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Piecing together the Inuit food security policy puzzle in Nunatsiavut, Labrador (Canada): protocol for a scoping review
  1. Renee Bowers1,
  2. Gail Turner2,
  3. Ian D Graham3,4,
  4. Chris Furgal5,
  5. Lise Dubois6
  1. 1Population Health, University of Ottawa, Ottawa, Ontario, Canada
  2. 2Quebec City, Quebec, Canada
  3. 3Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
  4. 4Department of Clinical Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
  5. 5Indigenous Environmental Studies and Sciences Program, Trent University, Peterborough, Ontario, Canada
  6. 6School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Renee Bowers; rbowe070{at}uottawa.ca

Abstract

Introduction Inuit Nunangat is the Inuit homeland in Canada. It is comprised of four Inuit regions. Inuit residing in these areas experience greater social and economic inequities than the general Canadian population. Food security exemplifies this inequity and is a distinct determinant of Inuit health. Policy can play an integral role in health equity. However, demonstrating this role can be a complex task, especially when there are both national and regionally specific policies pertaining to each of the Inuit regions. This scoping review will focus on Nunatsiavut, located in northern Labrador. This region is situated within a complex policy space due to the national, provincial and regional governance structures, geographical location and the breadth of factors pertaining to food security. This scoping review aims to identify the range of policies pertaining to food security in Nunatsiavut and complete a directed content analysis to code each policy against the applicable dimension of food security.

Methods and analysis The researchers will conduct a search strategy on the following four databases: MEDLINE (via Ovid), Embase (via Ovid), CINHAL and Scopus. A hand search of the relevant journals, conference abstracts and grey literature will be completed from April to October 2019. The following parameters will be extracted: a description of the policy, the organisation/institution that developed the policy, the definition of food security used or implied, and any stated intended targets or outcomes. The results will be compiled in a tabular form.

Ethics and dissemination Ethics approval is not required as primary data will not be collected. The findings from this scoping review will be disseminated through peer-reviewed journals and public presentations. The results of this scoping review will be validated by a Nunatsiavut Government Advisory Group.

  • food Security
  • inuit
  • policy

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Strengths and limitations of this study

  • It provides a comprehensive overview of a complex issue, food security.

  • It will demonstrate policy duplication and gaps that pertain to food security in Nunatsiavut, Labrador, Canada.

  • This study will use published information sources and is limited to the accuracy of the information.

  • The results of this study may not be generalisable to other Indigenous populations in Canada.

Introduction

Inuit are an Indigenous people living in the circumpolar region.1 This region spans four countries: the USA (Alaska), Greenland, Russia (Chukotka) and Canada.2 Within Canada, Inuit primarily live in the four land claim areas, Nunavut, Inuvialuit in the Northwest Territories, Nunavik in northern Quebec and Nunatsiavut in northern Labrador. These areas makeup Inuit Nunangat, referred to as the Inuit homeland.1 In 2005, Nunatsiavut became the first Inuit self-government in Canada through the implementation of the Labrador Inuit Land Claims Agreement. This agreement is between the Inuit of Labrador, the province of Newfoundland and Labrador, and the federal government of Canada. Nunatsiavut is constitutionally protected under the aboriginal and treaty rights of Indigenous peoples in Canada guaranteed by section 35 of the Constitution Act, 1982.3

Nunatsiavut was chosen for this scoping review primarily due to the low prevalence of food secure households in the region.4 Additional considerations include the complex policy landscape (regional, provincial and national) in which the Nunatsiavut self-governance model is situated due to the aforementioned agreement and the identification of food security as a priority in the Nunatsiavut Department of Health and Social Development health plan.5

Inuit in Canada experience ‘greater social and economic inequities than the general Canadian population that impact their health and wellbeing’.6 Inequities are defined as differences between the health between groups of people that are unfair or unjust. Food security exemplifies this definition and is a distinct determinant of Inuit health.7 Inuit within Nunatsiavut are less food secure than the general population in Canada. A 2014 survey completed in Nunatsiavut demonstrated that of the households surveyed, only 40.7% of respondents were food secure. In 2014, the same measurement for the general Canadian population was 88.0%.8 In 2012, 86.6% of the population in the province of Newfoundland and Labrador were food secure.4 8

Policy can have an important role in health equity. It can define a plan of action, set priorities and guide resource allocation.9–11 In the general Canadian population, the intersection of policy and food insecurity has been an active area of research.12 To date, policy interventions have demonstrated effectiveness in alleviating the burden of food insecurity within certain populations in Canada. One example is among social assistance recipients in Newfoundland. Policy changes attributed to this reduction were addressing insufficient incomes, moving income support clients into work and addressing the financial vulnerability of income support clients.13 Another example is within low-income adults aged over 65 years. The introduction of age-eligible publicly financed pensions at age 65 years for unattached low-income adults is attributed to reducing the prevalence of food insecurity by half in comparison to low-income Canadians aged under 65 years.14

The individual health impact has been one of the main considerations for food security and accordingly, food security has been considered a health issue. However, many of the policies that address food security are outside of the health domain.15 Instead, they are related to factors such as socioeconomic change, geography, environment and climate change.16 A variety of international and national documents have policy recommendations to improve food security. They include the Social Determinants of Inuit Health in Canada,5 the Report of the Special Rapporteur on the Right to Food,17Recommendations on Northern Sustainable Food Systems18 and Recommendations on Country/Traditional Foods from the Northern Policy Hackathon19 to name a few. This suggests that a multitude of policies are required to impact food security and they are potentially located across a diverse policy space.

This scoping review aims to first identify any policy implemented in Nunatsiavut that pertains to food security. Second, a content analysis will be completed to assess the policy against the four dimensions of food security (availability, access, utilisation and stability)20 to assess for gaps and/or policy overlap (ie, one area that has multiple policies). The results of this review can inform actions of stakeholders to advance their policy efforts for food security in Nunatsiavut.

A preliminary search for existing or similar scoping reviews has been completed. The databases searched were: JBI Database of Systematic Reviews and Implementation Reports, Cochrane Database of Systematic Reviews, the Evidence for Policy and Practice Information database and Epistemonikos. Similar or existing scoping studies or systematic reviews were not found. This scoping review is new and does not build on existing reviews.

Objective

Complete a scoping review of the literature on the range of policies that pertain to food security in Nunatsiavut, Labrador. This study dates are from April to October 2019. Using the Population, Concept and Context (PCC) elements, the objectives of this review are as follows:

  1. Identify the range of existing policies that pertain to food security in Nunatsiavut.

  2. Complete a directed content analysis to code each policy against the applicable dimension of food security (availability, access, utilisation and stability).

Methods

This review will be conducted as per the Joanna Briggs Methodology for scoping reviews21 from April to October 2019. The findings of the review will be reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension statement for reporting of scoping reviews.22

Inclusion/exclusion criteria

The inclusion criteria for this scoping review follows the relevant PCC elements. The population includes the Inuit of Nunatsiavut, the concept is food security and policy, and the context is current regional, provincial and federal policy. Each of these components is described in sections Population, Concept and Context in more detail.

Population

The included published and non-published research studies and grey literature will focus on Inuit in Canada, and specifically the Inuit of Nunatsiavut. As this is a relatively small population, the studies and documents will be either inclusive of or focus specifically on the Inuit of Nunatsiavut. It will exclude articles focusing on other Indigenous groups and articles that are not focused on Canada.

Concept

Two concepts will be explored in this scoping review, the first is policy and the second is food security. Policy for the purposes of this scoping review is a ‘general term used to describe a formal plan of action adopted by an actor to achieve a particular goal’.23 It will also include public policy which is the ‘expressed intent of the government to allocate resources and capacities to resolve an expressly identified issue within a certain time frame’.24 Accordingly, this review will include any legislation, regulations or programme policy that focus on food security in Nunatsiavut.

The second concept, food security, is defined as ‘when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life’.7 Food security has four dimensions. They are availability, meaning the quantity of safe and nutritious foods that are consistently available to individuals and meets their tastes and cultural traditions; access, which indicates individuals and households have the adequate economic and physical access to food; and utilisation, which refers to the proper biological use of food to provide sufficient energy requirements, essential nutrients, potable water and adequate sanitation. This also includes the knowledge and skills to prepare and preserve food. Stability is the fourth dimension of food security, which refers to the ability to be food secure in the present and in the future, mainly through a reliable supply of food products. The first three dimensions of food security are based on a ‘static concept of food security’. The fourth dimension is reflective of the ‘dynamic concept of food security’ and considers the current and future state of food security. All four dimensions must be met to achieve food security.20 25

Context

The scoping review will focus on any policy that pertains to food security. As Nunatsiavut can be impacted by federal and provincial policies, no restriction was placed on where the policy was developed. However, the policy must be inclusive of or specifically focus on Nunatsiavut and will include any policy that has a cultural component, such as providing country foods.

Information sources and search strategy

This scoping review will include publications of all types (eg, research studies of any design, editorials and commentaries). Both the published research and the grey literature will be searched. The grey literature search will consist of government websites and documents, newspapers, national Indigenous organization websites and publications, and legal documents. The documents in this scoping review will only include those in English due to constraints in translation resources. The time limit will be from 1985 till 2019.

A search strategy for databases was developed that consisted of keywords and Medical Subject Heading (MeSH) terms related to Inuit, food security and policy (see online supplementary appendix A). The search strategy will be conducted on the following four databases: MEDLINE (via Ovid), Embase (via Ovid), CINHAL and Scopus. A hand search of non-published research, the circumpolar health bibliographic database, relevant journals and conference abstracts, and a secondary search of journal sources will be completed. The authors of studies will be contacted for further information if required. For the grey literature search, the terms food security and Inuit will be used. The search will include federal databases and catalogues, such as Government of Canada publications, Canadian Public Documents collection, Policy Horizons, and federal and provincial department websites. Newspapers will include the Labradorian and the Evening Telegram, and national Indigenous organization websites will include the Inuit Tapiriit Kanatami and the Inuit Circumpolar Council. Other sources of the grey literature will be identified through a snowball sampling approach of the initial search. The grey literature search will be completed when saturation of the material is reached.

Patient and public involvement

No patient or public was involved.

Study records

Data management

For the research studies, database search results will be imported to Covidence systematic review software (Covidence, Melbourne, Victoria, Australia). After removal of duplicate articles, citation titles and abstracts will be screened. For the non-published studies and the grey literature, an Excel file will be created with the name and reference for the document. If there are multiple references to the same policy, the most recent reference will be included in the analysis to reflect the current context.

Selection process

For the research studies, at least two independent interviewers will screen articles in a two-level process. The level one screen will include the title and abstract for the inclusion of potential studies. Any studies with a yes or maybe will proceed to level two. The full document will then be reviewed. If there is disagreement, during level one or two, a third reviewer will provide input and the decision will be implemented accordingly. The process will differ slightly for the non-published studies and the grey literature. One reviewer will develop a list of documents and add a yes or no and rationale for inclusion into the Excel file. A second reviewer will review this list and provide a yes or no. Again, if there is disagreement, a third reviewer will provide a deciding opinion. The documents that have agreement on yes will be fully reviewed. The results of the scoping review will be discussed with the Nunatsiavut Government Advisory Group prior to analysis. Any additional suggestions will be incorporated. The results will be reported as per the PRISMA flow diagram.26

Data extraction process and analysis of results

The method by Hsieh and Shannon27 will be used to complete a directed content analysis. This will entail a document review by two independent reviewers to extract the relevant data for each policy using an a priori-designed data extraction form. The form will collect information on the following parameters: a description of the policy, the organisation/institution that developed the policy, the definition of food security used or implied, and any stated intended targets or outcomes. The extracted information will be compiled in a tabular form. If required as a result of the review, additional data outside of the aforementioned categories will be added to the data extraction form. Each policy will be coded against the relevant dimension of food security.

Local government engagement

This scoping review has a Nunatsiavut Government Advisory Group that consists of two representatives from the Department of Health and Social Development. This advisory group will consult with others within the Nunatsiavut Government as they deem necessary. The role of the group for this scoping review is to member check the list of policies prior to conducting the analysis to ensure that there are no gaps according to their local knowledge, to validate the findings after data extraction for each policy is completed and to validate the completed data analysis. Broader public engagement was not undertaken at this time as this scoping review is limited to the identification of publicly available information.

Ethics and dissemination

This review does not require primary data collection. However, prior to starting the scoping review, the Nunatsiavut Government Research Advisory Committee was informed. This group is separate from the advisory group and has a distinct function that involves reviewing research applications for research conducted in Nunatsiavut, to ensure that all research is completed with full knowledge of the Nunatsiavut Government and Labrador Inuit. The results of this review will be disseminated via peer-reviewed publications and informal presentation of results to the Nunatsiavut Government.

Conclusion

Policies for food security can span a broad space. This is attributed to the breadth of factors that contribute to food security, the levels of government (federal, provincial and regional) and number of government departments within the same level of government. This scoping review intends to identify the breadth of policies and understand how they compare to the dimensions of food security. Through this analysis, both gaps in current approaches and duplicity of efforts can be identified. There is a current gap in the literature on policy and food security among Inuit in Nunatsiavut. Results of this scoping review will inform policy actors within and outside of Nunatsiavut and the broader research community in their future research, policy and advocacy efforts to address food security in Nunatsiavut.

References

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Footnotes

  • Contributors RB developed the scoping protocol and wrote drafts for comments and review. GT, IDG, CF and LD provided feedback and suggested revisions to the various drafts of the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval is not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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