It has been a year since Health Canada released the new Canada’s Food Guide, which includes the “food guide snapshot” and accompanying web-based tools. The tools take a broad approach to healthy eating and its complexities; however, the underlying factors that affect food choices, such as race, culture, physical environments, and income (i.e., the determinants of health) are not addressed in the public-facing tools.

Health Canada has included a discussion of health inequities and the determinants of health in Canada’s Dietary Guidelines for Health Professionals and Policy Makers, a companion document to the food guide. The guidelines state that “addressing the determinants of health and reducing health inequities is required to help Canadians make healthy food choices.”[1] Household food insecurity, which is primarily due to the lack of income to buy healthy food, and limited access to traditional Indigenous foods due to the impacts of colonization, are two inequities highlighted in the guidelines.[1] These are both food security priorities at the BC Centre for Disease Control.  

Incorporating the dietary guidelines into your practice

Understand the circumstances that affect client’s food choices

As the common first point of contact for people accessing the health care system, physicians play an important role in understanding the determinants of health (e.g., food insecurity) that may prevent their clients from accessing a healthy diet. The prevailing approach to addressing food insecurity is to refer people to charitable food outlets such as food banks; however, these are short-term programs and have limited reach because of stigma and other barriers.[2] Research shows only 21% of food-insecure households access food banks and that increasing households’ financial resources is a more effective solution.[2-4] Resources exist to support physicians in discussions about life circumstances that impact access to healthy food.

The Kootenay Boundary Division of Family Practice’s Poverty Intervention Tool helps physicians identify socioeconomic challenges faced by clients and connects them with appropriate supports and services, such as social assistance programs.[5] The Northern Health Authority also developed a resource to guide health professionals in addressing food insecurity.[6]

Advocate for healthy public policy

Physicians have a long history of advocating for policy change and are often asked by decision makers to provide evidence-based interventions. By influencing public policy and impacting upstream barriers to healthy eating, physicians can facilitate change at a population level. Pinto and Bloch provide a primary care framework to address the determinants of health at an individual, organizational, and systemic-level.[7] As well, various advocacy tools and research exist to inform advocacy efforts. For example the First Nations Food, Nutrition and Environment Study provides a number of systems-level changes to support Indigenous people’s access to both healthy food and their traditional food, which supports physical, mental, and spiritual health.[8]

The dietary guidelines raise the importance of addressing the determinants of health and can support health professionals to make more informed recommendations in practice, programs, and policies. As trusted leaders, physicians can use these guidelines to amplify their voices to address inequities and in turn improve health.
—Henry Lau, RD
—Melanie Kurrein, MA, RD
Population Public Health, BC Centre for Disease Control, a part of Provincial Health Services Authority

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This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Health Canada. Canada’s dietary guidelines for health professionals and policy makers. 2019. Accessed 29 November 2019. https://food-guide.canada.ca/static/assets/pdf/CDG-EN-2018.pdf.

2.    Tarasuk V, Fafard St-Germain A, Loopstra R. The relationship between food banks and food insecurity: Insights from Canada. Voluntas 2019:1-12.

3.    Li N, Dachner N, Tarasuk V, et al. Priority health equity indicators for British Columbia: Household food insecurity indicator report. 2016. Accessed 17 December 2019. www.bccdc.ca/pop-public-health/Documents/Household%20food%20insecurity%20in%20BC_full%20report.pdf.

4.    Brown EM, Tarasuk V. Money speaks: Reductions in severe food insecurity follow the Canada Child Benefit. Prev Med 2019;129:105876.

5.    Kootenay Boundary Division of Family Practice. Poverty intervention tool. Accessed 4 December 2019. www.divisionsbc.ca/kootenay-boundary/our-impact/social-determinants-of-health/poverty-intervention-tool.

6.    Northern Health Authority. Household food insecurity: Guidelines for health professionals. 2019. Accessed 10 December 2019. www.northernhealth.ca/sites/northern_health/files/health-professionals/public-health-nutrition/documents/household-food-insecurity-guidelines.pdf.

7.    Pinto AD, Bloch G. Framework for building primary care capacity to address the social determinants of health. Can Fam Physician 2017;63:e476-e482.

8.    Chan L, Batal M, Sadik, et al. First Nations food nutrition and environment study. Final report for eight Assembly of First Nations regions: Draft comprehensive technical report. 2019. Accessed 11 December 2019. www.fnfnes.ca/docs/FNFNES_draft_technical_report_Nov_2__2019.pdf.