Harnessing the Potential of Social Enterprise in Garden Hill First Nation by Marina Puzyreva

CANADIANCCPA CENTRE FOR POLICY ALTERNATIVES MANITOBA Harnessing the Potential of Social Enterprise in Garden Hill First Nation By Marina Puzyreva

DECEMBERJUNE 20182017 Harnessing the Potential of Social Enterprise in About the Author: Garden Hill First Nation Marina Puzyreva is an economist and Research ---- Associate of the Canadian Centre for Policy Alternatives-Manitoba. In her past projects she was involved in research with First Nations communities and organizations on the issues of poverty, missing This report is available free of charge from the CCPA and murdered Indigenous women and funding for website at www.policyalternatives.ca. Printed child welfare services. She holds an MA from the copies may be ordered through the Manitoba Oﬃce University of Manitoba and a BA from the Higher for a $�� fee. School of Economics (HSE, Moscow).

Help us continue to offer our publications free online. Acknowledgements We make most of our publications available free The present research paper would not have been on our website. Making a donation or taking out a possible without the input of many individuals. membership will help us continue to provide people with access to our ideas and research free of charge. A big thank you to: You can make a donation or become a member Dr. John Loxley for the valuable supervisory on-line at www.policyalternatives.ca. Or you can assistance throughout the entire research process. contact the Manitoba office at ��-��-�� for more information. Suggested donation for this All the staff at Aki Energy Inc., particularly Darcy publication: $�� or what you can afford. Wood for introducing to the community and Shaun Loney for useful comments and suggestions. The team of researchers Dr. Shirley Thompson, Tosan Okorosobo and Malay Das from Natural Resource Institute at the University of Manitoba for their help with facilitating the survey distribution and collection and sharing their insights on the community and food insecurity issue. Unit �� – �� Main St., Winnipeg, MB R �W �N� �� -��-�� -��-�� Many community members, health care �� [email protected] practitioners, researchers and other individuals who generously shared their knowledge and perspectives: Steve McDougall, Oberon Munroe, Chief Arnold Flett, Larry Wood, Ivan Harper, Lionel Flett, Gloria Munroe, Byron Beardy, Kayla Farquhar, Melody Muswaggon, Derek Reimer, Dr. Sharon Bruce, Dr. Jonathan McGavock, Fishermen of Garden Hill, Members of the Northern Manitoba Food, Culture, and Community Collaborative. The generous support of the Social Sciences and Humanities Research Council of Canada through the Manitoba Research Alliance grant: Partnering for Change – Community based solutions for Aboriginal and inner-city poverty (Grant Nº 895-2011-1027, project Nº 790), is gratefully acknowledged. Table of Contents v List of Abbreviations 1 Introduction 3 Historical Background of the Community. Traditional Food Culture 6 Demography and Economy of Garden Hill First Nation Calculating Welfare Amounts Small-Scale Household Survey 16 Health Status of the Community Diabetes: Effective Medical And Lifestyle Interventions Diabetes Statistics And Costs Discussion 24 Food Programs: Addressing Food Insecurity Through the Model of Social Enterprise Food Affordability and Accessibility Education Discussion 33 The Path To The Healthy Living 38 Conclusion 40 References 46 Appendices Appendix A. List of Businesses in Operation Appendix B. Household Survey Questions 48 Endnotes

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ iii iv !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" List of Abbreviations

 Aboriginal Diabetes Initiative CD Community Development  Community Economic Development  Freshwater Fish Marketing Corporation  Garden Hill First Nation  Indigenous and Northern Aﬀairs Canada  Northern Healthy Food Initiative  National Household Survey  Non-Insured Health Beneﬁts  .e Northern Manitoba Food, Culture and Community Collaborative  Nutrition North Canada  Revised Northern Food Basket SE Social Enterprise TD Type  Diabetes

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ v vi !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" Introduction

.is paper explores the economy, the health sta- (e.g. fries, soda drinks). Since the incomes in the tus, and particularly the issue of food sovereign- community are low, the healthy food options (e.g. ty of Garden Hill First Nation (), a remote fruits, vegetables, meat, milk) become unafford- community located  kilometers northeast of able for many residents who instead tend to buy Winnipeg, Manitoba. Similar to many northern cheaper processed and packaged foods, replacing communities, in  the history of colonialism, traditional diets with one high in fat, sugar and assimilation and the legacy of residential schools sodium. As a result, a great number of commu- have shaped the egregious conditions of poverty nity members suffer from diabetes, high blood that many on-reserve residents struggle with every pressure and cardiovascular disease. For a long day. ’s formal economy is under-developed time diabetes was considered to be an adult dis- and among many other poverty-related issues the ease, however nowadays it is even diagnosed in residents are confronted with high rates of unem- children, something that was unheard of before ployment, a housing crisis and high food prices. the s in Indigenous communities. Treating Moreover, the loss of culture and often ties with diabetes and its complications and providing family have made it extremely difficult for the social assistance to the unemployed involves new generation to preserve traditional livelihoods significant amounts of government spending that focus on hunting, fishing and gathering, this which only end up maintaining the status quo. way undermining the community’s autonomy in In this situation innovative interventions that providing food to its residents. will guide  towards self-sufficiency and that Due to the remoteness of the region, food will positively transform the economy and health items and other necessities are shipped in from of the community are called for. .e new Social the south at high cost. .at cost is passed on to Enterprise (SE) called Meechim Inc. in  residents in the local Northern Store which has embraces the concept of Community Economic almost sole control over the provision of food. Development () and seeks to localize the food Prices are high and access is inconvenient as the production to meet the community’s needs by store is located on an island off reserve. .e only way of starting a local farm and engaging com- food available for sale on the reserve is junk food munity resources. .is strategy is believed to plug

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 1 the holes in the ‘leaky bucket’, making sure that Current government expenses on health money spent on meeting people’s needs stays in and social assistance will be used to argue that the community. Moreover, it is believed to help strengthening the community’s sovereignty will create jobs in farming, production, delivery, and result in long-term savings for the government, administration and help manage and reduce dia- provided the funds are directed towards preven- betes rates in the community by increasing access tion programs in a holistic way that acts on the to healthy, fresh, local food (Loney, n.d.). social determinants of health. Although the study .e idea of developing non-market solutions is community specific it echoes many problems for poverty stricken communities in Canada’s common with other northern communities. In North is not new. Some recommendations were the end, it is the hope of this paper to suggest developed but never acted upon, for some pro- some pertinent measures that need to be taken grams the funding was discontinued. In .omp- by government and the initiative promoters in son et al. (), the authors note that “Many order to help maintain the positive momentum people in First Nation communities feel they of the current efforts to localize food production. have been “studied to death.” Researchers have .is paper is produced out of a review of come, gathered data, and never been heard from publicly available statistics on , literature again.” (p. ). Community members are under- on , diabetes, food, and interviews with  standably leery of outside researchers. In these key informants that included community mem- circumstances, self-determination and com- bers, health practitioners, diabetes and food in- munity input are needed to ensure that there is security researchers, and specialists involved in sufficient support to implement the projects or healthy food initiatives. Moreover, valuable in- programs after the initial enthusiasm subsides sights have been incorporated from the group (Loxley, Silver, & Sexsmith, ). conversations with the project funders from .e In this paper the economic and health pro- Northern Manitoba Food, Culture and Com- file of the community, including the amount of munity Collaborative (). A survey of government spending on diabetes and welfare  individual households was conducted in De- will be presented. By putting Meechim Inc. in cember  and is also included in the study. the context of the community’s economic and .e survey distribution and collection was fa- health problems and needs, the SE’s goals (re- cilitated with the help of Dr. Shirley .omp- duce diabetes, create more jobs) will be assessed. son and student researcher Malay Das from the Moreover, the enterprise’s funding structure, Natural Resources Institute at the University of governance, community engagement, adminis- Manitoba. .e research follows the principles trative, financial and other barriers will be dis- of ownership, control, access and possession cussed. .e potential of Meechim Inc. to pave () of the generated information or data the road towards food sovereignty and self-reli- (for more information see First Nations Infor- ance will be examined. mation Governance Centre, ).

2 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" Historical Background of the Community: Traditional Food Culture

.e discussion of any economic or educational capitalism and colonialism (Carter, , pp. ff.), interventions to improve health and food sov- but was expanded in native communities after ereignty has to be first placed in the context of the white settlers began to penetrate the lands. In Indigenous reality and it is not possible without many cases it was missionaries who spearheaded giving a historical overview of the community the first white contact with Indians in the interi- and highlighting their perceptions and tradi- or of the continent (Ponting, , p.) and who tions around such an important component of brought along with them their own knowledge their everyday subsistence as food. of farming and gardening. At that time creating Before the arrival of white settlers, native agriculturally-based communities was the ma- people worked as gatherers and hunters. .e jor thrust of assimilation efforts (Ponting, , geographical area of the Island Lake region p.). .e treaties signed by native people surren- where the community of  is currently lo- dered their lands to facilitate white settlement cated was not very fertile. Traditional diet was and also made provisions for supplies intended comprised of foods that were “high in animal to help Indigenous communities utilize their re- protein, nutrient rich, and low in fat or high in maining lands or make a living from hunting and marine sources of fat” (Earle, , p. ). .e fishing. As noted in Cumming and Mickenberg food consumed by Indigenous people included (): “Typically farm implements and supplies fish, bear, rabbit, moose, and berries (Socha et would be provided only as an initial outlay, but al., ). In addition, before th century there quantities of ammunition and other hunting and was a great reliance on bison for the economy fishing materials would be furnished on an an- of the prairie Indian tribes. Bison was used not nual basis by the Government” (p. ). only a food source but also as a major compo-  is a signatory to the  adhesion to nent that the native craftsmen utilized to supply Treaty  (“Garden Hill First Nation”, ) and clothing, shelter, tools, and weapons (Cumming until , Garden Hill, Wasagamack, St. .e- & Mickenberg, , p. ). resa Point, and Red Sucker Lake all comprised Gardening and farming had a long tradition the single Island Lake First Nation. .e name of in Indigenous communities well before merchant the community — Garden Hill — recalls the gar-

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 3 dening tradition that was practiced in the com- of their meanings and origins, like the fall and munity for a number of years. .e majority of spring feasts. Food is often referred to as a cel- the gardens were root crops — potatoes, carrots, ebration. Sharing is widely encouraged (.omp- onions, turnips. Some of them were the “exotics” son et al., ). .e land is of a paramount im- such as squashes and corn. Although gardening portance to the Indigenous way of life and the may not have been their original historical prac- connection between land and food on the table tice, there is evidence collected by community needs to be reestablished. members that gardens used to flourish in the Additionally, certain types of food are consid- area before the welfare system and the Northern ered medicine. For example, whitefish is consid- Store took over. .e Northern Store established ered a helpful medicine against diabetes. Pickerel the monopoly over the transportation and sell- fat and swamp tea are some medicines that are ing of food in the northern communities which consumed to this day by a number of older com- almost substituted traditional livelihoods of munity members in  who try to maintain hunting, gathering and gardening. the traditional lifestyle. .e loss of lands that followed the coloniza- Furthermore, harvesting and hunting shaped tion process, confinement to the state allocated the language that the people of that region spoke. reserve land, institutional rules enacted through Although faded overtime, its revival is especially the Indian Act regarding the use of land and an- important for the retention of one’s identity and imal resources, sending children to residential recreating ties with the ancestral land. For ex- schools detaching them from their families — all ample, according to an Island Lake community led to the erosion of the traditional Indigenous member “bush tea” in the area’s dialect Oji-Cree way of life. .e traditional lifestyle was restrained translates as “gaagigebag” which describes the at the same time the market foods could not meet plant in the following way: “gaagige” is “forever” the need for a healthy diet. High transportation and “-bag” is a plant name suffix that means “a costs and logistical barriers resulted in extremely leaf” (Gourneau, n.d.). .us, the tea is prepared high food prices which contributed to the situ- with the “forever leaf” that can be harvested all ation of general poverty (Socha et al., ). As year round. a consequence, many Indigenous communities .e Indigenous way of life, although enor- underwent a significant detrimental transition mously constrained, has persisted and often in their eating habits (.ompson et al., ). remains strong among community members. .us, food insecurity has become a very .is brief introduction has shown that language, common problem in the North and now we are rituals, traditional medicine, perceptions about clearly seeing the negative repercussions that food (strong concept of sharing, traditional food came along with it — malnutrition, poor learn- as medicine) — are all components of the tradi- ing outcomes, developmental delays, depression, tional lifestyle, and, therefore, any intervention anxiety, suicide, worsening problem of diabetes should be building upon them in a holistic man- and cardiovascular diseases. By observing  ner. Furthermore, the fundamental historical households in , .ompson, et al. () connection to the land needs to be respected found that  of the households are severely and thus sustainable development is the type of food insecure, and  of the households are development to be followed. moderately food insecure. “Elders always say — go back to the way we used However, some traditional knowledge and to live — to me, that doesn’t mean to go back to practices are retained to this day. Some rituals teepees and wigwams. It is to go back to that remain — although perhaps not many are aware

4 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" way of life where you respecting everything that .e next section will proceed with the current you are taking.” demographic and economic analysis of  Byron Beardy, providing information on the community’s in- Community member and Food Security Coordinator, come and expenses and highlighting the com- Four Arrows Regional Health Authority. munity’s divergent economy.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 5 Demography and Economy of Garden Hill First Nation

.is section will provide a snapshot of the  ), Shaun Loney estimated there were , economy. Indicators such as population growth residents. When the author visited the Reserve and structure, unemployment rates, incomes in September , community members re- and government transfers will be discussed. ported that the population of  is reaching More specifically, the section will try to answer , people which makes  a fairly large the following questions: How much social assis- northern community. tance do  residents receive in total and how Turning to the official sources, we are able to much can individual families expect to collect? find that the National Household Survey () How much did the First Nation receive in sala- counted , people living in  in  which ries from the federal government in ? How had an increase of  in  years since , if much do the households spend on food? we compare it to the estimate from the  Using publicly available statistics on  Census Population and Dwelling Count Amend- demography and economics, the welfare rates as ments (See Table ). Additionally, in the Table  well as the survey of  households conducted as we can see that the Census data from Statistics a part of this research, approximations will be Canada differs from the total registered popu- given regarding the amounts of social assistance lation on reserve as reported by Indigenous and received by First Nation residents, spending on Northern Affairs Canada (). .e total regis- food and transportation. tered population of  on July  equaled With regards to population statistics, we can , persons with registered male and females observe some inconsistencies from a number of on reserve being  persons. sources. For example, according to Councillor Even though the total population reported in Morris Knott there were , people living in the  is less than the total registered popu-  in  which was mentioned in an article lation, all important statistical information on on the Manitoba government’s website (“Mani- labour force, incomes and household composi- toba government investing in healthy food ini- tion originate from this survey. .at is why we tiative for northern communities”, ); in an take the   survey data as a starting point October  article at  News ( News, for analysis.

6 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" ,04.- 1 Population Statistics for GHFN Source !"#$ !"## !""$ INAC Total registered population Total registered population n/a &,+&% (July %#"+); &,%*); On-reserve ),++) On-reserve )'## NHS; Census of Population n/a %,((+ ",5'5 (%,&*" according to revised count+)

,04.- 2 Workforce Characteristics, 2011: Percentages Labour Force Indicators GHFN Manitoba Participation rate )'.& +(.) Employment rate %'.* +)." Unemployment rate %*.% +.%

,04.- 3 Income Characteristics, 2011 Income characteristics GHFN Manitoba Persons "* years of age and over with income ",)&* '#",#)* Avg. total income (all persons with income ($)) "%,'*(5 )+,+'+ All persons with earnings (counts) &5# ++),#%# Avg. earnings (all persons with earnings ($)) %#,#(( )(,*(' Composition of total income ("##%) "## "## Earnings — % of income *+ (* Government transfer — % of income &% ") Other money — % of income % "%

!"#$%&: 678 2011, the socio-economic indicators prepared for 3609 (Income characteristics, 2015).

.e population of  has not only in- above  years old were either not in labour force creased in recent years but it also underwent or unemployed but looking for work, which in some structural changes: the number of young crude terms may suggest that this proportion of people is growing rapidly with persons aged – people were qualified to receive social assistance. increasing from  persons in  to  in .e high number of reserve residents living on , a growth of more that  (“ Profile, welfare is a well-documented fact. On Manito- , , Manitoba, ”;  Census). ba reserves it is estimated that about half of the Another distinct characteristic of the  residents live on welfare (Rabson, ). community is the low participation rate in the As for the income acquired by  resi- labour force (.) especially as compared to dents,  estimated that there were , per- the provincial rate (.). In  the popula- sons  years of age and over with income and tion  years of age and over totalled ,. Giv- the average total income equaled ,, which en the employment rate of ., we can find is almost  times less than the average total in- that around , people or . of population come for the province as a whole. Knowing this,

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 7 ,04.- 4 Salaries and Beneﬁts by Segment Segment !"#% !"#& Health $% &)( %'* $% )%' #&' Education $( +&# )"* $+ )*% ("# Social $&*" 5+( $&"* )5+ Economic development $(# )#+ $+* (%+ Public Works $*(5 %() $% &%& &+& Housing $%%) %(* $# Band government $&)" &(5 $'(( )&" Private enterprise $))% +"" $)*' '%) Total in salaries and beneﬁts $"% "+* &%# $"% '%& *''

!"#$%&: Garden Hill First Nation Notes to Financial Statements Year ended March 31, 2015

we can find that the total income in the com- .e social assistance programs have many munity equaled ,, in . components and the rates are dependent on many .ere were  persons with earnings which factors such as family’s composition, financial sit- exceeded the number of the employed persons uation and health status. In view of the complexi- by  people. Average earnings equaled , ties associated with calculating precise amounts and consequently the total earnings in the com- according to the situation of individual families munity were ,,. while having only aggregate data on families avail- Government transfer as percentage of income able from  , we have made a number of was , therefore government transfers in  assumptions to help us arrive at feasible approxi- summed to approximately ,,. mations of the welfare amounts received in . Most of the working population of  are .ese assumptions are as follows: employed in the public sector like band government, health facilities and the school. .e amount Income Assistance: of salaries and benefits as part of federal funding • .e Northern rates for the households for the First Nation is shown in Table . In total residing in remote areas that do not have the First Nation received  million in salaries all-weather road, rail or water travel access and benefits in the year ended March , . directly to the community are taken from the  Administrative Manual and applied in our calculations of the basic Calculating Welfare Amounts social assistance in . Like all Canadian citizens, registered Indians • .e assistance rates are averaged, so that may receive social assistance and social services they represent the average rates for families provided they meet the eligibility requirements. with one, two or three children irrespective First Nations Status Indians on reserve may re- of children’s ages. ceive Federal Income Assistance which is based  on provincial  rates. Moreover, First Na- • .e Northern Energy Cost Benefit () tions are eligible for assistance under a number is not included in the calculations. of other federal programs such as the Canada • In cases where  reports “ or more Child Benefit. children”, we are considering the family

8 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" ,04.- 5 Annual welfare transfers in GHFN Income Assistance Other Beneﬁts Total $+,5"%,(*+ $+,((&,)## $(+,*'&,2*,

to have only  children. .erefore, welfare • Given the lack of employment payments for additional children above opportunities in the First Nations  have not been taken into account, so communities, and, therefore, low incomes, that total transfer amounts are likely  is applied at the maximum level to all underestimated. census families with children. • .e rate of . — percentage of • Working Income Supplement () and unemployed persons and persons not in .e Child Disability benefit () are the labour force ( ) — is applied to not included in the calculations (Canada arrive at the number of families receiving Revenue Agency). income assistance. After performing the calculations, we have ar- • .e rates for participants with disabilities rived at the estimate of approximately . mil- are applied to  of households, which lion in annual welfare transfers to  (See is the share of the households with the Table ). diabetes in the total number of households In total both income assistance and salaries observed in the survey of the  individual sum up to . million. According to this calcu- households which will be discussed below. lation, and assuming the same population growth  is responsible for providing on-reserve as in the period between – (), the av- residents with social and income assistance ser- erage total income per person above  years of vices that follow provincial rates and eligibility age with income equals approximately , criteria. .e Northern rates for the households per year, which is  higher than the amount residing in remote areas that do not have an all- reported in Table  for . weather road, rail or access by water are taken Apart from the consolidated total it is in- from the  Administrative Manual and ap- formative to take look at how much a particu- plied in our calculations of the basic social as- lar household may receive in basic income assis- sistance in . tance under the specific family circumstances. For example, a couple with  children (,  and Other Programs:  years old) can expect to receive , per • Anther type of assistance is the Canada year (, per month); a single mother with  Child Benefit (), a program that children ( and  years old) — , per year replaced the Canada Child Tax Benefit (, per month), a single individual , per (), the National Child Benefit year ( per month) and a single individual with Supplement (), and the Universal disability , (. per month). Child Care benefit () in July . • In order to calculate the  where rates Small-Scale Household Survey differ according to the age of a child, we Living on income assistance in a northern com- have estimated the share of children under  munity and having enough money to ensure in census families to be equal to  and the a decent standard of living is easier said than share of children – to be  (, ). done. One of the greatest struggles that a resi-

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 9 /3:;<- 1 Total Household Monthly Income Distribution in the Sample

Histogram for “Average Total Monthly Income” 10

6 No of obs. No of 4

0 0 to 1,000 1,000 to 2,000 2,000 to 3,000 3,000 to 4,000 4,000 and Over

dent of  must face is feeding oneself and tion size (there were  households in  one’s family. in ), our survey brings out a number of key In order to help examine spending on food indicator values that are similar to the general by individual households, a survey was conduct- demographic analysis conducted by Statistics ed in December  as part of this research Canada in . .e following is a summary of project. .e respondents were presented with the key characteristics of the sample: a questionnaire that inquired about household • Total number of people in the surveyed income, source of income, monthly spending households is . Children aged – on food, transportation and health status. We years old constitute  of this number, greatly appreciate the assistance of Dr. Shirley almost identical to the  of the .ompson and student researcher Malay Das comprehensive household survey in  from the Natural Resources Institute at the according to . University of Manitoba in helping to facilitate • .e average annual income per person the distribution and collection of the question- above  years in a household with family naire. For a sample of the questionnaire please members employed for wages is , refer to Appendix B. (see Table ) whereas average earnings for .irty-ﬁve completed questionnaires were persons above  years old with earnings returned to the researcher. Nine questionnaires were , in  (, in  were removed from the analysis due to apparent dollars) according to . inconsistencies in the responses, which reduced the sample size to  households. .e responses • .e average annual income of people on for the question on household income were pre- social assistance in the sample is , sented in intervals and were later averaged for (see Table ) whereas the average amount analysis. Even with the evident shortcoming of of government transfers per person on the small sample size compared to the popula- social assistance equaled , in .

10 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" ,04.- 6 Descriptive Statistic for the Variable “Total Annual Household Income” Statistics Total sample Sub-sample #. source of income: Sub-sample !. source of income: wages, child benefits welfare, child benefits, pension Count %+ "& "% Mean %(,%%* )*,")( "(,''* Mean LCL* %#,'(% %+,'"+ "#,+5" Mean UCL** )),&(5 &),)*5 %*,)#' Variance %)' +5& %)( %#% (&( %*) ")% *"' %(5 Standard Deviation "* &5% "& %)' "" *"% Mean Standard Error ) #)+ ) 5#+ ) )%) Coefficient of Variation #.*( #.&" #.+& Minimum +,### "&,''& +,### Maximum *+,''& *+,''& &&,''&

* Lower conﬁdence limit ** Upper conﬁdence limit

,04.- 7 Descriptive Statistics for “Annual Income Per Person 18 Years Old and Above in a Household” Employed (source of income: Unemployed/Not in labour force (source of wages, child benefits) income: welfare, child benefits, pension) Mean %#,"5% (,&)* Standard Error ) 5+5 " %#5 Median "5,(&+ +,''5 Mode %*,&'( +,''5 Standard deviation "& &() & "5) Minimum %,'''"* ),### Maximum *+,''& "+,&'( Count "& "% Confidence level ('*%) 5 )*( % +*5

• .e rate of diabetes prevalence in the at least one person in a household earning a sample is . ( for the whole wage. Based on the sample of  households, population — see the section on diabetes) we have estimated the average (mean) total an- Figure  depicts the distribution of the total nual income per household to be , with a household monthly income with the greatest margin of error of plus or minus , at  share of households () in the survey earning conﬁdence level. between , and , per month. For the purposes of comparison with the Table  presents the descriptive statistics  , we have also looked at the annual for the variable “total annual household in- income per person  years old and above in a come” for the entire sample, as well as for two household which is presented in Table . .e sub-samples, according to the employment average annual income per person  years old status of the respondent — one with a group of and above in a household with source of income households on social assistance, another with of primarily wages and child beneﬁts equals

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 11 /3:;<- 2 Average Monthly Spending on Food Per Person in a Household. Breakdown by the Health Status of the Household

Households Without Diabetes Households With at Least One Member Diagnosed With Diabetes Cost of the Revised Northern Food Basket Per Person Per Month $450

$400

$350

$300

$250

$200

$150

$100

$50

Average Monthly Spending on Food Per Person in a Household Person Per Monthly Spending on Food Average $0 $0 $500 $1,000 $1,500 $2,000 $3,000 $2,500 $3,500 Average Monthly Household Income Per Person

,; for the households fully on social assistance is not indexed to account for the much sistance, it is ,. higher food and gas prices in the North” (p. ). Due to the strained ﬁnancial conditions of In general, and this applies to , the ma- people in  who predominantly live on wel- jor cost driver for the extremely high food prices fare, it is extremely hard to balance expenses for in the North is transportation. .e absence of an basic needs. all-weather road to the community puts heavy Nutrition North Canada () estimated that reliance on Perimeter Air for transportation and the cost of a nutritious diet for a family of four increases freight costs and inhibits resupply. An- for one week in  in March  equaled other major contributing factor to high costs is the . (“Cost of the Revised Northern Food amount of spoilage (Enrg Research Group, ). Basket in –”). .is so-called Revised .e main store where residents of  shop Northern Food Basket () includes  stand- for groceries is the Northern Store located on the ard food items and it is used by  to monitor Stevenson Island outside of the reserve. .e fol- the cost of healthy eating in isolated northern lowing is a list of a few selected items and their communities. Taking into consideration the fact prices in the Northern Store as of September  that a couple with  children may receive on av- with the prices for the same items in Winnipeg erage , per month in social assistance, the indicated in brackets: . for one kilogram of cost of such healthy diet would exhaust  of a green grapes (.), . for one large orange family’s monthly allotment. In an earlier study (), . for hamburger buns (.), . for (.ompson et al., ) found that ﬁsher fami-  whole wheat Wonder bread (.), . lies on welfare in  were very food insecure; for raisin cinnamon whole wheat bread (), . they further note that “the amount of social as- for a -litre carton of milk ().

12 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" /3:;<- 3 Average Monthly Spending on Food Per Person in a Household. Breakdown by the Employment Status of the Household

Hoseholds Earning a Wage Hoseholds on Welfare Cost of the Revised Northern Food Basket Per Person Per Month $450

$400

$350

$300

$250

$200

$150

$100

$50

Average Monthly Spending on Food Per Person in a Household Person Per Monthly Spending on Food Average $0 $0 $500 $1,000 $1,500 $2,000 $3,000 $2,500 $3,500 Average Monthly Household Income Per Person

Since the Northern Store is located on the is- spending on food per person. Afterward, how- land outside of the reserve, the cost of transpor- ever, the increase seems to gradually diminish tation is inevitably linked to the cost of grocery and above an income level of  per person, shopping in . From the survey it was found spending on food per person stabilizes at a level that  of the respondents spent approximately of  per month approximately. It is impor-  for transportation to the Northern Store,  tant to mention that even the highest observ- spend  and the remaining respondents spent able spending on food in the survey ( per up to  per trip to the grocery store. month for one person) constitutes about  .e graphs below depict the spending pat- of the required level of spending needed in or- terns on food items among the households in der to maintain a healthy diet as calculated by the survey. .e relationship between average the . Moreover, no apparent connection monthly household income per person and the is observed between spending more on food average monthly spending on food per person per month and not having diabetes in a house- in a household can be observed. .e average hold (Figure ). However, the situation is diﬀer- spending on food per person per month can be ent if we look at the households with members compared to the cost of the . Additional- employed for wages. As expected, they tend to ly, the breakdown of the observations by health have higher incomes and hence allocate larger status and employment status of the household amounts of money for food expenses (Figure ). is made respectively in two graphs. Overall, according to the survey, the average From the graphs it can be seen that initial- share of household’s income spent on food equals ly, as the average household monthly income . If we apply this rate to the total amount per person grows, so does the average monthly of social assistance and salaries found earlier

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 13 /3:;<- 4 Share of the Household Income Spent on Food Consumption

4 No of obs. No of 3

0 0 to 0.1 0.1 to 0.2 0.2 to 0.3 0.3 to 0.4 0.4 to 0.5 0.5 to 0.6 0.6 to 0.7 0.7 to 0.8 0.8 and Over

(.million), we can conclude that roughly for cheaper foods to eat, mostly canned food .million is spent on food in the community that is high on sodium, and even substituting per year. coke for water. A more detailed distribution of the house- “When they see cheap stuﬀ on the shelf, they hold income share spent of food in the sample would buy it doesn’t matter how many, they will can be found in Figure . .e histogram shows buy  or  items of those. .ey will buy anything how many people observed in the survey spent on cheap but it doesn’t matter how many they food in each given interval — between  to  of put in their cart. If there is something healthy their income, between  and , and so on. there and prices are more expensive, they won’t In conclusion, it can be observed from the bother looking at that.” above graphs that even those respondents who Lionel Flett, are employed and therefore have higher dis-  worker, Nursing station posable incomes tend to fall behind relative to what should be spent on a healthy diet. Apart “But the awareness needs to be engrained in from low incomes there are possibly other rea- them. You can buy healthier foods, maybe in sons for poor diets. .ere might be lack of food bulk. For example, barley versus wheat.” choices at the store. .ere is also lack of aware- Byron Beardy, ness about healthy food options. A related issue Community member and Food Security Coordinator, is the poor condition of the community’s hous- Four Arrows Regional Health Authority. ing. Households with no running water and no stove will be forced to buy food which doesn’t In conclusion, most of the money going into the need cooking. Overall, as the result of poverty First Nation comes from the Federal government and the high cost of food in , people have in the form of social assistance and salaries for developed unhealthy eating habits by looking the jobs in the sectors such as health and edu-

14 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" cation. .e money is subsequently spent on the Overall, low welfare rates that are not in- food and services of the companies, many of dexed to higher cost of living on reserves, com- which are owned by people who reside outside bined with poor infrastructure have an inevi- of the community (see Appendix A for the list of table negative impact on the well-being of the businesses operating in ). .is character- people living in . .e next section will izes the  economy as a divergent economy. discuss the health implication of this lifestyle It exhibits a lack of self-suﬃciency developed as and the associated health costs by connecting the result of the foreign ownership and control the ﬁndings of this section to the problem of of domestic resources and production for ex- diabetes that is insistently prevalent in many port out of the community (Loxley et al., ). Indigenous communities.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 15 Health Status of the Community

Nutrition is the focal point of many health prob- an essential hormone that regulates sugar lems. It was shown in the previous section that (glucose) in the bloodstream and helps the s residents’ spending on food is severe- the body to use it for energy. It is typically ly restricted by their low incomes relative to the diagnosed in children and young adults. cost of the healthy food basket. Poor nutrition • Type  Diabetes (TD), on the other hand, and a lack of exercise (Lemstra et al., ) have usually develops later in life, and it occurs inevitably contributed to the rising number of when the body cannot effectively respond residents living with serious diseases that impair to insulin in order to use or store the blood one’s ability to work, enjoy life and to fully par- glucose it gets from food. TD cases make ticipate in society. As in many remote northern up the majority of all diabetes incidences communities, the most common health problem (e.g.  of all cases in Manitoba in in  is diabetes. What follows is a discus- /, “Diabetes in Manitoba A Call to sion of the great impact of this health issue on Action”, ). .e common risk factors . .e nature of the disease and the possible for TD are age above , family history effective interventions that can ameliorate one’s of diabetes, decreased rates of physical condition will first be examined, followed by a activity, stress, unhealthy diet, obesity/ review of the costs resulting from many people metabolic syndrome. living with diabetes in . • Prediabetes or impaired glucose tolerance exists when blood glucose is elevated, Diabetes: Effective Medical and Lifestyle but not as high as in TD. Gradually, Interventions prediabetes is very likely to develop into TD; that’s why the detection of Diabetes is associated with elevated blood glu- prediabetes is important. cose and can be classified into four types: Type , Type , prediabetes and gestational diabetes. • Gestational diabetes may develop during • In case of Type  diabetes the body pregnancy (“Insulin Basics”, ; (pancreas) is unable to produce insulin, Canadian Diabetes Association, ).

16 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" If denied proper treatment, high glucose levels can are well-documented and it is referred to as a lead to serious damages to blood vessels, nerves “successful, validated, legitimate treatment for and organs such as heart, kidneys and eyes. (Ca- an otherwise intractable disease” (Keidar, ). nadian Diabetes Association, ; “Facts & Fig- In Adams el al () it was shown that surgery ures: Diabetes”, n.d.) .erefore, diabetes is often has lowered diabetes-related mortality by . associated with life-threatening complications Nevertheless, healthy diet and exercise are still such as kidney failure, heart attack, blindness, required after the surgery (“Weight loss surgery and neuropathy (losing feeling in the hands and and type  diabetes,” ). feet). People living with diabetes have lower life .ese studies carry two important messages. expectancy — the lifespan is reduced by  to  First, weight loss is critical. In this context, it is years (Canadian Diabetes Association, ). important to mention that the obesity risk factor Previously considered an adult disease, TD increases on-reserve. .erefore, lifestyle chang- is more and more frequently found in children, es such as low-calorie diet and exercise would whose diabetes complications will likely be more be a promising strategy to follow. Second, these severe than complications of those who acquired successful interventions have dealt with patients diabetes later in life (Strachan, ). While it at the early stages of TD or with prediabetes. is possible to manage diabetes through weight Consequently, early screening and interven- loss and associated lifestyle changes, many com- tion is important to avoid the many high costs plications have no cure. For example, people in that occur as a result of having to treat diabetes the late stages of chronic kidney disease need to complications. It is crucial to focus prevention go on dialysis or get a kidney transplant to stay on obese children, adolescents, and adults as alive (“Key Points: Living With Stage  Kidney well as pregnant mothers (Canadian Diabetes Disease”, ). Association Clinical Practice Guidelines Expert One of the main studies that looks into to find- Committee, ). It has been found that chil- ing effective interventions for people with TD dren born to mothers with Type  inherit the is the Diabetes Prevention Program (). .e gene for lower secretion of insulin, so they have  randomly selected , participants with an additional inherited inability to make insu- prediabetes and by organizing them into  into lin (Strachan, ). different treatment groups, the study found that modest weight loss through dietary changes and increased physical activity was the most effec- Diabetes Statistics and Costs tive strategy reducing the risk of diabetes by  Poorly managed diabetes leading to complica- (Diabetes Prevention Program Research Group, tions has a great impact on both individuals and ). Furthermore, a more recent study goes as the economy as a whole. .e number of patients far as to suggest that diabetes is reversible in a and the costs are startling. It was estimated that relatively short period of time of  weeks by in- in  that the cost of diabetes for the Cana- troducing dramatic changes in diet (a  kcal)/ dian healthcare system and economy equaled day diet). .e study participants had a relatively . billion, with complications accounting for short duration of TD (up to  years) (Lim et al., over  of the total (Canadian Diabetes Asso- ). Consistent with the idea of reducing en- ciation, , p. ). Similarly, at the level of the ergy intake, bariatric surgery (reducing stomach province, the diabetes prevalence rates and costs size) has proved to be an effective medical in- are substantial and continue to grow. In “Diabe- tervention. Despite some health complications tes in Manitoba  to ” () it was es- that can occur, the benefits of this procedure timated that given the same prevention efforts,

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 17 ,04.- 8 Patients on Register at the GH Nursing Station – August 2015 Chronic Care Program (Pediatric) Total Asthma Diabetes Cardiovascular Renal Autoimmune Other Total # of Patients%# ""% %' %) "' ' %5 %%

Chronic Care Program (Adult) Total Asthma Diabetes Cardiovascular Renal Autoimmune Other Total # of Patients (#+ (' &+" &%' (* 5' #

!"#$%&: Month End Submission for :7/6 Nursing Station

,04.- 9 The Number of Patients With Diabetes and Cardiovascular Disease, in Dynamics, 2015 Diabetes Dynamics, !"#% Jan Feb Mar April May June July Aug Pediatric: %& %& %& %& %" %" %5 %) Adults: &&% &&* &&* &&5 &*5 &*' &*' &+"

Cardiovascular Dynamics, !"#% Jan Feb Mar April May June July Aug Pediatric: %% %+ %+ %+ %# %# %# "' Adults: &%# &"* &"& &"* &%5 &%( &%( &%'

!"#$%&: Month End Submission for :7/6 Nursing Station

obesity levels and unchanging incidence rates the betes among the Indigenous population is three number of Manitobans diagnosed with diabetes to ﬁve times higher than that of the general Ca- would rise to , by . In , however, nadian population (Canadian Diabetes Associ- it was found that the number of Manitobans di- ation, , p. ). Similarly, complications are agnosed with diabetes in fact equaled ,, said to be found more often with the Indigenous which exceeded the original projection by . If population than in the non-Indigenous popula- prediabetes is included, then we are seeing even tion (Canadian Diabetes Association Clinical more worrying statistics — , people or Practice Guidelines Expert Committee, ). . of the population — which means that at Furthermore, Indigenous individuals are gener- least every  person in  is either at risk or lives ally diagnosed at a younger age than non-Indig- with diabetes (Canadian Diabetes Association, enous individuals, and Indigenous females expe- ). .e cost to the province was estimated to rience higher rates of gestational diabetes than be  million in  (measured in  dol- non-Indigenous females (Public Health Agency lars) which is expected to reach  million by of Canada, ).  (“.e Cost of Diabetes in Manitoba”, n.d.). While being a problem of considerable mag- .e Indigenous population is one of the eth- nitude at present, diabetes in First Nations com- nic groups that carries a heavier burden related munities is a fairly recent phenomenon. Before to this disease. It has been consistently reported , there was no evidence of diabetes among that the national age-adjusted prevalence of dia- Indigenous groups in Canada (“Facts & Figures:

18 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" /3:;<- 5 NIHB: Number of Distinct Claimants. GHFN 2005–2014

650 Diabetic Medication (Oral Medication and Insulins)

Diabetic Equipment (Testor/Test Strips) 550

450

350

250

150

50 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Diabetes”, n.d.). Dr. Heather Dean had first docu- sistent with national and provincial observations mented diabetes in children in Northern Manitoba that document and project the rising diabetes in the early s (Strachan, ). Now we can prevalence rates (Canadian Diabetes Associa- even observe increasing rates of TD in children. tion, ; “Facts & Figures: Diabetes”, n.d.). It is  hasn’t escaped the diabetes epidemic. important to mention that due to limited access Table  describes the number of patients from to screening and lack of surveillance data, this six categories of chronic care program at  statistic doesn’t include people with prediabetes, Nursing Station, including diabetes. so that the total impact of this health issue on .ere were  diabetes patients in adult care the community is underestimated. and  patients in pediatric care in  in Au- In order to determine the costs of diabetes in gust, . Over the course of eight months (from , a request was submitted to Health Can- January to August ) the number of adult dia- ada under the Access to Information Act. .ey betes patients increased by roughly , whereas were asked to release the information on the the number of diabetes patients in pediatric care amounts allocated by the Non-Insured Health has remained relatively stable, although it is not Benefits () Program for diabetes medica- showing the desired downward trend. .e num- tion and equipment in , and for transpor- ber of cardiovascular patients in adult care has tation to Winnipeg to access medically required increased by . .is statistic points to already health services not available on reserve. Moreo- astonishing numbers that, nevertheless, contin- ver, they were asked to state the number of peo- ue to grow. For the community of  people, ple receiving those benefits. .e responses are the number of diabetic patients constitutes  to be found in Table . of the total number of people (whereas provin- From Table  (page ) it can be seen that cially, in Manitoba this share equals . (Ca- the number of distinct claimants of diabetic nadian Diabetes Association, ). .is is con- medication (oral medication and insulins) is

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 19 ,04.- 10 Non-Insured Health Beneﬁts Program Expenditures for Diabetes. GHFN, 2005–2014 Diabetic Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Medication !""% !""$ !""' !""( !"") !"#" !"## !"#! !"#* !"#& (Oral Medication and Insulins) Distinct Claimants )+# )(' &%) &*' &5* &'5 *)% *)5 *5* *5' Amount Paid $"&5 %5' $"(5 +%5 $%#% (#" $%#" '*5 $%#+ )## $%#' #)( $%%" %)" $%)# 5'' $%)( &'+ $%&) #"%

Diabetic Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Calendar Equipment !""% !""$ !""' !""( !"") !"#" !"## !"#! !"#* !"#& (Testor/Test Strips) Distinct Claimants "') "'* %)# %+# )#+ %5( )#* )## &+" )+# Amount Paid $&( ()) $*" #*" $*5 &() $(% **) $(( 5)& $(& )*# $(5 )*) $(( %5" $5" &*# $(# '+'

Total Paid !""% !""$ !""' !""( !"") !"#" !"## !"#! !"#* !"#& (Medication and equipment) $#)$ "!! $!!) $') $!$# #'& $!'& %## $!(& #*& $!(* *(' $!)) %(& $*"( #(" $*#( )&$ $*#* )(#

higher that the number of people registered at the Dialysis Unit located in . .is pro- the nursing station. In  there were  dis- vides hemodialysis to the patients from across tinct claimants which forms around  of the the Island lake communities (Red Sucker Lake,  population. Figure  is based on the data , St .eresa Point, Wasagamack). .e Di- obtained from Health Canada, and it shows a clear alysis Unit has the capacity to accommodate  upward trend in the number of  claimants people and as of April  it is operating at full over the past  years (with an average growth capacity with a waiting list of  people. People on rate of  every year). the waiting list are all receiving their treatment .e total cost to government ( program) in Winnipeg. Health Canada pays for relocation for diabetes medication and equipment has also (accommodation, meals, transportation) for the been increasing steadily with an average growth first  months and after that it is the responsi- rate of  and equaled , in . .e bility of the patients to find their own accom- cost per patient has remained relatively stable modation. Sometimes the Dialysis Unit offers throughout the period. transient spots for people who are permanently Apart from those two categories of costs, the living in Winnipeg to come to  for a few government health program also pays for trans- days to visit their family or for a special occasion portation of diabetes patients to Winnipeg to like a wedding or a funeral. In total it costs . access services that are not available on reserve. million to operate the unit annually. .erefore, According to Health Canada, to maintain cost the annual cost of treating one patient on dialy- effectiveness, the region will try to coordinate sis equals approximately ,. multiple appointments before a client travels from Government also provides a diet supplement the community. Information in Table  is pro- for diabetic patients. .e diet can vary accord- vided for coordinated appointments and single ing to a person’s age, sex, activity level, current appointments. .e Government spent , weight, and body style. As noted in Norman (n.d.) for single endocrinologist appointments in  in order to promote weight loss, patients with and , in . TD are generally put on a , to , calo- Another major cost to government in con- rie diet per day. However, more calories per day nection with diabetes is the cost of operating are needed for more obese individuals initially.

20 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" ,04.- 11 Medical Transportation Costs — Endocrinologist Appointments. Apr. 1, 2008–Dec. 15, 2015 Fiscal year of # of appointments Estimated Cost** # of appointments with Estimated Cost for appointment a transportation cost appointments with transportation cost %##5/#' 5" $(% #"( (' $(% #"( %##'/"# "#' $"#( "'( "#( $"#( ('( !"#"/## #!% $##% $%! #!! $##% $%! !"##/#! #*) $'$ )"% (# $'$ '%% %#"%/") "*5 $""% +## "#* $""" #"% %#")/"& "'# $"'( +(" "55 $"'( +#* %#"&/"* "+& $"(5 )") "+# $"(( %&& %#"*/"+ 5& $(* "** +* $(& ++"

** Single Endocrinologist appointments =6.> does not include coordinated appointments ** paid costs only until about October 2015 ** note: transportation costs can include: air travel, meals and accommodation ** note: when an escort is required paid costs are included (note: approximately 30% of single endocrinologist appointments include and escort) ** does not include: in-city transportation, unpaid transportation/meals/accommodation (client or band paid) ** Destination of Appointments = Winnipeg ** unable to get data prior to 2008 due to system upgrade

,04.- 12 Summary of Diabetes Costs for GHFN, 2014 Calendar Year Category of Costs Amount, CAD NIHB: Diabetic Medication and Equipment $)"),'5" NIHB: Transportation Costs for Single Endocrinologist Appointments $"'(,+(" Dialysis Unit $",(##,### Subtotal $!,!##,$%!!* Diet supplement (diabetes) $)'%,### Total $!,$"*,$%!

Since the rates for diabetic diet supplement span breadth and complexity of these costs combined over  different calorie levels — from . per with limited access to information and compli- month for  kcal diet to . per month cations in obtaining specific patient data, they for  kcal diet — we will attempt to calculate are not examined in this paper. the total assistance amount based on an average Nevertheless, the costs found in this paper standard , calorie diet which implies an ad- are impressive (see Table ) with at least . ditional . per month to the basic social as- million/year spent on diabetes in . .is sistance. .is way, we arrive at , in diet poses a serious problem for the community and supplement payments per year for all diabetic calls for urgent action. .e next section will use patients in . some of the findings about successful preven- .ere are a number of other costs related to tion and costs to give a preliminary assessment diabetes, for example cost of doctor appoint- of why effective diabetes management is failing ments, out-of-pocket spending of diabetic patients, in the community at the level of primary care loss of employment and productivity. Due to the and support systems.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 21 Discussion assistance to people with TD to increase their Knowing the chronic nature of disease, the seri- consumption of healthy food might slightly in- ousness of its complications and the large num- crease their disposable income, but there is no ber of people who are affected in the commu- evidence that this is a sufficient and effective nity, it comes to no surprise that government measure to help people in the North achieve a spending on diabetes treatment is significant. It healthy diet, or that it helps reduce the diabe- is not, however, sufficient to ensure prevention tes epidemic. and provide quality care for everyone. “.e supplement that they give from the social .ere are a number of administrative and assistance is for the people who have diabetes; financial gaps that stand in the way of success- for them to buy healthy food. But that’s not ful diabetes prevention at the level of health usually the case.” care provision. First of all, even though regular Lionel Flett, screening, follow-up, and surveillance of indi-  worker, Nursing station viduals with prediabetes are necessary for effective intervention, the nursing station has no .e idea that people don’t make the right choic- record of patients with prediabetes. Due to a es and don’t spend money available to them on shortage of funding, medical facilities are over- healthy food recalls the results of the national loaded and it is difficult to follow up with each survey prepared for .e Canadian Diabetes As- and every patient. sociation by Environics Research Group in . .e survey sought to discover the public per- “On the system’s approach, so you screened spective on diabetes (factors driving increasing everyone (they screened the whole school one rates of TD, factors contributing to their risk of year) for kidney disease, high blood pressure, being diagnosed with TD, factors driving risk obesity and the amount of high blood pressure of complications for people living with diabetes, and kidney problems were so high the system etc.). .e results revealed that in the opinion of couldn’t deal with it.” the general public the responsibility for diabe- Jon McGavock, Research Scientist, tes resides with a person’s own decision to live Children’s Hospital Research Institute of an unhealthy lifestyle. Even though institutions Manitoba. such as the government, the food industry and In high risk First Nation communities, screen- the health care sector were often recognized as ing should take place from early childhood (Ca- playing a significant role (advertising and selling nadian Diabetes Association Clinical Practice of unhealthy foods, failing to help patients pre- Guidelines Expert Committee, ). Despite vent the onset of TD), personal choice emerged this recommendation, there are significant gaps as a leading contributing factor to diabetes. in surveillance information related to diabetes .e results of the poll are important because in the Indigenous populations (Canadian Dia- they reveal society’s general attitudes and, there- betes Association, , p. ). However, the ef- fore, the way we talk about the issue and how we ficiency of health care provision in First Nations deal with it. .is echoes the idea mentioned in is a subject for a separate thorough investigation. another study (Socha et al.,, , p. ) that the Second, as it relates to the previous argu- problem of ill health “is often framed in government, not identifying this critical category of ment solutions as a matter of individual choice”. people with prediabetes leads to ill-considered Particularly in the case of remote northern com- resource allocation, as in the case of the diabe- munities like , the context within which tes diet supplement. Providing after-diagnosis individual choices have to be made when it comes

22 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" to maintaining or improving one’s health condi- As far as a healthy diet is concerned, it was tion, is commonly overlooked. discussed earlier that weight loss due to low calorie intake is a major component in prevention. “.ose are the messages that we put out as However, the institutional set up will determine experts... diabetes is preventable, obesity whether people will follow through with the rec- is preventable and you have to make good ommendations at the appropriate time. choices.... We don’t ever talk about how people’s bodies are different, people are within these “If there is not enough food in the house  days very broad complex systems, we don’t talk about of the month, telling people to eat differently the food industry and the money that people is not going to work. So food insecurity is the have and how that influences what we buy and biggest problem to prevention.” government policies.... We assume that people Jon McGavock, Research Scientist, have disposable income, ability of people to get Children’s Hospital Research Institute of to places where the best food is, time to make Manitoba. it. We don’t ever talk about the context of food Solving food insecurity by providing access to but we expect people to navigate in this entire healthy, affordable and culturally appropriate complex environment. We make it sound like food alone will not address all the problems but it’s easy, yet it’s not.” it is necessary if the well-being of people who find Dr. Sharon Bruce, Associate Professor, themselves living in atrocious conditions of pov- Community Health Sciences, erty and malnutrition is to improve. .ere are a University of Manitoba. number of economic and educational initiatives Personal choices can only be said to be the leading that have already been introduced in  in cause of diabetes when there is a culturally sup- order to promote healthier lifestyles. Although portive environment in place that successfully ad- still in their initial stages, some of them recog- dresses many of the social determinants of health nize the need for structural changes to address first — food security, unemployment, housing and food insecurity and are aimed at building a local living conditions, barriers to health care access, food economy. Improving the life of the  early childhood development and many others. community residents is a demanding long-term Moreover, knowing the history of oppression and task with many aspects to consider — cultural, cultural disintegration of Indigenous communi- historic, financial and administrative, to name ties, there needs to be a strong awareness of men- a few. .e next section will discuss these initia- tal, spiritual and emotional aspects of health, for tives, uncovering details about their operation example through connection to traditional foods, and the main challenges they face, and will as- when expecting considerable improvements in sess the potential they have to contribute towards the health status of any Indigenous community. building a healthy community.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 23 Food Programs: Addressing Food Insecurity Through the Model of Social Enterprise

Social Enterprise (SE) is a form of business that is and services for local use, local re-investment known to use commercial strategies to advance of profits, long-term employment of local resi- social, environmental and human justice agendas dents, local skill development and local decision such as providing an important service, creating making (“Community Economic Development employment, and reducing poverty (“What is a Guiding Principles”, n.d.). .e economic ration- social enterprise?”, n.d.). .e new SE in  is ale for this strategy is well demonstrated in Lox- Meechim Inc., run by Aki Energy Inc. which fo- ley et al., (): “these principles are rooted in cuses on providing affordable food and improv- what we would call a “convergence” approach to ing the health status of the community members. economic development, by which we mean that, .e goal is to produce locally at the farm situated rather than looking beyond the community for on reserve, sell the produce at a local market at development,  seeks to produce to meet lo- prices lower than at the Northern Store, and to cal needs, to hire locally, to purchase locally, to potentially introduce more initiatives that would invest locally, and thus to create internal rather increase healthy food consumption in the future, than external economic ‘linkages’ ” (p. ). .ere- like a healthy food café. .e SE strives to meet fore, the long-run benefit of Meechim Inc. is de- the needs of the community (the lack of healthy velopment of the local economy and ensuring affordable food, lack of employment opportuni- that “money spent on meeting people’s needs ties) through the use of local resources (use of stays in the community” (Aki Energy, ). Ad- the reserve land to farm, hiring locals for the ditionally, this economic strategy is expected to positions in farming, production, delivery, and foster a sense of responsibility for the commu- administration). Likewise, reducing the rate of nity’s future among its residents and engrain the diabetes in the community is a key element of “we-can-do-it” mentality in the community that their mission (Loney, n.d.). found itself in egregious conditions of poverty Overall, Meechim Inc. aims at introducing, and that, according to the opinion of one com- promoting and strengthening some of the im- munity member, seems to be losing hope. portant principles of community economic de- However, given the size of the community, the velopment (), such as production of goods irregular healthy food market dates and, for the

24 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" time being, limited potential of the Meechim Inc. Food Affordability and Accessibility to provide healthy food for all,  residents North West Company will continue to buy food at familiar places such .e Northern Store has continuously been re- as the Northern Store. It is common to shop there garded as having many adverse impacts on food not only because there are few alternatives, but security and sovereignty in the northern hard- also because the Northern Store offers a number to-reach communities. For example, .ompson of important services besides selling food, such et al., () found that the Northern Store has as transferring money from South to North for produced negative impacts on a number of the families. Since it will remain a major food provider livelihood categories such as financial, natural, in the near future, it is important that the initia- physical, human, and social capital, food sover- tives to promote healthy living are also actively eignty, and food security. However, recently ef- developed and introduced there. .e Northern forts have been made to improve the image of the Store has been receiving the government sub- company by introducing a number of programs sidy on selected healthy food items under the focusing on food affordability and the benefits Nutrition North Canada Program () which of healthy eating. applies to the freight costs of foods shipped in One of the measures that the Northern Store and which generally results in lower food pric- has adopted for food affordability and accessi- es. .e North West Company which owns the bility is highlighting, through in-store signage, Northern Stores across the country has also run the savings to customers of the  subsidized a few of their own initiatives in  that will goods. As mentioned earlier, the  program be discussed further. However, whether there is has introduced a subsidy towards the freight a potential to effectively deal with the problem of costs of selected imported food items (mostly malnutrition though the Northern Store business nutritious perishables) shipped to the remote model without any major structural changes is northern communities.  is one of the eli- questionable. It is, after all, first and foremost in gible communities. .erefore, retail businesses business to make profit and if the profit is to be such as the Northern Store are eligible to receive found in chips and coke, that’s what it will sell. the subsidy of . per kg of the imported item .is section will critically examine the initia- (“Eligible communities”, ). Between April , tives already underway in . .e programs  and March ,  the program subsidized will be reviewed to ensure that the complex in- , kg of food in Island Lake () for a terventions in the community are understood; total of , (“–: Full Fiscal Year”). their scope, amount of investment and number Although the goal of the program is to make the of people involved will be described, wherever prices of imported food items equal to those in possible. As far as Meechim Inc. is concerned, Winnipeg, the statistics for the Refined North- this section will assess this initiative’s potential ern Food Basket () show that prices seem and offer recommendations for both govern- to have dropped significantly only in the first ment and entrepreneurs involved in the initia- year after the launch of the subsidy. .e cost of tive to help ease the barriers impeding the pro- the  had dropped from . in  to gram’s success. . in  (reduction of ). In the subse- .e following review has been divided into quent years, however, the prices were steadily two parts. First it will look into the programs growing up (up to . in ). Although we that try to deal with the high cost of food and, can still observe a reduction of . in the  second into the programs whose sole purpose is compared to March  (the year when the to educate about healthy eating and it benefits. program was introduced) (“Cost of the Revised

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 25 Northern Food Basket in –”, n.d.), and of malnutrition. Providing young children with some community members have indeed pointed free snacks should be encouraged, however it is out that a few selected items have decreased in a one-time action and the health benefits of the price, overall, evidence of a significant positive sugar containing items such as juice and cereal impact is hard to see with the cost of the  are disputable. It is critical to remember in this continuing to grow. Evidence of price reductions case that any support, however targeted, will is not consistent and the program clearly falls nevertheless be coming from an entity that is short of its objective to make the prices of im- controlled by non-residents of the community ported food items equal to those in the South. and it will only have a limited incentive to sig- In addition to participating in the  pro- nificantly challenge the status quo. gram, the North West Company is involved in the breakfast program in partnership with the Meechim Inc. Breakfast Clubs of Canada and Minute Maid, Given the lack of opportunities to reduce food which supplies Minute Maid apple and orange prices though the traditional model of import- juice to  schools in nine northern communi- ing food from the South, more innovative ways ties, including . As part of this program the of dealing with the issue have emerged. After North West Company provides the storage facili- having experienced the success of another pro- ties and assumes the freight costs of the item de- ject that involved doing energy and water retro- livery (Graham, ). .e North West Company fits on the most energy-inefficient homes of low also supplies  pallets of breakfast cereal (Post income people, the entrepreneurs at Aki En- Honey Bunches of Oats) to the school in  ergy have decided to expand their social enter- with the first shipment received in March . prise to focus on food sustainability. .ey have .e North West Company has also launched created Meechim Inc. in . It currently .e Healthy Horizons Foundation which is meant consists of Meechim Farm, Meechim Healthy to financially assist northern communities with Food Market, the Canteen at the Arena and the programs targeted at youth that will positively School to Farm Program. .eir approach has affect their health through nutrition, physical adopted many of the guiding principles of  activity and learning. with an overarching goal of ensuring the local Furthermore, from phone conversations with control of food production and building the lo- the North West Company’s director of business cal food economy. development, it was learned that the company In the fall of ,  cleared  acres of has some interest in understanding the health land on the outskirts of the community, and in needs of the community. It has engaged in the the spring of , Meechim farm had begun its pharmacy partnership with Manitoba Keewati- first planting season (Aki Energy, ). In sum- nowi Okimakanak Inc. () to supply medi- mer , the farm continued its operation and cine to the costumers of . Moreover, they for the second year in a row the workers at the have an interest in launching diabetes screening farm are growing vegetables (potatoes, turnips, clinics in the future. carrots, squash, beans, lettuce, corn, tomatoes), In sum, even though the North West Com- and raising chickens. pany may be invested more heavily in alleviating .e Province of Manitoba Northern Healthy food insecurity in other communities, their ef- Food Initiative () provided the start-up forts in  are scarce and do not extend be- funding of ,. To put this number into yond the  and the breakfast program, which perspective, it constitutes one third of what exhibits a fragmented approach to the problem the  program annually allocates in subsidy

26 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" amount for . In  an additional , to them is what makes a true community has been obtained from a few different funders economic development initiative (Loxley et such as , Aboriginal Economic Develop- al., , p. ). ment Fund (), Canadian Feed .e Children. • Once introduced, the ways of At present, Meechim Inc. has created  jobs communicating about this new healthy for community members. food opportunity to the residents .e Meechim Healthy Food Market sells were not well defined. As the result, both food grown at the farm and food imported anecdotal evidence exists that the farm from the South at prices lower than the Northern was detached from the community, at Store. By organizing the market on reserve, the least in the first summer of operation. initiative is also trying to decrease expenditures Teachers and students at the local school of customers on transportation. .e market has and workers at the nursing station were not been operating regularly due to review of unaware of the farm. the strategy and to internal reorganization, but the leadership is planning to run it a few times • Meechim Inc. hasn’t been actively a month after the necessary arrangements are communicating with the leadership of made to secure a venue and protect it from be- the community. Following  months after ing vandalized. the leadership change, contact with the Attempting a previously unexplored area of new chief hasn’t been established. .e business is risky and if the market is not well communication with the Chief and Council studied, this can result in financial losses. First is maintained through one councilor. Nations communities in general have had many • .ere is no sustained funding for the different types of interventions and initiatives enterprise at the moment. .erefore, the coming into their communities. .e road is lit- lack of communication and the community tered with failed programs. It is important to involvement at the planning stages of the carefully study the new market and ensure that SE can in part be attributed to the shortage the connections are made with the community of funding that is needed to engage in members so they are supportive of the initiative. broad market analysis and consultations. .e project organizers are learning as they pro- As a SE, Meechim Inc. is trying to gress, and some challenges have surfaced along gradually cease reliance on programs and the way. .is is to be expected. Some of the in- become a self-financing business. However, sights on the functioning of the new SE and its it may not be possible in the earlier stages. challenges are discussed below. • .e first year after the locally raised • Relationship building is a challenge for chickens were slaughtered at the farm, the such a large community as . Despite Healthy Food Market faced difficulties having the former chief of  as the selling the produce to community Executive Director and co-founder of Aki members. .e lack of consumer education Energy and having the approval of Chief might have been responsible for the low and Council, the social enterprise was sales of the chicken. According to the  introduced with only a limited community worker Lionel Flett people “just think they involvement. Even though this social weren’t properly handled”. enterprise intends to have community members’ best interests in mind, having • .e soil in  is not fertile and needs people define what development means fertilizers, which is an additional cost.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 27 • Since the community members’ incomes • In order to increase the awareness of are low, Meechim Market has to adapt the healthy food options offered by the to the days when community members farm, the new School-to-Farm program are most likely to have money (welfare has been initiated which educates youth payment days). Sometimes it is hard about gardening. .e children from grades to adapt to this schedule because the  to  plant vegetables in pots in their administration can change the rules when classrooms, which they later they plant they get pressure from people. at the farm and have a feast when the • If the weather conditions are not favorable, vegetables are grown. the market cannot be held as planned and Although progress is being made, the initiative is the imported food can spoil (Food Matters yet to develop their business strategy to address Manitoba, ). all the aforementioned challenges (e.g. provide • .e Northern Store lowers its prices better training to the local staff, advertise at the during Meechim Market days, increasing big annual community gatherings, supply food competition. on time for the events such as hockey games at the arena). Once improved, it is hoped that the • Initially it was estimated that the enterprise model can be replicated to other communities. would be able to offer  jobs (Loney, n.d.), however it was only able to offer  positions.  • According to the student researcher who has Wabung Fisheries Co-op Another SE in  is the Island Lake Wabung been heavily involved with the work of the Fisheries Producers Cooperative Ltd. (Wabung). farm at the first year of its operation, there .e Garden Hill Fishers Association () is a lack of accountability and management first established a fishing cooperative in  skills in the work of the farm and market when the government granted the Island Lake personnel. Employees can easily steal the Nations’ fishers a license to harvest and export produce without anyone noticing. Business fish commercially to other provinces in Canada tactics might need to be integrated in order (.ompson et al., ). Initially the coopera- to prevent theft such as allowing workers to tive ran under the name Island Lake Opaki- have discounts for the items they sell. tawek Cooperative (). In  it had ap- Some of the above challenges have already been proximately  fisher members (.ompson et addressed, such as: al., ). .e biggest physical asset belonging • An advisory board for Meechim Inc. has to the cooperative is a fish-processing plant that been created which consists of  community is located by the lakeshore on the outskirts of members including one councilor, and one the community. person from Aki Energy Inc. .e change in the cooperative’s operation oc- • .e effective solution has been found for curred when new government rules required the the poor soil quality. , lbs of fish have fish to be processed by Freshwater Fish Market- been purchased from the local fish plant to ing Corporation () before exporting out- use as a soil fertilizer (source: Aki Energy side the province. Such restrictions granted a Inc. Project Status Report, April ). monopoly to the  and prevented fishers of • To prevent theft, a shipping container  from exploring diverse marketing options. was retro-fitted to be a permanent market .e fileting operations ceased and the process- structure for the Healthy Food Market. ing plant closed for many years. After the plant

28 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" had closed, fishers were faced with higher trans- the intermediary ensured better returns for the port costs as they had to transport the whole fishers than selling wholesale (Rony, ). fish (.ompson et al., ). .ompson et al., However, getting a decent market share while () found that commercial fishing and selling competing with the experienced producers (e.g. of the unprocessed fish at  was unprofit- Gimli Fish) can be challenging. Finding the able. Fishers experienced the loss of . per kg target market on their own will require better of fish sold due to high shipping costs, low prices marketing tools and skills among the members received and lack of planning and resources to of the cooperative, especially knowing that the make improvements. buyers are limited. Moreover, government policies restricted the It is important that the Wabung Coop find plant from selling the freshly caught fish locally a stable long-term buyer in order to maintain (at school or at any community event) unless it an influx of money and develop a solid capital was inspected by federal officers from Freshwa- base (Rony, ).  is that buyer. In the fall ter Fish Marketing Corporation (). , the Wabung Co-op supplied , lbs Recently, however, Wabung Fisheries received of mainly pickerel to . Manitoba’s recent a special dealer’s license from  that allows proposal to withdraw from  (Annable & De them to process the fish they catch. .e plant re- Pape, ) may deprive the cooperative from the opened in September  (Tides Canada, ). advantage of having this stable long-term buyer. In September  when the researcher visited A carefully developed business plan is need- the plant, it employed  people and was in the ed to address all of the marketing challenges. process of hiring more staff. .e initial business plan was developed and re- Now the fishers are in need of funds to up- vised by the researcher Mohammed Rony and grade their facilities, purchase and upgrade re- Dr. Shirley .ompson in  and  (Rony, frigerants, ice making machines, carts on rails, ; .ompson et al., ). sanitizers, and water pumps. At the sharing cir- cle discussion attended by the researcher, fish- Backyard Chicken Raising ers talked about the lack of proper equipment to .e backyard chicken project is part of the food fish and financial difficulties in sustaining their security program at the Four Arrows Regional traditional livelihood. It was estimated by one Health authority with core funding being provid- stakeholder that the plant would need an addi- ed by the . .e program hopes to empower tional investment of approximately , people of Island Lake (which includes ) to to buy all necessary equipment in order to pro- produce food locally. To that end they are trying cess fish. In  the plant received , in to provide training needed to engage community grant money though their partnership with the members in small-scale gardening and farming. Northern Manitoba Food, Culture, and Com- .e chicken raising program follows a five-year munity Fund () at Tides Canada, and plan. .e first year the program covers  of , in . the costs (coop, – meat birds, feed). Every- With the  dealer’s licence, Wabung thing is prefabricated down South and later trans- Coop could sell fish directly to local residents ported via winter road. At the end of the season through Meechim Inc. Moreover, Wabung Co- families slaughter and eat the chickens they have op sold some whole and filleted fishes to Win- raised. .e second year the program makes new nipeg farmers markets, engaged in direct inter- supplies, however the families are encouraged to net marketing and sold to restaurants and retail pay for at least  of their feed. .e third year, stores in Winnipeg (Rony, ). Selling without the families are expected to buy their own feed

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 29 and start paying for the chickens. In the fourth .e program cannot, therefore, be said to main- year the families become experienced enough tain historical traditions, but rather introduce to provide support and educate the families that new practices. Even though the program is be- are just starting with the program. Families can lieved to pass down the knowledge of farming keep chickens over the winter and proceed with to the community through continuous train- incubation. Support from the program organ- ing and support for the participants (e.g. pro- izers is available all year round over the phone. gram organizers are creating a chicken raising Since the program was introduced in , a manual), the potential to significantly alleviate total of  families have been involved in the Is- food insecurity though this program is limited. land Lake region, including  families in . Significant scaling up may not be possible for a .e success rate for the birds was , with pre- number of reasons. First of all, there is a lack of dation being the main cause for the losses. .ere demand for this kind of activity among families. was one family with layers, but no family had Second, the limited funding can only support a moved to incubation. few families. One fully insulated coop costs ,. In addition, it costs , per one trip to deliver the Lunch Program at School supplies to the communities via winter road. Because of the scarcity and high prices of healthy .e costs of setting up local small-scale farming food, it is a challenge to offer nutritious meals can rise unexpectedly, that is why the planning to the children at the local school. .e lunch stage is crucial for the success of the program. program offers meals at lower prices than if the According to the program coordinator, a  lb. food was purchased by families and prepared at bag of chicken feed can cost  in the South, home, and it gives parents a good opportunity to however the price can increase to  if deliv- ensure their children are not hungry and ready ered to the community by plane. to learn. However, according to one community .e relevance of this program to the tradi- member, most of the food offered by the program tional food and culture is explained in the fol- cannot be referred to as healthy. lowing way: “In the lunchtime they don’t usually eat healthy “I do believe that the chickens we are doing now because they have hotdogs, burgers, stuff like is not appropriate. Appropriate meaning it is not that. Same thing with the lunch program, they natural. But nowadays our people love chicken. don’t have enough money to feed the  kids, it And going to back the land we do have birds will cost more money to buy healthy foods.” like ruffed grouse, they are called wild chicken. Lionel Flett, Particularly the migration road is in the Red  worker, Nursing station Sucker Lake. We have those birds and we also .ere are other examples of the unhealthy food have white ptarmigans. .ey are there all year choices at the school lunch program. .e dieti- round. .erefore, there is chicken activity in our cian working in  observes that the children communities. But now we are domesticating at the school usually have orange juice for both everything, so that’s why I thought we should breakfast and lunch, whereas the recommend- introduce our local chicken to alleviate some ed serving is one tetra pack (half a cup) per day. food insecurity problems.” .erefore, the lunch program, although making Byron Beardy, sure the children do not stay hungry, will require Community member and Food Security Coordinator, revisions and need to find solutions to the prob- Four Arrows Regional Health Authority. lem of purchasing healthier foods.

30 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" Education Aboriginal Diabetes Initiative () Nutrition North Canada Cooking classes are offered at school  times a In  the  educational program is funded year for the children in grade  for the duration of directly to the community. .e goal is to pro-  classes. Approximately  children participate. mote awareness about healthy eating, especially among the younger population. Examples of their educational initiatives in  are: vegeta- Discussion ble discovery day in  classrooms, traditional .e healthy food initiatives in  comprise food preparation workshop guided by Elders efforts targeted at food availability and afford- (in total  workshops which involved  par- ability as well as education. It important to note ticipants) (FourArrows, ). In addition, that many programs serve more than just one the school has set up the mentorship program purpose. By having food affordability as their where high school students mentor the elemen- main purpose, some programs like Meechim tary school children. After school they provide Farm and Market are also localizing food systems healthy snacks (milk, fruits) to the younger kids and providing training opportunities through and play games. Grocery store tours with a the local farm, individual gardening, and fish- dietician are another educational activity. .e ing, making a step towards a convergent econo- tours provide gift cards for participation and my. In case of educational programs, they bring pay for transportation. From the conversation people together to support one another and by with the dietician it was found that the attend- making those gatherings entertaining and social ance was  people in October , – people they are becoming not solely about education, at the next tour in January . Additionally, but also about mental wellness. cooking classes are offered on a regular basis, Initiatives focusing on food affordability usually every Friday. though localisation of the food systems include  social enterprises which employ at least  local School-to-Farm Project people with the potential to offer more jobs. To .is project is part of Meechim Inc. which teach- date at least , has been invested in the es children from grades  to  about gardening. projects that promote local healthy food produc- .ey plant vegetables in the pots in their class- tion, not to mention about  million annually rooms, which they later they plant at the farm in  subsidy for the imported healthy foods and have a feast when the vegetables are grown. at the Northern Store. .e program started in . Although there is still a great reliance on the Northern Store, we can observe a positive trend Drop the Pop of self-determination and local control of the “Drop the pop” is the initiative of the Kidney food systems manifested in Meechim Inc. and Foundation of Canada that aims to educate young Wabung fisheries co-op. Nevertheless, these so- children about the dangers of sugary drinks. A cial enterprises are yet to expand sufficiently to grant of  was given to Kistiganwacheeng El- be able to offer enough food for the communi- ementary School in  in  for the Drop ty. For example, at the end of the  farming the Pop challenge. Schools challenge students season, approximately  chickens had been to avoid drinking sugary beverages for five con- slaughtered at the Meechim Farm. Dividing by secutive days (Kidney Foundation of Canada, the number of families in private households Manitoba Branch, n.d.). results in an average of one chicken per family. .e similar concern has been raised in Das

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 31 (). If the national average for chicken con- in the community, mostly from the older genera- sumption per person is considered, the  tion, maintain traditional lifestyles. A survey of chicken production needs to be increased dra-  households conducted in July  in Islam et matically in order to accommodate this stand- al., () revealed that  of households either ard. To add to the challenge, the families were hunted or fished, or received country food from reluctant to buy the Meechim chicken for fear relatives. Ensuring a more or less stable supply of it hadn’t been properly handled. country foods will require commercialization of .erefore, educational programs have to traditional and country foods. .is gives rise to accompany the changes in food production to some concerns such as deterioration of sharing provide understanding of the actual risks and networks, overhunting, and safety inspections benefits of the new food options. People have de- barriers. However, this is an idea to explore more veloped a habit of a certain diet and it will take a thoroughly, and it has already been successfully conscious and informed effort to recognize and tested in Nunavut, a territory which is confront- take advantage of the healthy options as they be- ed with many of the same challenges relating to come available. .e main characteristics of the food insecurity as Manitoba’s North. educational programs in  are, first of all, In order to have a lasting impact on food sus- the use of the products available at the North- tainability and affordability, a holistic approach ern Store, and second, focus on youth as the fu- will be required with different players enhanc- ture change-makers. Nevertheless, programs ing and supporting each other’s work. .e new targeted at adults are equally important since SE in  is making a positive step towards parents are a great influence on their children. providing healthy foods to the community by As the  worker Lionel Flett mentioned: “We raising chickens, turkeys, and growing a wide need help from home. .ey [children at school] range of fruit and vegetables. Community eco- bring junk food from home”. nomic development as promoted by Meechim Overall, the impact of the educational pro- Inc. is not looking beyond the community for grams on the health status of the community development, but rather seeks to produce to will be very limited unless the issues of high meet local needs, to hire locally, to purchase food prices, transportation, and low incomes locally, to invest locally (Loxley et al., ), at are given priority. Children may attempt to stay the same time reigniting the practice of gar-  consecutive days without Coke, but will they dening for future generations to follow. Nev- have financial and mental support from their ertheless, given the size of the community and families who struggle with many issues of pov- the great demand for food which will still pose erty, addictions and perhaps domestic violence, a great dependence on the Northern Store, the to keep up the healthy habit? combination of both active development of the As for reinforcing cultural values (the impor- SEs and increasing people’s purchasing powers tance of reviving historic traditions was empha- in case of the imported foods may be required. sized earlier in the section that dealt with the In- .e next section will bring together the informa- digenous perceptions around food), the fishing tion found about the food programs, the health, plant is the enterprise that is continuing with a and the economic situation of the community traditional occupation. Gardening also strengthens to highlight the required sustained efforts from the natural bond with food from the land. Apart government, SE management, and community from these programs, no country food project members to make the transition from healthy was identified. Nevertheless, a number of people food projects to healthy living.

32 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" The Path to the Healthy Living

Our analysis of challenges and opportunities role in slowing down development of TD and, of promoting healthy living has given rise to a perhaps, even preventing it completely. However, number of critical themes. What are some of dietary changes as a strategy to address diabetes the things we need to consider first in order to in First Nation communities such as  can- reduce diabetes and improve the overall well- not be isolated from many social determinants being of community members in the future? of health like unemployment, housing and living What efforts and policy changes are needed in conditions, barriers to health care access, early both the short and the long run? .is section childhood development, racism and social exclu- will show, with the use of examples, that the sup- sion — all of those aspects that form the conditions port should come from diverse institutions and in which people are born, grow, live, work and age. groups. .e discussion may be applied to many In turn, adverse social conditions can create physi- remote northern communities. ological and psychological stress. It is recognized that stress affects cardiovascular and immune sys- • Social determinants of health; recogniz- tems, and if tension persists for the long-term, it ing complexity: .e first fundamental idea lays makes people more vulnerable to infections, high in the fact that noticeable health improvements blood pressure, diabetes, stroke, depression, and will not occur unless a complex holistic approach aggression (Marmot, ). Moreover, living in that includes a variety of programs and supports adverse conditions creates the feeling of shame, is applied. insecurity and worthlessness. As noted in Mik- konen and Raphael () “Stressful living condi- “By just introducing the changes to diet, it tions make it extremely hard to take up physical would take more than a generation to see a leisure activity or practice healthy eating habits change in diabetes.” because most of one’s energy is directed towards Dr. Sharon Bruce, Associate Professor, coping with day-to-day life. .erefore, taking Community Health Sciences, University of Manitoba. drugs — either prescribed or illegal — relieves only It has been scientifically proven that weight loss the symptoms of stress. Similarly, healthy living associated with a low-calorie diet plays a critical programs aimed at underprivileged citizens are

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 33 not very efficient in terms of improving health ditional values and the realities of the market and the quality of life.” (p. ). economy creates obstacles for moving forward as in the case of a country food market. SEs, how- “.ere is an Ojibway term called mino- ever, can in some ways create economic oppor- bimaadiziwin which means ‘living in a good tunities for local residents and revive traditional way’, not trying to isolate it down to a factor. livelihoods. For many years “export promotion Physical, emotional, spiritual, mental healths based on foreign capital and relative neglect of are all important.” the need of the Aboriginal community” (Loxley, Jon McGavock, Research Scientist, , p. ) was the most common strategy sug- Children’s Hospital Research Institute of Manitoba. gested for the Canadian North. In contrast, SEs .e end goal maybe to reduce diabetes, but the try to challenge this well-established model by measures to achieving that goal will have to replacing the export promotion strategy with the tackle many other social ills. .e need for strate- strategy of local production for local use. Espe- gic actions on the social determinants of health cially nowadays when younger generations are was one of the important actions highlighted in less interested in living off the land than their “Diabetes in Manitoba A Call to Action” (). ancestors, there is an acute need to find struc- turally different ways to provide food and other • Encouraging early intervention and preven- basic items for the community which may com- tion: Early intervention is important to stop the bine traditional and corporate aspects, however exacerbation of adverse habits and health condi- with the overall emphasis on living in a sustain- tions. First of all, early detection of prediabetes able way (conserve and replenish). Consultations and action on it will ensure the condition doesn’t with the particular communities are necessary develop into TD. .is calls for a separate inves- in order to understand how traditions can be tigation into the efficiency of the nursing unit, better integrated with the task of alleviating their staffing and capacity problems and funding poverty, and how the opinions of Elders can be needs. Furthermore, research shows strong cor- better emphasized. .ere is already some rec- relation between early childhood experiences and ognition from the community members that the lifelong health outcomes. As mentioned in “Early SEs will act as appropriate models for economic Childhood Experiences And Health” (): “it is and social development. Loney () notes that widely recognized that factors such as nutrition, “Elders are recognizing social enterprises as a housing quality, and household and community modern version of how things used to be done” safety — all linked with family resources — are (p.). strongly linked with child health.” (p. ). .erefore, concentrating on children will also ensure • Stimulating the sense of urgency and in- that we are preventing many diseases from de- volvement within the community: .e sense veloping into conditions in their adulthood that of urgency to address many of the poverty-relat- will require costly medical treatment. Children ed issues in the remote northern communities have already been a focus of a number of pro- is often lacking. Extreme poverty makes people grams and foundations (North West Company’s lose hope. .e associated loss of dignity and Healthy Horizons Foundation, peer mentorship self-respect can prevent community members program at the school in ). from taking action to deal with matters of im- portance. .is can negatively affect the uptake • Vision — finding balance between tradi- of new initiatives that in theory are thought to tional and modern: .e conflict between tra- bring positive change. Educating and involv-

34 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" ing community members is critical, especially to maintain special diets, people who are in large communities like . Are commu- at the increased risk of developing TD nity members informed of the new opportuni- are not given the same opportunity, hence ties? Have the benefits of the new interventions prevention measures are ignored. Second, been made clear? Do community members be- the amount of assistance is not indexed to lieve that outsiders decide for them how to build the higher prices in the North. And third, the community instead of them being allowed the extra money is spent in the Northern to take the lead? Answers to those and similar Store which means the policy supports the questions can explain why the community is not current model of importing food from the actively responding to new initiatives. South. .e solution to the last concern can be working with the local SE to link the • Education: In the food area, sustaining balance supplement to the healthy food options between education and healthy food options is produced locally, for example though pivotal because it will ensure that people are pre- vouchers for Meechim’s healthy products. sented with alternatives and the resources spent on the educational programs are not wasted. In ) &e Canada Revenue Agency () New this way, educating children at school about the Qualified Donee Regime. In January harms of soda drinks may not be effective, while   created a list of eligible donees, the school-to-farm project which connects edu- including municipal or public bodies cation about healthy eating to the farm where that can issue official donation receipts the children can grow their own food can pro- and are eligible to receive gifts from duce better results. registered charities. Before this policy change, funders supporting projects in • Improving government programs and poli- communities could transfer grants directly cies: No significant change is possible without to communities. However, at present some revisions in the current policies and programs. communities are not included in the list Loney () calls it “making it easy for prob- of eligible donees, and the money transfer lem solvers” (p. ). SE directors in  have becomes problematic. Communities that highlighted some policy barriers that should be want to be recognized as qualified donees removed in order to help promote the work of must apply for registration and once SEs and ensure more thoughtful government registered must ensure that they accurately resource allocation. issue donation receipts, correctly valuate ) Diabetes Diet Supplement. .e Diabetes non-cash gifts, maintain proper books Diet Supplement is the addition to the and records, and provide  with access monthly basic assistance that is intended when requested (Milley, ). .us, Tides to help diabetic patients purchase the food Canada, which administers the , items required. As was estimated earlier, was not able to transfer their grant to based on the standard , calorie diet  directly. Transferring the grant and  diabetic patients in , the total money through the University of Manitoba amount of assistance could reach , has resulted in the loss of money due to the per year. .ere are a couple of concerns University charging an administration fee about this allotment as it relates to the of . .erefore, the change has affected northern community. First of all, while the the sovereignty of communities to receive diabetic patients are supported financially funds.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 35 )  Subsidy. It was shown in an earlier tion and northern communities (e.g., roads, safe section that the cost of the  remains water systems, housing, and public transit).” (p. high despite the introduction of the  ). Loxley () is also arguing for government subsidy. .e report by Enrg Research subsidization. He explains that in the reality of Group observes: “.e  program is the market economy, the ‘needs’ of the commu- lowering prices on  eligible products. nity are equated with ‘demands’. In this situa- In this respect, the program is working. tion low purchasing power means a low level of However, costs remain high. Is lowering effective demand, therefore many ‘basic’ needs prices enough for local residents who are will not be met through the marketplace. Rec- managing their households on limited and tifying systemic failures of this sort will require fixed budgets? We believe the answer is subsidization of services to communities. Lox- “No.” .at said,  is part of the solution, ley () further concludes that subsidization but not the entire solution.” [Italics added] of services is a “crucial element in successful CD (Enrg Research Group, ). At present activities designed to meet community needs” the subsidy is applied to the freight costs (p. ). Moreover, Enrg Research Group () of the imported food items. SE directors recommends an increase in government funding argue that while the imported foods are be allocated to the  subsidy. Due to popula- supported, the local food production is tion increases in the North and country foods not (Loney, ). It would be helpful to having “sustainability and acceptance challeng- see the subsidy going to the farm, into the es”, the report predicts a rise in demand for the labour of growing local food as the costs  subsidy. .e authors advise that the  of operating the small-scale local food SE should be indexed to inflation or to changes in in the North are high (e.g. overhead costs major cost drivers of retail prices in the North. are relatively high, wages should be socially SEs are faced with many challenges (e.g. com- acceptable, workers need training). peting with monopolies such as North West At this point it is unclear whether the Company in terms of prices, product range and new SEs in GH will have enough capacity additional services; transforming the tastes and to provide healthy food for the whole habits of the local residents in case of buying community over the long-term. If this healthier foods, facing high operating cost of is not attainable, other means of food running a small-scale business), and while some supply have to be substantially improved. of the matters are in their control (e.g. hire a Benefits can come from infrastructure more responsible manager, improve their busi- improvements like building an all-weather ness strategy, increase community involvement), road, that might eventually lower the price others are difficult to address with existing re- of imported food (for more information see sources. Often significant amounts of time are Manitoba East Side Road Authority, ). required for the new initiative to be accepted by the members of the northern community. A long • Stable long-term financial support and history of government projects and outside in- government subsidies: .e case for govern- terventions that were not well-considered may ment subsidy is not new. In the .ompson et be responsible for a slow uptake of the new ini- al., () study of the Wabung Fisheries Coop, tiatives. It is also known that the federal gov- authors conclude that in order “to improve sus- ernment has a tendency of walking away from tainable livelihoods, government investment is funding programs that communities have come needed to improve infrastructure in First Na- to rely on (“Who’s Accountable to the Commu-

36 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" nity?”, ). .at’s why there exists a cautious and committed leadership in the community view of anything imposed from outside. will ensure that people are supported without While there are no oversimplified solutions creating dependency, and that the investments to the issue of food insecurity, the SE model is are going to empower people, which is particu- a step in the right direction provided it encom- larly important for funders. passes all the necessary requirements: active New SEs can explore different funding op- community involvement and education, co- tions. Some programs to consider are: operation with volunteer and research groups, ) .e Communities Economic Development strong First Nation leadership support, prepar- Fund () provides loans for commercial edness to wait for the positive outcomes. Even fishing to purchase repair of equipment though a self-sustaining business is the goal, SE used in a viable fishing operation.  will find it extremely difficult to prosper with- can also provide guidance and support to out subsidization, especially at the initial stages complete a business plan. of operation. ) ’s National Child Benefit Reinvest- ment () program designed to support • Considerations for SEs: It becomes impor- innovative community-based projects tant to present a clear economic and social case with the focus on five activity areas on- for subsidization of SEs to sympathetic govern- reserve: childcare; child nutrition; support ments, funding agencies, or foundations (Loxley, for parents; home-to-work transition; and , p. ). Moreover, demonstrating strong cultural enrichment (, n.d.).

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 37 Conclusion

Colonial practices have seriously disrupted In- However, unhealthy food consumption is digenous traditional economies, governments, hardly a matter of personal choice for community and social relations. .e associated significant members as the cost of food is extremely high, socio-cultural changes within Indigenous com- especially for people who live on social assistance. munities such as  have led to drastic life- According to the survey conducted as part of this style transformations. .e increase in perma- research, it was found that the average share of nent settlements (reserves), the introduction household’s income spent on food is around . of the market economy and the import of food Furthermore, the survey revealed that even the from the south resulted in the decreased reli- highest observable spending on food ( per ance on country foods for subsistence and in month for one person) is  below the required a more sedentary life style. As a consequence, level of spending needed in order to maintain the food-related health problems have become healthy diet as calculated by the . common. Obesity and many chronic condi- In these conditions, Meechim Inc. has taken tions — diabetes, heart disease, high blood a positive stance to eradicate food insecurity by pressure — are increasingly prevalent in . re-building the local economy. .e new SE is con- Moreover, racism and the loss of family ties fronted with many challenges — the slow pace of through residential schools have created a lot community involvement, difficulties in accessing of trauma for Indigenous people that prevents funding and unfavorable social and geographical them from effectively coping with many of the conditions. Nevertheless, it was shown that while aforementioned diseases. improvements are needed, it has the potential Inaction on poverty and food insecurity prob- not only to help make food more affordable but lem in  is costly. In this study it was esti- also to bring people together and instill the “we- mated that . million in government expendi- can-do-it” approach to dealing with issues in the tures goes to treating diabetes in the community community. It is worth remembering, however, annually. And the lack of employment oppor- that the new initiative will only achieve mean- tunities is responsible for annual government ingful results if intensive input from the com- spending of . million in social assistance. munity is encouraged and sustained.

38 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" Government also has a role to play to keep cannot solely guarantee success in eliminating the momentum of the local food production many serious health problems such as diabetes. going through improvement of policies, in pro- .e paper highlighted the major problems ject funding and in increasing subsidy amounts. in the  related to economy and health by Likewise, the critical themes as they pertain backing up the discussion with the most recent to the improvement to the overall health status statistics and concrete examples evoked by the and well-being of community members were community members. It is the author’s hope that discussed, mainly focusing on social determi- the study will assist the community and the SE nants of health, education, government policies, in promoting their initiative and in better under- long-term subsidizing and ineﬃcient funding al- standing the connection between health, food location. Treating and addressing the pandemic and education. Moreover, it may also be useful of diabetes within Indigenous populations will for the SE to think through its strategy and the require a holistic approach because access to outcomes they want to achieve both in the im- healthy food, although extremely important, mediate future and in the long-term.

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 39 References

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!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 41 .e First Nations Information Governance Cen- thompsoncitizen.net/news/nickel-belt/break- tre. Ownership, Control, Access and Posses- fast-club-of-canada-minute-maid-provide- sion (™): .e Path to First Nations In- juice-to-northern-schools-with-north-west- formation Governance. (May ). Ottawa: company-.sthash.OuYtnmD.dpuf .e First Nations Information Governance . Registered Population. First Nation Pro- Centre. Retrieved from http://fnigc.ca/sites/ files. http://fnp-ppn.aandc-aadnc.gc.ca/fnp/ default/files/docs/ocap_path_to_fn_informa- Main/Search/egPopulation.aspx?_ tion_governance_en_final.pdf =&lang=eng. Food Matters Manitoba. (). Northern Sun  (n.d.). First Nations National Child Ben- Stories of growing & gathering. Retrieved efit Reinvestment () Initiative Proposal from http://www.foodmattersmanitoba.ca/ Development & Reporting Guide. Retrieved wp-content/uploads///Northern-News- from https://www.aadnc-aandc.gc.ca// letter_winter__online.pdf --HQ//texte-text/nc- FourArrows (, March ). Manitoba shares brg__eng.pdf . Retrieved from https://www.youtube. Income characteristics. (, January ). Re- com/watch?v=-pDfepaaEY trieved from Indigenous and Northern Af- Garden Hill First Nation Independent Auditors’ fairs Canada. Retrieved from http://pse-esd. Report Consolidated Financial Statements aadnc-aandc.gc.ca/fnp/Main/Search/n- (). Retrieved from http://fnp-ppn.aandc- come.aspx?_=&lang=eng aadnc.gc.ca/fnp/Main/Search/DisplayBinary- Insulin Basics (). Retrieved from American Data.aspx?__FF=&FY=- Diabetes Association http://www.diabetes. &=Auditedconsolidated org/living-with-diabetes/treatment-and-care/ financialstatements&lang=eng medication/insulin/insulin-basics Garden Hill First Nation Notes to Financial Islam, D., .ompson, S., Zahariuk, S., Mail- Statements Year ended March , . Re- man, M. (). Garden Hill First Nation. trieved from http://pse-esd.aadnc-aandc. Household Food Survey Shows Food Pric- gc.ca/fnp/Main/Search/DisplayBinaryData. es are Unaffordable for Community and its aspx?__FF=&FY=- Fishermen: Winnipeg based fish market will &=Auditedconsolidatedfi- help fishermen survive. [PowerPoint slides]. nancialstatements&lang=eng Retrieved from http://esac.ca/wp-content/ Garden Hill First Nation (). Four Arrows Re- uploads///Durdana-Islam-Poster-pre- gional Health Authority Inc. Retrieved from sented-in--.pptx http://www.fourarrowsrha.ca/profiles/ Keidar, A. (). Bariatric Surgery for Type  Gourneau, D., (n.d.). Naming of Wild Plants. Diabetes Reversal: .e Risks. Diabetes Care Adapted from Michael Price’s  Pres- (Supplement ): S-S. http://dx.doi. entation [PowerPoint slides]. Retrieved from org/./dc-s https://nasagcce.files.wordpress.com/// Key points: Living with stage  kidney disease. cycles_ojibwe_plant_names.ppt (, December ). Retrieved from National Graham, I. (). Breakfast Club of Cana- Kidney Foundation https://www.kidney.org/ da, Minute Maid provide juice to north- patients/peers/stage ern schools with North West Company. Re- Kidney Foundation of Canada, Manitoba Branch trieved from .ompson Citizen http://www. (n.d.). Drop .e Pop: Overview And General

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!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 43 .e Non-Insured Health Benefits () Pro- Socha, T., Zahaf, M., Chambers, L., Abraham, R., gram General Information (n.d.). Retrieved Fiddler T. (). Food Security in a North- from Health Canada http://www.hc-sc.gc.ca/ ern First Nations Community: An Explor- fniah-spnia/alt_formats/pdf/nihb-ssna/gener- atory Study on Food Availability and Ac- qa-qr-eng.pdf cessibility. Journal of Aboriginal Health. Norman, J. (n.d.). Treatment of Diabetes: .e Retrieved from http://www.naho.ca/jah/eng- Diabetic Diet. Retrieved from http://www. lish/jah_/__food-security.pdf endocrineweb.com/conditions/diabetes/treat- Strachan, S. (). Dealing with diabetes. Winni- ment-diabetes peg Health Region. Retrieved from Winnipeg Ponting, R. J. (). Arduous journey: Canadian Regional Health Authority http://www.wrha. Indians and decolonization. Toronto, Ont.: mb.ca/wave///dealing-with-diabetes.php McClelland and Stewart. .ompson S., Kamal A. G., Alam M.A., Wiebe Public Health Agency of Canada. (). Diabe- J. (). Community Development to Feed tes in Canada: Facts and figures from a public the Family in Northern Manitoba Commu- health perspective. Ottawa. Retrieved from nities: Evaluating Food Activities Based on http://www.phac-aspc.gc.ca/cd-mc/publica- .eir Food Sovereignty, Food Security, and tions/diabetes-diabete/facts-figures-faits- Sustainable Livelihood Outcomes. Cana- chiffres-/pdf/facts-figures-faits-chif- dian Journal of Nonprofit and Social Econ- fres-eng.pdf omy Research. Vol. , No  Fall / Automne, . pp. – Rabson, M. (). Manitoba reserves the worst in Canada. Federal government remains si- .ompson, S., Rony, M., Temmer, J., & Wood, lent on the issue. Winnipeg Free Press. Re- D. (). Pulling in the indigenous fishery trieved from http://www.winnipegfreepress. cooperative net: Fishing for sustainable live- com/opinion/analysis/manitoba-reserves-the- lihoods and food security in Garden Hill worst-in-canada-.html First Nation, Manitoba, Canada. Journal of Agriculture, Food Systems, and Communi- Registered population. (, January ). Re- ty Development, (), –. http://dx.doi. trieved from Indigenous and Northern Af- org/./jafscd... fairs Canada http://fnp-ppn.aandc-aadnc. gc.ca/fnp/Main/Search/egPopulation. Tides Canada (). Wabung Fisheries Co-op aspx?_=&lang=eng revitalizes fishery in Garden Hill, Manitoba. Retrieved from http://tidescanada.org/sus- Rony, M. (). Impact Investing & Aboriginal tainable-food-systems/wabung-fisheries-co- Community Economic Development: From op-revitalize-fishery-in-garden-hill-manitoba/ Fishing Net To Financial Net (Master’s thesis, University of Manitoba, Winnipeg). Re- Weber, B. (). Inuit hunting market: cultur- trieved from https://umanitoba.ca/institutes/ al betrayal or necessity? Retrieved from  natural_resources/pdf/theses/Rony,Mo- News North http://www.cbc.ca/news/canada/ hammad..pdf north/inuit-hunting-market-cultural-betrayal-or-necessity-. Roshanafshar S., Hawkins, E. (). Food insecurity in Canada. Statistics Canada. Cata- Weight loss surgery and type  diabetes. (). logue no.--X.  -. Retrieved Retrieved from WebMD http://www.webmd. from http://www.statcan.gc.ca/pub/- com/diabetes/type--diabetes-guide/weight- -x//article/-eng.pdf loss-surgery-and-type--diabetes

44 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" What is a social enterprise? (n.d.). Retrieved –: Full Fiscal Year (). Nuitrition from Social Enterprise http://www.socialen- North Canada. Retrieved from Government terprisecanada.ca/learn/nav/whatisasocial- of Canada, http://www.nutritionnorthcanada. enterprise.html gc.ca/eng// Who’s Accountable to the Community? ().  Census Population and Dwelling Count Breaking Barriers, Building Bridges: State of Amendments. Statistics Canada  Cen- the Inner City Report . –. Retrieved sus. Retrieved from Province of Manitoba from http://www.policyalternatives.ca/sites/de- https://www.gov.mb.ca/asset_library/en/sta- fault/ﬁles/uploads/publications/Manitoba tistics/demographics/communities/popula- Oﬃce///State_of_Inner_City.pdf tion_and_dwelling_count_amendments.pdf

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 45 Appendices

Appendix A. options. Prices are high. Occasionally List of businesses in Operation. provides gasoline for sale. On Stevenson Island. • New Store • & e Northern Store Construction started in September .  employees of which  () are First Currently operating. Independently owned Nation. business. Food products choice similar to • Ministik that of the Northern Store. – full-time staff plus owner. Less than • Meechim Farm and Market  groceries. Large selection of GM and  employees. hardware merchandise. • Danny’s Store. • Mikiskew .e biggest store on the reserve. – full-time staff and – casual. Good • Ma&Pa Stores. selection of grocery products, although No information on the number. limited selection of fresh produce. Significant amount of frozen meats. • Pharmacy. Located in the Nursing Station, jointly - Source: Northern Food Retail Data started by  and the Northwest Collection & Analysis by Enrg Research Company. Opened in August . Group • Taxi boats. On Reserve Independently owned.  dollars to go • & e Convenience Store across the lake to the Northern Store. Two full time including owner plus some • Wabung Fisheries Co-op casual employees. Very limited grocery (Fish Plant)

46 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" Appendix B. . Spending on food and utilities Household Survey Questions. a) How often do you buy food for your household from the local stores? ) General . More often than  times a week a) How many people live with you in one house- . Twice a week hold, including yourself? . Once a week b) How many of them are children younger than . Once in  weeks  years old? . Depending on when money is available c) Are you currently…? (right after paydays, welfare days, etc.) . Student . Other — please specify . Employed for wages b) How much money do you spend on food per . Self-employed trip? . Out of work and looking for work . Less than  . Out of work but not currently looking for . – work . – . Retired . – . Other — please specify . – d) What is your total household’s monthly in- . – come? . – . Less than  . – . – . – . ,–, . – . , to , . – . , to , . More than  . , to , . Other — please specify . , to , c) How much of it is spent on transportation like . , to , boat taxi or gas? Please indicate the amount. . , to , d) How much do you spend on heating and elec- . , to , tricity per month? . , to , . Less than  . More than  . – . Other — please specify the amount of your . – income . – e) What is the source of the income? Please . – check all that apply. . More than  . Wage . Other — please specify . Employment and Income Assistance . Child beneﬁts Health . Retirement pension a) How many members of your household are . Other — please specify diagnosed with diabetes? b) How many members of your household are diagnosed with any other chronic disease (cardiovascular, autoimmune, renal diseases)?

!"#$%&&'$( )!% *+)%$)'", +- &+.'", %$)%#*#'&% '$ ("#/%$ !',, -'#&) $")'+$ 47 Endnotes

1 For example, see “.e Great Northern Plan” () by J. have not kept pace. Particularly, there is inadequate fund- Loxley. .e plan had a complete section on agriculture. ing for special needs under Income Assistance. 10 Many Indigenous families on reserve do not receive this 2  is a fly-in community that is not accessible by all- benefit because they are not filing their income taxes or weather road. are unaware of the program (McKie, ). 3 “Food insecurity exists within a household when one or 11  is an increase of  to the monthly basic benefits more members do not have access to the variety or quantity of  households. .e  is intended to assist the of food that they need due to lack of money.” (Roshanaf- households with the increase in the cost of basic neces- shar & Hawkins, ). sities resulting from rising energy costs, such as the in- 4 Tea made from a composition of herbs collected in the bush. creased cost of transporting goods to northern commu- 5 In  the mandatory long form census was replaced by nities ( Administrative Manual, n.d.). the voluntary National Household Survey () whose 12 . e  provides up to , per year (. per month) results are extensively used here as the most recent data for each child eligible for the . on . It should be mentioned that due to the change 13 We are acknowledging that not all of the salaries may go from a mandatory to a voluntary survey, part of the differ- the local residents. Some people are employed from out- ences between the  and  data might be attribut- side the reserve. However, this percentage is not known. able to the non-response bias, although the extent of this 14 bias is impossible to determine with certainty. Global non- Includes only basic income assistance: no additional dis- response rate for  was .. In previous research ability benefits are accounted for. dealing with the   data concerns were raised about 15 .e minimum average annual income for person above  the quality and reliability of this data, especially in case of years old in the household in the sample is , which is smaller communities (Lezubski, Silver, ). an extremely low value. .is might be due to misinterpre- 6 Source:  Census Population and Dwelling Count tation of the question (e.g. the respondent reporting only Amendments. his/her income and not the income of the household as a whole which resulted in a low value after the division by 7 If we apply the earnings as percentage of income rate () the number of members in a household). However, due to to the total income in the community ,,, we ar- true reason behind the reported number not being iden- rive at the slightly different figure — ,,. tified, the observation is not omitted. 8 Average incomes are based on actual dollar amounts. 16 . e cost is “approximately  higher than shipping 9 Clark () notes that the Federal Income Assistance rates freight a comparable distance in the South” (Enrg Re- are supposed to be based upon provincial rates, but they search Group, ).

48 !"#"$%"# !&#'(& )*( +*,%!- ",'&(#"'%.&/ — 0"#%'*1" 17 For the average price of the  per person per month, 29 .ere were approximately  chickens in  — half of we have assumed  weeks in a month. In addition, the dif- them were layers, another half of them were meat birds. ferences between the diet of an adult and that of a child 30 “Tomorrow” in Ojibway-Cree language. are not taken into account. 31 . is peer mentorship program is designed in collabora- 18 To compare to the average calorie intake for various gen- tion with the research team from the Manitoba Institute der and age groups at three different levels of physical of Child Health. Children play low organized games in activity, see https://www.cnpp.usda.gov/sites/default/ the gymnasium such as basketball for  minutes, then files/usda_food_patterns/EstimatedCalorieNeedsPer- eat the healthy snack and talk to older kids. .e purpose DayTable.pdf of the program is to promote active living and engage 19 Obesity rates are higher in Indigenous groups than non- into some knowledge sharing and teaching. .e after Indigenous groups:  of adults and  of children and school intervention lasts  minutes and takes place  youth are overweight or obese (Canadian Diabetes As- days a week. .e goal is to build the capacity for the com- sociation, , p. ) munity to run their own program. .e health outcomes of this intervention were assessed and it was found that 20 . e total number of adult/pediatric care patients in the the program had improved the weight and healthy living table doesn’t not reflect the actual total number of people knowledge in children (Eskicioglu et al., ). on register at the Nursing station. For example, the same person can be on file for two or more illnesses simulta- 32 . e total number of census families in private households neously (e.g. both diabetes and renal disease; diabetes, is  ( Census data) cardiovascular and renal and so forth). 33 . e government of Nunavut has a Country Food Dis- 21 Registered male and females on own reserve, June . tribution Program which assists hunters’ and trappers’ Source: http://fnp-ppn.aandc-aadnc.gc.ca/fnp/Main/Search/ organisations and municipalities with the costs of op- egPopulation.aspx?_=&lang=eng erating country food infrastructure (e.g. markets, community freezers) (Country Food Distribution Program, 22 “ .e Non-Insured Health Benefits () Program is a n.d.). For a few years, the program has been supporting national program that provides coverage to registered the Iqaluit country food market which is part of Iqaluit- First Nations and recognized Inuit for a limited range based social enterprise Project Nunavut. Although having of medically necessary items and services that are not to deal with irregular supply, locals were quickly buying covered by other plans and programs.” (.e Non-Insured whatever was available at the market, making this pro- Health Benefits (), n.d.) ject a huge success. .is confirmed that many families 23 Hemodialysis is the procedure to filter one’s blood in or- were ready to buy traditional country foods to supple- der to remove wastes, extra salts and fluids. ment their diets despite the common concern for the 24 According to a Dialysis Unit worker there were cases of “betrayal of sacred Inuit traditions” (Weber, ). Some patients on dialysis who were homeless (shared with re- community members think that “it’s not the Inuit way of searcher over the phone) life to sell to others” (ibid.). However, the reality is that 25 To put this number in the context of the total Health the market feeds the families and, once commercialized, Canada transfers: ,, was transferred to  by hunting and gathering brings enough income to hunt- Health Canada in  and ,, in  (Garden ers to maintain the traditional lifestyle. .e estimated Hill First Nation Independent Auditors’ Report Consoli- cost of one hunting trip in Nunavut is between , dated Financial Statements, ). and , (ibid.). Full government subsidization of the hunters’ costs is the only way to ensure that both sharing 26  houses in  have no water service. Source: Four and hunting traditions are preserved (Kim, ). Until Arrows Regional Health Authority http://www.fourar- this is introduced, it is impossible to consistently supply rowsrha.ca/profiles/ country foods and keep the sharing tradition alive when 27 ‘Meechim’ is the word for ‘food’ in Oji-Cree. costly hunting technology is involved. 28 Currently the farm occupies – of the allocated land. 34 See more at http://www.cedf.mb.ca/fisheries-program/

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