Six Nations Community Health

Addressing key social barriers on the Six Nations Reserve is critical to tackle the high prevalence of obesity, type 2 diabetes, and cardiovascular disease in this community.

McMaster Researcher

Citation

Anand S.S., Davis A.D., Ahmed R., Jacobs R., Xie C., Hill A., Sowden J., Atkinson S., Blimkie C., Brouwers M., Morrison K., de Koning L., Gerstein H., Yusuf S., "A family-based intervention to promote healthy lifestyles in an Aboriginal community in Canada," Canadian Journal of Public Health, 98, 6, (2007). 

Joseph P., Davis A.D., Miller R., Hill K., McCarthy H., Banerjee A., Chow C., Mente A., Anand S.S., "Contextual determinants of health behaviours in an Aboriginal community in Canada: pilot project," BMC Public Health, 12, 952, (2012). 

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What is this research about?

Researchers worked in partnership with the Aboriginal community on the Six Nations Reserve in Brant County, Ontario to understand the factors that influence health on the Reserve. Obesity, type 2 diabetes, and cardiovascular disease are highly prevalent in Aboriginal people in Canada. The high prevalence of these health issues can be attributed to an interaction between changes in the dietary and physical lifestyle of Aboriginal communities in Canada over the last two generations and low socioeconomic status. The purpose of this research was to examine whether a household-based intervention could promote weight-loss and improve the dietary and activity choices of participating families and to explore the contextual factors on the Reserve which may make it difficult for individuals to make healthy dietary and physical activity choices.  

What did the researchers do?

In the first study, the research team recruited families from the Six Nations Reserve who had at least one child living at home. The researchers designed an intervention program that involved after-school physical activity programs for children and regular home visits by an Aboriginal health counsellor who helped set dietary and physical activity goals for each member of every household. Some of the families were randomly assigned to the intervention group, which received the household-based program. Some of the families were randomly assigned to the usual care group, which consisted of access to Canada's Food Guide to Healthy Eating, Canada's Physical Activity Guide to Healthy Active Living, and the after-school physical activity programs for children. At the beginning of the study, the researchers measured energy and nutrient intake, physical activity level, knowledge and attitudes about healthy diet practices, weight, blood pressure, and body fat of participants. After six months the researchers measured these variables again to see if they were any significant changes within and between groups. Finally, when the researchers obtained the results, they shared and discussed them with the Six Nations Health Committee. 

In the second  study, the research team worked with 63 participants who had been involved with the previous study to understand what contextual factors in the Six Nations Community impact health behaviours. Using questionnaires, the researchers collected information on the built environment and "walkability" of the Six Nations Reserve, the accessibility and affordability of healthy foods, and the perceptions of tobacco use and accessibility in the community.  

What did the researchers find?

In the first study, the researchers found that the household-based lifestyle program had some positive, but moderate effects on changing the diet and physical activity behaviours of the participants in the intervention group. For example, they found that: 

  • Energy intake decreased for both the intervention and usual care groups, but did not differ significantly between groups 
  • Consumption of fats, oils, sweets, and trans fatty acids decreased significantly in the intervention group compared to the usual care group 
  • However, consumption of fruits and vegetables was low in both groups at the beginning and end of the study 
  • Water consumption increased and soda consumption decreased in the intervention group compared to the usual care group 
  • Sedentary behaviours decreased in the intervention group compared to the usual care group 
  • However, there was no statistically significant change in body weight or body fat percentage in the intervention group compared to the usual care group 

After reviewing the results, the Six Nations Health Committee suggested that there are several barriers on the Six Nations Reserve that may have factored into the intervention's modest impact. These barriers include the lack of bicycle pathways and sidewalks on the Reserve, safety concerns when walking at night, the absence of a fresh produce distributor on the Reserve and, the high price of fresh produce purchased off the Reserve. 

In the follow-up study, the researchers found that many of the concerns raised by the Six Nations Health Committee in the previous study were supported. The data showed that: 

  • The majority of participants perceived the "walkability" of the Six Nations Reserve as poor 
  • All participants purchased their groceries off the Reserve, spending an average of $151 per week on groceries ($11 per week more than the Ontario average), and making an average of 5 trips per month to buy groceries off of the Reserve  
  • The majority of participants perceived tobacco use to be a problem in the community, especially among teenagers  
  • They also believed that tobacco advertisements should be banned and that tobacco sales should be under greater law enforcement 

How can you use this research?

This research is particularly important to the Six Nations community, and other Aboriginal communities across Canada, as it demonstrates the potential effect that a household-based intervention program can have on weight loss, diet, and physical activity. This research also illuminates need for strategies that address the social barriers that restrict Aboriginal people from making healthy dietary and physical activity decisions. Specifically, the research emphasizes the need to enhance the walkability of the Six Nations Reserve, improve the accessibility of affordable fresh produce, and address tobacco accessibility and use among teenagers. Ultimately, this research can help the Six Nations community make evidence-based, culturally aligned changes that address prominent health concerns.  

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