Recognizing the role of gender and food security in type 2 diabetes nutrition education in rural southwestern Ontario
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Food systems and health systems are interdependent. Historically, however, strategies that focused on the development of these systems evolved in isolation from one another. Non-communicable diseases such as type 2 diabetes have an etiology that is strongly linked to food systems. Type 2 diabetes is taking an ever-increasing toll on health, and health systems, globally, and in Canada. In response, health professional organizations propose an advocacy approach to improve food system characteristics linked to the development of diabetes. Opportunities for, and barriers to, such initiatives have not yet been examined in the health geography literature. The primary objective of this dissertation is to contribute to the development of a framework for action for nutrition educators working in rural areas to use to promote local sustainable food systems. The ultimate objective is to improve the diet, and by extension, the health of those suffering from type 2 diabetes. As part of the research approach, a gendered analysis was employed for the following reasons: First, labour around food production, food procurement and food preparation and health care work is provided predominantly by women. Second, there is a gendered profile of pattern of illness and access to care for people with type 2 diabetes. The research methodology was comprised of a case study and mixed methods approach. Nineteen communities in southwestern Ontario were selected for inclusion in the case study using criteria based on the Rurality Index of Ontario. Data were collected through extensive literature reviews, 34 semi-structured interviews with health professionals, a survey of 24 people afflicted with type 2 diabetes and ‘in situ’ observations. Analysis of the findings using grounded theory techniques, such as iterative coding, revealed barriers to, and opportunities for, supporting local sustainable food systems by area health professionals working at local, regional and national scales. This thesis provides important information about gender roles, community capacity, sense of community, and health professional training that should be considered in the development of policies to promote local sustainable food systems.