Abstract
The Center for Indigenous Innovation and Health Equity (CIIHE) at Oklahoma State University Center for Health Sciences (OSU-CHS) is a community–academic partnership with Indigenous peoples from Alaska, Hawai’i, and Oklahoma. The CIIHE supports communities to strengthen traditional food practices and food sovereignty and evaluate the impact of those efforts on health. In February 2022, the CIIHE sponsored and hosted a virtual conference to better understand how food sovereignty initiatives can improve health. More than 600 participants gathered to hear the latest research and practice in the areas of public health and agriculture, nutrition, community-based and Indigenous knowledge, and health economics. Community-led food sovereignty initiatives being implemented as part of the CIIHE were featured along with other Indigenous initiatives in urban, rural, and reservation communities. A survey was administered to conference participants to assess food sovereignty topics and priorities for future research. In this Practice Note, we describe innovative community-led initiatives presented as part of the conference and recommendations for action emerging from qualitative and quantitative data collected from conference participants.
Keywords: health equity, Indigenous food sovereignty, food security, Indigenous communities, Indigenous knowledge, community–academic partnership, decolonization
INTRODUCTION
Food sovereignty is “the right of peoples to healthy and culturally appropriate food produced through ecologically sound and sustainable methods, and their right to define their own food and agriculture systems” (Via Campesina, 2008). Indigenous food sovereignty extends this focus by emphasizing a community’s relational responsibility to care for their foodways according to their traditional practices and beliefs (Coté, 2016; Maudrie et al., 2023). The Indigenous food sovereignty movement has gained attention within the fields of nutrition and public health for its potential to address food insecurity and diet-related chronic conditions, such as diabetes and hypertension that disproportionately burden Indigenous communities (Nikolaus et al., 2022). However, limited information on food sovereignty and its impact on health have been published within the scientific literature (Maudrie et al., 2023).
The Center for Indigenous Innovation and Health Equity (CIIHE) is a community–academic partnership that began in 2021 to support Indigenous food sovereignty initiatives and evaluate the outcomes of these initiatives on health. The CIIHE emerged from a long-standing partnership between Oklahoma State University, the University of Hawai’i, and American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities across the United States. In February 2022, the CIIHE held a virtual Indigenous Food Sovereignty and Health Conference with the aim to explore unanswered questions, such as: what does food sovereignty mean across diverse Indigenous communities and how does it relate to community health?; How do we engage community, leadership, and policymakers toward a common goal of improving health?; and What knowledge gaps exist? In this Practice Note, we describe the conference and survey findings from conference participants that examined food sovereignty initiatives and community priorities for future research and practice.
INDIGENOUS FOOD SOVEREIGNTY AND HEALTH VIRTUAL CONFERENCE
The Indigenous Food Sovereignty and Health Conference was a two half-day conference held virtually on February 16 and 17, 2022. The conference intentionally centered the work and voices of Indigenous researchers and community practitioners from the fields of public health, nutrition, agriculture, and food sovereignty. A Native facilitator opened the conference and transitioned participants between sessions. The conference featured 14 presenters, 12 of whom were Indigenous and represented tribal governments, Indigenous communities, Native-led nonprofit organizations, and universities.
Both conference days began with a song and blessing. On the first day, the keynote presentation focused on the role of food sovereignty initiatives in Indigenous communities, approached from a multidimensional, holistic framework that centered Indigenous ways of knowing and reframed health as a community and societal responsibility rather than an individual responsibility (Jernigan et al., 2023). This was followed by a panel presenting case studies of food sovereignty initiatives within the CIIHE network, including an Alaska Native Elders health program that teaches salmon fileting, moose hide tanning, and gathering plants and roots to make salves (Demientieff et al., 2023). Another case study described the revitalization of traditional Choctaw gardens to restore healthy food traditions (Thompson et al., 2023). Day 1 ended with a focus on Indigeneity as continuity, the importance of protecting the sacred passing down of cultural traditions and knowledge from Indigenous Elders to youth.
Day 2 began with a series of “Lightning Talks,” which were 15-minute presentations followed by 5-minute question and answer sessions. Topics included the development of a tribal farm that led to an Indigenous Supported Agriculture program and reservation-based mobile market (Hayman et al., 2023) and a traditional Native foods education and demonstration gathering (Wark et al., 2023). Additional topics included a curriculum focused on traditional Indigenous foodways and the economic benefit of food sovereignty initiatives presented by a health economist. The conference closed with an overview of the food sovereignty movement within Indigenous communities, its role in the health and wellbeing of Indigenous peoples and lands, and a call for strengthening the movement.
PARTICIPANT SURVEY
An online survey was administered to participants upon their registration and remained available until the conference ended. The 21-question survey collected demographic information and qualitative and quantitative data about community food sovereignty including availability and importance of various food resources (e.g., tribal convenience stores, gardens, commodity foods), access to traditional foods (e.g., “In your community, how easy is it to access your traditional Native foods?” with response options ranging from “very” to “not at all”), and open-ended questions about food, culture, and health (e.g., “Do you participate in traditional food-related practices or ceremonies? Why or why not? Please explain”). Descriptive statistics for the online survey data were analyzed using SAS version 9.4. to produce a mean and standard deviation for age and counts and frequencies for categorical variables. The qualitative data were analyzed with Dedoose software (version 9.0, SocioCultural Research Consultants, LLC; Los Angeles, CA) using a thematic analysis to detect recurring codes until they reached saturation and then identify the main themes from the codes (Hsieh & Shannon, 2005).
A total of 1,113 participants registered for the conference; 622 participants attended on day 1 and 619 attended on day 2. There were 418 surveys submitted to REDCap. Data were then exported to Excel, sorted, and reviewed to check for duplicate responses and rows with missing data. After checking for data quality, a total of 372 non-duplicated and complete surveys were analyzed.
The mean age of survey respondents was 43.4 (SD = 13.8), with a range of 18–78. Most participants identified as American Indian (48.7%), White (37.1%), and other (9.4%), including Métis and First Nations in Canada and Haida (Table 1). Approximately, 66% of attendees were Indigenous, which included participants from First Nations from Canada, Māori from New Zealand, and other groups. Just over half, 51%, of participants reported living in an urban environment, 21.7% in a rural environment, and 19.5% on a reservation.
Table 1.
Demographic characteristics of Participants That completed the Food Sovereignty and Health Survey (n = 372)
| Demographic characteristic | N = 372 |
|---|---|
|
| |
| Age, M ± SD (range) | 43.4 ± 13.8 (18–78) |
| Race/ethnicitya, n (%) | |
| American Indian | 181 (48.7) |
| Alaska Native | 9 (2.4) |
| Asian or Asian American | 20 (5.4) |
| Black | 13 (3.5) |
| African American | 6 (1.6) |
| Hispanic/Latino(a) | 29 (7.8) |
| Middle Eastern or Northern African | 3 (0.8) |
| Native Hawaiian | 1 (0.3) |
| Pacific Islander | 4 (1.1) |
| White | 138 (37.1) |
| Otherb | 35 (9.4) |
| Prefer not to answer | 5 (1.3) |
| Currently employed, n (%) | |
| Yes | 285 (81.9) |
| No | 63 (18.1) |
| Employment organizationc, n (%) | |
| University | 76 (26.7) |
| Government | 42 (14.7) |
| Hospital | 2 (0.7) |
| Commercial business | 14 (4.9) |
| Non-profit organization | 106 (27.3) |
| Otherb | 45 (15.8) |
| Area of workc, n (%) | |
| Research | 45 (15.9) |
| Health care | 47 (16.6) |
| Education | 67 (23.6) |
| Policy | 10 (3.5) |
| Agriculture | 39 (13.7) |
| Otherb | 76 (26.8) |
| Role if not currently employed, n (%) | |
| Student | 23 (36.5) |
| Retired professional | 14 (22.2) |
| Parent | 12 (19.1) |
| Otherb | 14 (22.2) |
| Type of living environment, n (%) | |
| Urban | 188 (51.0) |
| Rural | 80 (21.7) |
| Reservation | 72 (19.5) |
| Oklahoma tribal jurisdictional area | 17 (4.6) |
| Otherb | 12 (3.3) |
Check all that apply.
“Other” choice descriptions for race, employment organization, area of work, role if not currently employed, and type of living environment are found on qualitative summary report.
Participants received this question only if they checked “yes” for currently employed.
PARTICIPANT INSIGHTS
Participants provided insights into important sources of food, cultural, and traditional food access and practices, and the ways in which food sovereignty is practiced within their communities. When asked about the importance of various food sources, more than half of respondents reported hunting (62.4%), gathering (60.8%), and fishing (66.4%) as important sources of food in their communities (Table 2). Over one-third of participants felt tribal farms were an important source of food (34.7%), and more than half (52.7%) reported that community-supported agriculture programs were important. Most respondents (72.8%) stated that community food sharing was an important source.
Table 2.
Importance of Community Food Sources (n= 372)
| Importance | N (%) |
|---|---|
|
| |
| Grocery stores | |
| Very | 319 (85.8) |
| Somewhat | 25 (6.8) |
| Not very | 0 (0.0) |
| Not at all | 0 (0.0) |
| Does not exist | 13 (3.5) |
| Needs to be added/improved | 19 (5.1) |
| Convenience stores | |
| Very | 109 (29.3) |
| Somewhat | 136 (36.6) |
| Not very | 73 (19.6) |
| Not at all | 30 (8.1) |
| Does not exist | 6 (1.6) |
| Needs to be added/improved | 6 (1.6) |
| Community/family gardens or farms | |
| Very | 176 (47.3) |
| Somewhat | 97 (26.1) |
| Not very | 38 (10.2) |
| Not at all | 8 (2.2) |
| Does not exist | 23 (6.2) |
| Needs to be added/improved | 53 (14.3) |
| Farmer’s markets | |
| Very | 165 (44.4) |
| Somewhat | 118 (31.7) |
| Not very | 30 (8.1) |
| Not at all | 3 (0.8) |
| Does not exist | 33 (8.9) |
| Needs to be added/improved | 46 (12.4) |
| Tribal farms | |
| Very | 97 (26.1) |
| Somewhat | 42 (11.3) |
| Not very | 23 (6.2) |
| Not at all | 9 (2.4) |
| Does not exist | 133 (35.8) |
| Needs to be added/improved | 85 (22.9) |
| Community supported agriculture | |
| Very | 104 (28.0) |
| Somewhat | 92 (24.7) |
| Not very | 40 (10.8) |
| Not at all | 12 (3.2) |
| Does not exist | 63 (16.9) |
| Needs to be added/improved | 70 (18.8) |
| Hunting | |
| Very | 141 (37.9) |
| Somewhat | 91 (24.5) |
| Not very | 52 (14.0) |
| Not at all | 24 (6.5) |
| Does not exist | 48 (12.9) |
| Needs to be added/improved | 23 (6.2) |
| Gathering | |
| Very | 142 (38.2) |
| Somewhat | 84 (22.6) |
| Not very | 37 (15.3) |
| Not at all | 17 (4.6) |
| Does not exist | 47 (12.6) |
| Needs to be added/improved | 43 (11.6) |
| Fishing | |
| Very | 155 (41.7) |
| Somewhat | 92 (24.7) |
| Not very | 54 (14.5) |
| Not at all | 13 (3.5) |
| Does not exist | 37 (10.0) |
| Needs to be added/improved | 29 (7.8) |
| Trade/barter | |
| Very | 85 (22.9) |
| Somewhat | 89 (23.9) |
| Not very | 67 (18.0) |
| Not at all | 21 (5.7) |
| Does not exist | 59 (15.9) |
| Needs to be added/improved | 57 (15.3) |
| Sharing/other family or community members | |
| Very | 175 (47.0) |
| Somewhat | 96 (25.8) |
| Not very | 36 (9.7) |
| Not at all | 8 (2.1) |
| Does not exist | 25 (6.7) |
| Needs to be added/improved | 46 (12.4) |
| Commodities programs | |
| Very | 112 (30.1) |
| Somewhat | 105 (28.2) |
| Not very | 30 (8.0) |
| Not at all | 24 (6.5) |
| Does not exist | 50 (13.4) |
| Needs to be added/improved | 39 (10.5) |
| Supplemental Nutrition Assistance Program or Supplemental Nutrition Program for Women, Infants, and Children | |
| Very | 202 (54.3) |
| Somewhat | 74 (19.9) |
| Not very | 26 (7.0) |
| Not at all | 13 (3.5) |
| Does not exist | 22 (5.9) |
| Needs to be added/improved | |
| Food banks | 29 (7.8) |
| Very | 197 (53.0) |
| Somewhat | 104 (28.0) |
| Not very | 21 (5.7) |
| Not at all | 14 (3.8) |
| Does not exist | 13 (3.5) |
| Needs to be added/improved | 30 (8.1) |
| Restaurants/fast food | |
| Very | 126 (33.9) |
| Somewhat | 143 (38.4) |
| Not very | 58 (15.6) |
| Not at all | 13 (3.5) |
| Does not exist | 15 (4.0) |
| Needs to be added/improved | 16 (4.3) |
In terms of culture, most participants (83.4%) rated their tribe’s/community’s cultural practices as important, and more than half stated that food was part of their tribal origin stories (54.2%) (Table 3). However, nearly, half of respondents (48.7%) reported that it was not easy to access their traditional Native foods, despite their cultural importance and the fact that most respondents (52%) reported that young people in their community were interested in food traditions.
TAbLE 3.
Participants Were Asked Questions Related to Traditional Foods and Culture
| Questions | N (%) |
|---|---|
|
| |
| In your community, how easy is it to access your traditional Native foods? | |
| Very | 28 (7.6) |
| Somewhat | 121 (32.9) |
| Not very | 125 (34.0) |
| Not at all | 54 (14.7) |
| Not applicable | 40 (10.9) |
| In your community, how easy is it to access healthy foods? | |
| Very | 107 (29.2) |
| Somewhat | 181 (49.3) |
| Not very | 68 (18.5) |
| Not at all | 11 (3.0) |
| Not applicable | 0 (0.0) |
| How involved is your community in producing healthy and/or traditional foods? | |
| Very | 42 (11.4) |
| Somewhat | 165 (44.8) |
| Not very | 112 (30.4) |
| Not at all | 34 (9.2) |
| Not applicable | 15 (4.1) |
| Is a food or food resource mentioned in your origin stories? | |
| Yes | 194 (54.2) |
| No | 30 (8.4) |
| Maybe | 26 (7.3) |
| I don’t know | 108 (30.2) |
| How important is food in your tribe’s/community’s cultural practices? | |
| Very | 242 (68.4) |
| Somewhat | 53 (15.0) |
| Not very | 17 (4.8) |
| Not at all | 4 (1.1) |
| I don’t know | 38 (10.7) |
| Do you think that young people in your community are interested in food traditions? | |
| Yes | 191 (52.2) |
| No | 28 (7.7) |
| Maybe | 112 (30.6) |
| I don’t know | 35 (9.6) |
| To the best of your knowledge, how much of the food eaten in your community is produced (e.g., farmed, gathered, hunted, etc.) by your community? | |
| Most | 9 (2.5) |
| A lot | 35 (9.6) |
| Some | 124 (34.2) |
| A little | 164 (45.2) |
| None | 31 (8.6) |
Virtually, all participants (95%) believed that food sovereignty initiatives improve the health of Indigenous peoples and want to see these initiatives expanded (Table 4). Specific food sovereignty initiatives that were identified as priorities were tribal farms (22.9%) community-supported agriculture programs (18.8%), and community and family gardens and farms (14.3%).
Table 4.
Participants Were Asked to Indicate Their Agreement With the Following Statements on Food Sovereignty and Health
| Statement and agreement | N (%) |
|---|---|
|
| |
| I believe high blood pressure is improved by Indigenous food sovereignty initiatives | |
| Strongly agree | 219 (60.8) |
| Agree | 123 (34.2) |
| Disagree | 2 (0.6) |
| Strongly disagree | 16 (4.4) |
| I believe overall health is improved by Indigenous food sovereignty initiatives | |
| Strongly agree | 265 (73.2) |
| Agree | 81 (22.4) |
| Disagree | 0 (0.0) |
| Strongly disagree | 16 (4.4) |
| I would like to see additional Indigenous food sovereignty initiatives | |
| Strongly agree | 277 (76.5) |
| Agree | 67 (18.5) |
| Disagree | 1 (0.3) |
| Strongly disagree | 17 (4.7) |
| I would like to see existing Indigenous food sovereignty initiatives expanded or strengthened | |
| Strongly agree | 284 (78.5) |
| Agree | 59 (16.3) |
| Disagree | 2 (0.6) |
| Strongly disagree | 17 (4.7) |
| I would welcome more data on the relationship between health and Indigenous food sovereignty initiatives | |
| Strongly agree | 260 (71.6) |
| Agree | 82 (22.6) |
| Disagree | 3 (0.8) |
| Strongly disagree | 18 (5.0) |
| I trust research institutions or universities to conduct studies on Indigenous food sovereignty initiatives | |
| Strongly agree | 82 (23.0) |
| Agree | 159 (44.5) |
| Disagree | 89 (24.9) |
| Strongly disagree | 27 (7.6) |
| I already know a researcher that I would be willing to partner with if I wanted to collect data on Indigenous food sovereignty initiativesa | |
| Strongly agree | 30 (13.1) |
| Agree | 61 (26.6) |
| Disagree | 100 (43.7) |
| Strongly disagree | 38 (16.6) |
| I already know a community (or community member) that I would be able to partner with if I wanted to collect data on Indigenous food sovereignty initiativesa | |
| Strongly agree | 16 (37.2) |
| Agree | 16 (37.2) |
| Disagree | 10 (23.3) |
| Strongly disagree | 1 (2.3) |
Participants received this question only if they were employed.
Qualitative data exploring cultural practices found that most participants who reported taking part in traditional food practices or ceremonies did so through ceremonies or celebrations, gardening, gathering, participating in tribal food sovereignty program, fishing, hunting, cooking traditional recipes, harvesting, or seed-saving. Respondents reported they often engaged with these practices to reconnect or learn about their Indigenous identity and heritage.
I currently do not participate in any traditional food-related practices or ceremonies. My immediate family members did not know my Native ancestors and so all of that information has been lost. It has been a huge goal of mine to learn and reconnect with this part of my heritage.
Another common reason for engaging with traditional food practices was to pass down Indigenous knowledge to younger generations:
I cook and teach my daughter how to cook traditional foods and recipes passed down from generation to generation. I think it’s an important part of culture and diet and when I am older, I want my daughter to be able to cook comfort foods for me and also keep passing the traditions to her child or children. I would love to learn and teach more.
Respondents also detailed the barriers they faced in participating in traditional food-related practices including limited access to traditional food resources and knowledge, not living in proximity to their homelands or living in a city, and lack of access to the knowledge shared or passed on by their families and communities. Many people felt traditional food practices had been lost in their families through colonization. One person described their persistence in the face of barriers:
No, because my family did not practice their traditional food-related practice or ceremonies. I am doing my best to learn on my own.
Despite these barriers, participants commonly reported they knew family members, friends, community members, and elders engaging in traditional food-related practices.
DISCUSSION
The Indigenous Food Sovereignty and Health Conference successfully gathered over 600 participants to share in a discussion about the role of food sovereignty and health in Indigenous communities. The high proportion of Indigenous conference participants (66%) speaks to the excitement about this topic, the value of centering Indigenous voices and perspectives, and the need for further research within this area. The importance of hunting, gathering, and fishing, underscores the need for more inclusive measurement tools that incorporate Indigenous traditional foods in assessments of nutrition and food security (Maudrie et al., 2023).
Traditional foods and the revitalization of these foods and food practices were of strong importance to most survey respondents. Over half reported that food is a part of their cultural origin stories and that young people in their community are interested in food traditions. However, 34% reported that it was not very easy to access their traditional Native foods due to colonization and the disruption of intergenerational knowledge. This finding highlights the need to protect Indigenous land use rights as essential public health activities, supporting the sustainability of Indigenous foods, food security, and culture.
Most survey respondents reported that Indigenous food sovereignty initiatives can improve health in Native communities, and strongly agreed that they would welcome more data on the relationship between health and Indigenous food sovereignty initiatives. This consensus is particularly important given the ways in which respondents reported that engaging in food sovereignty practices provides them not only with improved health but also a way to reconnect or learn about their Indigenous identity and heritage, serving as an important conceptual linkage (Jernigan et al., 2023).
An Indigenous food sovereignty and health framework broadens the understanding of health to incorporate the health of the environment (Ka’ula et al., 2023; Maunakea et al., 2023; Sowerwine et al., 2023). Such an approach responds to conference participants’ calls for better approaches to the health disparities Indigenous communities’ face. Though Indigenous food sovereignty is an emerging area of study within public health, the CIIHE communities are strengthening traditional food practices and food sovereignty initiatives in their community, tailoring their interventions to specific community priorities, and assessing the health impacts. Both the process and findings from the CIIHE initiatives, as well as the data collected as part of this inaugural conference are guiding a future research agenda for Indigenous food sovereignty and health (Nguyen et al., 2023). The success of the conference celebrates the great level of interest in the topic and the value of community voices guiding this science.
Acknowledgments
We thank Cara Nichols of Savor Education LLC who served as the technical host and assisted with event coordination and conference facilitator Vickie Oldman of Seven Sisters Community Development Group LLC. We thank Clemma Muller, PhD, at the Institute for Research and Education to Advance Community Health (IREACH) at Washington State University, who provided a review of survey questions. Finally, we thank the conference planning committee, conference presenters, and the conference participants. We gratefully acknowledge the financial support for the conference provided by the Office of Minority Health (Grant 1CPIMP211317) and the National Institute on Minority Health and Health Disparities (Grant U54MD011240).
Footnotes
This article is part of the Health Promotion Practice focus issue titled, “Indigenous Food Sovereignty as a Path to Health Equity.” The issue presents community-academic partnerships that advance health guided by a decolonizing and Indigenous framework. We are grateful to the Center for Indigenous Innovation and Health Equity, funded through the Office of Minority Health (CPIMP211317), for providing support for the issue. The entire issue is available open access at: https://journals.sagepub.com/toc/hppa/24/6.
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