Unveiling the Nexus of Health Disparities: Navigating Food Deserts in Canadian Healthcare

Introduction

Embarking on my Master of Health Studies journey through the course "Critical Foundations in Health Disciplines," I am navigating the relationship between myself as a healthcare professional and the health issues surrounding food deserts and food security within Canada's healthcare systems. Food deserts, represent areas where residents lack access to grocery stores or food markets offering healthy and affordable foods. These areas highlight the prevalence of food insecurity resulting from limited nearby options. Individuals in these food deserts need to rely on corner stores or fast-food establishments, significantly influencing their dietary choices and increasing the risks of obesity and chronic diseases. Across eight major cities in Canada, all but Montreal has areas classified as food deserts, with statistics in Winnipeg showing an impact on 9.1% to 14.5% of its population. Toronto includes thirteen communities with food desert challenges, and Vancouver's lower east side, recognized as one of the nation's poorest areas, further worsens citizens' struggles by restricting access to healthy and affordable food options in its infrastructure (Hilario, K.M., 2021).

Figure 1: Examples of food deserts in Canada. From top left to right: Toronto and Vancouver. From bottom left to right: Saskatoon and Winnipeg (Hilario, K. M., 2021).

Our class discussions explore the interconnections in healthcare, emphasizing how individuals, society, and health outcomes interact. This blog aims to illustrate these connections by:

1. Exploring the concept of health from contemporary perspectives

2. Discussing the impact of social determinants of health (SDoH) and their role in shaping food deserts and insecurity

3. Navigating through the lens of the socio-ecological framework (SEF)

4. Exploring the disproportion of chronic diseases on marginalized communities and strategies for prevention

5. Looking to the future of healthcare in Canada

By sharing these discussions, I will emphasize the need of addressing food deserts as a critical health issue, highlighting the significance of tailored strategies in crafting a more fair and healthier nation for all Canadians.

What is Health?

The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." This definition, proposed in 1948, highlights that health is more than just the absence of illness or disease; it encompasses a holistic state of well-being that includes physical, mental, and social aspects (WHO, 1948). Contemporary perspectives, such as those suggested by McCartney G., et al., (2019), suggest redefining health beyond the traditional WHO definition. These modern views emphasize other aspects of health encompassing emotional, functional, and structural components that extend beyond mere absence of disease (McCartney, G., et al., 2019). As discussed in our class forum the outdated WHO definition, while aspirational, does not consider current medical advancements enabling us to manage and cope with diseases, significantly enhancing overall well-being. Food insecurity, especially prevalent in food deserts, negatively affects health by causing nutritional deficiencies, worsening chronic conditions, and adversely affecting mental health. Efforts to address food insecurity becomes vital in improving overall health outcomes, bridging disparities, and ensuring access to nutritious food for enhanced well-being.

Social Determinants of Health

SDoH significantly influence vulnerability to food deserts and food insecurity, including income disparities, poverty, and limited access to nutritious food due to inadequate nearby stores/markets. As part of our discussions, these determinants encompass factors such as socioeconomic status, education, employment, age, gender, race, social support networks, physical environment, and access to healthcare, significantly shaping an individual's health trajectory (Government of Canada, n.d.). These factors drive individuals in marginalized areas towards less healthy and more affordable alternatives. In communities lacking grocery stores, inadequate physical environments perpetuate food insecurity. Educational disparities, high unemployment rates, and inequitable policies compound these challenges. Racial and ethnic disparities, transportation limitations, language barriers, low health literacy, lack of food education, and insufficient community resources are crucial SDoH factors (Government of Canada, n.d.). Addressing these interconnected determinants through collaborative cross-sector efforts is imperative to reduce food deserts and ensure fair access to healthy food options for all communities. Furthermore, food insecurity itself acts as a SDoH.

The Socio-Ecological Framework and Food Deserts

The SEF serves as a model revealing the intricate interplay between individual health and broader societal factors. This framework reveals how various spheres—ranging from the individual, interpersonal relationships, organizations, and community dynamics to public policies—profoundly affect health outcomes (Lebel et al., 2016). Through my exploration, detailed in blog posts titled "Food Deserts: A Socio-Ecological Framework," "Food Deserts in Canadian Cities: A Comparison using the Socio-Ecological Model," and "Unveiling the Ecosystem of Food Deserts: A Socio-Ecological Perspective," I highlighted the significant influence of personal constraints at the individual level on susceptibility to food deserts. Meanwhile, interpersonal relationships within families and social circles play a pivotal role in shaping dietary preferences. Additionally, the practices of food-related businesses, community-level factors such as proximity to grocery stores, grassroots efforts, and government policies fundamentally decide the presence and distribution of resources creating food deserts. A comparative analysis between Calgary and Montreal revealed disparities in food desert prevalence, driven by urban layout, community initiatives, and differing public policies. Montreal's endeavors to keep competition in low-income areas contrast with Calgary's "CalgaryEATS! Food Action Plan," aiming to address food desert issues (Peters, K. 2022). Effectively addressing food deserts needs a comprehensive, multi-level approach that encompasses individual behaviors, social connections, organizational practices, community characteristics, and government interventions to ensure fair access to healthy food options for all communities.

Chronic Disease, Prevention, and Marginalized Communities

Marginalized communities, such as those indicated in Figure 2, endure disproportionately higher health impacts due to multiple factors such as food insecurity, limited healthcare access, and historical injustices contributing to elevated rates of chronic diseases (Batal, M., et al., 2021). Our class discussions illuminated how biased nutritional information, reduced likeliness to be breast screened and escalating opioid addiction often stem from trauma and generational trauma linked to historical events such as the Indian Act, the Sixties Scoop, Residential School systems, and Indian hospitals. Expanding our exploration, we considered other marginalized groups prevalent within our professions: LGBTQIA2S+ individuals, sex trade workers, Indigenous children and youth, African communities, and unhoused populations.

These marginalized communities disproportionately bear the burden of chronic diseases, significantly burdening healthcare systems and underscoring the imperative need for preventive strategies. Effectively understanding and addressing these chronic diseases necessitate adopting a comprehensive perspective of health within the SEF. This approach considers both individual constraints and wider societal influences. Diet, acknowledged as a critical lifestyle determinant, profoundly affects various chronic conditions, including obesity, cardiovascular disease, hypertension, stroke, type 2 diabetes, metabolic syndrome, certain cancers, and potentially neurological disorders. This interconnectedness underscores the complexity and interdependence among these health challenges (Gropper, S. S., 2023).

The Future of Healthcare in Canada

Various initiatives and programs are actively addressing the challenge of food deserts and insecurity, aiming to create sustainable solutions and ensure access to nutritious food. Private sector involvement, such as mobile grocery stores and food trucks are directly targeting communities lacking access to fresh produce. Alberta Health Services (AHS) is addressing the healthcare needs of marginalized groups, like Indigenous peoples through targeted strategies such as taking crucial steps in understanding community profiles, supplying extended health coverage, and fostering awareness of their history and culture within the healthcare system (AHS, n.d.). The Government of Canada's Local Food Infrastructure Fund (LFIF) dedicates $20 million over two years to support community-based organizations, particularly in Northern and remote regions, building food systems tailored to local needs. Projects, with funding ranging from $100,000 to $500,000, aim to improve access to healthy, local foods for those facing food insecurity. Simultaneously, innovative approaches like bus stop farmers' markets and the Mobile Food Market in Halifax, Nova Scotia, bring fresh, affordable produce to areas in need, fostering healthy and sustainable food systems while promoting community engagement (Johnson, C., 2021). Additionally, the Flashfood app connects consumers with discounted surplus food from local grocery stores, contributing to waste reduction and offering affordable, quality food to users while supporting stores in minimizing food waste. These combined efforts highlight a commitment to tackling food insecurity through multifaceted, community-driven solutions and innovative platforms, ensuring a healthier and more accessible food landscape for the future.

Conclusion

My studies in 'Critical Foundations in Health Disciplines' highlights the links between individuals, communities, and health outcomes. I focus notably on food deserts and security within Canada's healthcare systems. These conversations stress the pressing need to confront the multifaceted challenges posed by food deserts, particularly their profound impact on accessing nutritious foods, especially for marginalized communities. Employing the SEF, we unravel the complex array of factors influencing health, spanning from personal choices and social dynamics to broader societal interventions, revealing stark disparities among cities and advocating for targeted strategies. Recognizing the pivotal role of SDoH and Canada's commitment to universal healthcare, initiatives like the LFIF and platforms such as Flashfood demonstrate collective efforts for fair access to healthy food options at more affordable prices. Our dialogues also underscore the disproportionate burden of chronic diseases on marginalized groups, urging the adoption of preventive strategies integrating individual health decisions into wider societal contexts. Looking forward, Canada's healthcare future hinges on comprehensive, inclusive approaches that address disparities, promote inclusivity, and implement tailored strategies responsive to our diverse population's needs, aiming for a more fair and healthier nation.

References:

Alberta Health Services. (n.d.). Diverse Populations Primary Health Care Resource Centre. Alberta Health Services. Retrieved from https://www.albertahealthservices.ca/info/Page8431.aspx

Batal, M., Chan, H. M., Fediuk, K., Ing, A., Berti, P. R., Mercille, G., Sadik, T., & Johnson-Down, L. (2021). First Nations households living on-reserve experience food insecurity: prevalence and predictors among ninety-two First Nations communities across Canada. Canadian journal of public health = Revue canadienne de sante publique, 112(Suppl 1), 52–63. https://doi.org/10.17269/s41997-021-00491-x

Government of Canada. (n.d.). What Determines Health? Health Promotion and Population Health. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

Gropper S. S. (2023). The Role of Nutrition in Chronic Disease. Nutrients, 15(3), 664. https://doi.org/10.3390/nu15030664

Hilario, K. M. (2021). Food Deserts in Canadian Cities. Retrieved 30 November 2023 from Food Deserts in Canadian Cities (arcgis.com)

Johnson, C. (2021). 5 Innovative Solutions to Food Deserts. Shareable. Retrieved 1 December 2023 from https://www.shareable.net/5-innovative-solutions-to-food-deserts

Lebel, A., Noreau, D., Tremblay, L., Oberlé, C., Girard-Gadreau, M., Duguay, M., & Block, J. P. (2016). Identifying rural food deserts: Methodological considerations for food environment interventions. Canadian Journal of Public Health / Revue Canadienne de Santé Publique, 107(S1), eS21-eS26. Retrieved on October 22, 2023, from https://doi.org/10.17269/CJPH.107.5353

McCartney, G., Popham, F., McMaster, R., & Cumbers, A. (2019). Defining health and health inequalities. Public Health, 172, 22–30. https://doi.org/10.1016/j.puhe.2019.03.023

Peters, K. (2022). CalgaryEATS! Food Action Plan 2022 Progress Update (Report No. CD2022-0460). City of Calgary. Retrieved 29 October 2023 from CalgaryEATS! Food Action Plan 2022 Progress Update (escribemeetings.com)

Tarasuk, V., & Mitchell, A. (2020). Household food insecurity in Canada, 2017-18. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/

World Health Organization. (1948). Constitution of the World Health Organization. couv arabe.indd (who.int)