Research reportEating well with Canada's food guide? Authoritative knowledge about food and health among newcomer mothers☆
Introduction
The Canadian federal government has been disseminating nutrient requirement recommendations for Canadians through food guides since 1942, when Canada's Official Food Rules was published by the federal Health Department in 1942 (Bush et al, 2007, Katamay et al, 2007). Since then, these recommendations have evolved from prescriptive diets to the current 2007 version, Eating Well with Canada's Food Guide (CFG), which has been translated into ten languages in addition to English and French. CFG aims to be a “description of a healthy pattern of eating intended to reduce the risk of chronic disease and obesity, and meet nutrient requirements for most Canadians [which] focuses on the amount and type of food to eat” (Bush et al., 2007). CFG is based on substantial epidemiological evidence and emphasizes preventing chronic disease through decreasing salt and saturated fat intake, increasing fruit and vegetable intake, and increasing physical activity (Bush, Kirkpatrick, 2003, Katamay et al, 2007).
The guide itself is a six-page booklet that outlines food intake patterns developed for nine groups stratified by sex and age, providing specific recommended serving numbers per day. The key message is to “enjoy a variety of foods from the four food groups” (Vegetables and Fruit; Grain Products; Milk and Alternatives; and Meat and Alternatives). Each of the food groups is presented as one stripe of a rainbow, with representative foods from each food group depicted pictorially. CFG also aims to “reflect Canada in 2007” (Bush et al., 2007), implying that it reflects the multicultural range of foods consumed by Canada's residents. As the primary health promotion tool for disseminating Health Canada's ideal food intake pattern, CFG's effectiveness likely depends on individual Canadians' exposure to and response to these guidelines, and how well the guidelines concord with culturally-informed understandings of food, health and their inter-connectedness.
Food-based dietary guidelines such as CFG and the USDA's MyPyramid in the United States are intended to improve public health by encouraging healthy individual eating decisions, which include decisions that parents make in feeding their children (Bush et al., 2007). However, these guidelines are not without controversy. There is ongoing academic and public debate as to the CFG's appropriateness, including its potential to in fact promote rather than prevent weight gain (Freedhoff, Hutchinson, 2014, Kondro, 2006). In addition to these critiques, while CFG aims to reflect Canada's cultural diversity, it is limited in meeting this aim in two respects. First, while the depiction of foods on the CFG website reflects a slightly greater diversity of foods by cultural preference, the guide itself features foods generally associated with a Western diet. Second, CFG's framework employs a Western biomedical perspective, which may not encompass other social and cultural frameworks for understanding health and nutrition (Airhihenbuwa, 1995). Research on health and nutrition knowledge has demonstrated that frameworks for understanding health and nutrition vary significantly between different cultural groups in Canada (Ristovski-Slijepcevic, Chapman, & Beagan, 2008). The aim of this study is to generate knowledge about how CFG is comprehended by newcomer mothers of young children in terms of the types of foods recommended, in order to inform public health strategies for future redevelopment and reconceptualization of CFG. The analyses explore the interplay between newcomers' previous dietary knowledge and practice and how their exposure to Canadian dietary guidelines via CFG, dietitians, community nutrition programs, physicians, and other sources influences dietary change on arrival to Canada.
To examine the changes in diet associated with migration to Canada, we use Brigitte Jordan's concept of authoritative knowledge, which examines how particular health-related practices and ways of knowing are legitimized in a “community of practice” in specific situations (Jordan, 1993). Jordan (1993) argues that in any particular domain of human understanding, there are several different ways of knowing, but very often one type of knowledge – “authoritative knowledge” – gains authority over the others. This authoritative knowledge is often associated with a stronger power base, and is validated and accepted through both practice (medical or otherwise) and social interaction (Irwin, Jordan, 1987, Sargent, Bascope, 1997). Jordan's work examines the interplay between parallel cultures that result from the introduction of Western medical knowledge and practice, in particular between traditional birthing practices and Western medical birthing practices. Other scholars have applied the concept of authoritative knowledge to a variety of settings to further explore parallel forms of knowledge in the areas of reproductive health and nutrition (Chadwick, 2010, Ellison, 2003, Fiedler, 1996, Kingfisher, Millard, 1998, Saravanan et al, 2012, Vaga et al, 2013). The framework is well-suited to the context of migration, which exposes individuals to new ways of knowing.
Using Jordan's model we aim not only to identify the different forms of knowledge and explore how these influence child feeding practices, but also to examine what causes some forms of knowledge to be devalued in favor of others. We apply this model to examine the overlapping and potentially competing forms of knowledge to which individuals are quickly exposed through the process of migration. This paper focuses first on identifying the ways that this diversity of knowledge might influence the appropriateness of Health Canada's dietary guidelines and CFG as a tool, and the applicability of these guidelines to our study participants. Second, we aim to identify the different types of knowledge about food and health in this sample. Overall, this research aims to inform the design of culturally competent programs aimed at improving young children's diets in newcomer families in Toronto, and will also assist providers and policymakers in understanding how child caregivers use and interpret nutrition recommendations.
Section snippets
Research partners and coordination
The research was conducted in partnership with a hospital-based initiative to improve access to healthcare among new immigrant families, along with the support of several community centers and programs in the study area. The Office of Research Ethics at the University of Toronto approved the study and the research team followed standard guidelines for best practice in research ethics regarding informed consent, confidentiality and anonymity.
Study setting
The research was conducted in the Jane and Finch
Participant demographics
Interviews were completed with 32 participants who had arrived in Canada within the last five years with equal numbers of native Spanish speakers from Latin America and native Tamil speakers from Sri Lanka. Among Tamil participants, 10 arrived in Canada as family class immigrants, and six arrived as refugee claimants. Among Latin American participants, five arrived as family class immigrants, and 11 as refugee claimants. The median age of the index child was 3 (range = 1–5), and the median
Discussion
This analysis provides strong evidence of a variety of conceptualizations of the relationship between food and health in these samples of Latin American and Sri Lankan Tamil newcomer mothers, and that community programming introducing newcomers to CFG strongly influences shifts in these conceptualizations toward biomedical concepts of nutrition. Overall, the range of conceptualizations evident in this sample limits the utility of CFG as a tool for dietary guidance. There are three key
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Acknowledgements: We would like to thank our interviewers Wasi Sivakumar and Laura Mandelbaum, and Jennifer Levy, for their contributions to the study design and data collection, and Tina Moffat for her insightful comments on earlier drafts of this paper. We would also like to thank our many community partners in the Jane and Finch neighborhood for their insights, and support with recruitment, as well as Yogendra Shakya at Access Alliance Multicultural Health and Community Services for his inputs on study design. Finally, we would like to thank our participants for sharing their time and their stories with us. This study was funded by the Citizenship and Immigration Canada- funded New Immigrant Support Network at the Hospital for Sick Children, Toronto, a grant from the Ontario Metropolis Centre (CERIS) and by a Canadian Institutes of Health Research (CIHR) Banting and Best Canada Graduate Scholarship awarded to Laura Anderson during her doctoral studies