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A Spotlight Article from the Coalition's Special Project on Food-Based Dietary Guidelines (FBDGs) Incorporating Sustainability
While FAO and other agencies recommend that FBDGs be developed and implemented in a multisectoral, multistakeholder, inclusive process (Wijesinha-Bettoni et al, 2021), there is a need to better describe what this means, in particular, for specific population groups such as indigenous peoples.
How can the process to develop or revise and implement FBDGs take into consideration indigenous perspectives, be inclusive and contribute to equity?
The United Nations has described Indigenous peoples as: “inheritors and practitioners of unique cultures and ways of relating to people and the environment. They have retained social, cultural, economic and political characteristics that are distinct from those of the dominant societies in which they live.” And while examples of the resiliency of Indigenous Peoples abound (Ford, JD, 2020), the loss of traditional culture and practices as well as historical traumas and colonialism have impacted health outcomes of Indigenous Peoples all over the world and across the life course, as has been seen during the Covid-19 pandemic (Power, T, et al, 2020).
Consumer food-related behaviours – including what, how, where and when people acquire, store, prepare, eat and dispose of food– vary across social, economic, demographic attributes among others and so do dietary patterns, therefore dietary guidance becomes more relevant as it considers these multiple aspects of dietary behaviour. However, Indigenous Peoples not only have unique lived experiences and practices regarding food and eating, but also their own ways of knowing, doing and being (Cochran et al. 2008). Therefore, there is a need to consider how Indigenous Peoples’ perspectives can be included in the development or revision and implementation of dietary guidance in the countries in which they live, while maintaining the necessary academic rigor and standards for scientific evidence that underpin the credibility of dietary guidelines. For this purpose, we share efforts in Canada and Australia.
In 2007, Health Canada released a revised Food Guide with new features and title – Eating Well with Canada’s Food Guide that, for the first time, included a tailored a Canadian Food Guide for First Nations, Inuit and Métis people (CFG-FNIM). The First Nations, Inuit and Métis are the constitutionally recognized Indigenous Peoples of Canada. This tailored guide recognized the importance of both traditional and store-bought foods in contemporary food patterns of Aboriginal Peoples. The CFG-FNIM was translated into Cree, Ojibwa and Inuktitut in addition to French and English.
The creation of this tailored guide was a participatory process with Indigenous governing councils, academics and specialists in the field of Indigenous nutrition, public health and food sciences. Health Canada officials consulted with the Inuit Tapiriit Kanatami, Métis National Council and Federal Provincial Territorial Group on Nutrition. Additionally, two Indigenous dieticians were part of the National Nutrition Advisory Group for the writing of the tailored guide (FAO, forthcoming).
While the dietary guidelines of Canada were revised in 2019, the 2007 tailored food guide are still cited as the recommendations for the Indigenous Peoples of Canada (Health Canada, 2021). The 2019 revision process involved a smaller group of experts for the inclusion of information regarding traditional foods and public health information for Indigenous Peoples of Canada.
In Australia, the Centre of Research Excellence in Aboriginal Chronic Disease Knowledge Translation and Exchange and the Aboriginal and Torres Strait Islander peoples co-created a tool consisting of 14 questions for editors, reviewers, funders and researchers to appraise the quality of studies and consider processes and outcomes with and for the benefit of Aboriginal and Torres Strait Islander peoples (Harfield, 2018). This could inform evidence gathering efforts and inclusivity for FBDGs.
There remains a wide disparity in the available evidence and the inclusion of Indigenous perspectives for the development, revision and implementation of FBDGs is still rare. Addressing evidence disparities and engaging Indigenous expertise in a co-creation process can start to address the nutrition gap among Indigenous Peoples not only in Canada and Australia but in many other countries.
References
Cochran PA, Marshall CA, Garcia-Downing C, Kendall E, Cook D, McCubbin L, Gover RM. Indigenous ways of knowing: implications for participatory research and community. Am J Public Health. 2008 Jan;98(1):22-7. doi: 10.2105/AJPH.2006.093641. Epub 2007 Nov 29. PMID: 18048800; PMCID: PMC2156045.
FAO (forthcoming) Inclusion of different perspectives in FBDGs. The case of Indigenous Peoples’ engagement in the Canada Food Guide. Rome, FAO
Ford, J.D., King, N., Galappaththi, E.K., Pearce, T., McDowell, G. and Harper, S.L., 2020. The resilience of indigenous peoples to environmental change. One Earth, 2(6), pp.532-543.
Harfield S, Pearson O, Morey K, Kite E, Glover K, Canuto K, Streak Gomersall J, Carter D, Davy C, Aromataris E, Braunack-Mayer A. 2018. The Aboriginal and Torres Strait Islander Quality Appraisal Tool: Companion Document. Adelaide, Australia: South Australian Health and Medical Research Institute,
Health Canada. 2021. Revision process for Canada's food guide. In: Government of Canada. Canada’s food guide. Accessed 16 June 2022. https://www.canada.ca/en/health-canada/services/canada-food-guide/about/revision-process.html#a5
Power T, Wilson D, Best O, et al. 2020. COVID-19 and Indigenous Peoples: An imperative for action. J Clin Nurs;29(15-16):2737-2741. doi:10.1111/jocn.15320
Wijesinha-Bettoni, R., Khosravi, A., Ramos, A. I., Sherman, J., Hernandez-Garbanzo, Y., Molina, V., ... & Hachem, F. (2021). A snapshot of food-based dietary guidelines implementation in selected countries. Global Food Security, 29, 100533.