Why act now?

Sangita Sharma leads multiple research projects aiming to improve quality of life in Indigenous communities.

MJ Fell with files from Department of Medicine news staff - 26 January 2017

How did a global health researcher with roots in India and England, after working and living in Cameroon and Jamaica find herself so passionate about improving the health and wellness of Indigenous populations of northern Canada?

"The fact that a healthy survival with access to good food and health care is so difficult in the North, even in a wealthy country like Canada… That was surprising to me," says Sangita Sharma-affectionately known to many simply as Gita. Sharma is the Endowed Chair in Indigenous Health at the University of Alberta, Centennial Professor, and Professor in Indigenous and Global Health Research in the Faculty of Medicine & Dentistry.

"Canada's North has some unique challenges not really seen elsewhere in the world. Sleeping outdoors is not an option. Finding food such as fresh fruit and vegetables or simply walking to find medical help is extremely difficult, if not impossible… I saw there was so much that could be done to improve health if we worked together with the people living in northern Canada."

Sharma was already an internationally recognized leader in her field of nutritional epidemiology in 2010, when she first started working at the University of Alberta in the Department of Medicine. Shortly after moving to Edmonton, she received the very prestigious British Nutrition Society Silver Medal Award, a first for someone living outside of Europe. Sharma has since garnered a long list of accolades including being named a Global Edmonton Woman of Vision in December 2016, and recently receiving $1.1-million funding from the Royal Alexandra Hospital Foundation, in support of a four-year project working with vulnerable populations in Edmonton, focused on nutrition, health care access and risk factors for chronic disease.

Insights into improving health

The goal of Sharma's research is to document risk factors for chronic diseases and barriers to accessing health care, including screening services, for Canada's Indigenous populations and new Canadians adapting to living in Canada.

"Initially there was simply no data available, especially for children and youth. We are now collecting evidence around chronic disease, lifestyle and nutrition in order to create prevention programs and to inform policy makers to better support both our Indigenous peoples, as well as new Canadians that may share similar health struggles," Sharma explains.

Sharma and her team have collected evidence that gives important insights into how the health of both populations are reaching such critical rates of chronic diseases, including some cancers, and leading to a life expectancy up to 12 years shorter for Indigenous peoples, compared to the non-Indigenous population.

Limited access to health care

Imagine being away from your home and family, in an unfamiliar place, speaking to doctors in a language other than your first and hearing medical terminology that is difficult to understand… all during one of the most stressful and scariest moments of your life, such as a recent cancer diagnosis.

Why Indigenous health research matters

To Indigenous communities: This work aims to improve health and wellness and reduce chronic disease and suffering in Indigenous communities.

To Albertans: Indigenous peoples make up six per cent of Alberta's population and nearly half of that number is under the age of 25 years. New Canadian youth are also a growing population. Improving the health of all our youth will mean a healthier future for Alberta overall.

To the health care system: The greatest impact on the health care system will be a reduction in chronic disease in the province.

Northern Indigenous populations living in isolated communities may have to travel to a far-away urban centre for initial and continuing medical care. Sharma notes that, "this is where people suffer substantially-having to travel for life-saving medical attention, often alone and to very unfamiliar places."

Part of Sharma's work focuses on improving cancer-screening rates for earlier diagnosis, treatment, and therefore better prognosis. "We are working with the communities in Arctic Canada to identify the barriers to accessing cancer screening services, and so far the community has come up with amazing suggestions to improve the uptake of cancer screening services."

Alarming rates of type 2 diabetes

According to Sharma, Canada's Indigenous populations were likely far healthier when following a more traditional diet-one that is not only nutritious, but also very tasty. The adoption of westernized diet and sedentary lifestyle, along with limited access to health care, has led Indigenous populations to an alarming rate of type 2 diabetes three to five times higher than the non-Indigenous population in Canada.

As a member of the Alberta Diabetes Institute, Sharma is seeking ways to reduce rates in both Indigenous and new Canadian populations for this and other chronic diseases.

Why Act Now? The lower cost of prevention

The cost of preventing chronic diseases such as diabetes, heart disease, obesity, cancer, hypertension and stroke is minimal compared to the strain of treating these diseases within the health care system. Programming and education for Indigenous populations and new Canadians is essential to lowering chronic disease in both populations.

Working closely with Indigenous communities and integrating cultural traditions is key to overcoming some of the challenges. Consultation and collaboration are the cornerstones to Sharma's research and programs. "The community already knows what the issues are and have ideas for possible solutions," says Sharma. "We work together to find solutions that work for the community."

The Why Act Now project started in 2011, led by Sharma with funding partners including Alberta Health & Wellness; Public Health Agency of Canada; Alberta Diabetes Institute; Alberta Diabetes Foundation; Royal Alexandra Hospital Foundation; The Stollery Charitable Foundation; United Way, and Edmonton Community Foundation. This project studied the unique barriers to health and good nutrition for Indigenous and new Canadian youth. Edmonton was the natural place to start as it has the second highest urban Indigenous population in Canada. The project gathered data from 553 multi-ethnic, 11- to 23-year-olds, in Edmonton of Indigenous, African, Asian and European descent.

Sharma and her team found that 90 per cent of Indigenous youth surveyed were not getting enough dietary fibre and exceeded acceptable sodium intake. Many were falling short of their basic nutrient requirements including B12, zinc, selenium and iron, nutrients that would have been abundant in traditional diets.

Sharma launched a partnership with the Edmonton Catholic School Board and the Edmonton Public School Board, including amiskwaciy Academy, to develop and pilot a culturally appropriate intervention program for urban Indigenous youth in Grades seven to 12. Youth helped to design and refine program elements.

The result is a rich library of resources, available for download at whyactnow.ca, grounded in the context of the medicine wheel encompassing spirit, body, mind and emotion, as well as good nutrition.

In support of this ongoing work, Sharma has just recently received $50,000 in funding from the Edmonton Oilers Community Foundation for the implementation of Why Act Now programming in community organizations.

"Funding is extremely difficult to get for improving the health of Canada's Indigenous population. In such a wealthy country, we have people who do not have access to healthy, culturally appropriate food. Everyone has that right. This is a basic human right," Sharma states.

Getting to know northern Canada

With Canada marking the 150th anniversary of confederation, Sharma suggests Canadians visit northern Canada, embrace the amazing culture and traditions ... and taste delicious and nutritious traditional foods.

"Canadians would also then realize how isolated some of the communities really are and how difficult it is to access health care, and fresh fruit and vegetables. This all plays significant factors in the health struggles many Indigenous people face today. We need to all work together to improve the health and wellness of the Indigenous population, the first peoples of this great country."

For almost as long as there's been a Canada, there's been a University of Alberta. Over the next year, in honour of Canada's 150th anniversary, we're proudly celebrating the people, achievements and ideas that contributed to the making of a confederation.