Exploring Healthy Eating Perceptions, Barriers, and Facilitators among Urban Indigenous Peoples in Saskatchewan.

Urban Indigenous populations encounter distinctive challenges in maintaining traditional dietary practices, compounded by the complexities of socio-economic and environmental factors and the modern urban lifestyle. This qualitative study explores the perceptions of healthy eating, along with the facilitators and barriers to such practices, among urban Indigenous peoples in Saskatoon, Regina, and Prince Albert. Through virtual interviews, we engage 14 participants from these cities. Utilizing NVivo for thematic coding, we apply inductive thematic analysis to reveal relevant themes. The study highlights a preference for nutrient-rich, natural, and minimally processed foods, with a significant emphasis on incorporating traditional Indigenous foods into diets. These preferences are deeply entwined with cultural identity and underscore the importance of traditional foods in maintaining cultural heritage and promoting well-being. Despite the intrinsic value of these traditional foods, participants face several barriers to healthy eating, including economic constraints, limited access to traditional foods, and the psychological impacts of historical trauma. Nevertheless, facilitators such as community and family support, engagement in traditional food practices, and a growing awareness of nutritional knowledge are identified as being crucial in supporting healthy dietary choices. This research underscores the complex interplay of cultural, economic, and environmental factors in shaping the dietary practices of urban Indigenous peoples.

Design and implementation of the Our Health Counts (OHC) methodology for First Nations, Inuit, and Metis (FNIM) health assessment and response in urban and related homelands.

OBJECTIVES: Methods for enumeration and population-based health assessment for First Nations, Inuit, and Metis (FNIM) living in Canadian cities are underdeveloped, with resultant gaps in essential demographic, health, and health service access information. Our Health Counts (OHC) was designed to engage FNIM peoples in urban centres in "by community, for community" population health assessment and response. METHODS: The OHC methodology was designed to advance Indigenous self-determination and FNIM data sovereignty in urban contexts through deliberate application of Indigenous principles and linked implementation strategies. Three interwoven principles (good relationships are foundational; research as gift exchange; and research as a vehicle for Indigenous community resurgence) provide the framework for linked implementation strategies which include actively building and maintaining relationships; meaningful Indigenous community guidance, leadership, and participation in all aspects of the project; transparent and equitable sharing of project resources and benefits; and technical innovations, including respondent-driven sampling, customized comprehensive health assessment surveys, and linkage to ICES data holdings to generate measures of health service use. RESULTS: OHC has succeeded across six urban areas in Ontario to advance Indigenous data sovereignty and health assessment capacity; recruit and engage large population-representative cohorts of FNIM living in urban and related homelands; customize comprehensive health surveys and data linkages; generate previously unavailable population-based FNIM demographic, health, and social information; and translate results into enhanced policy, programming, and practice. CONCLUSION: The OHC methodology has been demonstrated as effective, culturally relevant, and scalable across diverse Ontario cities.

RéSUMé: OBJECTIFS: Les méthodes de dénombrement et d'évaluation populationnelle de la santé des personnes des Premières Nations, des Inuits et des Métis (PNIM) vivant dans les villes du Canada sont sous-développées, ce qui laisse des lacunes dans les informations essentielles sur le profil démographique, la santé et l'accès aux services de santé. Le projet Notre santé compte (NSC) vise à collaborer avec les personnes des PNIM dans les centres urbains au moyen d'une évaluation de la santé des populations et d'une intervention « pour nous-mêmes, par nous-mêmes ¼. MéTHODE: La méthode NSC est conçue pour renforcer l'autodétermination autochtone et la souveraineté des données des PNIM vivant en milieu urbain par l'application délibérée de principes autochtones et de stratégies de mise en œuvre connexes. Trois principes imbriqués (« les bonnes relations sont fondamentales ¼; « la recherche en tant qu'échange de cadeaux ¼; et « la recherche comme vecteur de résurgence des communautés autochtones ¼) constituent le cadre de stratégies de mise en œuvre connexes : l'établissement et le maintien actifs de relations; la guidance, la participation et le leadership significatifs des communautés autochtones dans tous les aspects du projet; le partage transparent et équitable des ressources et des avantages du projet; et les innovations techniques, dont l'échantillonnage en fonction des répondants, les enquêtes de santé exhaustives et personnalisées, et les couplages avec les fonds de données de l'Institut de recherche en services de santé (ICES), pour produire des indicateurs d'utilisation des services de santé. RéSULTATS: L'approche NSC a réussi dans six agglomérations urbaines de l'Ontario : à renforcer la souveraineté des données et la capacité d'évaluation de la santé des populations autochtones; à recruter et à mobiliser de vastes cohortes représentatives des PNIM vivant en milieu urbain et sur les territoires connexes; à personnaliser des enquêtes de santé exhaustives et des couplages de données; à générer des informations démographiques, sanitaires et sociales non disponibles auparavant sur les populations des PNIM; et à traduire ces résultats en politiques, en programmes et en pratiques améliorés. CONCLUSION: Il est démontré que la méthode NSC est efficace, culturellement appropriée et modulable dans différentes villes de l'Ontario.

Our Health Counts: Examining associations between colonialism and ever being incarcerated among First Nations, Inuit, and Métis people in London, Thunder Bay, and Toronto, Canada.

OBJECTIVES: Indigenous peoples have a disproportionately high prevalence of incarceration in the Canadian justice system. However, there is limited Indigenous-driven research examining colonialism and the justice system, specifically associations between racism, externally imposed family disruptions, and history of ever being incarcerated. Therefore, this study examined the association between the proportion of previous incarceration and family disruption, experiences of racism, and victimization for Indigenous adults in London, Thunder Bay, and Toronto, Ontario, Canada. The three communities expressed that they did not want comparison between the communities; rather, they wanted analysis of their community to understand where more supports were needed. METHODS: Indigenous community partners used respondent-driven sampling (RDS) to collect data from First Nations, Inuit, and Métis (FNIM) peoples in London, Thunder Bay, and Toronto. Prevalence estimates, 95% confidence intervals, and relative risk were reported using unweighted Poisson models and RDS-adjusted proportions. RESULTS: Proportions of ever being incarcerated ranged from 43.0% in London to 54.0% in Toronto and 72.0% in Thunder Bay. In all three cities, history of child protection involvement and experiencing racism was associated with an approximate 25.0% increase in risk for previous incarceration. In Toronto and London, victimization was associated with increased risk for incarceration. CONCLUSION: This research highlights disproportionately high prevalence of ever being incarcerated among FNIM living in three Ontario cities. Experiencing racism, family disruption, and victimization are associated with incarceration. Decreasing the rates of family disruption, experiences of racism, and victimization should inform future policy and services to reduce the disproportionately high prevalence of incarceration for FNIM people living in urban settings.

RéSUMé: OBJECTIFS: Les personnes autochtones présentent une prévalence démesurément élevée d'incarcération dans le système judiciaire canadien. Il y a cependant peu d'études dirigées par des Autochtones sur le colonialisme et le système judiciaire, en particulier sur les associations entre le racisme, les perturbations familiales imposées de l'extérieur et les antécédents d'incarcération. C'est pourquoi nous avons fait porter notre étude sur l'association entre la proportion d'incarcérations antérieures et de perturbations familiales, les expériences de racisme et la victimisation chez les adultes autochtones vivant à London, Thunder Bay et Toronto (Ontario), au Canada. Les trois villes ont dit ne pas vouloir que nous fassions de comparaisons entre elles; elles voulaient plutôt des analyses de leur ville pour savoir où des mesures de soutien supplémentaires étaient nécessaires. MéTHODE: Des partenaires associatifs autochtones ont utilisé l'échantillonnage en fonction des répondants (EFR) pour collecter des données auprès des personnes des Premières Nations, des Inuits et des Métis (PNIM) à London, Thunder Bay et Toronto. Les estimations de prévalence, les intervalles de confiance de 95 % et le risque relatif ont été présentés à l'aide de modèles de Poisson non pondérés et de proportions ajustées selon l'EFR. RéSULTATS: La proportion de répondantes et de répondants ayant déjà été incarcérés était de 43 % à London, de 54 % à Toronto et de 72 % à Thunder Bay. Dans les trois villes, la fréquentation des services de protection de l'enfance et l'expérience du racisme étaient associées à une hausse d'environ 25 % du risque d'incarcération antérieure. À Toronto et à London, la victimisation était associée à un risque accru d'incarcération. CONCLUSION: Cette étude souligne la prévalence démesurément élevée de l'incarcération antérieure chez les personnes PNIM vivant dans trois villes de l'Ontario. L'expérience du racisme, les perturbations familiales et la victimisation étaient associées à l'incarcération. La réduction des taux de perturbations familiales, d'expérience du racisme et de victimisation devrait éclairer les politiques et les services futurs afin de réduire la prévalence démesurément élevée de l'incarcération chez les personnes PNIM vivant en milieu urbain.

Mapping pandemic responses in urban Indigenous Australia: Reflections on systems thinking and pandemic preparedness.

OBJECTIVES: We investigate some of the strengths and challenges associated with Covid-19 responses in urban Indigenous communities in Brisbane, Australia. Our research reflects on the interconnected dynamics that impact health outcomes and mitigate or exacerbate the risk of Covid-19 spreading within urban Indigenous communities. METHODS: Three systems thinking workshops were held in 2021 with Indigenous and non-Indigenous stakeholders (N15/workshop) from State and Federal services, along with Aboriginal Community Controlled Health Organisations. All worked in the urban Indigenous health sector. Stakeholders produced a Causal Loop Diagram (CLD) incorporating the critical feedbacks determining the dynamics influencing health outcomes. The aim of the research was to help stakeholders' build awareness of how the structure of the system influences health outcomes. RESULTS: Stakeholders identified 6 key dynamics which have a negative or positive impact on mitigating risks of Covid-19 infection. By mapping these dynamics within a CLD, 7 intervention points were identified. CONCLUSIONS: Systems thinking provides a useful tool in identifying the complexities associated with navigating health challenges, but further research is needed to develop frameworks that work in conjunction with Indigenous Australian methodologies. IMPLICATIONS FOR PUBLIC HEALTH: Indigenous voices and communities must lie central to health responses/policies for Indigenous peoples. When systems thinking is done by or in collaboration with stakeholders it provides a visual language that can help design public health policy. What can be ascertained is that their effectiveness is predicated on systems thinking's integration with Indigenous methodologies that acknowledges Indigenous self-determination and challenges Eurocentric representations of health and Indigeneity.

Exploring the Implications of COVID-19 on Food Security and Coping Strategies among Urban Indigenous Peoples in Saskatchewan, Canada.

The COVID-19 pandemic has notably impacted food security, especially among urban Indigenous communities. This study aimed to examine the impact of the pandemic and related lockdown measures on the food security of urban Indigenous peoples in Saskatchewan, Canada. In partnership with Indigenous co-researchers, we designed an online survey disseminated via SurveyMonkey® (San Mateo, CA, USA) from August 2021 to August 2022. This survey detailed background information, the Household Food Security Survey Module (HFSSM), state of food access, and traditional food consumption habits. Of the 130 Indigenous respondents, 75.8% were female, 21.9% male, and 2.3% non-binary, with an average age of 36.2 years. A significant 68.4% experienced food insecurity during the pandemic's first four months. Increased food prices (47.1%) and reduced market availability (41.4%) were the dominant causes. Additionally, 41.8% highlighted challenges in accessing traditional foods. Relying on community resources and government food distribution programs (40.7%) was the most reported coping strategy for those experiencing food insecurity. Notably, 43.6% reported receiving no government financial support during the crisis. This study emphasizes the severe food insecurity among urban Indigenous communities in Saskatchewan during the pandemic. The findings highlight the immediate need for interventions and policies that ensure access to culturally relevant food, especially for future crises.

The neoliberal multicultural state and the urban Indigenous associative model in Santiago de Chile.

This article argues that since the recovery of democracy in Chile in the early 1990s, the state has been reshaping the Indigenous socio-political landscape by adopting neoliberal multiculturalism as a governance model. By not posing significant challenges to the state's neoliberal political and economic priorities, Indigenous cultural activity has been carefully channelled to meet state expectations of what constitutes urban indigeneity. Drawing on the minority and multicultural studies literature and ongoing ethnographic fieldwork, this article analyses how Mapuche civil society navigates the complexities of two relational models of state/ethnic minority interaction: ethno-bureaucracy and strategic essentialism. Although Mapuche associations have tried to accommodate their interests within the limits of neoliberal multiculturalism, the article argues that this governance model has established incentives for inclusion and exclusion in the socio-political apparatus, resulting in a fragmentation of the Mapuche associative landscape in urban Chile.

Interventions for Indigenous Peoples making health decisions: a systematic review.

BACKGROUND: Shared decision-making facilitates collaboration between patients and health care providers for informed health decisions. Our review identified interventions to support Indigenous Peoples making health decisions. The objectives were to synthesize evidence and identify factors that impact the use of shared decision making interventions. METHODS: An Inuit and non-Inuit team of service providers and academic researchers used an integrated knowledge translation approach with framework synthesis to coproduce a systematic review. We developed a conceptual framework to organize and describe the shared decision making processes and guide identification of studies that describe interventions to support Indigenous Peoples making health decisions. We conducted a comprehensive search of electronic databases from September 2012 to March 2022, with a grey literature search. Two independent team members screened and quality appraised included studies for strengths and relevance of studies' contributions to shared decision making and Indigenous self-determination. Findings were analyzed descriptively in relation to the conceptual framework and reported using guidelines to ensure transparency and completeness in reporting and for equity-oriented systematic reviews. RESULTS: Of 5068 citations screened, nine studies reported in ten publications were eligible for inclusion. We categorized the studies into clusters identified as: those inclusive of Indigenous knowledges and governance ("Indigenous-oriented")(n = 6); and those based on Western academic knowledge and governance ("Western-oriented")(n = 3). The studies were found to be of variable quality for contributions to shared decision making and self-determination, with Indigenous-oriented studies of higher quality overall than Western-oriented studies. Four themes are reflected in an updated conceptual framework: 1) where shared decision making takes place impacts decision making opportunities, 2) little is known about the characteristics of health care providers who engage in shared decision making processes, 3) community is a partner in shared decision making, 4) the shared decision making process involves trust-building. CONCLUSIONS: There are few studies that report on and evaluate shared decision making interventions with Indigenous Peoples. Overall, Indigenous-oriented studies sought to make health care systems more amenable to shared decision making for Indigenous Peoples, while Western-oriented studies distanced shared decision making from the health care settings. Further studies that are solutions-focused and support Indigenous self-determination are needed.

"Where Creator Has My Feet, There I Will Be Responsible": Place-Making in Urban Environments through Indigenous Food Sovereignty Initiatives.

There is a growing emergence of Indigenous Food Sovereignty (IFS) initiatives across urban centers within many regions of Canada. Urban Indigenous communities are leading these efforts to revitalize Indigenous foods and agricultural practices while promoting food security and increasing Land-based connections within cities. However, the socio-ecological environments within these urban contexts affect IFS initiatives in unique ways which have not been previously explored. This study addresses these gaps by drawing on qualitative interviews with seven urban Indigenous people leading IFS initiatives within Grand River Territory (situated within southern Ontario, Canada). Applying community-based participatory methods, this research explored how place impacts IFS initiatives within urban environments. Thematic analysis generated two overarching thematic categories: Land access, and place-making practices, revealing a bi-directional, dynamic interaction between place and urban IFS initiatives. Relationships with landowners, control of land, and external factors determined how Land was accessed in urban environments. Place-making practices involved fostering relationships with Land, upholding responsibilities, and cultivating Land-based knowledges. Therefore, IFS initiatives are impacted by Land access, but also facilitate place-making for urban Indigenous Peoples. These findings demonstrate pathways towards Indigenous self-determination and IFS within urban contexts, which can be applicable to other urban Indigenous communities.

Relationality, Responsibility and Reciprocity: Cultivating Indigenous Food Sovereignty within Urban Environments.

There are collective movements of Indigenous food sovereignty (IFS) initiatives taking up place and space within urban environments across the Grand River Territory, within southern Ontario, Canada. Indigenous Peoples living within urban centres are often displaced from their home territories and are seeking opportunities to reconnect with culture and identity through Land and food. This research was guided by Indigenous research methodologies and applied community-based participatory research to highlight experiences from seven Indigenous community members engaged in IFS programming and practice. Thematic analysis revealed four inter-related themes illustrated by a conceptual model: Land-based knowledge and relationships; Land and food-based practices; relational principles; and place. Participants engaged in five Land and food-based practices (seed saving; growing and gathering food; hunting and fishing; processing and preserving food; and sharing and distributing), guided by three relational principles (responsibility, relationality, and reciprocity), framed by the social and physical environments of the place. Key findings revealed that employing self-determined processes to grow, harvest, and share food among the Indigenous community provide pathways towards IFS. This study is the first to explore urban IFS initiatives within this region, offering a novel understanding of how these initiatives are taking shape within urban environments.

Concrete Lessons: Policies and Practices Affecting the Impact of COVID-19 for Urban Indigenous Communities in the United States and Canada.

Throughout the Americas, most Indigenous people move through urban areas and make their homes in cities. Yet, the specific issues and concerns facing Indigenous people in cities, and the positive protective factors their vibrant urban communities generate are often overlooked and poorly understood. This has been particularly so under COVID-19 pandemic conditions. In the spring of 2020, the United Nations High Commissioner Special Rapporteur on the Rights of Indigenous Peoples called for information on the impacts of COVID-19 for Indigenous peoples. We took that opportunity to provide a response focused on urban Indigenous communities in the United States and Canada. Here, we expand on that response and Indigenous and human rights lens to review policies and practices impacting the experience of COVID-19 for urban Indigenous communities. Our analysis integrates a discussion of historical and ongoing settler colonialism, and the strengths of Indigenous community-building, as these shape the urban Indigenous experience with COVID-19. Mindful of the United Nations Declaration on the Rights of Indigenous Peoples, we highlight the perspectives of Indigenous organizations which are the lifeline of urban Indigenous communities, focusing on challenges that miscounting poses to data collection and information sharing, and the exacerbation of intersectional discrimination and human rights infringements specific to the urban context. We include Indigenous critiques of the implications of structural oppressions exposed by COVID-19, and the resulting recommendations which have emerged from Indigenous urban adaptations to lockdown isolation, the provision of safety, and delivery of services grounded in Indigenous initiatives and traditional practices.

'Work it out': evaluation of a chronic condition self-management program for urban Aboriginal and Torres Strait Islander people, with or at risk of cardiovascular disease.

BACKGROUND: Chronic diseases disproportionately burden Aboriginal and Torres Strait Islander people in Australia, with cardiovascular (CV) diseases being the greatest contributor. To improve quality of life and life expectancy for people living with CV disease, secondary prevention strategies such as rehabilitation and self-management programs are critical. However, there is no published evidence examining the effect of chronic condition self-management (CCSM) group programs for Aboriginal and Torres Strait Islander people who have, or are at risk of, CV disease specifically. This study evaluates the Work It Out program for its effect on clinical outcome measures in urban Aboriginal and Torres Strait Islander participants with or at risk of CV disease. METHODS: This study was underpinned by a conceptual framework based on Aboriginal and Torres Strait Islander community control. Participants had at least one diagnosed CV disease, or at least one CV disease risk factor. Short-term changes in clinical outcome measures over (approximately) 12 weeks were evaluated with a quasi-experimental, pre-post test design, using paired t-tests. Factors contributing to positive changes were tested using general linear models. The outcome measures included blood pressure (mmHg), weight (kg), body mass index (kg/m2), waist and hip circumference (cm), waist to hip ratio (waist cm/hip cm) and six minute walk test (6MWT). RESULTS: Changes in several clinical outcome measures were detected, either within the entire group (n = 85) or within specific participant sub-groups. Participant's 6MWT distance improved by an average 0.053 km (95% CI: 0.01-0.07 km). The change in distance travelled was influenced by number of social and emotional wellbeing conditions participants presented with. The weight of participants classified with extreme obesity decreased on average by 1.6 kg (95% CI: 0.1-3.0 kg). Participants with high baseline systolic blood pressure demonstrated a mean decrease of 11 mmHg (95% CI: 3.2-18.8 mmHg). Change in blood pressure was influenced by the number of cardiovascular conditions participants experienced. CONCLUSIONS: Short-term improvements seen in some measures could indicate a trend for improvement in other indicators over the longer term. These results suggest the Work It Out program could be a useful model for cardiovascular rehabilitation and prevention for other urban Aboriginal and Torres Strait Islander populations.

Cura Encantada: Medicina Tradicional e Biomedicina entre os Pankararu do Real Parque em São Paulo / Enchanted Healing: Traditional Medicine and Biomedicine between Pankararu of Real Parque in São Paulo

Esta dissertação busca se aproximar das concepções Pankararu de cura e suas relações com a biomedicina. Embora os Pankararu sejam originários da região do submédio São Francisco, no Estado de Pernambuco, depois de um intenso processo de migração, muitos deles passaram a residir na Favela do Real Parque, em São Paulo. Este estudo se concentra nos Pankararu do Real Parque. Este trabalho descreve partes da cosmologia Pankararu e suas formas tradicionais de cura, na busca de compreender a integração dessas práticas com o atendimento biomédico do Município de São Paulo. Descrevo então como ocorre essa integração, assinalando os conflitos e os processos de "tradução" e ressignificação de seus elementos rituais para o contexto urbano. O crescente número de etnias que vivem na metrópole suscita indagações quanto à transformação e readaptação de seus discursos. Esta etnografia pretende explicitar como é realizado esse movimento e as formas de afirmação identitária e de conquistas políticas, principalmente, no campo da saúde.(AU)

This essay seeks to approach the Pankararu concepts of healing and their relations with Biomedicine. Although Pankararu originate from the region of São Francisco submid, in the State of Pernambuco, after an intense process of migration, many ofthem took up residence in the shantytown of Real Parque, in São Paulo city. This study focuses on the Pankararu of Real Parque. This paper describes parts of the Pankararu cosmology and their traditional ways ofhealing, seeking to understand the integration of these practices with biomedical care in São Paulo city. I describe,then, how this integration occurs, pointing out the conflictsand the processes of "translation" and their redefinition of ritual elements to the urban context. The growing number of ethnic groups living in the metropolis raises questions aboutthe transformation and upgrading of their speech es. This ethnography aims to explainhow this movement takes place and the forms of identity affirmation and political achievements, especially in the health field.(AU)