Citizens' Health as a Great Factor for the Country's Prosperity - Research Paper Example

Nutritional Deficiencies in a First Nations Population Introduction Health is an important aspect in the physical and mental development of human beings. In fact, one of the parameters in assessing the advancement of society is the level of health of the individuals living in the community. One element in determining the health of the people is through their nutrition. Nutrition generally refers to the process of nourishing the body (Nutrition, 2011). Nourishment of the body would require ingestion of the six general categories of nutrients – protein, carbohydrates, fat, fibers, vitamins and minerals, and water – that would help the body fight off diseases and promote the overall health of the being. Majority of the inhabitants in Third World Countries live below the poverty line, and this reflects their level of health and nutritional intake. Many people in these countries survive by taking only one meal a day. Water is a vital element in maintaining a person’s health. People living in dry and arid lands have limited access to water. They have to dig deep into the desert lands to have water to drink. And most likely, the water taken is not safe for drinking. According to Michael Latham (Program in International Nutrition director, Cornell University), in his lectures at Pullman Washington State University, malnutrition in the Third World Countries cause death and diseases among the people. From protein deficiency alone, 10 million people are dying annually. Millions are also suffering from vitamins and minerals deficiency (Urvina, 1984). Malnutrition and micronutrient deficiency are reported to comprise 32 percent of the world disease problem (Nelson, 2006). But nutritional deficiencies exist in the First World Countries or developed countries as well. Developed countries, such as Canada, USA and other European countries, also experience malnutrition among the populace. Malnutrition is these countries can be attributed to several factors. One reason for such imbalanced nutritional intake is eating of junk food, which besides not giving the nutrition needed by an individual, also contains excessive salt and traces of other unhealthy elements. Malnutrition is also attributed to the lack of access of individuals to nutritious food, or lack of means to purchase them. One of the causes of malnutrition is limited financial resource that leads to prioritizing less buying of nutritious food (Aberg, 2006). According to Pett (1950), no foolproof system has been devised in determining malnutrition because of the variation in individuals, in that even healthy individuals have different urine and blood biochemical results. He said that malnutrition could occur in the following stages that overlap each other: a) inadequate consumption of food or particular nutrients, or interference in utilization and absorption of nutrients that results to malnutrition, b) a decrease in “bodily reserves” that may only be detected through biochemical tests, c) impairment in functioning although the tissues show no changes, and d) changes in the structure of tissues (common clinical evaluation used). Structural changes must be confirmed with dietary background and laboratory tests, otherwise, the clinical evaluation could result to error (Pett, 1950). In the many studies conducted in Canada, subjects who follow good dietary regimen even show signs of malnutrition (Pett, 1950). This can be clearly seen in the First Nations of Canada. First Nations is the terminology used to refer to the aboriginal groups, the Inuit and Métis (Terminology of First Nations, n.d.). The term replaced the use of “Indian” in the 1970s, as well as “Band” when referring to original peoples in Canada (Government of Saskatchewan, 2009, para. 17). The government has the primary obligation to improve the health and nutritional intake of the First Nations in Canada. It is actively engaged in the promotion and improvement of health of the people through Health Canada. Health Canada is the agency of the Federal government that oversees and manages the improvement of the people’s health, but upholds their freedom of choice according to the different circumstances of the people (Health Canada, About, 2011). Through the implementation of health promotion and prevention programs, health care costs can decrease while the quality of life will increase (Health Canada, About, 2011). Literature Review According to Health Canada (Diseases, 2010), the First Nations community and the Inuit have a high level of concerns related to health that includes chronic diseases, contagious diseases and short life expectancy. Comparing the current statistics with the other people in Canada, the First Nations people and the Inuit have 1.5 times higher rate in heart disease; 3 to 5 times higher in Type II diabetes for the First Nations while it is continually rising in the Inuit population; and the tuberculosis is 8 to 10 times more for both populations (Health Canada, Diseases, 2010). Nutrition can be gauged using the two approaches, through the nutritional food intake and biometric measurements that includes the body-mass index (BMI). BMI is the usual obesity indicator used to determine health level (Indicators of well-being, 2006). For the 2002-2003 BMI measurements for the on-reserve First Nations people, more men were overweight than women with 42 percent and 32 percent respectively, while more women were obese (with 40 percent) than men (32 percent) (Indicators of well-being, 2006). According to Eckhardt (2006), micronutrient malnutrition and overweight/obesity that afflict adults are chronic diseases risks. Obesity has become a major health concern. It is defined as an “excessive storage of energy in the form of fat, has adverse effects on health and longevity” (NIH, 1985, as cited in Canadian Institutes of Health, Introduction, 2010, para. 3). While 7 percent of Canadians were obese in the early 1970s (Torrance et al., 2002, as cited in Canadian Institutes of Health, 2010), the number increased to one-fourth of the population in 2004 (Starky, 2005, as cited in Canadian Institutes of Health, 2010). Lawrence (n.d.) also mentioned that obese and overweight people are really malnourished since they are not ingesting appropriate food. The New England Journal of Medicine reported that a 40-pound overweight can increase risks in the following: 360 percent more to suffer a heart attack, more likely to have cancer by 80 percent, acquiring Type II diabetes by 2800 percent, more susceptible to high blood pressure by 260 percent, will likely to suffer degenerative arthritis by 400 percent, and increased dying rate of 110 percent (Lawrence, n.d.) A healthy weight is associated with the status of health and incidence of chronic diseases (Health Canada, Determinants, 2003). Physical activity and following a healthy food regimen can greatly improve one’s health status (Health Canada, Determinants, 2003). The First Nations Regional Longitudinal Health Survey (RHS) for 2002 – 2003 revealed that 9.1 percent of the First Nations population rarely eats nutritious and balanced food (Health Canada, Determinants, 2003). Those surveyed who reported that they do not eat nutritious and balanced diet comprise 2.8 percent of the population surveyed (Health Canada, Determinants, 2003). One-fourth of all First Nations households have “inadequate” water supply “in terms of volume and/or health requirements” (Health Canada, Determinants, 2003, p. v). Health is gauged by social and economic elements, the environment, and the behavior of the person (Health Canada, Determinants, 2003). These determinants do not exist alone but play interactively with the other determinants (Health Canada, Determinants, 2003). The body-mass index of the population was also taken during the RHS survey. The BMI which derives a ratio of weight as against the height does not determine the body fat measurement but widely used to show the health risks connected with falling below or above the ideal weight ratio (Health Canada, Determinants, 2003). The RHS survey was participated 238 communities of First Nations peoples (First Nations Information Governance Committee 2006, as cited in Health Canada, Determinants, 2003) with 22,602 respondents (10,962 adults, 4,983 youth; 6,657 children) that accounted for 5.9 percent of the target population of 28,178 (Health Canada, Determinants, 2003). The report for the RHS survey though only considered the data from respondents 18 years old and above (Health Canada, Determinants, 2003). Projects Implemented to Fight Malnutrition Many programs have been initiated in Canada to improve the health, nutrition and food security of aboriginals, most of which are government-led or funded. The Health Canada's Aboriginal Diabetes Initiative, for instance, is aimed at reducing the incidence of Type II diabetes among aboriginal people. The ADI coordinates with First Nations Organizations, Tribal Councils, Provincial Territories, and Inuit community groups. Together, they create culturally appropriate community-based programs. The ADI delivers a range of prevention, screening and treatment programs that includes enhanced training for home and community care for chronic disease management. Many benefits can be derived in community-based Aboriginal health promotion. First and foremost would be the development of awareness among the members of the community on the importance of food and nutrition in maintaining a high level of health among the people. Ingesting of food should not only concern eating of vegetables and the right food, but also eating a balanced diet so that all the nutritional needs of a person in a day can be supplied. There are a number of strategies that have been developed in order to combat malnutrition. Establishment of community gardens is the most common strategy utilized in indigenous communities. A community garden can provide fresh and nutritious vegetables and fruits for community members. Planting, weeding and tending to the plants provide good opportunities for physical activity, community pride and social interaction. Community gardens though focus more on vegetables and short-term crops so that the members can harvest the crops within a few months. Vegetables are also suitable for smaller land area. The sustainability of a community garden often depends on one or two individuals who will coordinate the activities with the other members, as well as seek funding for costs associated with the activity that includes transportation, fuel, repair of equipment, purchase of supplies, and other related expenditures. The selected site must be within the vicinity of the residential areas for easy access by the members. Residents with experience in gardening and growing vegetables can share their knowledge with the members. This type of garden could develop food action plans and healthy living based on communal activity near health centers and schools. It can offer savings to community members from regular travel by ferry to the nearest grocery store, revitalize traditional knowledge on food and plants, and bring the community together. The garden could also be used to support other programs. Establishment of school gardens is a popular strategy in indigenous and mainstream schools to supplement the nutritional needs of the people. School gardening though can be attended only during school days. Thus, the types of vegetables to be planted must be considered so that they can be harvested before the school ends. This is a viable strategy because skilled school staff can adequately manage the garden to be assisted by the students. A school-based garden is integrated in the school curriculum that teaches students the basics of gardening, composting, healthy eating, etc. A community kitchen can complement the nutrient needs of people with limited income. This strategy has been successful in many communities that it has become a developmental tool utilized by welfare groups, health organizations, socio-civic groups and elementary schools. This is an effective strategy because of the economic, social and health benefits kitchen members attain from the program. Sustaining this program might pose a problem when there is insufficient funding. Lack of funds will affect the activities of the organizing group, upgrade in the administrative supplies and equipment (e.g. computer), less support staff, etc. Community kitchens provide relief from financial, nutritional, and social challenges. Through bulk purchasing and large-quantity food preparation, participation in this activity is both low cost and time efficient. The community organizers have to shoulder the expenses in training the members until they have acquired the necessary skills to function of their own. But the trained group might not sustain the program if they have no means to purchase the food supply in bulk. In this case, the organizing group has to subsidize a portion of the expenditure of the community kitchen. The organizers may request for donations from corporate businesses or concerned affluent individuals. But when donations come in trickle, the total operations will surely be affected. Overview of Community Kitchen A community is a group of people that live together in a specific area, and bounded together by common cultural beliefs, tradition, values and practices. It may also refer to a group that shares particular characteristics or interests such as religion, ethnicity, occupational status, or sexual orientation, even though they do not live in the same geographical area. In the context of Aboriginal health research, a community constitutes the personal responsibility of an individual to the collective society and the latter towards the individual. A community kitchen refers to a group of individuals who meet regularly to cook healthy meals, bake nutritious goods, or preserve foods. The participation of everyone is necessary in the menu selection, shopping, preparation and cooking. The community kitchen, also called collective kitchen, model is not new to Canada. In fact, the Frankston Community Kitchens Pilot Project implemented in Australia is patterned after the community kitchens model of Canada (Promising Practice Profiles, 2004). Generally, community kitchens provide a venue for people to assemble to plan and prepare nutritious meals, to socialize and enjoy. Cooking meals together saves both time and money. There are kitchens that focus on cooking for families, single mothers, older adults, unmarried adults, ethnic groups and new mothers. Community kitchens are usually operated by religious groups or civic organizations and held at community centers, schools and churches. Joining a community kitchen provides numerous benefits to an individual that includes: a) increased sense of community, b) greater access to healthy and affordable food, c) enhanced social support by providing a safe and supportive environment, d) decreased stress and isolation, e) an increase in self esteem, f) a boost in self-reliance, g) increased knowledge on healthy food, h) access to healthy and safe cooking techniques, i) more savings than cooking individually, j) greater satisfaction from group activity and experience, k) getting a sense of belongingness, l) meeting other people, m) getting involved in a neighborhood activity, n) learning shopping tips and budgeting, o) learning proper menu planning, and p) learning about the resources available in the community. The communities of the First Nations people in Canada are located in areas far from the centers of commerce. Their communities do not have all the necessary food that provides complete nutritional needs. They may have to travel in order to purchase them. The use of community kitchen is a feasible approach in lessening the cost of preparation and cooking of food. Moreover, since communal cooking of food entails planning, nutritious food can be prepared for every meal. A community kitchen is a sound approach because community members contribute to the planning, budgeting, shopping and cooking of meals. Cooking of food on a one-time basis for several households will lessen fuel consumption as well as time and labor spent compared with cooking at individual homes. Purchasing of goods in bulk or wholesale would also entail less expense since the purchaser can avail of a larger discount from the seller. The amount saved from the one type of food can be used to purchase another kind of goods. More variety in the kind of food would provide more nutrients for the community members. Planning and Implementing Community Kitchen Program A Community Kitchen is a safe and empowering environment where diverse groups of people can come together to learn and share skills in budgeting, planning, shopping, and cooking healthy meals that they can bring home to their families. Utilizing community kitchens in the First Nations is a strategic approach in fighting malnutrition. First Nations people are culturally close-knit groups that value closeness of the members of the community. This cultural trait is a valuable asset in the implementation of a community kitchen since community kitchen members will have to work together for a long time. Aims and Objectives The objectives of implementing a community kitchen are as follows: a) to develop an awareness among the members of proper nutritional balance to prevent malnutrition, b) to impart knowledge upon the members the available traditional food and their utilization to promote health and wellness, c) to supplement the nutritional needs of a selected group in a First Nations community, d) to meet the financial deficiency of the community through bulk purchases, e) to teach the members the different nutritional values of each type of food, f) to teach the members the different food preparation techniques and menu for variation, g) to save time through one-time purchases and one-time cooking for a bigger number of community members, h) to teach community members the proper planning, budgeting and purchasing of food, geared towards having inexpensive but nutritious meals, i) to teach the members the proper handling and preservation of food to avoid contamination and food poisoning, and j) to teach the members on other health-related issues (e.g. common health problems of the community, food requirements for specific types of diseases, savings of the family annually by not getting sick). Moreover, during group lectures, the members will be provided information on shopping for packaged foods, reading labels for nutritional content, and identification of products based on packaging methods (e.g. fresh, canned, frozen, dried). Strategies and Management Not everyone in the community may be open to the idea of a community kitchen being established in the settlement. This may be considered by the First Nations people as an intrusion into their community life. Thus, an information campaign is necessary to convince the people of the importance of a community kitchen. Organizing a community kitchen may need the assistance of the local institutions in the area, such as the school or health clinic. The organizer should be culturally sensitive to the local practices and traditions and make sure that introduction of new cooking or eating practices will not offend cultural sensitivities. The community where the collective kitchen will be implemented is the area where a higher incidence of malnutrition exists. The community may have a number of Type II diabetes cases, obese individuals, growing children, and underweight people. These data can be taken from the local census and statistics offices and the local health clinics. The inhabitants in the community are not affluent, with less income, or less opportunity to earn a living. A holistic approach will be implemented in the community kitchen so that the program will not only focus on preparing and eating of healthy food. The kitchen will be linked with other community kitchens, the local government and leaders, concerned civic groups, and the health care sector. The health care sector can provide resource persons to speak on specific topics. It should be noted though that the objective that the objective of the collective kitchen is to fight malnutrition in the greater number of people. Thus, not only the members of the collective kitchen shall undergo BMI and physical measurement evaluations but also their family and household members as well. The target group for the community kitchen should number 30 persons. This quantity would be a viable lecture-size group and can be accommodate in a classroom, health clinic or community hall. Bulk purchases shall also be made enough for the group and their families. Assuming that each household will have four members (e.g. husband, wife and two children; or the couple with one children and one elderly adult), the bulk purchase shall be made for 120 persons. This will give a substantial savings for the group. However, the group will be divided into subgroups of 10 members each for the actual cooking and preparation of food. The subgroups may use the same venue for cooking and preparation according to a designated schedule or they may select a location which is convenient for the members of each subgroup. Each subgroup will have a leader and an assistant leader who will assist the leader or assume leadership in the absence of the leader. A general secretariat will be organized from among the members who will record the names, addresses and contact numbers of the members; the contact numbers of the suppliers and the food they supply; expenses of the group; and other relevant data. They will also record the minutes of the meetings, as well as the suggestions of the general membership. The secretariat will also be charged with the function of coordinating with the health care professionals in the area or the local officials after proper communication channels have been established by the organizers. Initial costs of the training shall be defrayed by the organizers. Thus, the project must have a sponsor so that the individuals involved in the training and organizing would have enough funding for mobilization and logistics. The members will undergo three lecture-type meetings in the first two weeks of the launching of the project. This will include identification of the sources of food and venue for cooking and preparation. Budgeting, planning, purchasing, cooking and preparation of food shall begin on the third week. The members will be greatly involved in the third week activities, with the organizers facilitating them. The organizers then should have sufficient knowledge of the health problem and the basic nutrition and dietary requirements of the people. They will be the first to teach the members on proper food intake. Every month afterwards, one resource person from the local health clinic, the local government, a physician, a nutritionist, etc. will speak to the members to broaden their perspective on health issues and the improvement of health to fight malnutrition. Members will also be encouraged to undertake research (new menu, other suppliers of food that give higher discount) and share with the rest of the members. The community kitchen is aimed to become functional on its own so that the organizers can transfer to other communities and likewise assist other First Nations people in improving their health. However, the organizers will retain communication and linkage with the members of the kitchen group for evaluation of progress and sharing of information. Sustainability and Linkages A community kitchen must be sustained in order to improve the nutrition of the kitchen members and their families. Thus, linkages must be established with other organizations, individuals and the government. The changing climate has affected the planting and harvesting patterns of fruits and vegetables, and these patterns affect the eating and consumption behavior of the First World populations. The group must work with Health Canada to know more about these evolving planting and eating patterns and the changes in food availability. Health Canada has a program that addresses these issues from which the kitchen group can benefit from. Information vital to health, diseases and nutrition of First Nations people are available at Health Canada (Health Canada, Statistical, 2009) which the kitchen group can utilize. The kitchen group can also coordinate with the federal, provincial/territorial, regional and community agencies in developing long-term Federal Food Security Strategy, that would include Food Mail Program and other initiatives aimed at addressing nutrition and health issues in isolated northern communities. Communication will also be made with the local health clinic and health agencies to maintain continued monitoring of the health status of kitchen members and their families. This is necessary in order to gauge the health improvement of the participants. Local civic groups with information on food resources and suppliers should also be tapped so that the group will have updated data on where to procure cheaper food, or where to buy other food resources not available in one supplier. Sustainability of the project is of utmost consideration if nutrition has to be maintained. Buying of food resources in bulk may not be always possible since the available budgetary contribution of the members may not be sufficient. Thus, the group must be able to source out donations and financial assistance from the government or concerned civic groups. Assistance may come not only in terms of money but also fresh food donations that will form part of the nutritious menu. The group may also seek donors of freezers so that freshness of food can be prolonged. The group must also be updated with the new trends in cooking inexpensive and nutritious meals by acquiring menu and recipe from other agencies. Program Evaluation The project will be coordinated with the local health clinic. As mentioned before, ingestion of food that contains all the nutrients and dietary needs may still be malnourished. So, a comprehensive clinical assessment shall be made that comprise tissue structure changes and biochemical tests. The tests shall be made every six months. Physical measurements can be taken by the local health clinic or health care practitioner every three months. However, a member of the community kitchen can be trained on how to take the BMI other physical measurements, which can be taken once a month. Improvement in health should not only be monitored but also the activities and records of the group. Thus, all expenses and amount of fruits and vegetables utilized per cooking should be listed. Through proper recording, analysis and trending will be easier to see. This would allow projection of the appropriate quantity needed per cooking session, and in turn avoid wastage or spoilage of cooked food. Spoilage would not occur in preserved food (e.g. pickled) since they are prepared with the intention of prolonging its life. The kitchen group may also coordinate with the local health agency or civic group to make an assessment of the progress of the project and the improvement in the health and nutrition of the people. Constant communication and involvement with other groups will break the walls of isolation of remote First World communities. The members of the collective kitchen will also undertake program evaluation of their activities and developments. Regular evaluation is necessary so that the organizers can revise, update and plan the content of every session. The members may want to learn a particular processing or preservation technique. Enthusiasm of the members can be sustained if the organizers can transmit to them knowledge that coincide with their interests. The organizer may distribute survey questionnaires once a month in one of the group sessions that asked their opinions and ideas on the progress of the program and their desired learning. Conclusion Malnutrition is a primary concern in the First Nations communities. One of the causes of malnutrition is poverty or financial insufficiency to sustain health for a longer period of time. The community kitchen is a very sound approach to fight malnutrition because many members of the community can share in the planning of specific nutritious meals day after day. Bulk purchases will entail bigger discounts. There is also a sharing of labor among the community members, with one group cooking for one set of schedule and another group for another set of days. This saves time for the members, and which time can be utilized for other work thus, making them more productive. For a community kitchen to be sustained in the First Nations communities, organizers must be dedicated to the cause since financial problems will always crop up. Kitchen organizers should persistently seek funding support from others groups or businesses to defray the necessary expenditures. After weeks of training (which already entails cost on the part of the organizers for transportation and food), purchasing of food must be sustained. Some kitchen members may have some money to contribute, but the rest may not have. To maintain health, eating of healthy food must be done daily. Thus, when it occurs that the contribution of the community members to the food budget is below the projected cost, the organizers must shell out some money. A community kitchen though must not be a stand-alone project. It can be linked with other programs within the community in order to strengthen it. Thus, the members may engage in garage sales, selling of newspapers, or making of simple homemade projects (e.g. traditional bracelet or necklace) that can be sold in the market. The members of the community kitchen may also establish a community garden which harvest can supplement the needs of the community kitchen. The organizers of the community kitchen should also link the group with other organizations with the same objective so that there will be an exchange of knowledge and best practices. The kitchen should also be linked with the local leaders and donor organizations so that they can provide material and moral support, if not financial support. These contributions from outside groups can do a great impact on the project. The cost of treating diseases and food-related illnesses would be greater than the expenditure allotted for maintaining physical health and well-being. References Aberg, J. 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