Type 2 diabetes mellitus (T2DM) is one of the most common preventable chronic diseases in Canada, affecting 3.7 million Canadians. It has serious consequences for individuals, including a higher risk of heart attack, stroke and kidney failure, their families and the health-care system.
Indigenous peoples bear a disproportionate burden: First Nations on reserve have T2DM rates three to five times higher than the rest of Canada. Yet, they remain underserved and underrepresented in health policy and decision-making. Since T2DM has no cure, prevention must address the social determinants of health – the social, environmental and economic factors that shape well-being.
Food insecurity – the lack of reliable access to affordable, nutritious food – is a critical determinant of T2DM risk. Food-insecure adults are twice as likely to have diabetes. Rates of food insecurity among Indigenous households are two to six times higher than the national average, with nearly half of First Nations people on reserve experiencing food insecurity.
Historical injustices, including loss of land and forced displacement, have harmed food security and sovereignty. Traditional foods (TFs) such as fish, game and berries have been essential for nutrition and culture. However, many communities have shifted toward market foods (MFs) that are more processed and less nutritious. This dietary transition is linked to increased obesity – a major T2DM risk factor.
Food in remote Indigenous communities is often unaffordable. In Nunavut, staple items cost twice as much as in southern Canada. In more than 50 per cent of Northern communities, a single North West Company store is the only grocery outlet, often without year-round road access.
Families may sacrifice food to pay for other essentials. Food scarcity also increases stress, which worsens insulin sensitivity and diabetes risk. High costs of harvesting TFs and producing local food, including fuel and equipment, further push families toward cheaper, less nutritious MFs.
Among Cree children in Grades 4-6, diets are dominated by sweetened beverages and snacks, with inadequate calcium and Vitamin D intake. These diets meet calorie needs but lack nutrients, contributing to insulin resistance. Poor eating habits in childhood perpetuate a cycle of poor health.
The federal government has tried to respond. Nutrition North Canada subsidizes retailers to reduce food prices, but the savings passed to consumers are unclear. During the COVID-19 pandemic, $100 million was allocated to food banks. While important for emergency relief, food banks are a short-term solution to a long-term problem.
Evidence shows that food security programs designed, governed, and led by Indigenous communities are the most effective. Examples include:
- Community greenhouses in Inuvik, Northwest Territories, extend growing seasons from mid-May to late September.
- Kuujjuaq, Nunavik, where greenhouses were used to meet several nutritional requirements and reduce dependency on costly imports.
- Harvest-sharing programs in Northern Ontario First Nations, that provided snow goose and other TFs to families unable to hunt, improving nutrition and cultural ties.
- Discount programs, as shown in a Danish web-based supermarket study, in which price reductions have led to healthier purchases.
These initiatives are participatory, culturally grounded and tailored to local needs.
Addressing food insecurity in Indigenous communities is about more than food access. It is about:
- Preventing T2DM and other chronic diseases.
- Preserving cultural identity through traditional diets.
- Restoring control over local food systems.
Food sovereignty is health sovereignty and will help create a future where every community has access to healthy food.
