Equity, Diversity, and Inclusion in Nutrition: Unpacking Canada’s Challenges and Opportunities for Growth

Ensuring that legislation and public policy are adapted to respect the principles of equity, diversity, and inclusion (EDI) is a continuous effort that must be integrated across all disciplines, including nutrition. The focus of EDI can entail a broad range of factors, including but not limited to race, ethnicity, religion/faith, immigration status, gender, sexual identity and orientation, disability, income, educational background, socioeconomic status, and literacy (1). Alongside a moral obligation to ensure no one is disadvantaged in accessing nutritious foods, poor nutrition is linked to several negative health outcomes that place a significant burden on Canada’s public health care system (2). In 2014, Canadian’s not meeting food recommendations contributed to 13.8 billion dollars in direct and indirect health care costs (2). The Global Burden of Disease Study reported that unhealthy eating habits are the leading risk factor for death and the second leading risk factor of disability within Canada (3). Unfortunately, suboptimal nutrition is not solely a matter of choice for all Canadians, as many individuals face limited access to higher quality foods and resources (2). This is often due to insufficient attention given to EDI in this area, resulting in significant disparities in food security and overall health outcomes (2). As such, it is crucial to continue prioritizing this issue and working towards equitable solutions. Hence, this paper will aim to identify and describe what are current challenges/opportunities for EDI in nutrition. The main areas of focus will be on cultural competence and socio-economic limitations regarding nutrition, specifically within the Canadian context.

Cultural Competence

In 2019, a report on international migration and displacement trends among G20 nations revealed that Canada has become a highly sought-after destination for refugees, asylum seekers, international students, job seekers, and immigrants (4). Hence, as Canada’s population continues to become more ethnically diverse, it is crucial to broaden our knowledge of food beyond the confines of the Western diet.

1.1 Canadian Food Guide

A significant aspect that warrants attention is the recently updated Canadian food guide (CFG). Shedding light on this, Lane & Vatanparast (5) conducted a study in Southern Saskatchewan, wherein they carried out in-depth interviews with newcomers. Culturally sensitive dietary advice and education were identified as a gap in the system, particularly within the CFG. For instance, the current food guide fails to provide adequate guidance for cultures whose staple foods include maize or pulses (5). Further discussion revealed that this lack of inclusion stems from expectations that the Western diet will fit the needs and expectations of newcomers to Canada (5). Moreover, Anderson et al. (6) found that many Canadian newcomers struggle to follow dietary guidelines because they are unfamiliar with how to prepare CFG-recommended foods and lack the knowledge about alternative ingredients to replace the traditional ones they are accustomed to. Studies such as these emphasize the vital importance of tailoring health initiatives to meet the unique needs of diverse ethnic groups in Canada, highlighting the significance for health customization. 

1.2 Ethnocultural Sensitivity within Education

The significant shortcomings of the Canadian Food Guide sparks concern about the level of awareness among educators and policy makers regarding EDI within the field of nutrition. Hack et al. (7) conducted a study to evaluate the cultural competence of third- and fourth-year nutrition students. The study found that students scored the lowest in the multicultural knowledge assessment section, out of the five areas examined (i.e., skills, attitudes, awareness, desires, and knowledge). Students within the study also reported feeling that the cultural competence curriculum had deficiencies and identified that increasing an emphasis on taking courses on cultural foods was a valid path to improvement (7). The Aboriginal community in Canada is another example of a specific population that is often overlooked. A survey of nearly 150 subjects (from the Dieticians of Canada Aboriginal Nutrition Network and regular dieticians interested in Aboriginal nutrition) revealed that 95% of respondents believed that all dietitians and graduating dietetic interns should be minimally competent in Aboriginal health and culture (8). Furthermore, an American study by Davis & Haughton (9) developed a model for multicultural nutrition counseling competencies, of which the results are likely applicable to Canadian dietitians as well. They found that irrespective of whether the subjects provided nutritional counseling to culturally diverse clients, they exhibited limited expertise in multicultural nutrition counseling skills, multicultural awareness, and multicultural food/nutrition knowledge (8).  

1.3 Mainstream incorporation of ethnic foods

The Canadian diet is easily subject to diversification by the environment in which individuals live (10). For instance, Canadians who have moved to Vancouver have reported incorporating new foods into their diet due to the larger array of cuisines and ethnic groups in the area (10). It is important that visible minorities do not have to retreat to cultural hotspots (such as Chinatown, or Indian markets) to find ethnic foods. Incorporating diverse foods into mainstream shops and restaurants is a powerful way to foster cultural sensitivity, particularly among policy makers who create resources, such as the Canadian Food Guide.

Socio-economic limitations in accessing foods

Food insecurity is a distressing reality for many families, often resulting in inadequate access to food or even going without food on some days (11, 12). This can lead to monotonous diets lacking in variety and essential nutrients, causing feelings of uncertainty and anxiety due to deprivation and lack of choice (11). Households facing food-insecurity may have to rely on charitable sources of food or resort to stealing to acquire the food they need (11, 12). In addition, they may miss out on the social aspects of sharing meals with family and friends or partaking in other social food-related practices (11, 12).  

2.1 Implications for Low-Income Households

According to the 2023 Canadian Consumer Price Index (13), despite the slowing down of inflation within the last year, grocery prices remain elevated. In their efforts to cut costs on groceries, low-income households are more likely to report zero expenditure across some food groups compared to higher income households within Canada (14). Low-income households tend to allocate a higher proportion of their food budget to milk and grain products, while dedicating a lower proportion to purchasing fresh fruits, vegetables, and meats, as compared to high-income households (14). Furthermore, a study in Atlantic Canada looking at food insecurity of low-income single mothers, reported that 96.5% of households have experienced food insecurity within the past year (15). The study also revealed that almost a quarter of low-income households reported child hunger as well (15). To avoid going hungry and not having a meal at the table, many individuals find themselves being forced to purchase items on sale, leftovers, and filling foods which sacrifice nutrition for a longer shelf life (16).

2.2 Social Stigma and Logistical Barriers

Although food banks, open kitchens, and federal subsidies are available, many Canadians face multiple challenges in accessing these resources. Food insecurity has been linked to feelings of alienation, embarrassment, sense of inequity, frustration, and the fear of being labeled by others (16). Those reliant on public resources, such as food banks, also encounter various obstacles aside from the social stigma. For instance, transportation distance and time to these facilities limits accessibility for many Canadians. Furthermore, the financial burden of transportation, prolonged waiting periods, and scheduling constraints of food bank facilities all serve as formidable barriers to accessing vital food resources (17).

Improving EDI for Canadians requires being mindful to the needs of everyone, particularly within areas that leave others disadvantaged. Eating nutritious food is essential to avoid the onset of chronic diseases. However, as discussed in this paper, not all Canadians have access to the same foods or nutrition related resources. The lack of cultural competence prevails within the Canadian food guide, nutrition related degrees/professions, and mainstream markets. Within these three realms it is essential to increase awareness about food (beyond the Western diet) when trying to tackle EDI in nutrition. Furthermore, socioeconomic limitations continue to burden Canadians. Low-income households are unable to afford fresh foods and are forced to be more conservative in how they ration their grocery budget. Lastly, individuals who opt to utilize public resources, such as food banks, are confronted with social stigmatization and logistical barriers. This leads to many Canadians, including children, living in hunger.

References - Are available upon request