An important challenge for today’s nutrition professionals is communicating effectively with an increasingly diverse Canadian population. It is well established that culture has a strong influence on an individual’s food intake, attitudes and behaviors. Demonstrating multicultural competence requires sensitivity to cultural differences between ourselves and those of different gender, age, religion, race or ethnicity, education or income. For nutrition professionals, this requires knowledge of culturally relevant foods and food habits and the ability to incorporate this into interventions and communications that promote desirable health and behavior changes. Showing knowledge of and respect for an individual’s food practices and customs and building a trusting relationship can help nutrition professionals facilitate healthful changes in the eating and exercise patterns of all their patients and clients.
The 2006 census showed that Canada’s population has grown rapidly, primarily due to an increase in international migration1. According to the 2001 Census, foreign-born Canadians made up almost 20% of the population with a marked increase in Chinese, Filipino and South Asian immigration2-3. Given the diversity of the Canadian population, nutrition professionals need to be culturally competent in order to provide the best and most relevant patient care.
Despite our universal healthcare system, not all Canadians are benefiting equally from advancements in health care. For example, health disparities among new Canadians, First Nations and Inuit populations include differences in mortality rates, incidence of chronic diseases and access to care. Many circumstances, including socioeconomic or environmental factors, language barriers and/or cultural attitudes regarding medical care, may contribute to these differences. Health Canada is working to reduce the health disparities between First Nations and Inuit and other Canadians. The focus is on addressing early childhood health priorities; acting on major threats to Aboriginal health, such as diabetes and communicable diseases; and supporting effective health services and partnerships in First Nations and Inuit communities4.
Immigration to a new country often leads to a substantial shift in a person’s lifestyle and environment as he or she becomes acculturated. Some anthropologists define acculturation, which includes dietary adaptations, as the exchange of cultural habits that results when groups come into continuous contact. Both cultures change, but each group remains distinct5.
Access to the abundant food supply and adoption of North American eating patterns may result in dietary choices higher in protein, fat and/or calories and potentially lower in fruits and vegetables than traditional eating patterns in some other countries. This may result in increased risk for chronic diseases. A recent American study suggests that, for immigrants, number of years of residence in the US is associated with higher body mass index beginning after 10 years6. Nutrition professionals can play an important role in the acculturation process by determining the degree to which lifestyle interventions should focus on maintaining traditional healthy eating habits, adopting healthy aspects of eating in North America and promoting adequate levels of physical activity to help prevent weight gain and chronic disease7.
While it may be ideal for health professionals and clients to be culturally matched, evidence suggests most health care providers can learn to address the needs of specific cultural groups8. Health care professionals who receive multicultural training can overcome cultural barriers to treat clients more effectively.
Training may include self-study or a course or workshop on multicultural foods (including selection, preparation and storage), food habits, customs, health behaviors and language, including body language. Training should focus on increasing awareness of the cultural experience and background of those being served. For example, many Canadians may benefit from information on nutrition topics such as serving sizes and reading food labels. Finding appropriate distribution channels within local communities is a way to deliver culturally relevant nutrition and health information as well.
The following table highlights some food practices, health issues, dietary concerns and strategies for three population groups4,9-13.
|Cultural Group||Food Practices||Diet Related Health Issues||Dietary Concerns||Strategies|
|Asian||Traditional diets vary widely by country and region of origin. Some common elements include: diet largely composed of rice, vegetables and fruits; low intake of dairy foods except for ice cream or some yogurt; protein is primarily from fish, pork and poultry, as well as nuts, legumes and/or tofu; food is prepared by stir-frying, steaming, grilling, deep-frying, baking or boiling.||Some types of cancer, osteoporosis and stroke; lactose intolerance; risk for heart disease, diabetes and obesity increases with dietary acculturation||Overall diet may be low in calcium and high in carbohydrates and sodium.||Encourage continued variety. |
Evaluate calcium intake and suggest other food sources of calcium if inadequate.
Provide tips for reducing sodium intake.
|First Nations, Inuit & Métis||Traditional foods will vary by region. Diet will also vary depending on urban, rural or Reserve lifestyle, and geographic location. Some common elements include: traditional meats and wild game and fish; wild berries; bannock. Northern communities may rely on canned and frozen vegetables and fruits and powdered and canned milk due to the accessibility and expense of transporting fresh foods.||High incidence of diabetes (especially type 2 in children); obesity; substance abuse; heart disease and stroke; communicable diseases; shorter life expectancy; lactose intolerance Poor access to health care services is also a concern.||Diets high in refined carbohydrates, saturated fats and sodium.||Encourage use of traditional foods. |
Emphasize the nutritional benefits of canned and frozen produce and powdered and canned milk products.
Evaluate calcium intake and suggest other food sources of calcium if inadequate.
Provide as a resource the Eating Well with Canada’s Food Guide for First Nations, Inuit & Métis.
|South Asian||Traditional diets vary widely by country and region of origin. Some common elements include: rice, lentils, beans, spices, curries, ghee (clarified butter) paneer (cheese), whole wheat flour and yogurt. Common food preparation methods are marinating, frying and baking. Vegetarianism is a traditional lifestyle for some regions.||High incidence of cardiovascular disease, hypertension, abdominal obesity and diabetes.||Diets high in saturated fat.||Preserve healthy cultural food practices, such as continued use of complex carbohydrates. |
Suggest modifications of traditional dishes to lower intake of fat.
Encourage intake of low-fat dairy foods, lean meats, fresh vegetables and fruits and healthy fats.
Provide strategies for a healthy vegetarian lifestyle.
Provide strategies for moderate weight loss and physical activity.
There is a frequent perception that advice to “eat healthfully” will mean giving up familiar or traditional foods and trying to conform to the eating patterns of the dominant culture. Nutrition professionals are charged with overcoming this barrier, which involves making nutrition communications culturally relevant while assisting individuals in adopting healthful food habits. Often this means adapting nutrition messages and developing flexible approaches for nutrition education and counseling.
Food guidance tools, such as food guide graphics developed or adapted by various countries, organizations or ethnic groups, can be very useful in nutrition communications. These education tools recognize ethnic foods and/or various dietary patterns (e.g., vegetarian diets) while demonstrating how the overall diet can be assembled to achieve health goals. For instance, Health Canada has developed a Food Guide targeted to Aboriginal groups (see Additional Resources). Providing practical tips for making small changes in food selection and preparation that allow individuals to retain food practices from their culture can greatly improve acceptance and the likelihood of positive health behaviours and outcomes14.
In addition to resistance to modifying food habits, there are often cultural barriers to exercise. Health professionals can encourage clients to get recommended amounts of physical activity by assessing their interests and suggesting culturally relevant pursuits. For example, being familiar with local community resources, including classes, events and facilities, is one way to overcome barriers such as cost, language and a sense of unfamiliarity.
Strategies to overcome linguistic and cultural barriers to care can include the use of bilingual providers, bilingual/bicultural community health workers, interpreters and translated print materials15. Some strategies may work best in specific settings, while others have wide application and can be useful in all settings.
Centretown Community Health Centre. The Diabetes Food Guide to Healthy Eating.
Citizenship and Immigration Canada. Cultural Profiles Project. http://www.cp-pc.ca/english/
Dietitians of Canada. Vegetarian Food Guide Rainbow.
Health Canada. Eating Well with Canada’s Food Guide. http://hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html.
Health Canada. Eating Well with Canada’s Food Guide – First Nations, Inuit and Metis. http://hc-sc.gc.ca/fn-an/food-guide-aliment/fnim-pnim/index_e.html
Stein K. Cultural literacy in health care. J Am Diet Assoc. 2004; 104:1657-9.
Toronto Public Health. Guide to Understanding Halal Foods.
University of Calgary. Diversity ToolKit. http://www.ucalgary.ca/~dtoolkit/index.htm