Exploring the Social Determinants of Health in Nutrition Care for South Asian Communities: A Narrative Review
Publication: Canadian Journal of Dietetic Practice and Research
17 January 2025
Abstract
The South Asian (SA) diasporic communities in Canada experience a greater burden of diabetes and cardiovascular disease (CVD) compared to white populations. Nutrition interventions often focus on individual behaviours and fail to consider that the social determinants of health (SDH) have a greater impact on chronic disease risk. A narrative review was conducted to identify the SDH in nutrition care interventions for the SA diaspora in Canada. The final analysis included fourteen articles from which SDH were identified and categorized based on the Social Ecological Model (SEM). The study analysis yielded the following needs in dietetic practice based on the SEM: (1) intrapersonal – need for language appropriate services, and representation of cultural foods and non-Western health perspectives in dietary guidelines, (2) interpersonal – understanding family and friends as social supports, (3) community – incorporating peer and community leader influences, (4) institution – importance of faith-based locations as community hubs, and client workplaces as a barrier to attending appointments, and (5) policy – advocacy for transportation and childcare access, adequate and secure income, and equitable care. These findings urge dietitians to move beyond cultural awareness, sensitivity, and competence to practicing cultural safety and humility in their practice, which is integral to providing equitable care.
Résumé
Les communautés diasporiques sud-asiatiques (SA) du Canada sont plus touchées par le diabète et les maladies cardiovasculaires (MCV) que les populations blanches. Les interventions nutritionnelles sont souvent axées sur les comportements individuels et ne tiennent pas compte du fait que les déterminants sociaux de la santé (DSS) ont un plus grand impact sur le risque de maladies chroniques. Une revue narrative a été menée afin d’identifier les DSS dans des interventions de soins nutritionnels destinées à la diaspora SA au Canada. L’analyse finale incluait quatorze articles où des DSS ont été identifiés et catégorisés sur la base du modèle socioécologique (MSE). L’analyse issue de l’étude a mis en lumière les besoins suivants dans la pratique de la diététique basée sur le MSE : (1) intrapersonnels – besoin de services linguistiquement adaptés et d’une représentation des aliments culturels et des perspectives de santé non occidentales dans les directives nutritionnelles, (2) interpersonnels – compréhension que la famille et les amis sont des soutiens sociaux, (3) communauté – intégration de l’influence des pairs et des leaders communautaires, (4) établissement – importance des lieux confessionnels en tant que carrefours pour les communautés, et des lieux de travail des clients en tant qu’obstacle à la participation aux rendez-vous, et (5) politiques – plaidoyer pour l’accès au transport et à la garde d’enfants, à un revenu adéquat et fixe, et à des soins équitables. Ces résultats révèlent que les diététistes doivent aller au-delà de la conscience, de la sensibilité et de la compétence culturelles et intégrer dans leur pratique la sécurisation culturelle et l’humilité, des aspects cruciaux de soins équitables.
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Conflicts of interest: The authors declare that there are no competing interests.
Author contributions: SB and CB reviewed the data, completed the analysis, and wrote the manuscript. ATB and AM conceptualized the study and supervised the project. All authors have critically reviewed the results, revised this manuscript, and have approved the final manuscript.
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Canadian Journal of Dietetic Practice and Research
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SharminiBalakrishnanMPH, RD, CristinaBeneaMPH, RD, AnanyaBanerjeePhD, and AnishaMahajanPhD, MPH, RD. Exploring the Social Determinants of Health in Nutrition Care for South Asian Communities: A Narrative Review. Canadian Journal of Dietetic Practice and Research.
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