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Social Determinants of Health among Indigenous Peoples

Funded by Alberta Centre for Child, Family & Community Research (ACCFCR)

Indigenous peoples are the youngest and fastest growing population in Canada. No matter where they live, Indigenous peoples face unique challenges such as high rates of smoking, illegal substance and alcohol use, poor nutrition, food insecurity and limited access to health care services. This is further complicated by higher unintentional injury, suicide rates and shorter life spans in comparison with the rest of the nation. Reasons for some of these challenges can be traced to historical events such as colonization and the trauma of residential schools. However, there is a paucity of contemporary literature with detailed and comprehensive information on social issues experienced by Indigenous peoples. The IGHRG team undertook a systematic literature review to collate evident and identify priority issues in Indigenous peoples’ health care. The review provides a foundation for a plan of action to address the health and well-being of Indigenous communities, community members, leaders and elders.

The systematic review collected all reliable information about social determinants of health among Albertan Indigenous peoples. Grey literature was gathered from Indigenous communities, Indigenous organizations, key community people, interested stakeholders, the provincial and federal governments and academics. In addition information and supplements on Indigenous health were collected from all relevant health and social science departments at Alberta universities, nine Alberta Network Environments for Aboriginal Health Research (NEAHR), Institute of Peoples’ Health (IAPH), Canadian Institutes of Health Research (CIHR), Alberta Native Friendship Centers Association (ANFCA), Aboriginal Organizations and Services in Alberta, and the Alberta Human Rights Commission.

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Asthma rates are rising worldwide. The reasons for this, as well as the factors that contribute to its development are largely unknown. The effect of diet on asthma risk has been studied, and one proposed theory is the protective effect of a diet high in antioxidants and low in pro-inflammatory factors. Flavonoids are a group of antioxidant and anti-inflammatory compounds found in fruits and vegetables. The first meta-analysis of the effect of fruit and vegetable intake on the risk for developing asthma and wheezing was performed on the currently available literature. The meta-analysis found a promising link between flavonoids in fruits and vegetables and a lower incidence of asthma and its symptoms. Future research will focus on investigating a particularly vulnerable population: low income African Americans living in Baltimore whose diet is low in fresh fruits and vegetables and high in fats from animals, high fat/high sugar foods and sugary beverages. This diet is high in pro-inflammatory foods as well as being low in antioxidants. Research will focus on the extent to which a diet such as this can impact the incidence of asthma along with exposure to environmental allergens and pollutants.

Helping Ourselves to Health:

Alaska Native Villages (in partnership with the Alaska Native Tribal Health Consortium)

For Indigenous people in Alaska, increasing rates of overweight and obesity cause significant health problems. Similar to other Indigenous people around the world, the Yup’ik people of Alaska have experienced a transition from their traditional foods to a Westernized diet in recent history. The result of this is the increased intake of processed, market foods high in fat, sugar, and energy as well as lower rates of physical activity. Ultimately, diet quality and health have suffered. The Helping Ourselves to Health study aims to understand and enhance obesity prevention among rural Alaska Indigenous people. The objectives of the study are to investigate the impact of a food assistance program, as well as to gather information about current dietary makeup. The proportion of traditional food versus market foods is a particular item of interest. The information gathered will be used to produce an education intervention aimed at increasing diet quality through increased intake of traditional foods, fruit, and vegetables as opposed to processed foods. Six rural community in the Yukon-Kuskokwim region of Western Alaska are participating in a cross sectional study to gather information on the most frequently consumed foods gathered from 24 hour recalls. This data will be used to create a culturally appropriate, quantitative food frequency questionnaire. The food frequency questionnaire will be used to assess dietary intake, the extent of nutrition transition, as well as providing baseline data for future interventions. (Click here to view publications)

Colorectal Adenoma case-control study in Japanese Brazilians

Incidence of colorectal cancer (CRC) is lower in men of Japanese descent living in Brazil than in Japan (highest rates of CRC in the world) or Hawaii (third highest rates of CRC). This occurrence may be due to dietary and lifestyle differences between populations. The first step in the research was to create a validated food frequency questionnaire (QFFQ) for the specific populations using 24 Hour Recalls, food diaries and interviews. The QFFQ will be used to investigate the effect of specific factors on CRC incidence: including folate, smoking, alcohol, calcium, fruit and vegetable intake as well as heterocyclic aromatic amine consumption (from well cooked meat). (Click here to view publications)

The Multiethnic Cohort Study

The Multiethnic Cohort Study of Diet and Cancer (MEC) was funded by the National Cancer Institute (NCI) in 1993. The MEC is being conducted at the University of Hawaii Cancer Center, in Honolulu, HI, and the Keck School of Medicine, University of Southern California (USC) in Los Angeles, CA. The cohort of over 215,000 men and women are primarily of African-American, Japanese, Latino, Native Hawaii, and Caucasian descent. The ethnic diversity of Hawaii and California made it possible to develop this large study with its unique representation of minority populations. (Click here to view publications)

Barbados National Cancer Study

The Barbados National Cancer Study (BNCS) is a nationwide case-control study investigating environmental and genetic factors for breast cancer (BC) in a predominantly African-origin population with similar ancestry as African-Americans. This report evaluates associations of incident BC in the BNCS to various factors, including demographic, anthropometric, reproductive and family history variables, not investigated previously in this population. The reproductive patterns of African-Barbadian (AB) women tended to differ from those of American-American (AA) women (later age of menarche, earlier age at first pregnancy, higher frequency of lactation and infrequent use of exogenous hormones) and could help to explain their considerably lower postmenopausal incidence of BC. The relationship between reported family history and BC, combined with the associations noted for several reproductive and other variables, supports the genetic and environmental contributions to BC which may very in populations across the African diaspora. Further investigations of other populations may clarify these issues. (Click here to view publications)

African-origin populations in Cameroon (urban and rural), Jamaica, and Manchester, UK

Development of a quantitative food frequency questionnaire and assessment of nutritional intake.

The objective was to develop the methods for assessment of food and nutrient intake using standardized food frequency questionnaires (FFQ) in the three African origin populations from Cameroon, Jamaica and Caribbean migrants to the United Kingdom. The design was a cross-sectional assessment of diet from a representative sample in each site, using either a 2-day food diary or a 24 hour recall method to determine foods for inclusion on the food frequency questionnaire. Subjects were aged 25-79 years. Considerable variations exist within sites. (Click here to view publications)

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