McMillan (2012) also on important vitamins, why they are highlights the role of the community important to health, food serving size, This category of programs and organized hunt in “bolstering traditional and tables showing which food sources initiatives is broad, encompassing livelihoods within the community (both traditional and market) are rich culture based programs that promote through teaching youth traditional in those vitamins. Dene/Métis food mental, spiritual, and physical well- skills” (p. 96). sources identified in the first fact sheet being; programs that include practices include caribou, moose, fish (baked that encourage family eating and Community food programs are lake trout), muskrat, beaver, rabbit/ sharing; programs that promote widely depended on by users and are hare, goose, duck, ptarmigan/grouse, intergenerational knowledge and skills considered an essential service in the and wild plant greens (such as dock, transmission; community led food north (Ford et al., 2013). In fact, Ford fireweed, dandelion greens and lamb’s assessments and asset mapping; and et al. (2013) found that community quarters). The vitamins included in the programs that target populations at food program users tend to be second fact sheet are Vitamins A, B higher risk of food insecurity. As noted chronically food insecure. However, (riboflavin, thiamine, niacin), and C, as in Kuhnlein et al.’s (2014) report, “[t]he these researchers also highlight a well as calcium, iron, protein, and fat extent to which [traditional] knowledge contradiction in the way that some (from traditional food sources) (NWT, is transmitted to future generations food programs are funded which in HSS, 2002). plays an important role in determining fact can lead to increased vulnerability the health and wellness of individuals to food insecurity. They note, for While little information could be and communities” (p. 162). Also example, that the food bank in Iqaluit obtained regarding community-based included in this section are programs is funded through community events initiatives to educate about healthy aimed at reducing the prevalence of like bingo, a setting in which residents food choices, it is likely that many chronic diseases for their focus on who are already food insecure spend First Nations and Métis communities encouraging healthy lifestyles. what little money they have. This can in the NWT are implementing their contribute to a perpetuation of poverty. own culturally relevant initiatives. Food sharing networks and community Ford et al. also indicate that additional Kuhnlein et al. (2013) identifies a food programs are short-term, research is needed, including the extent range of activities implemented in the temporary programs targeted at to which community food programs community of Tetlit Zheh to promote populations at higher risk of food are utilized and effectively serve the knowledge of and access to healthy insecurity. The only information needs of communities; policy research traditional and market foods, while that could be found on food sharing on the complexities of implementing Kuhnlein (2014) notes that nine of networks came from two articles policy to support food security in CINE’s 12 Indigenous communities identified in the literature search on remote northern communities; policy had implemented health promotion the sharing of meat from community research related to wildlife management initiatives. Key components of these organized and household-organized which has direct implications for initiatives include: recognizing an hunts within a specific Dene community the availability of traditional foods; inventory of available resources; (McMillan, 2012; McMillan & Parlee, and enhancing the evidence base on reinforcing community-based 2013). These two studies highlight the successful interventions for policies knowledge sharing of available foods benefits of community hunt meat- aimed at strengthening the traditional and harvesting methods; and using sharing strategies in contributing to subsistence sector and links to food cultural knowledge to render foods social-ecological resilience towards security.

56 Community food programs are widely depended on by users and are considered an essential service in the north (Ford et al., 2013). © Credit: iStockPhoto.com, ID 4857715 © Credit: iStockPhoto.com, There have also been several programs that have focused on reducing the prevalence of chronic disease. A long-standing health promotion initiative has been the federal measures (NWT, HSS, 2011a). The Strategy Fund, a community-based government’s Aboriginal Diabetes Chronic Disease Management Model health promotion initiative meant Initiative. Established in 1999 with priority came out of recommendations to assist communities working on initial funding of $58 million over 5 resulting from a review of health tobacco harm reduction and cessation, years, the initiative is now in its third programs by the Office of the Auditor active living, healthy pregnancies and phase, having expanded in 2005 with General and sets the Department of injury prevention. The fund supports a budget of $190 million over 5 years HSS “to identify a core set of diabetes new single year community-based and then again in 2010 with a budget education, prevention and treatment projects that improve health and of $50 million per year. The aim of the programs and identify and collect data wellness, promote healthy lifestyles, initiative is to support health promotion to measure program results and improve and reduce preventable diseases and primary prevention activities and program delivery” (NWT, HSS, 2012, (NWT, HSS, 2011b). Applicants must services to reduce type 2 diabetes p. 15). Included in this priority are be non-government, not-for-profit among Aboriginal people. This includes: actions aimed at health promotion, organizations. Projects may focus “initiatives for children, youth, parents physical activity and other preventative in one or more of five areas: healthy and families; diabetes in pre-pregnancy healthy choices. As part of this health pregnancies, active living and healthy and pregnancy; community-led food priority, the government identified as eating, tobacco harm reduction and security planning to improve access an action for the 2012/13 fiscal year cessation, injury prevention, and sexual to healthy foods, including traditional the need to ”assist individuals to better health. In the focus area of active living and market foods; and enhanced manage their chronic disease and reduce and healthy eating, these projects can training for health professionals on complications and hospitalizations be targeted at increasing awareness clinical practice guidelines and chronic including the Diabetes Self-Management and health promotion activities about disease management strategies” Pilot Program and the Diabetes active living, healthy eating and being (Health Canada, 2012, para. 7). These Capacity Building Project” (Ibid., p. at a healthy weight; offering activities programs and services are delivered 31). As a first step in developing a that cover both fitness and nutrition; in partnership with Tribal Councils, territory-wide integrated chronic disease teaching people how to choose, buy, First Nations organizations, Inuit management strategy, the DHSS is and prepare healthy food; or providing community groups, and Provincial and collaborating with the Canadian Health nutrition education for families (Ibid., p. Territorial governments. The Initiative Services Research Foundation on four 2). Funding is provided to a maximum is administered by the Territory’s Health improvement pilots focused on mental of $10,000 per project for registered and Social Services Department. health, diabetes, renal disease and non-profit groups working to benefit system level changes (Leith, Kirvan, the community. Projects are selected The Government of the NWT also Verma, Lewis, & Robertson, 2012). No through a proposal writing process, recently set a priority to improve further details about these programs can with priority given to projects that have the health status of the population be located through internet sources. active and supportive partners which through the development of a provide funding, space, resources or culturally appropriate chronic disease In 2011, the Government of the NWT volunteer staff, or contribute in some management model that tracks outcome also established the Health Promotion other way to the project.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 57 7.4 Harvester support systems through the passing of 7.5 Poverty reduction and traditional knowledge about hunting and sustainable wildlife from one generation to the next. community economic management Encouraging community hunts is development also a method of ensuring long-term Strategies aimed at supporting food security as they incorporate an The programs included in this section traditional harvesting practices and element of community-based ecological focus on interventions to address the consumption of traditional/ management directed at improving poverty and diminish crowding in country foods, as well as sustainable conditions related to declining animal housing, as well as initiatives that build wildlife management, are important populations (McMillan, 2012). In capacity and promote self-reliance in the for addressing food insecurity among McMillan’s First Nations study long-term. As noted earlier, northern Aboriginal peoples in northern Canada community in the NWT, the community Canadians, and Aboriginal people in (Kuhnlein et al., 2014). These strategies hunt was organized with consideration particular, generally experience higher encourage food sharing, increase the for ensuring a sufficient harvest through rates of unemployment and poverty, accessibility of healthy food options, the careful choosing of the hunt lower levels of education, and poorer and ensure long-term food security and location, as well as consideration for housing and health status. The role food sovereignty. encouraging participation in the hunt that these determinants play in food and minimizing travel costs (p. 94). insecurity was emphasized in numerous Several initiatives are targeted at studies (Egeland & Harris, 2013; improving food security through the Several publications identified in the Willows et al., 2008, 2011; Tarasuk promotion of traditional harvesting. literature search presented results from et al., 2014; Slater et al., 2013; Ford The Commercial Harvest Program community monitoring programs in the et al., 2013). Despite the existence of is designed to assist First Nations, NWT. McDonald (2009) and McMillan social assistance programs in NWT communities, organizations and (2012) undertook assessments of the communities to address poverty, governments to implement and most commonly harvested traditional little information could be found on conduct commercial harvests for a meat, fish, and bird species for wildlife programs with a poverty reduction number of traditional food plant and management purposes. In addition, focus; the research on poverty reduction animal species, while the Traditional Parlee et al. (2014), in response to programs and their association with Harvest Program is designed to assist community concerns about the spread food insecurity is noticeably lacking. community and regional organizations of Chronic Wasting Disease (CWD) in However, Arctic co-operatives are in harvesting local plant and animal local caribou populations, demonstrated an example of an initiative aimed at species (NWT, Industry, Tourism how traditional knowledge can be addressing food insecurity by building and Investment, n.d.). Traditional used to monitor changes in the Arctic capacity and promoting self-reliance. food acquisition is also supported ecosystem in the absence of more formal through the Government of the monitoring processes. Specifically, they Food cooperatives are a form of NWT’s Western Harvesters Assistance drew on the traditional knowledge community development which can Program, which “provides grants to of the Łutsël K’é Dene First Nation provide social benefits (Kuhnlein et Aboriginal organizations that promote and data from previous research to al., 2014, p. 177). Co-operatives in renewable resource harvesting”, and determine whether there were any Canada’s north “share a vision of people the Community Harvesters Assistance changes in the availability, range and working together to improve … social Program which “provides funding to condition of local caribou. Their study and economic well-being” (Arctic Co- Local Wildlife Committees to distribute found few changes in the condition of operatives Ltd., 2007, para. 1). Some of to members to defray the operating caribou, only changes in terms of its the objectives of Arctic co-operatives costs of harvesting” (Epp, 2009, p. 18). availability and range, indicating that are to provide merchandise services in In 2012, the Government of the NWT community concerns over the spread of the most economical and efficient way to increased its funding to the program to CWD into the region were unwarranted members and to provide an environment over $1 million dollars (NWT, Office of at the present time. Such monitoring for promoting capacity building the Executive, 2012). is essential, as is the need to exercise through the recruitment, development caution in communicating about such and training of northern people in In the previous section, community diseases, as concerns over the spread of employment and management positions. hunts were discussed for their infectious diseases in traditional food Arctic Co-operatives provide a range of encouragement of meat sharing as a sources can trigger a greater avoidance services to its members, but the majority mechanism for fostering community of these foods. There is clearly a need of their business is focused on providing well-being as well as for bolstering for greater monitoring of wildlife retail services which aim to help reduce knowledge about traditional food populations. the cost of buying groceries. One of

58 the attributes identified as contributing Program aimed to work with producers spring planting or fall harvesting. In the to the success of co-operatives in the to establish, expand and develop land case of Deline’s community garden, in north is a culture of sharing (Arctic Co- based initiatives to increase yields and 2009 produce from the harvest became operatives Ltd., Canada’s North, 2007). efficiencies (NWT, Industry, Tourism healthy snacks at snack time or were Most members of co-operatives in the and Investment, n.d.; Epp, 2009, 2011). given to home economics classes to NWT are Dene (Arctic Co-operatives, While little additional information could cook with (Ibid.). By 2011, all but three Canada’s North, 2007). According to be found on the Internet regarding the NWT communities had implemented the Arctic Co-operatives website, there Northern Agri-Foods Program, more some type of local production are co-operatives in eight communities information is available regarding the system with some moving to larger in the NWT: Fort Good Hope, Deline, Small Scale Foods Program. established sites and/or incorporating Holman, Sachs Harbour, Colville greenhouses (Ibid.). Table 9 identifies Lake, Lutsel K’e, Fort McPherson, and The Small Scale Foods Program has the communities involved in the Small Yellowknife. shown considerable growth since it Scales Foods Program, by region. was initiated in 2006, from six to 30 7.6 Innovation in community gardens (NWT, Industry, Several initiatives are also targeted at Tourism and Investment, 2011). This improving food security through the infrastructure, transportation program provides funding for seeds promotion of traditional harvesting, and local food production and small tools, and assists in the including the Commercial Harvest selection and development of sites for Program, Traditional Harvest Program, Barriers in transporting and storing community gardens in conjunction with the Western Harvesters Assistance foods in northern Canada contribute groups of residents, Band Councils or Program, and the Community to food insecurity, translating into local community governments. Youth Harvesters Assistance Program. These poorer quality nutritious foods at costs are also targeted through the school have been described in greater detail in a considerably higher than in southern system by bringing workshops into the previous sub-section. Canada (Kuhnlein et al., 2014). school and having classes help with Initiatives included in this category focus on overcoming these types of TABLE 9: COMMUNITIES INVOLVED IN THE SMALL SCALE FOODS PROGRAM, BY REGION barriers. While no initiatives related to improvements in infrastructure or transportation could be identified in Region Communities the review of literature (likely because the search terms utilized in the review Dehcho Region Fort Liard, Fort Simpson, Jean Marie River, Nahanni Butte, would not have been broad enough to Trout Lake, & Wrigley capture such initiatives), the literature did reveal some food sovereignty initiatives aimed at encouraging local Inuvik Region Aklavik, Fort McPherson, Inuvik, Tsiigehtchic, & Tuktoyuktuk food production.

The Government of the NWT has implemented the Growing Forward initiative aimed at promoting local North Slave Region Behchok, Dettah, N’dilo, Gameti, Lutselk’e, Whati, agricultural production. Components Yellowknife, & Wekweeti of this initiative include the Small-Scale Food Program and the Northern Agri- Food Program (Kuhnlein et al., 2014, Sahtu Region Colville Lake, Deline, Fort Good Hope, Norman Wells, Tulita p. 172). These two programs involve partnerships with the Government of Canada and the Government of the NWT to develop the agricultural South Slave Region Enterprise, Fort Providence, Fort Resolution, Fort Smith, Hay sector so as to improve healthy local River, Hay River Reserve, & Kakisa food choices. The Small Scale Foods Program aimed to establish market gardens in communities across the Source: Compiled from NWT Industry, Tourism and Investment and Health Canada, 2011. Small Scale Foods Program, NWT, while the Northern Agri-Foods pp. 6-8.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 59 © Credit: AboriginalImages.ca, "Cree Youth on Hill" "Cree Youth © Credit: AboriginalImages.ca,

7.7 Youth engagement and recreation sectors to address two initiatives, many of which fall under of the Government’s priority areas: the umbrella of the Healthy Choices Aboriginal people recognize the active living and healthy eating, which Framework. The first, Drop the Pop, importance of building capacity and links with the federal government’s is designed to encourage students and empowering youth with knowledge Pan Canadian Healthy Living Strategy their families to consume healthier related to food security so that they will (NWT, ECE, 2007, p. 2). Within this beverages and foster long-term healthy have the tools they need to adapt to the framework, the DHSS collaborates with food intakes (NWT, HSS, 2011c; 2011d). adverse changes affecting their people Education, Culture and Employment The program is a partnership between (Kuhnlein et al., 2014). This section will (ECE) and with Municipal and Health Canada (Aboriginal Diabetes describe programs and initiatives aimed Community Affairs to promote health Initiative); Arctic Cooperatives Limited; at providing education about nutrition within all grade levels in schools, the Canadian Public Health Association and health to children and youth, as health centres and communities (Ibid.). – NWT/Nunavut Branch; Co-op; well as programs that pass knowledge However, most of these programs/ the Government of NWT’s DHSS, about traditional foods and harvesting initiatives are implemented through ECE, and Environment and Natural practices from older generations to the public school system, where healthy Resources departments); the Food children and youth. living curriculum is often incorporated First Foundation – NWT; northern at each grade level. grocery stores; the Northern Nutrition The NWT Department of Health and Association; the NWT/NU Public Social Services (DHSS) collaborates Schools are often the most effective Health Association; NWT/NU Dental with other departments in implementing means of instilling knowledge about Association; and the NWT Medical a range of health promotion programs good nutrition and healthy lifestyle Association (Joint Consortium for and initiatives under the umbrella choices in children and youth. School Health, 2012). Funding for this of the Healthy Choices Framework. The DHSS collaborates with other program is based on school size, ranging The Healthy Choices Framework is departments in implementing a range from $750 to $2000 (proud2bnwt, 2011). a joint plan for the health, education of health promotion programs and The Sip Smart program is a partnership

60 between the HSS and ECE departments Stroke Foundation in communities 7.8 Summary of the Government of the NWT and across Canada, including in the includes curriculum aimed at raising NWT. This initiative sees volunteers In the NWT, most health promotion awareness among students in Grades 4 making presentations to students from programs/initiatives are targeted at the through 6 on the negative health effects Kindergarten to Grade 8 on topics such general NWT population rather than associated with the consumption of as healthy eating, active lifestyle and First Nations or Aboriginal populations sugary drinks and providing children smoke-free living (Heart and Stroke specifically. Some of these are aimed with the knowledge and skills they Foundation, 2011). specifically at health promotion, while need to make healthy beverage choices others are broader in scope, with health (Joint Consortium for School Health, One initiative is aimed at improving promotion as only one of many aims. 2012, p. 66). The Healthy Food for food security through the promotion Incorporating a stronger emphasis on Learning grant is provided to schools of traditional harvesting among youth. traditional foods in health promotion is in the NWT to assist in providing The ‘Take a Kid Trapping Program’ a more recent phenomenon. However, nutritious foods for students. Funds can encourages youth to learn traditional the success of most of these programs/ be used for meal/snack programs, skill skills such as hunting, fishing, and initiatives, with the exception of perhaps building programs, or kitchen supplies trapping. The program is cost-shared by the Healthy Foods North program,14 has to support food programs. In addition, the federal and territorial governments not been evaluated, especially not in the all health boards employ health through NWT’s Industry, Tourism context of improving diet and nutrition promotion specialists who are involved and Investment and Municipal and within the First Nations and Métis in school health promotion. Kids in Community Affairs departments and population. This gap in knowledge with the Kitchen was initiated by the Food the federal government’s Growing respect to health promotion must be First Foundation in partnership with Forward Program (NAHO, 2013). addressed so that knowledge about what Health Canada’s First Nations and Inuit Funding is provided to schools that works well and in what contexts can be Health Branch and schools in the NWT organize youth on-the-land skills shared by communities. (Health Canada, 2010). The program is training. In 2011, 2274 youth were targeted at children aged six to 11 and involved from 49 different schools focuses on healthy eating, nutrition (NAHO, 2013). Youth are taken out on education, and safe food handling and the land for up to two weeks and learn cooking skills. Students are provided a wide variety of activities from hunting with information about nutritious food and gathering, to traditional food choices and opportunities to practice preparation and important lessons about food preparation techniques in an proper preparedness for on-the-land eight week program, delivered once excursions. per week either during or after school. An additional school-based health promotion program, Jump Rope for Heart, was initiated by the Heart and

14 The Healthy Foods North program has been evaluated by several researchers, however the focus has been primarily on Inuit and Inuvialuit populations.

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 61 © Credit: iStockPhoto.com, ID 23826923 8.0 CONCLUSION

Improving the nutritional health of The analysis of research conducted on insecurity is considered generally quite First Nations and Métis of the NWT the nutritional health of First Nations high for residents of the NWT because has been a health priority and research and Métis peoples in the NWT up to of higher costs of living and lack of focus for decades. There has been a 2014 revealed a steadily increasing trend availability of affordable quality market trend towards increasingly substituting in publications over time, based on foods. It is considered even higher for traditional foods with market foods by five-year intervals. Most of this research Aboriginal residents who have lower younger generations. This, coupled with has been undertaken by the Centre socio-economic status compared the poor selection, poor availability, and for Nutrition and the Environment to non-Aboriginal residents. In the high costs of quality market foods in of Indigenous Peoples. The existing NWT, food security is also impacted remote and northern locales, and high research clearly demonstrates the by environmental contamination rates of poverty, has led to nutritional nutritional benefits of traditional foods, and climate change. The body of deficiencies. While impacts of these as well as additional benefits that literature on these two topics is again deficiencies on health status remain promote healthy living and wellness. quite limited. There have been few unclear, there are signs that a public The research has also highlighted the studies that have examined the levels health crisis may be looming. This considerable variability in traditional of contaminants in traditional food makes it imperative that the gaps in food consumption based on gender, sources, and few that track changes knowledge related to the nutritional age, geography, and seasonality of food over time. Most of the literature and health of First Nations and Métis in sources. Despite this, there remain research focused on the food security of the NWT be filled so that effective gaps in knowledge stemming from Inuit rather than First Nation and Métis responses can be implemented. These a tendency of most literature and populations. Of those that do focus on gaps in knowledge relate primarily to research to focus on broad population First Nations and Métis, findings show patterns of traditional and market food groups at a specific point in time. that there are no substantial health risks consumption, determinants of nutrient Studies focused on differences between associated with consuming traditional deficiencies, the level of contaminants specific Aboriginal sub-populations foods. While some individuals may in specific food sources, the impact or communities (including differences consume higher than tolerable levels of climate change on the quality and between urban and rural populations, of contaminants from certain foods availability of specific traditional foods, between First Nations and Métis during certain times of the year, these and the prevalence of chronic diseases populations, and between lower and levels are generally not considered usual associated with diet and nutrition. They higher socio-economic status), that intake levels either because they are also relate to the need to respond to aim to identify motivations behind consumed in large quantities for only a the diversity of Aboriginal peoples. food choices, and that track food short period of the year or because the Clarifying our understanding of how the consumption patterns of individuals food sources that contain the highest nutrition transition manifests in specific over time are needed in order to gain levels of contaminants are typically sub-populations is necessary to allow a clearer picture of the extent of the consumed by few individuals. Further, for targeted health promotion initiatives dietary transition for First Nations and the food sources that show the highest which are seen as being more effective Métis. levels of contaminants are more likely than general approaches in improving to be consumed by the Inuit rather than the overall health and well-being of First Food insecurity has been identified in the First Nations and Métis. Clearly Nations and Métis peoples. the literature as a major impediment the benefits of consuming traditional to improving diet and nutrition. Food foods outweigh the risks, yet there is a

The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps 63 Climate change impacts food security through changes in the local environment that affect the quantity, availability, and accessibility of traditional food sources. © Credit: iStockPhoto.com, ID 13386164 © Credit: iStockPhoto.com,

noticeable gap in the literature regarding impacts and studies on the effectiveness, Some have recognized the need to how to effectively communicate these durability, and long-term viability of promote traditional food sources as a messages to First Nations and Métis in adaptations. strategy for improving the health of the NWT. First Nations and Métis peoples, while Also lacking are literature and data others emphasize physical activity or Climate change impacts food related to the health impacts of poor aim to instill knowledge about diet security through changes in the diet and nutrition for First Nations and and nutrition. These programs and local environment that affect the Métis peoples. What exists is primarily initiatives involve multi-level and quantity, availability, and accessibility related to residents of the NWT in multi-sectoral approaches and target a of traditional food sources. There is general, rather than to Aboriginal range of age groups. However, there is a currently a dearth of literature focusing populations. The limited data available noticeable gap in knowledge regarding on the impacts of climate change seem to suggest that while prevalence the effectiveness of health promotion on food security, specifically on its of diabetes and cardiovascular diseases programs and initiatives in improving impacts to the quality and availability is generally lower for First Nations overall health within First Nations of specific traditional foods. Most of and Métis in the NWT compared and Métis. There is a body of literature this body of literature is very general, to other Aboriginal populations in that highlights the need for health with biophysical systems, vulnerabilities, Canada, the risk factors for these promotion to be culturally relevant socio-economic impacts and health diseases are generally high, suggesting so that uptake of key messages is impacts of climate change being the that prevalence of these diseases will maximized by Aboriginal populations. dominant focuses. The literature is continue to rise. Given this, it is essential that health also primarily focused on impacts to promotion programs and initiatives Inuit and their ability to adapt. Clearly, Current health promotion programs and be put in place that target Aboriginal more research is required in this area initiatives that incorporate a focus on populations and communities for First Nations and Métis, especially diet and nutrition appear to target the specifically. specific assessments of climate change risk factors for these chronic diseases.

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*Young, T.K., Szathmary, E.J.E., Evers, S., & Wheatley, B. (1990). Geographic distribution of diabetes among the native population of Canada: A national survey. Social Science & Medicine, 31: 129-39. The nutritional health of the First Nations and Métis of the Northwest Territories: A review of current knowledge and gaps sharing knowledge · making a difference partager les connaissances · faire une différence ᖃᐅᔨᒃᑲᐃᖃᑎᒌᓃᖅ · ᐱᕚᓪᓕᖅᑎᑦᑎᓂᖅ

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