Programs and policies that align with Canada’s Dietary Guidelines provide an opportunity to create supportive environments for healthy eating. Understanding and acting on the barriers that make it challenging for Canadians to make healthy food choices are essential for the successful implementation of these guidelines.
Decisions about healthy eating are influenced by many aspects of our social and physical environments, from household income and food skills to government food policies. The health sector works at federal, provincial, territorial, and regional levels to build understanding of nutrition issues and foster inter-sectoral approaches. This is to ensure that decision makers consider the health impacts of policies and programs along with other government priorities.
Health charities and professional regulatory bodies/associations, in their efforts to reduce the risk of chronic disease and promote health, complement the efforts of governments to support implementation of dietary guidelines.
All sectors—including agriculture, environment, education, housing, transportation, the food industry, trade, as well as child, family and social services—have a role to play for Canada’s Dietary Guidelines to have far-reaching and longstanding effects on the nutritional health of Canadians. It is necessary to identify and address the physical, economic, and social barriers to healthy eating. These sectors can make policy decisions within their sphere of influence to improve the accessibility and availability of nutritious foods to Canadians of all ages and backgrounds. Identifying barriers, and opportunities, during policy and program development is essential to the creation of supportive environments for healthy eating across the country.
Healthy eating requires that nutritious foods be available and accessible.
Access to, and availability of, nutritious food options vary within and between population groups. Health inequities arise when these differences are unfair and avoidable. 1 Dietary guidelines are intended to contribute to advancing health equity while ensuring that they do not make inequities worse.
Health inequities are related to factors and conditions (biological, social, cultural, economic, and environmental) that affect health. 1 2 3 These factors and conditions are the determinants of health. The determinants of health have also been made more specific for some Indigenous populations of Canada by taking a more holistic outlook that addresses the unique historical, economic, political and social factors impacting the wellness of Indigenous populations. 4 5 These specific determinants include the social determinants of First Nations health and the social determinants of Inuit health.
The determinants of health combine in ways that impact eating behaviour. It is essential to identify barriers to accessibility and availability of nutritious foods. This can help identify the most appropriate and effective interventions to promote supportive environments for healthy eating across the country.
Canada’s Dietary Guidelines are one part of a comprehensive approach to supporting healthy eating. Addressing the determinants of health and reducing health inequities is required to help Canadians make healthy food choices that are aligned with the guidelines in this report.
Certain populations are at increased risk of poor dietary intakes.
Nutritional risk factors (such as low intakes of vegetables and fruit) for chronic diseases and conditions are often termed “modifiable.” However, many people are not able to make changes because their food environment or life circumstances do not support accessibility and availability of nutritious foods. Underlying health inequities can contribute to food insecurity and poorer health outcomes in some groups in Canada. Those at greater risk of poor health include: Indigenous Peoples, people living on low incomes, people living in rural areas, and newcomers to Canada. 1 These groups are often affected by a number of factors that influence their ability to make healthy eating decisions.
For example, Indigenous Peoples who live in remote, isolated, and northern communities often have limited access to nutritious foods (including traditional food). This may be negatively influenced by limited employment opportunities and low incomes; environmental changes affecting traditional food harvesting and consumption; lack of access to the land and resources; loss of cultural identities, traditional knowledge, and food practices; and the unreliable supply, quality, and high prices of store foods in remote communities. 6 Underlying determinants have contributed to an unacceptable socio-economic gap between Indigenous and non-Indigenous communities. 4 5
In another example, newcomers to Canada may bring with them a food culture they wish to preserve and share. Supporting the preservation of food cultures may help maintain healthy eating habits among newcomers. It may also help sustain the “healthy immigrant effect.” This is the observation that recent immigrants—particularly those migrating in adulthood—are sometimes in better health compared to Canadian-born residents. 7 This advantage is often lost over time because of factors such as acculturation. Additionally, access to nutritious foods may be difficult because of a combination of issues, such as lower income, language and transportation barriers, as well as availability issues, such as limited markets for culturally acceptable foods. 8
Food insecurity refers to the limited or uncertain availability of nutritionally adequate and safe foods. It also refers to the limited or uncertain ability to acquire acceptable foods in socially acceptable ways.
Rates of food insecurity are higher among Indigenous households than non-Indigenous households.
Rates of moderate and severe food insecurity range from 22% to 63% of Indigenous households (depending on which population has been surveyed), 12 13 14 15 16 17 18 19 whereas the national average of household food insecurity in Canada is 8%. 20
Further, rates of food insecurity are especially pronounced in northern, remote, and isolated communities. 22
Children and older adults from all backgrounds can be particularly vulnerable to poor dietary intakes. A child’s food choices are shaped by the foods that parents or caregivers are able to select and prepare. Household income, parental employment status, and parental health all affect the food choices available to children. In addition, adult food purchasing decisions are influenced by other factors, including convenience, commercial messages, and endorsements targeting children. Children themselves are vulnerable to the complex information environment—in particular food marketing techniques that have been shown to steer food choices in the direction of highly processed products. 9 10
Older adults now outnumber children in the Canadian population. 11 Older adults may be at risk of poor dietary intake, depending on whether they were exposed to positive or negative influences on their health over time. Older adults can be affected by socio-economic conditions, such as lower income, which may limit their ability to travel, purchase and transport nutritious foods. 23 24 Changes in functional ability can also influence the food choices and eating behaviour of adults in later life. Some older adults face mobility or dexterity issues that can cause them to increasingly rely on others for food shopping and meal preparation. 24 They may face social isolation with changes in family and social networks and loss of loved ones over the years. Social isolation can lead to depression and a lack of motivation to prepare and consume nutritious meals. 24 While women are more likely to lose a spouse, widowers may have fewer food skills and be less able to prepare nutritious meals for themselves. Older adults’ food intake can also be affected by physiological changes, such as poor oral health, diminished appetite, sensory changes, altered digestive processes, chronic health issues, and the effects of medication. 23 24
To support healthy eating for all Canadians, collective action on the determinants of health is needed by all sectors to complement and extend the foundation for healthy eating provided by Canada’s Dietary Guidelines.
- Footnote 1
- Public Health Agency of Canada. Reducing health inequalities: a challenge for our times [Internet]. Ottawa: Public Health Agency of Canada; 2011 [cited 2018 Sep 14]. 1
- Footnote 2
- World Health Organization. Improving Equity in Health by Addressing Social Determinants. Geneva: World Health Organization; 2011. 2
- Footnote 3
- Public Health Agency of Canada. Population health promotion: an integrated model of population health and health promotion [Internet]. Ottawa: Public Health Agency of Canada; 1996 [cited 2018 Sep 14]. 3
- Footnote 4
- Assembly of First Nations. First Nations Wholistic Policy and Planning: a transitional discussion document on the social determinants of health. Ottawa: Assembly of First Nations; 2013. 4
- Footnote 5
- Inuit Tapiriit Kanatami. Social determinants of Inuit health in Canada [Internet]. Ottawa: Inuit Tapiriit Kanatami; 2014 [cited 2018 Sep 14]. 5
- Footnote 6
- Power E. Food Security for First Nations and Inuit Background Paper. Ottawa: Prepared for the First Nations and Inuit Health Branch, Health Canada; 2007. 6
- Footnote 7
- Vang ZM, Sigouin J, Flenon A, Gagnon A. Are immigrants healthier than native-born Canadians? A systematic review of the healthy immigrant effect in Canada. Ethn Health. 2017;22(3):209-241. 7
- Footnote 8
- Sanou D, O’Reilly E, Ngnie-Teta I, Batal M, Mondain N, Andrew C, et al. Acculturation and nutritional health of immigrants in Canada: a scoping review. J Immigr Minor Health. 2014;16(1):24-34. 8
- Footnote 9
- Sadeghirad B, Duhaney T, Motaghipisheh S, Campbell NC, Johnston BC. Influence of unhealthy food and beverage marketing on children’s dietary intake and preference: a systematic review and meta-analysis of randomized trials. Obes Rev. 2016;17(10):945-959. 9
- Footnote 10
- Boyland EJ, Nolan S, Kelly B, Tudur-Smith C, Jones A, Halford JC, et al. Advertising as a cue to consume: A systematic review and meta-analysis of the effects of acute exposure to unhealthy food and non-alcoholic beverage advertising on intake in children and adults. Am J Clin Nutr. 2016;103(2):519-533. 10
- Footnote 11
- Statistics Canada. Age and sex, and type of dwelling data: Key results from the 2016 Census [Internet]. Ottawa: Statistics Canada; 2017 [cited 2018 Sep 14]. 11
- Footnote 12
- Chan L, Receveur O, Sharp D, Schwartz H, Ing A, Tikhonov C. First Nations Food, Nutrition and Environment Study (FNFNES): results from British Columbia (2008/2009). Prince George: University of Northern British Columbia; 2011. 12
- Footnote 13
- Chan L, Receveur O, Sharp D, Schwartz H, Ing A, Fediuk KI. First Nations Food, Nutrition and Environment Study (FNFNES): results from Manitoba (2010). Prince George: University of Northern British Columbia; 2012. 13
- Footnote 14
- Chan L, Receveur O, Batal M, William D, Schwartz H, Ing A, et al. First Nations Food, Nutrition and Environment Study (FNFNES): results from Ontario (2011/2012). Ottawa: University of Ottawa; 2014. 14
- Footnote 15
- Chan L, Receveur O, Batal M, William D, Schwartz H, Ing A, et al. First Nations Food, Nutrition and Environment Study (FNFNES): results from Alberta (2013). Ottawa: University of Ottawa; 2016. 15
- Footnote 16
- Chan L, Receveur O, Batal M, William D, Schwartz H, Ing A, et al. First Nations Food, Nutrition and Environment Study (FNFNES): results from the Atlantic (2014). Ottawa: University of Ottawa; 2017. 16
- Footnote 17
- Chan L, Receveur O, Batal M, Sadik T, Schwartz H, Ing A, et al. First Nations Food, Nutrition and Environment Study (FNFNES): results from Saskatchewan (2015). Ottawa: University of Ottawa; 2018. 17
- Footnote 18
- Huet C, Rosol, R, Egeland GM. The prevalence of food insecurity is high and the diet quality poor in Inuit communities. J Nutr. 2012;142(3):541-547. 18
- Footnote 19
- Health Canada. Office of Nutrition Policy and Promotion. Summary data tables on household food insecurity in Canada in 2011-12 [Internal analysis]. 19
- Footnote 20
- Health Canada. Household food insecurity in Canada statistics and graphics (2011 to 2012) [Internet]. Ottawa: Health Canada; 2017 [cited 2018 Sep 14]. 20
- Footnote 21
- Egeland GM, Pacey A, Cao Z, Sobol I. Food insecurity among Inuit preschoolers: Nunavut Inuit Child Health Survey, 2007-2008. Can Med Assoc J. 2010;182(3):243-248. 21
- Footnote 22
- Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada, 2014[Internet]. Toronto: Research to identify policy options to reduce food insecurity (PROOF); 2016 [cited 2018 Sep 14]. 22
- Footnote 23
- Shlisky J, Bloom DE, Beaudreault AR, Tucker KL, Keller HH, Freund-Levi Y, et al. Nutritional Considerations for Healthy Aging and Reduction in Age-Related Chronic Disease. Adv Nutr. 2017;8(1):17-26. 23
- Footnote 24
- Ramage-Morin PL, Garriguet D. Nutritional risk among older Canadians. Health Rep. 2013;24(3):3-13. 24
- Footnote 25