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NUNAVUT/NORTHWEST TERRITORIES: Healthy Foods North – A culturally appropriate and community-based program to promote healthy eating and lifestyle

“Working with stores, workplaces, and community partners, the Healthy Foods North program aims to make healthy foods more available and affordable”

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Partners:
Government of Nunavut (NU), University of North Carolina at Chapel Hill, Nutrition Research Institute Kannapolis, American Diabetes Association, Government of Northwest Territories (NWT), Arctic Co-operatives Limited, and North West Company

Communities:
Cambridge Bay and Taloyoak, NU
Inuvik and Tuktoyaktuk, NWT

Population of Communities:
From 809 – 3,484

Target Group:
Inuit and Inuvialuit

Project Principles:
Promote traditional food and activities; Improve people's diet; Provide nutrition education; Increase physical activity; Reduce risk of obesity and disease

Implementation Level:
Inter-Territorial

Stage of Development:
Ongoing

Background

In Northern communities of Nunavut and Northwest Territories, risk factors for chronic diseases such as heart disease and diabetes are high. This is largely attributed to a rapid transition in the Arctic diet and lifestyle. Physical activity levels are decreasing with less hunting activity and increased dependence on cars, snowmobiles and all terrain vehicles for transportation. Traditional foods are increasingly replaced with processed foods high in sugar and fat, and low in fibre and nutrients. Based on this potential burden of disease, the need for intervention was recognized by the territory. The Healthy Foods North (HFN) program was established by the Government of Nunavut to promote traditional foods and activities, improve people's diet, increase physical activity, and reduce the risk of obesity and chronic disease.

By working closely with local Inuit and Inuvialuit community groups, program leaders have developed a multi-level intervention program that functions at the individual, household and community level. Led by project managers Cindy Roache (Nunavut) and Elsie De Roose (Northwest Territories), the program is currently taking place in four communities: Cambridge Bay, Taloyoak, Inuvik and Tuktoyaktuk. The project involves two main interventions:

  1. Store interventions: including taste tests, cooking demonstrations, posters, flyers, and shelf labels with the Healthy Foods North logo identifying healthier alternatives; and
  2. Community component: integration of activities into workplaces and community events including coffee station makeovers, health fairs, school programs, the use of local media, as well as promoting traditional foods in cooking classes and walking programs.

Interventions are tailored for each community based on input from community members. Local residents are employed as much as possible to carry out the program.

Healthy Foods North
Image Credit: Healthy Foods North

Partnerships

From the beginning, the Healthy Foods North project has been guided by the philosophy that it remains community-driven and community-owned. The program has brought together partners from all sectors including government, community organizations, stores and workplaces. The program is unique in that so many different groups in the community are involved – in Inuvik, a community of 3,484, it is rare to meet someone who has not heard of the program.

Partner organizations at all levels, as well as within the communities, provide guidance on who to approach, which stakeholders to involve, and who will provide feedback on the materials and activities. Capacity building has been an immensely important part of the success and sustainability of the program. In Taloyoak, the Hamlet has essentially taken over the program. In other cases, the communities are now putting their own programs under the Healthy Foods North banner. Everybody knows the program, recognizes the logo, and in Nunavut, all materials are translated into Inuktitut and Inuinnaqtun. Because Healthy Foods North is completely accepted, it has become a natural umbrella for other programs.

Generating Buy-In

Getting partners to the table was not a challenge – the project leaders did numerous presentations to local boards and community groups, and the word spread quickly. Now it has come full circle and people are coming forward and asking how they can help. Many are volunteering their time to hang posters, help facilitate taste tests and coffee station makeovers, give out pedometers, and host walking groups.

The project would not be successful without its incredible partnerships. Healthy Foods North (HFN) has multiple partners who contribute funding, in-kind contributions and staff time. Local grocery stores have been very involved, and store managers have worked with Healthy Foods North so that when people ask questions, they know what to recommend (e.g., products high in fibre and low in sugar).

Lessons Learned

The project leaders have identified three important lessons learned, including:

  1. Importance of building partnerships – as the program has grown it has had a “snowball effect,” and many people now want to be a part of it;
  2. Listening to the community – from the beginning, HFN has used a bottom-up as opposed to a top-down approach; and
  3. Building capacity –the goal is to make the program sustainable so that when a researcher leaves or funding ends, the program will continue.

Several factors have contributed to the success of the program including: (1) Excellent communication skills; (2) Involving the community at all stages; and (3) Doing formative evaluation work. The project team spent one to two years doing background work and gathering baseline data. They subsequently presented the information and asked the community to help them create solutions. Community members identified what was important for them, which foods they wanted to intervene on, and recommended culturally acceptable foods and messages they would like to recommend as alternatives. The project team also worked with the stores and community leaders to identify their issues. This approach laid the foundation for the program.

More and more communities are now requesting to be part of Healthy Foods North. The very success of the program, and the fact that it is growing so fast, has led to new challenges. The project team is challenged to recruit and train new people, and to continue the project’s solid research methodology as the program expands.

For each community, the program is based on information collected in that community. Following the gathering of baseline data, there is a community workshop. Finally, there is the development of materials, and translation into local languages. Currently, four communities are running the program and the communities of Gjoa Havan, NU and Ulukhaktok, NWT will start the program in fall 2009. Word is spreading fast and other communities have already approached the government asking how they can start the program. The fact that other communities are coming forward and requesting the program is an incredible and totally unanticipated spin-off.

Another unanticipated spin-off was the growth of the program’s own objectives. The program grew from its initial focus on promoting healthy eating and physical activity to incorporating nutrition education. Cancer, obesity, diabetes, heart disease, hypertension, and stroke are all nutrition related, and as the Arctic diet has undergone a rapid transition, it has affected all of these chronic diseases. Although they did not originally set out to, the project has grown to address all of these conditions by addressing nutritional inadequacies in the local diet. Additionally, the Government of Nunavut has incorporated Healthy Foods North into the Department’s Public Health Strategy and is using the project to inform Departmental decision-making and policy development.

Advice to Other Communities

The principal investigator, Dr. Sangita Sharma, and a consultant, Dr. Joel Gittelsohn, who are providing the expertise for the Healthy Foods North project, have substantial experience working on similar community-based food store intervention programs. Their other projects have ranged from inner-city to rural settings in the United States and Canada, including healthy stores projects in inner-city Baltimore, and on two Apache Indian reservations, and a diabetes project with First Nations in Northwest Ontario. Because the project is community-driven, it can be adapted to almost any setting. The underlying framework is to:

  • Do formative work including collecting background information and baseline data;
  • Find out what is going on in the community, who are the key players, what the problems are, and what the priorities are for the local community; and
  • Build partnerships by getting everyone around the table discussing their issues and working together to address them.

Evaluation and Impact

The interventions that are currently running will continue for a period of 12 months. During the next phase, post-intervention information will be collected on participant’s height, weight, amount of physical activity, and diet. Through questionnaires, other factors such as food and nutrient intake, and amount of money spent on food will be collected as part of the overall assessment. There is also process information collected during each phase, as well as food costing. Data will be used to compare results pre- and post-intervention. Results will be disseminated to local communities, governments, and to journals, and will hopefully be used to effect policy and strategy development.

It is still too early to know what the health outcomes will be, but one store has already ordered 35% more fruits and vegetables since the program began. Participating grocery stores have reported that products promoted by Healthy Foods North are flying off the shelves. The program has not been successful with all foods, but the majority of promoted foods have gone over really well. Some successful examples include using skim milk powder over coffee creamers, replacing chips with homemade popcorn, adding frozen vegetables to meat-based stews, and using fruit in smoothies. Promoting local foods such as fish (e.g., Arctic char), and traditional meats such as muskox or caribou, is also important to the program because they are full of essential nutrients.

The long-term goal is to expand Healthy Foods North throughout Nunavut and the Northwest Territories. The emphasis on building capacity in the communities has paid off, and the many requests to expand the program speak more to the success of the program than anything.

Contact

Program Contact - Nunavut

Cindy Roache, Healthy Foods North
Department of Health and Social Services
P.O. Box 1000, Station 1000
Iqaluit, NU X0A 0H0
Telephone: 867-975-5729

Program Contact – Northwest Territories

Healthy Foods North
c/o Elsie De Roose, Territorial Nutritionist
Department of Health and Social Services
Box 1320
Yellowknife NT X1A 2L9
Telephone:  867-873-7925

Dr. Sangita Sharma
Endowed Chair in Aboriginal Health
University of Alberta, Professor of Aboriginal and Global Health Research
Aboriginal and Global Health Research Group
Faculty of Medicine, 5-10 University Terrace
8303-112 St.
Edmonton, Alberta, T6G 2T4
Email: gita.sharma@ualberta.ca

Resources

Healthy Foods North
This link will take you to another Web site (external site)www.healthyfoodsnorth.ca

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