Health and Social Services - Yukon

Health and Social Services

1YUKON NUTRITION FRAMEWORK

Yukon Nutrition Framework

March 2010

ISBN 978-1-55362-464-6

2 YUKON NUTRITION FRAMEWORK


Table of Contents

Message from the Minister of Health and Social Services ...........................................................................................................5

Why create a nutrition framework for the Yukon? ..........................................................................................................................7Introduction .........................................................................................................................................................................................7Ready to take action ..........................................................................................................................................................................7Summary of nutrition goals .............................................................................................................................................................8Our process .........................................................................................................................................................................................8

Goal 1: Promote healthy eating practices...........................................................................................................................................9Objectives ............................................................................................................................................................................................9Rationale...............................................................................................................................................................................................9What’s happening now .................................................................................................................................................................. 10Proposed next steps ........................................................................................................................................................................ 12

Goal 2: Improve Food Security ........................................................................................................................................................... 13Objective ............................................................................................................................................................................................ 13Rationale............................................................................................................................................................................................. 13What’s happening now .................................................................................................................................................................. 16Proposed next steps ........................................................................................................................................................................ 17

Goal 3: Support special populations and their nutrition needs .................................................................................................. 18Objective ............................................................................................................................................................................................ 18Rationale............................................................................................................................................................................................. 18What’s happening now .................................................................................................................................................................. 19Proposed next steps ........................................................................................................................................................................ 21

Goal 4: Address nutrition-related health issues facing Yukoners ............................................................................................ 22Objectives ......................................................................................................................................................................................... 22Rationale............................................................................................................................................................................................ 22What’s happening now ..................................................................................................................................................................23Proposed next steps ....................................................................................................................................................................... 25

References................................................................................................................................................................................................27

Figures

Figure 1: Determinants of healthy eating ......................................................................................................................................... 14

Figure 2: Determinants of food security .......................................................................................................................................... 15



Message from the Minister of Health and Social Services

I am pleased to release the Yukon Nutrition Framework.

Healthy eating is integral to healthy living, growth and development. Equally important, eating is social, pleasurable, and a basic human need. Focusing on nutritional health will foster healthy Yukoners and healthy Yukon communities.

The Yukon Nutrition Framework aims to continue to build and expand nutrition services with focus given to healthy eating, food security, chronic health conditions and special populations. This framework is a foundational piece and offers strategic direction for services.

The development of the Yukon Nutrition Framework has been a collaborative effort and has resulted in a long-term plan to address nutrition issues facing Yukoners. I am proud to say that the department of Health and Social Services supports these goals towards healthy eating.

Glenn Hart Minister



Why create a nutrition framework for the Yukon?

INTRODUCTION

Good nutrition is an important part of individual and community health and well-being. It is crucial for healthy growth and aging, effective functioning of the body, and protection from illness and infection, and essential for children’s development. Nutrition provides added benefits, supporting a positive frame of mind and active participation in the family, school, workplace and community.

Without it, there can be serious consequences over time. Inadequate nutrition contributes to poor health and increased risk of chronic disease, and compromises productivity, employment and food security. Taking a proactive approach to healthy eating, from providing accurate nutrition information to supporting local and traditional foods, can improve Yukoners’ overall health, quality of life, and may even reduce long-term health care costs.

The Yukon Nutrition Framework is a long-term plan to address the major nutrition issues facing Yukoners in an organized and integrated way. This collaborative effort by multiple stakeholders is based on guidance from Yukon Registered Dietitians (RDs) and spells out four main goals as its focus for improvement. With the development of this document, Yukon joins others across the country in taking a harmonized and forward-looking approach to addressing local nutrition issues. Most provinces, as well as the territory of Nunavut, already have a nutrition or healthy living framework, action plan or strategy in place.

The framework’s primary users are expected to include the Yukon Government, First Nation governments and organizations, health professionals, schools, and non-governmental agencies. It is intended to help these groups strengthen leadership, coordination, planning and decision-making, as they work to promote healthy eating among all Yukoners.

READY TO TAKE ACTION

There are a number of key factors driving this framework to improve nutrition:

Firstly, Yukoners have demonstrated a strong appetite to take action and improve their health. According to the 2003 Yukon Health Status Report, over half of Yukoners took steps to improve their health in the previous year (2002). The most common strategy was to increase physical activity, but some also changed eating habits, lost weight, or tried other ways to improve their health. The 2008 Yukon Healthy Living Survey* showed that a significant number of Yukoners, especially those living outside Whitehorse, have a strong interest in increased access to nutrition information. This nutrition framework aims to strengthen that momentum.

Secondly, the mission of the Government of Yukon’s Department of Health and Social Services supports a long-term focus on nutrition. It aims to protect, promote and restore the well-being of Yukoners in harmony with their living environments and facilitate access to quality health programs and services.

With this emphasis, the department is in a position to take a coordinating lead in territorial nutrition programming.


Health and Social Services’ objectives and strategies include:

public protection from preventable diseases

programs to screen for, monitor and prevent public health risks

strong community programs that support those most at risk

improved access to information and education

and, enhanced support to children and families.

The Yukon Nutrition Framework’s goals, objectives and proposed actions align closely with the department’s.

SUmmARY Of NUTRITION gOAlS

The Yukon Nutrition Framework presents four goals as the main areas of focus. Each of these goals outlines objectives, identifying areas where work can be done, explains the rationale behind it, and suggests next steps to help achieve these objectives.

The priority areas for this framework are:

1) to promote healthy eating practices

2) improve food security

3) support special populations and their nutrition needs

4) and, address major nutrition and health issues facing Yukoners.

OUR pROCESS

The Yukon Nutrition Framework began in mid-summer 2008 with a review of similar frameworks in use across the country. The process continued later in 2008 with a small-scale consultation, primarily involving Yukon Registered Dietitians, approximately a dozen across the territory. Asked to identify existing nutrition-related activities throughout Yukon, gaps in services or programming, and priority areas for action, they provided the foundation for this document. The Framework’s four key goals, objectives for each goal, and proposed actions, were then developed and shared with a broader range of stakeholders and experts via a targeted, formal consultation.

A steering committee of nutrition experts and health professionals provided valuable guidance, input and insights throughout this framework’s development and completion.


Goal 1: Promote healthy eating practices

ObjECTIvES

1. Develop policies and guidelines that support healthy eating.

2. Create, expand and maintain educational programs, resources or services that provide nutrition expertise and information on healthy eating.

RATIONAlE

Healthy eating contributes to overall health and can reduce the risk of chronic disease.(1) However, research shows that Canadians could be eating better. A recent study of eating habits in Canada (excluding Yukon) indicated that many Canadians do not meet daily recommendations for fruit and vegetables and milk products as outlined in Eating Well with Canada’s Food Guide.(2). Available information about Yukoners’ eating habits suggests that we are no different than the rest of the country — the 2003 Yukon Health Status Report indicates that only 40% of Yukoners consume the recommended amounts of fruits and vegetables.(3)

Healthy eating requires the promotion of supportive environments. What we eat depends not only on personal choice, but also on our knowledge of good nutrition, and availability and pricing of healthy foods. The creation of supportive environments, through policies and guidelines, resources, and programming, can improve knowledge of healthy eating and food preparation, and opportunities to choose healthy food options.

Priorities for achieving this goal:

Schools and childcare providers are important target audiences. Developing healthy eating practices during childhood sets a good foundation for growth and development, and positive eating patterns throughout life.

Workplaces, where people spend a significant amount of their time, are another important focus. Facilitating healthy eating practices at work can contribute to a full and productive working life, and environment.

Communities and general public can gain increased access to healthy foods and awareness of good nutrition if existing barriers are reduced.

Health care professionals and support staff are important role models and agents for positive change. Supporting them in delivering current nutrition information to clients can facilitate consistent and accurate messaging.

YUKON NUTRITION FRAMEWORK

WhAT’S hAppENINg NOW

Signs of Success…

Drop the Pop — Challenging kids to re-think their drink

There is growing awareness that drinking too many sweetened drinks can have negative effects on your health. These drinks make us feel full, but have no nutritional value and contain large amounts of sugar. Drinking two cans of pop per day for a week provides us with more than two cups of sugar! Sweetened drinks often replace healthier drinks and foods that our bodies need. All of this can contribute to obesity, heart disease, weak bones, Type 2 Diabetes and cavities.

The Yukon Drop the Pop (Re-Think Your Drink) program was established in 2006 to encourage children to do just that: drop pop from their list of favourite drinks and make better beverage choices.

“Drop the Pop challenges Yukon students to stop drinking pop and all sweetened beverages for one week in March, which is Nutrition Month,” says Lorna Arsenault, Community Dietitian with the Yukon Health Promotion Unit. “Students report what they drink and teachers keep track. The program gives out prizes for participation to the students and schools that do the best in cutting out pop and sweet drinks.”

Drop the Pop has been run annually across all three northern territories to great success, with the maximum annual participation in Yukon reaching more than 2000 students from Grades K to 7. Teachers are provided with support through the program’s teaching manual, posters, display materials and prizes.

“This program works so well because it’s a positive fun way to engage kids on the topic of how to choose healthy beverages, snacks and foods,” says Arsenault. “Teachers tell us that children love the challenge, look forward to the program and have a new interest in keeping track of what they drink. We’re very happy to work with schools to provide such important information to children and families. The school environment provides us with a great opportunity to harness the energy and enthusiasm of students, help kids soak up new information and keep them engaged in finding healthy ways to eat and quench their thirst.”

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Signs of Success….

Promoting healthy eating, healthy bones

People with osteoporosis are at a higher risk of bone fracture because of reduced bone density and other changes in bone structure. The good news is that a nutritious diet and regular exercise both help to maintain healthy bones. That was one of the messages delivered through several programs run by the Recreation and Parks Association of the Yukon (RPAY).

In 2008, RPAY began delivering a program called Speaking of Bones. “The program raises awareness about osteoporosis,” says Kim Hunter, RPAY’s Healthy Eating Coordinator. “It teaches people about what osteoporosis is, its risk factors, how it’s diagnosed, what you can do to keep your bones healthy and strong, how the disease can be treated and how to live well with osteoporosis. The program was delivered to the general Yukon public, organized community groups, community nursing and other health care professionals.”

RPAY brought a physician who specializes in osteoporosis, to Whitehorse. “He did presentations to health professionals and the public,” says Hunter. “There was very strong interest. At his public talk, we had about 120 people, both men and women, from the age of 30 upwards.”

The Calcium Challenge was a nutrition challenge, also run by RPAY. It helped to raise awareness about building stronger bones by encouraging people to eat more calcium-containing foods. “Participants were given a card that helped them calculate the amount of calcium they were getting each day, and compare it to the amount they should be getting,” says Hunter. “The card also listed foods that contain calcium. We got a lot of positive feedback from people who were surprised that they weren’t getting enough calcium in their diet.”


pROpOSED NExT STEpS

To develop policies and guidelines supportive of healthy eating.

Schools and child care providers:

Work with key stakeholders to create guidelines promoting the use of healthy and food-safe options in school-based activities. For example, areas of focus could include healthier options for fund raising, school cafeterias and vending machines, and competitive pricing of healthy foods.

Workplaces:

Encourage the development of healthy eating polices in workplaces, such as healthy meetings as outlined in Eat Smart, Meet Smart, and good work-life balance.

Communities:

Work with food purchase outlets and other retail food providers to provide and promote healthy food choices.

Support the creation of guidelines for the safe procurement, handling and service of Yukon-harvested foods for use in schools and other public food service venues.

To create, expand and maintain educational programs, resources or services that provide nutrition expertise and information on healthy eating.

Schools and childcare providers:

Maintain and enhance school-based programming to support children and families in developing knowledge and skills around healthy eating.

General public:

Expand public access to nutrition professionals and to reliable and consistent nutrition information, such as through Dial-a-Dietitian, a free nutrition information line.

Develop and implement Yukon-specific nutrition programming and resources to address healthy and food-safe food preparation and skill development.

Create more opportunities for the general public to access healthy eating programming, with specific focus on rural communities.

Workplaces:

Support and review the development of initiatives that promote healthy eating in the workplace.

Health care professionals and support staff:

Provide continuing education opportunities about healthy eating for allied health professionals and health educators.

Increase access to training on healthy menu planning and preparation of healthy foods for publicly funded programs that provide meal services. For example, training could be provided to home support workers, early childhood education staff, mental health workers, and community service providers.


Goal 2: Improve Food Security

ObjECTIvE

Create, maintain and sustain initiatives to improve access to adequate, safe, affordable and appropriate food for all Yukoners.

RATIONAlE

Canada’s Action Plan for Food Security defines food security as, “the ability of all people, at all times, to have physical and economic access to sufficient, safe, and nutritious food, to meet dietary needs and preferences for an active and healthy life.”(4) Food security is important because the health and well-being of individuals and the prosperity of a nation require a well-nourished population(5). Those who experience food insecurity often experience poorer health, are more likely to have multiple chronic health conditions, and suffer more social and psychological distress.(6) Food insecurity most often affects families with lower incomes, single parent families, members of households using social assistance, and rural residents.(7)

In Yukon, a higher percentage of residents (21%) experience food insecurity than Canadians in general (14.7%).(8)

This is likely due to the general high cost of living in the north, high food costs in remote communities and limited availability of nutritious food. For example, the cost of a nutritious food basket in Old Crow in 2008 was 2.4 times more expensive than the same food basket in Whitehorse.(9)

Food security may be a greater issue in rural Yukon. The 2008 Yukon Healthy Living Survey, which focused on families with children in Kindergarten to Grade 7, reported that 45% of rural Yukon families had enough food to eat, but not always their preferred kinds of food, compared to 21% for Whitehorse families. 19% of rural Yukon families worried that food would run out before they got money to buy more, compared to 14% for Whitehorse families. The 2008 Yukon Healthy Living Survey also shows that more than half of respondents living outside Whitehorse travel to the capital city to shop because they are not satisfied with food options available in local stores. The top reasons for leaving a home community to buy food are to purchase food at a lower cost, to obtain better quality food and to have more choice.1

Positive action is needed in order to improve food security:

Broadly speaking, all Yukoners and all Yukon communities are important target audiences. Access to food is a human right for all.

Those who are subsisting on low incomes in rural Yukon may be particularly vulnerable to food insecurity and require special attention, service and support.

In order to reach this broad audience, collaboration will be required with non-governmental organizations, First Nation governments and various levels and departments of the Yukon Government.

A cooperative approach will encourage engagement amongst all sectors of the population, and is more likely to create comprehensive solutions for food security issues.

To better understand how access to nutritious food and community support may impact healthy food choices in Yukon, please see the accompanying diagrams. The following diagrams are from Nutrition in Nunavut, A Framework for Action. They examine the relationship between healthy eating and food security in a northern environment.

1 While it may not be practical to expect stores in small remote communities to meet all the local residents’ food needs, these responses do indicate a food access issue exists in rural Yukon.


COLLECTIVE DETERMINANTS OF FOOD CHOICES

HEALTHYEATING

Physical Health

Food Preferences

Nutritional Knowledge

Mental Health

Beliefs about Healthy Eating

Culture

Physical Environment

Economic Environment

Public Policy

-family-peers

-income-education

-gender

-food availability-food accessibility

-food marketed for profit

-influences multiple environments

Social Environment

Environment

INDI

VIDUAL DETERMINANTS OF FOOD CHOICES

Determinants of healthy eating

Figure 1: Determinants of Healthy Eating — Both broad and individual factors influence a person’s opportunities to achieve healthy eating. (Development based on: Understanding the Forces that Influence Our Eating Habits. CJPH, Vol. 9, Supplement 3, July/August, 2005.)

(Nutrition in Nunavut, A Framework for Action)


BROADER SUPPORT & INFLUENCES

COMMUNITY &INDIVIDUAL

FOOD SECURITY

DETERMINANTS OF FOOD SECURITYSkills-literacy

-hunting-cooking

-shopping-handling of food

Availability Traditional

-hunting equipment-animal migration

-weather-community freezers

-time

Funding

Regulation

Research

Advocacy

Programs & Services

Networks

Partners

Policies & Priorities

Prices

Income

Culture

Education

Sharing

Advocacy

Safe

Availability Store

Food Quality

Determinants of food security

Figure 2: Determinants of food security. Food security exists for individuals when they have access to suffiencient, nutritious, acceptable, safe food to maintain health. A range of influences or determinants both broad and more immediate affect an individual’s state of food security. Food security is foundational to achieve healthy eating.

(Nutrition in Nunavut, A Framework for Action)




Whitehorse Food Bank — Helping Yukoners get the food they need

The Whitehorse Food Bank opened its doors on the last day of April 2009. Within just a few months, the food bank had built up a client base representing more than 1,200 Yukoners.

“The community response has been amazing in so many ways,” says Julie Ménard, Executive Director of the Food Bank Society of Whitehorse. “People seem to know about us all over the territory, because clients are coming in not just from Whitehorse but other communities as well. We’ve had so many people donate food, or volunteer. Businesses and organizations have been helping out. Even our clients will come back and return food that they don’t use, so that we can give it to someone else. Everyone wants to share, and to make sure that food is not wasted.”

The Food Bank is open five days a week, with food hampers given out on Tuesdays and Thursdays. Once a month, each client is given a bag of food that will feed the number of people in their household for at least three days. The hamper contents vary with what’s available from donations, but the goal is to follow recommendations in Canada’s Food Guide.

“Many people are struggling because of lack of employment and other issues, and we don’t really know if we are helping everyone enough,” says Ménard. “But we do know that clients are pleased with the food we can provide and we are very happy that we can help so many people with just the generosity of our community.”

The Food Bank is already working to expand its role. Food hampers now include educational information, such as recipes or tips on how to make a nutritious lunchbox for school children. The hope is that the Food Bank can also provide education and workshops on cooking, budget management, smart shopping and reading food labels. Their long-term goal is to help the Food Bank clients of today become more food secure and independent in the future.


pROpOSED NExT STEpS

To create, maintain and sustain initiatives to improve access to adequate, safe, affordable and appropriate food for all Yukoners.

Educational and/or supportive opportunities:

Increase opportunities for those on a limited income to learn about budget-friendly and healthy food procurement and preparation.

Support the development, enhancement or maintenance of long-term community-based food security initiatives such as community kitchens.

Continue to promote the consumption of Yukon traditional foods as healthy and safe food choices.

Interagency collaboration:

Engage with rural communities to explore ways to increase the availability of healthy and reasonably priced foods.

Collaborate with Yukon-based agencies and governments to create a plan of action to address food insecurity in Yukon.

Assess the need for the creation of a local interagency food security and healthy eating coalition.

Community-based initiatives:

Continue to support the creation and maintenance of sustainable harvesting activities and locally grown food initiatives, such as community gardens and greenhouses.

Support and collaborate with community-based programs that provide emergency food services, such as food banks and soup kitchens.

Food costing:

Create a Yukon-wide cost monitoring program based on the cost of a nutritious food basket.


Goal 3: Support special populations and their nutrition needs

ObjECTIvE

Create or enhance and maintain initiatives to support optimal nutrition for special populations and their nutrition needs.

RATIONAlE

Some populations have more or different nutrition needs than others. This can be due to a number of factors, such as health condition(s), age and life stage, or cultural and social conditions. These special populations may require extra support to obtain healthy foods, to gain nutrition knowledge and skills, or access to professional nutrition services.

First Nation people face higher rates of chronic disease. For example, in Canada, prevalence rates of Type 2 Diabetes are three to five times higher among aboriginal people than non-aboriginal people.(10) They also have higher rates of heart disease and some cancers.(11) In Yukon, many First Nation people live in rural areas, which can mean higher food costs and less access to food choices and nutrition programming.

With First Nation’s self-government well-established in Yukon, this framework recommends a collaborative approach. First Nation governments would provide direction and guidance to enhance current nutrition-focused activities.

Pregnancy, infancy, childhood and youth are all times of life where optimal nutrition is key to building lifelong health. Pregnant women, infants, children and youth all have unique nutrition needs. It is important that families and caregivers be provided with the information, skills, and resources to meet these needs.

Elderly and home bound people have unique health needs and are a fast growing segment of the Yukon population.(12) The elderly are at higher risk of chronic disease and poor nutrition because of decreasing mobility, increased risk of isolation, fixed incomes, and decreased sense of smell, taste, and appetite. Good nutrition during the aging years is associated with fewer hip fractures, decreased institutionalization rates and increased autonomy and independence.(13)

Persons living with mental illness and/or cognitive disabilities, such as Fetal Alcohol Spectrum Disorder (FASD), are at increased nutrition risk. They are more likely to live in poverty, social isolation, or have unstable living conditions.(14) Those with serious mental illness are significantly more likely than the general population to experience nutrition-related chronic illnesses such as cardiovascular disease, metabolic syndrome, and Type 2 Diabetes.(15,16) These population groups are also at higher risk of potential nutrient deficiencies, feeding issues, and nutrition side-effects from medications used for treatment. Enhanced access to dietitian services, nutrition resources, education, and programming can play an important role in the interdisciplinary care team and in improved health outcomes.



Signs of Success…. for pregnancy, infancy, childhood and youth

Healthy Babies, Healthy Families jumpstarts a lifetime of good eating habits

It’s never too early to start building good eating habits and at the Skookum Jim Friendship Centre in Whitehorse, good nutrition starts even before birth. The Skookum Jim Prenatal Nutrition Outreach Program (PNOP) works with pregnant women and those with babies up to one year old.

The program coordinator, Bonnee Bingham, is a good example of just how effective the program can be. She started out as a participant in the program, and then became a program support worker before she took on the coordinator’s job.

“Nutrition is so important, it’s the basis of personal health,” says Bingham. “If you don’t have proper nutrition, you’re not going to be a healthy being. It just takes a little shift in thinking to turn something into a much healthier meal.”

Bingham works with a growing number of clients, just over 60 in 2008, to promote good prenatal health and nutrition, infant nutrition, parent-baby attachment and self-care for parents.

“We promote exclusive breast feeding for babies up to six-months-old,” says Bingham. “We also do cooking classes to show parents how easy it is to make your own healthy baby food or to make homemade soup. We do weekly drop-in lunches using whole foods and whole grains, based on the Canada Food Guide. A lot of our clients are surprised at how healthy food can taste so good. It helps them realize they can do this at home too. Our hope is that we can start a lifetime of good eating habits for our clients and their families.”

The program also provides families with the tools for healthy eating, including baby food grinders, food vouchers and (after the soup-making class) a soup pot. “You can teach people skills, but without the tools to continue, the education can be wasted,” says Bingham.


Signs of Success... for persons living with mental illness and/or cognitive disabilities

Fab Food Program serves up nutrition skills and knowledge

The phrase “let’s do lunch” has taken on new meaning for a group of mental health services’ clients in Whitehorse. Every Thursday at the Shipyards Park Building, they literally “do” lunch, including menu planning, shopping, food preparation, serving customers, collecting payment and cleanup.

The Fab Food Program began in May 2009 and has been attracting a growing customer base of food-lovers. It’s coordinated by Patrice Cameron and Andrea Underwood, both Mental Health Services Support Workers with the Yukon government’s Early Psychosis Program. “We had started a weekly cooking class with our clients in October 2008,” says Cameron. “When the opportunity to offer a lunchtime meal at Shipyards Park came up the following May, we knew we had some clients who would be interested and ready to take this on.”

Because of their mental illness, the clients that Cameron and Underwood work with have experienced disruptions to their education, employment and independent living. “This program helps them build a sense of community, participate in a supportive work environment and gain confidence, nutritional knowledge and cooking skills,” says Cameron.

The cuisine at the Fab Food lunch varies from week to week, including Moroccan, Indian, English and Spanish dishes. The food is always fresh and prepared from scratch.

“Some of our clients already have some excellent skills in the kitchen, which they’ve been able to share,” says Cameron. “Everyone is learning a lot about how to find good recipes and make delicious meals from fresh healthy foods within a limited budget.”

The group also learned how to grow and harvest their own food by looking after two plots at the Whitehorse community garden. Some of the spices, vegetables and berries from the garden were used for the weekly lunch program.

“This program has definitely improved the health of our clients, both nutritionally and socially,” says Cameron. “We talk about the vitamin and mineral content of the foods we’re preparing and our clients have learned about how diet affects health in a casual natural way, while we’re working together as a team. They’ve gained these new skills and are also gaining confidence about pursuing other goals in education and employment.”

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pROpOSED NExT STEpS

To create or enhance and maintain initiatives to support optimal nutrition for special populations and their nutrition needs.

First Nations:

Enhance and build working partnerships between nutrition professionals and First Nation governments and organizations.

Work with First Nation governments and organizations to develop or enhance nutrition programming aimed specifically at their needs.

Pregnant women and infants:

Continue to offer and enhance supportive nutrition programming to nutritionally-vulnerable pregnant women and infants, such as Canada Prenatal Nutrition Program (CPNP).

Children and youth:

Examine the need and feasibility of a school-based meal program that would include all Yukon children.

Increase nutrition screening and assessment of children and youth.

Elderly and homebound:

Continue to offer and to enhance professional nutrition services to the elderly, including those who remain active in the community, the homebound and institutionalized.

Assess availability and need for enhanced community-based support services, such as Meals on Wheels, with particular attention to services in rural communities.

Persons living with mental illness:

Enhance working partnerships between dietitians and interdisciplinary mental health care teams.

Assess the need for enhanced nutrition education and programming for persons living with mental illness.


Goal 4: Address nutrition-related health issues facing Yukoners

ObjECTIvES

1. Create or support programs, resources or services that promote awareness and prevention of nutrition-related chronic disease.

2. Create, enhance, and maintain initiatives to support optimal clinical nutrition services for Yukoners.

RATIONAlE

Across Canada, the prevalence of chronic disease is rising with cardiovascular disease, cancer, and Type 2 Diabetes among the top causes of mortality.(17) Chronic disease can significantly affect quality of life and have a serious economic impact on individuals and on society in general. In Yukon, over 50% of the population reports having at least one chronic condition. This figure increases to 90% by the age of 65.(18) Of particular concern, the prevalence of diabetes in the Territory is increasing(19) and more Yukoners are obese than other Canadians — a major risk factor for developing chronic disease.(20)

Healthy eating is one common factor that has been shown to reduce the risk of developing chronic disease, help with symptom management, and slow disease progression. Registered Dietitians play an important role in working with those who have chronic disease, advising on healthy food choices to help manage symptoms and prevent long-term complications. By providing nutrition programs, resources and services, governments and dietitians have the opportunity to reduce health care costs while improving the quality of life for those at risk, or with chronic disease.

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Collaborative care for Yukoners with chronic conditions

The Chronic Conditions Support Program in Yukon has been working since 2005 to promote optimal health for Yukoners with chronic disease. Until recently, the focus was on diabetes, but now the program is expanding to include other chronic conditions, such as Chronic Obstructive Pulmonary Disorder (COPD), hypertension and congestive heart failure.

“Those with chronic conditions are a major client group of our health care system,” says Lucie Wright, Chronic Disease Management Coordinator. “Yet in many ways our system is set up to deliver acute care, rather than chronic care. Our program is working to change that emphasis, through provision of quality chronic care and tools for patient self-management.”

The program employs chronic disease management clinicians who work in doctors’ offices, as part of the primary health care team. “Our program emphasizes working together to ensure the patient stays as healthy as possible,” says Wright. “For example, we work to reduce chronic disease complications through planned proactive care such as tracking patients and recalling them for important tests before problems occur. We look at all aspects of a client’s care, including medication, activity and diet.”

The program has already seen some success. When it first began, only nine per cent of clients had appointments to discuss their self-management goals. Now, that percentage has increased to 40 percent. The patient helps set the agenda for these appointments, but generally they are meant to cover diet, activity, medication, smoking, stress management and other health-related goals.

The Chronic Conditions Support Program already works collaboratively with dietitians through referrals, courses and community visits, but would like that partnership to expand even further. “We’d like to have dietitians spend time in the doctors’ offices to work with our clients as part of the primary health care team. There’s a lot of interest in that because nutrition is such a key aspect of managing disease and self-care.”



Diabetes Education Centre helps Yukoners manage their disease

Diet is considered to be one of the five cornerstones of diabetes management, with the other four being medication, activity, stress management and increased knowledge.

The Diabetes Education Centre in Whitehorse works in all five of these areas to help Yukoners with diabetes, providing a core of knowledgeable health professionals who assist approximately 400 to 600 clients. “The Centre is a client-centred local resource, where people can come with their concerns,” says Sharlene Clarke, Registered Dietitian at the Diabetes Education Centre and Whitehorse General Hospital. “There is often a gap between the most current information and public perceptions about diabetes. We work to provide our clients with the most up-to-date information available.”

Clarke finds that people often think that managing diabetes through diet is about limiting sugar. “We teach people as best we can that the diabetic diet is about portion control and healthy eating,” she says.

When a new client visits the Centre, an assessment is done to find out how much the patient knows about diabetes, what they’d like to learn and what their concerns are. Clients may fill out a food history form, which the staff uses to help them adapt their eating habits. Educational material is available about topics such as healthy eating, carbohydrate counting, reading food labels, the glycemic index and the effects of sugar and fat. “We don’t just look at blood sugar, but also at whether the patient is getting enough vitamins and minerals, as well as appropriate carbohydrates, protein and fats,” says Clarke. “It’s very much about ensuring the patient’s diet is close to what’s recommended in Canada’s Food Guide.”

The Centre provides information through one-on-one interviews, Telehealth videoconferencing, workshops and classes. It also provides support and information to other health care workers in Yukon.

“Feedback from our clients is positive,” says Clarke. “Generally our patients are both concerned and highly motivated to learn more about diabetes and the diabetic diet. I get a lot of professional satisfaction in helping someone feel that they are able to manage their diabetes.”


pROpOSED NExT STEpS

To create or support programs, resources or services that promote awareness or prevention of nutrition-related chronic disease.


Support public awareness campaigns aimed at reducing risk factors for diabetes, heart disease, cancer and other nutrition-related chronic diseases facing Yukoners. Align with other healthy living campaigns where appropriate.


Work to create partnerships with First Nation organizations and governments to promote awareness of chronic disease prevention and/or management.

To create or enhance and maintain initiatives to support optimal clinical nutrition services for Yukoners.


Assess effectiveness and reach of clinical nutrition services for individuals with chronic disease in Whitehorse and in rural Yukon, and work to enhance services where needed.


Form partnerships with Yukon-based allied healthcare professionals and existing chronic conditions support programs to coordinate and enhance delivery of clinical nutrition services.

Work with Yukon-based agencies to track prevalence and to analyze indicators of chronic disease in Yukon.

Work with First Nation governments or organizations to support First Nations-specific educational programming with regards to chronic disease prevention and/or management.



References

1. Joint World Health Organization (WHO)/Food and Agriculture Organization of the United Nations (FAO) Expert Consultation. Diet, Nutrition and the Prevention of Chronic Diseases (2002). Available at: whqlibdoc.who.int/trs/WHO_TRS_916.pdf.

2. Garriguet, Didier. Health Statistics Division, Statistics Canada. “Canadians’ Eating Habits.” Health Reports 18: 2 (2007). Available at: www.statcan.gc.ca/pub/82-003-x/2006004/article/habit/9609-eng.pdf.

3. Yukon Health & Social Services. Yukon Health Status Report (2003). Available at: www.hss.gov.yk.ca/publications/.

4. Agriculture and Agri-Food Canada. Canada’s Action Plan for Food Security (1998). Available at: www.agr.gc.ca/misb/fsec-seca/pdf/action_e.pdf.

5. Health Canada. Nutrition for Health: An Agenda for Action (1996). Available at: www.hc-sc.gc.ca/fn-an/nutrition/pol/nutrition_health_agenda-nutrition_virage_sante-eng.php.

6. Tarasuk VS, Vozoris NT. “Household Food Insufficiency is Associated with Poorer Health.” Journal of Nutrition 133 (2003): 120-6.

7. Gervais, Jean, Ledrou, Ingrid. Statistics Canada. “Food Insecurity.” Health Reports 16:3 (2005). Available at: www.statcan.gc.ca/studies-etudes/82-003/archive/2005/7841-eng.pdf.

8. Ibid.

9. Indian and Northern Affairs Canada. Regional Results of Price Surveys (2008). Available at: www.ainc-inac.gc.ca/nth/fon/fc/rgrs-eng.asp#yk.

10. Public Health Agency of Canada. Diabetes in Canada. 2nd ed. (2003). Available at: www.phac-aspc.gc.ca/publicat/dic-dac2/english/01cover-eng.php.

11. Health Canada. First Nations Comparable Health Indicators (2005). Available at: www.hc-sc.gc.ca/fniah-spnia/diseases-maladies/2005-01_health-sante_indicat-eng.php#mortality.

12. Yukon Bureau of Statistics. Age and Sex. Information Sheet #C06-02. (2007). Available at: www.eco.gov.yk.ca/stats/pdf/age06.pdf.

13. Health Canada. Healthy Aging in Canada: A New Vision, a Vital Investment from Evidence to Action. (2006) Available at: www.phac-aspc.gc.ca/seniors-aines/alt-formats/pdf/publications/pro/healthy-sante/haging_newvision/vision-rpt_e.pdf.

14. Dietitians of Canada. (n.d.). The Role of Dietitians in Collaborative Primary Mental Health Care Programs. Available at: www.ccmhi.ca/en/products/documents/ENDietitiansToolkit.pdf

15. Dickerson, F., Brown, C.H., Fang, L., Goldberg, R.W., Kretebbuhl, J., Wohlheiter, K., Dixon, L. “Quality of Life in Individuals with Serious Mental Illness and Type 2 Diabetes.” Psychosomatics 49:2 (2008): 109-114.


16. Kilbourne, A.M., Brar, J.S., Drayer, R.A., Xu, X., Post, E.P. “Cardio-vascular Disease and Metabolic Risk Factors in Male Patients with Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder.” Psychosomatics 48:5 (2007): 412-417.

17. World Health Organization. (n.d.). Facing the Facts: Chronic Diseases in Canada. Available at: www.who.int/chp/chronic_disease_report/media/CANADA.pdf

18. Yukon Health & Social Services. Yukon Health Status Report (2003). Available at: www.hss.gov.yk.ca/publications/

19. Public Health Agency of Canada. Report from the National Diabetes Surveillance System: Diabetes in Canada (2008). Available at: www.phac-aspc.gc.ca/ccdpc-cpcmc/ndss-snsd/english/index-eng.php.

20. Ibid.

Note: 2008 Yukon Healthy Living Survey is an unpublished study. For more information on data, please contact Yukon Health and Social Services, Health Promotion Unit.

Health and Social Services

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Health and Social Services - Yukon