Indigenous Peoples, settler colonialism, and access to health care in rural and northern Ontario.

In Canada rural and northern communities, particularly Indigenous communities, face challenges disproportionate to their urban counterparts in accessing health care services. Existing health research on rural communities has tended to emphasize and reinforce the rural/urban dichotomy in access to and delivery of services, leaving the notion of "rural" as an under-interrogated concept. Drawing on a qualitative study of health care providers, community members, and Indigenous Elders, we explore Indigenous people's beliefs about vaccination to complicate notions of rurality in order to illuminate the ways in which space and settler colonialism both shape and limit choices around health care access.

"You Need ID to Get ID": A Scoping Review of Personal Identification as a Barrier to and Facilitator of the Social Determinants of Health in North America.

Personal identification (PID) is an important, if often overlooked, barrier to accessing the social determinants of health for many marginalized people in society. A scoping review was undertaken to explore the range of research addressing the role of PID in the social determinants of health in North America, barriers to acquiring and maintaining PID, and to identify gaps in the existing research. A systematic search of academic and gray literature was performed, and a thematic analysis of the included studies (n = 31) was conducted. The themes identified were: (1) gaining and retaining identification, (2) access to health and social services, and (3) facilitating identification programs. The findings suggest a paucity of research on PID services and the role of PID in the social determinants of health. We contend that research is urgently required to build a more robust understanding of existing PID service models, particularly in rural contexts, as well as on barriers to accessing and maintaining PID, especially among the most marginalized groups in society.

Examining Indigenous food sovereignty as a conceptual framework for health in two urban communities in Northern Ontario, Canada.

While land is a nexus for culture, identity, governance, and health, as a concept land is rarely addressed in conversations and policy decisions about Indigenous health and well-being. Indigenous food sovereignty, a concept which embodies Indigenous peoples' ability to control their food systems, including markets, production modes, cultures and environments, has received little attention as a framework to approach Indigenous health especially for Indigenous people living in urban spaces. Instead, discussions about Indigenous food sovereignty have largely focused on global and remote and rural communities. Addressing this gap in the literature, this article presents exploratory work conducted with Waasegiizhig Nanaandawe'iyewigamig and Shkagamik-Kwe Health Centre, two Indigenous-led Aboriginal Health Access Centres in urban service centers located in Northern Ontario, Canada.

A Case Study in Personal Identification and Social Determinants of Health: Unregistered Births among Indigenous People in Northern Ontario.

Under international law, birth registration is considered a human right because it determines access to important legal protections as well as essential services and social supports across the lifespan. Difficulties related to birth registration and the acquisition of personal identification (PID) are largely regarded as problems specific to low-income countries. For Indigenous people in northern and rural Canada, however, lack of PID, like birth certificates, is a common problem that is rooted in the geography of the region as well as historical and contemporary settler colonial policies. This communication elucidates the complicated terrain of unregistered births for those people living in northern Ontario in order to generate discussion about how the social determinants of health for Indigenous people in Canada are affected by PID. Drawing on intake surveys, qualitative interviews and participant observation field notes, we use the case study of "Susan" as an entry point to share insights into the "intergenerational problem" of unregistered births in the region. Susan's case speaks to how unregistered births and lack of PID disproportionately impacts the health and well-being of Indigenous people and communities in northern Ontario. The implications and the need for further research on this problem in Canada are discussed.

Retail food environments, shopping experiences, First Nations and the provincial Norths. / Environnement alimentaire de la vente au détail et expériences de magasinage dans les collectivités des Premières nations du nord des provinces.

INTRODUCTION: This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada. METHODS: We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences. RESULTS: Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%), Saskatchewan (83%) and Manitoba (72%). Respondents to the survey (n = 92) expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods. CONCLUSION: There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.

INTRODUCTION: Cet article porte sur l'environnement de la vente d'aliments dans les collectivités des Premières nations du nord des provinces, en particulier sur la concurrence éventuelle dans la vente au détail de la North West Company (NWC) ainsi que sur les expériences d'achats alimentaires de la population vivant dans le Nord canadien. MÉTHODOLOGIE: Nous avons utilisé deux méthodologies pour évaluer l'environnement alimentaire de la vente au détail dans le Nord. D'abord, nous avons cartographié les détaillants en alimentation du Nord afin d'examiner le degré de concurrence au détail dans les régions nordiques, en prêtant une attention particulière aux collectivités qui ne sont pas accessibles à l'année par la route. Ensuite, nous avons enquêté auprès des personnes vivant dans les collectivités du Nord canadien à propos de leurs expériences d'achat au détail et de magasinage. RÉSULTATS: Cinquante-quatre pour cent des collectivités du nord des provinces et du Grand Nord n'avaient aucune épicerie en concurrence avec la NWC. Les provinces comptant les plus fortes proportions de collectivités nordiques sans concurrence dans la vente au détail étaient l'Ontario (87 %), la Saskatchewan (83 %) et le Manitoba (72 %). Les participants au sondage (n = 92) ont fait état de leurs préoccupations quant à leurs expériences d'achat dans trois grands secteurs : le coût des aliments, la qualité et la fraîcheur des aliments et la disponibilité de certains aliments. CONCLUSION: La concurrence dans la vente au détail est limitée dans le nord des provinces. Au Manitoba, en Saskatchewan et en Ontario, la NWC ne fait face à aucune concurrence dans au moins 70 % des collectivités nordiques. Les consommateurs du Nord canadien considèrent que les aliments nutritifs sont peu abordables, et ils souhaitent avoir accès à un plus grand choix d'aliments périssables en bon état.

Challenges in assessing food environments in northern and remote communities in Canada.

Effective tools for retail food environments in northern and remote communities are lacking. This paper examines the challenges of conducting food environment assessments in northern and remote communities in Canada encountered during our experience with a food costing project. One of the goals of the Paying for Nutrition in the North project is to develop guidelines to improve current food costing tools for northern Canada. Paying for Nutrition illustrates the complex context of measuring food environments in northern and remote communities. Through the development of a food costing methodology guide to assess northern food environments, several contextual issues emerged, including retail store oligopolies in communities; the importance of assessing food quality; informal social food economies; and the challenge of costing the acquisition and consumption of land- and water-based foods. Food environment measures designed for northern and remote communities need to reflect the geographic context in which they are being employed and must include input from local residents.

Social stratification and adolescent overweight in the United States: how income and educational resources matter across families and schools.

The current study examines how poverty and education in both the family and school contexts influence adolescent weight. Prior research has produced an incomplete and often counterintuitive picture. We develop a framework to better understand how income and education operate alone and in conjunction with each other across families and schools. We test it by analyzing data from Wave 1 of the U.S.-based National Longitudinal Study of Adolescent Health (N = 16,133 in 132 schools) collected in 1994-1995. Using hierarchical logistic regression models and parallel indicators of family- and school-level poverty and educational resources, we find that at the family-level, parent's education, but not poverty status, is associated with adolescent overweight. At the school-level, the concentration of poverty within a school, but not the average level of parent's education, is associated with adolescent overweight. Further, increases in school poverty diminish the effectiveness of adolescents' own parents' education for protecting against the risks of overweight. The findings make a significant contribution by moving beyond the investigation of a single socioeconomic resource or social context. The findings push us to more fully consider when, where, and why money and education matter independently and jointly across health-related contexts.

The multidimensional relationship between early adult body weight and women's childbearing experiences.

This study has three primary goals that make an important contribution to the literature on body weight and childbearing experiences among United States' women. It sheds light on the physiological and social nature of this relationship by examining whether the consequences of early adult weight for lifetime childbearing are shaped by historical social context, women's social characteristics, and their ability to marry. We analyze data from two female cohorts who participated in the National Longitudinal Study of Youth (NLSY79). Cohort 1 entered early adulthood before the U.S. obesity prevalence increased. Cohort 2 entered early adulthood after the obesity prevalence increased. We find that early adult weight is negatively related to the childbearing trajectories and marital status of Cohort 1 but not Cohort 2. Failing to account for race/ethnicity and women's educational background as confounders masks some of these associations, which are evident for both White and Black women. Our results suggest that the health consequences of body weight do not fully drive its impact on childbearing. Rather, the lifetime fertility consequences of early adult weight are malleable, involve social processes, and are dependent on social context.