Background: Nutrition North Canada (NNC) is a retail subsidy program implemented in 2012 and designed to reduce the cost of nutritious food for residents living in Canada’s remote, northern communities. The present study evaluates the extent to which NNC provides access to perishable, nutritious food for residents of remote northern communities. Design: Program documents, including fiscal and food cost reports for the period 2011–2015, retailer compliance reports, audits of the program, and the program’s performance measurement strategy are examined for evidence that the subsidy is meeting its objectives in a manner both comprehensive and equitable across regions and communities. Results: NNC lacks price caps or other means of ensuring food is affordable and equitably priced in communities. Gaps in food cost reporting constrain the program’s accountability. From 2011–15, no adjustments were made to community eligibility, subsidy rates, or the list of eligible foods in response to information provided by community members, critics, the Auditor General of Canada, and the program’s own Advisory Board. Measures to increase program accountability, such as increasing subsidy information on point-of-sale receipts, make NNC more visible but do nothing to address underlying accountability issues Conclusions: The current structure and regulatory framework of NNC are insufficient to ensure the program meets its goal. Both the volume and cost of nutritious food delivered to communities is highly variable and dependent on factors such as retailers’ pricing practices, over which the program has no control. It may be necessary to consider alternative forms of policy in order to produce sustainable improvements to food security in remote, northern communities.

The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.

ousehold food insecurity, defined as insecure or inade quate access to food because of financial constraints, is increasingly recognized as a serious public health problem in many affluent nations. 1-4 The latest national estimate for Canada indicates that 12.6% of households experienced food insecurity in 2012, 5 but important geographic variations exist within the country, with heightened vulnerability in the North. 5-7 Since national moni toring began, Nunavut has consistently had the highest rates of food insecurity, 5,6,8 with the rate reaching 46.8% in 2014. 8 Food insecurity is strongly associated with poor nutrition 9-13 and adverse mental and physical health outcomes across the life cycle. 14-22 Recent research also indicates that food insecurity is a robust and independ ent predictor of increased health care use 23 and expenditures. 24,25 Food insecurity represents an experience of material depriva tion strongly influenced by the economic resources of house holds, 26-30 but high food prices are also considered an important driver of food insecurity in Canada's North. 7,31-34 In April 2011, the Government of Canada replaced the longstanding Food Mail Program with Nutrition North Canada, a marketdriven food retail subsidy intended to make perishable, nutritious foods more affordable and accessible in northern communities that do not have yearround rail, road or marine access. 34-36 Similar to the Food Mail Program, Nutrition North Canada serves communities that are predominantly inhabited by Indigen ous Peoples and have high rates of food insecurity, low educa tional attainment, low income, underemployment and unem ployment. 34,37,38 Whereas the Food Mail Program consisted of an air freight transportation subsidy transferred to Canada Post for the delivery of numerous perishable foods, nonperishable foods and essential nonfood items, 35,37,39 Nutrition North Canada is a retail subsidy focused primarily on perishable, nutritious foods and transferred directly to southern suppliers and northern retailers, who are expected to pass on the full subsidy to con sumers at the point of purchase 35,40

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Objectives. The study goal was to evaluate the growth status of preschool-age Canadian Inuit children. Study design. As part of a larger study of population health across the Canadian High Arctic, the International Polar Year Inuit Health Survey collected growth and nutrition data on 388 children aged 3 to 5 years. Methods. Data collection included anthropometric measures, health history, food frequency and 24-hour recall. Height and BMI were compared with the 2000 Centers for Disease Control and Prevention (CDC) growth reference (1); 24-hour recall and FFQ results were tabulated to produce daily and monthly frequencies of consumption of market and country foods. Results. Mean height-for-age z-scores were comparable, but body mass index z-scores were significantly greater than the U.S. standard reference population for all age and sex categories. The overall prevalence of overweight was 50.8%. There were significantly more boys (57.1%) than girls (45.2%) in the overweight category. An examination of biological, socio-economic and dietary factors, including birth weight, breastfeeding, day care attendance, traditional and market food consumption and sweetened beverage consumption revealed no significant associations that could explain the development of obesity risk in this population. Conclusions. Stature in preschool-age Inuit children is comparable to the U.S. reference, indicating that the previously reported secular trend toward increasing height has continued. Overweight prevalence is higher than that previously reported in Inuit children and may be occurring at an earlier age. The gender difference in child overweight prevalence runs counter to that reported in adults, leading to concern that contemporary growth patterns may result in significant increases in obesity-related illness for young Inuit men. (Int J Circumpolar Health 2010; 69(2):151-157)