You need to incorporate accessibility into your assessment and planning in order to understand a client’s capacity to acquire and store healthy foods. Accessibility in terms of the food guide refers to the financial and geographical capacity to purchase safe and healthy foods and beverages. There have been several sociological terms to define a community’s access to food, such as: a food desert which has limited access to nutritious and affordable food; a food swamp which has increased access to fast foods; and a food oasis which has access to nutritious options and even less access to unhealthy options (Bridle-Fitzpatrick, 2015). A sample of questions you may ask clients include: “Tell me about the ways that you access or purchase food”; “Do you have any issues accessing or purchasing food?”; “Do you have sufficient income to purchase the food you need?”; “Tell me about your capacity to ensure safe storage of foods?” You may want to probe about nutritious foods specifically, such as fruits and vegetables, protein, and grains.
Incorporation of the above questions into your assessment is important as the answers provide insight into the client’s needs related to accessible and safe foods. Some of the barriers that Canadians encounter are related to limited financial capacity and living in areas where they have limited to no access to reasonably priced foods, fresh fruits and vegetables, clean drinking water, and infrastructure that allows for the safe storage of food and beverages. For some, it might be an economical solution to purchase frozen (versus fresh) fruits and vegetables or dried or bulk legumes. However, this solution does not recognize the complexity of the issues concerning food safety and accessibility, particularly considering that costs are still high and safe storage can still be an issue.
Many times, eating unhealthy foods is not a choice. Rather, it is influenced or directly impacted by the social determinants of health. Many people have consistently less access to affordable, safe, and nutritious foods. These people may live in rural, remote (including Northern Canadian regions and Indigenous communities) and disadvantaged communities, and they may have limited income, and/or they may be homeless. Even in urban areas, some neighbourhoods do not have easy access to grocery stores or transportation. Access to clean drinking water in Indigenous and remote communities is another example of how the social determinants of health can impact food safety and accessibility. Whelan and colleagues (2018) have indicated that healthy food is more expensive than unhealthy food in rural areas. They have also found that there is variability in quality of food, particularly fruits and vegetables, with limited stock in stores and less diversity in food choices. It has been found that the cost of store-bought food can be drastically higher in rural and remote regions, particularly when these regions are only accessible by air (Randazzo & Robidoux, 2018). For example, it is often estimated that prices can be two to three times higher in Northern communities, as compared to prices in urban centres in Canada.
See Film Clip 3.1 in which Dr. Shelagh McCartney speaks about the complexities of food safety and accessibility in Northern and Indigenous communities.
Film Clip 3.1: Dr. Shelagh McCartney speaking about complexities of food safety and accessibility
In addition to engaging in conversations with clients about their needs, health professionals also have a responsibility to be a social justice advocate by assessing and addressing social determinants of health. Alongside Canadian policymakers, it is vital that health and social professionals respond to the inequities pertaining to financial and geographic access to nutritious and safe foods. Olstad, Campbell, and Raine (2019) indicate that future policies need to move beyond helping Canadians make informed food choices to also include social policies that focus on inequities by addressing the social determinants of health. It is not sufficient to develop a food guide without attention to the social policies and structures that impact a person’s capacity to purchase, store, and benefit from nutritious foods.