Performance Measurement Strategy – 4.1.2 Nutrition North Canada

Strategic Outcome (INAC): The North
Strategic Outcome (Health Canada): First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status
Strategic Outcome (PHAC): Protecting Canadians and empowering them to improve their health

August 2016

Sector (INAC): Northern Affairs Organization
Sector (Health Canada): First Nations and Inuit Health
Sector (Public Health Agency of Canada): Conditions for Healthy Living

PDF Version (253 Kb, 35 Pages)

Table of contents

• 1.0 Introduction
• 2.0 Profile
• 3.0 Governance, Stakeholders and Partners
• 4.0 Logic Model
• 5.0 Risk Assessment
• 6.0 Performance Measurement – Data Collection
• 7.0 Evaluation Strategy
• 8.0 Contacts
• 9.0 References

1.0 Introduction

The following document outlines the new performance measurement strategy for the Nutrition North Canada Program. This replaces the previous performance measurement strategy developed in 2010, updated in 2014, and further updated and Treasury Board approved in February 2016.

As per INAC‘s 2016-2017 Program Alignment Architecture, Nutrition North is identified  as a Sub-Program under 4.1 Northern Governance and People, which contributes to the Department’s Strategic Outcome The North.

Nutrition North Canada – Nutrition Education Initiatives contributes to the following Health Canada Strategic Outcome “First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status”, and is reflected within the department’s Program Activity Architecture, as an activity under the Sub-Sub-Program 3.1.1.3 Healthy Living, which falls under Sub-Program 3.1.1 First Nations and Inuit Health Promotion and Disease Prevention, and Program 3.1 First Nations and Inuit Primary Health Care. This information is described in Health Canada’s Performance Measurement Framework (PMF) (2016-2017), approved in Fall 2015.

Nutrition North Canada – Nutrition Education Initiatives contributes to the following Public Health Agency of Canada (PHAC) Strategic Outcome: “Protecting Canadians and empowering them to improve their health”, and is reflected within the department’s Program Activity Architecture, as an activity under the Sub-Program 1.2.2 Conditions for Healthy Living and Program 1.2 Health Promotion and Disease Prevention.  This information is described in PHAC‘s Performance Measurement Framework (PMF) (2016-2017).

2.0 Profile

The 2016-2017 Performance Measurement Framework of INAC identifies the following expected results for the Nutrition North Sub-Program:

“Residents in eligible communities have access to nutritious, perishable food at a subsidized rate.”

This Sub-Program is one of three that support the Northern Governance and People Program 4.1 with the expected results of:

“Northerners have greater control over their economic and political affairs”; and,
“Affordability of perishable, nutritious food in eligible communities is strengthened.”

The Northern Governance and People Program, in turn, supports The North Strategic Outcome:

“Self-reliance, prosperity and well-being for the people and communities in the North.”

Nutrition North Canada Nutrition Education Initiatives is one of the activities within Health Canada’s Sub-Sub-Program 3.1.1.3, “Healthy Living”, which includes in its objective to address the greater risks and lower health outcomes associated with chronic diseases among First Nations and Inuit individuals, families and communities.  In addition, the expected results in Health Canada’s PMF (2016-2017) for 3.1.1.3 is “First Nations and Inuit have access to healthy living programs and services” and “First Nations are engaged in healthy behaviours.” These expected results align with Health Canada’s strategic outcome 3, “First Nations and Inuit communities and individuals receive health services and benefits that are responsive to their needs so as to improve their health status”.

For the PHAC, the Nutrition North Canada Nutrition Education Initiatives will be delivered as an activity under PHAC‘s Sub-Sub-Program 1.2.2.1 Healthy Child Development, which falls under the Sub-Program 1.2.2 Conditions for Healthy Living, and Program 1.2 Health Promotion and Disease Prevention.  Expected results identified for these Programs include: “Communities have the capacity to respond to health inequalities of targeted populations” and “Program participants experience improved health and wellbeing.”

2.1  DescriptionMany communities across Canada’s three territories as well as the northern parts of some provinces are accessible only by air for part, or all, of the year. The cost of living and doing business in these isolated communities is higher than in more southern regions. Necessities such as perishable food must be flown into these communities. Electricity, maintenance and food storage costs are higher for stores and affect the prices of food on store shelves. The amount spent on food is considerably higher in these communities as a result.To better understand the multitude of factors leading to the high cost of food in these communities, INAC commissioned a major study on food retailing in the North. An example from the study illustrates the cost difference in operating a store in a northern community serviced by an all-weather road and a northern isolated community:

“For comparative purposes, the La Ronge, SK store, serviced by an all weather road (non-NNC eligible), has inventory costs in the range of $30,000 per 1,000 sq. ft. of store area.  Per 1,000 sq. ft. of store area, Iqaluit’s and Baker Lake’s, NU costs are about $146,000 and $128,000, respectively. The Gjoa Haven, NU store’s costs are in the range of $277,000 per 1,000 sq. ft., or about 9.3 times that of the La Ronge, SK store. However, the Gjoa Haven, NU store is quite small, so calculations on the basis of store square ft. could be subject to other factors. The fact remains that inventory costs per square foot are substantially higher in the North.”^Footnote 1

These higher prices make it more difficult for Northerners to afford a nutritious diet from store bought foods. Therefore, in order to alleviate the costs of nutritious, perishable foods purchased in isolated communities and to encourage nutritious eating, the Government implemented the Nutrition North Canada program on April 1, 2011. Foods eligible for a subsidy and the tool to measure the price trends in eligible communities of a basket of nutritious foods (the Revised Northern Food Basket^Footnote 2) are based on Canada’s Food Guide. This program replaces the Food Mail Program which had operated since the late 1960s.

The objective of the Nutrition North Canada Program is to help make perishable, nutritious food more accessible^Footnote 3 and more affordable^Footnote 4 than it otherwise would be to residents of eligible^Footnote 5 isolated northern communities without year-round surface (road, rail or marine) access. It is supported by an Advisory Board, which ensures that Northerners maintain a direct voice in the Program. Eligible northern communities benefit from improved access to healthy food.

Given that there are a number of factors that influence healthy eating patterns other than food cost, Health Canada and PHAC complement the Nutrition North Canada retail subsidy by providing funding to support culturally appropriate retail and community-based nutrition education initiatives. These initiatives aim to increase knowledge of healthy eating and develop skills for the selection and preparation of healthy store-bought and traditional or country foods.

2.2 Target population(s)Nutrition North Canada is a program of general application; it targets all Northerners living in eligible isolated communities in Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Newfoundland and Labrador, Yukon, the Northwest Territories and Nunavut. One hundred and twenty-one communities are eligible for the Nutrition North Canada retail subsidy. To be eligible for the Program a community must lack year-round surface (road, rail or marine) access. Until October 1, 2016, eligibility also required that a community have used Food Mail^Footnote 6, the department’s previous northern transportation subsidy program. Effective October 1, 2016, this eligibility criterion was removed, expanding the number of eligible communities to one hundred and twenty-one communities from one hundred and three. All eligible communities also receive the full benefits of Nutrition North Canada, with the partial subsidy designation having been removed to enable all communities to have access to the full subsidy.The majority (90%) of people living in communities serviced by Nutrition North Canada are Aboriginal people. Aboriginal people in the North face considerable social and economic challenges and tend to fare worse on a range of social and economic indicators in comparison with their non-Aboriginal counterparts (e.g., low rates of educational attainment, high rates of overcrowding, low income levels, higher rates of mortality and suicide). Poor conditions are often attributed to the disruption of Aboriginal peoples’ traditional economies and the loss of control over traditional lands and resources in areas where there are limited employment opportunities. This population is younger, and growing faster, than Canada’s non-Aboriginal population. According to Statistics Canada, the Aboriginal population increased by 232,385 people, or 20.1% between 2006 and 2011, compared with 5.2% for the non-Aboriginal population. These dynamics result in a noticeable median age gap between Aboriginal and non-Aboriginal Canadians: In 2011, the median age of the Aboriginal population was 28 years; 13 years younger than the median of 41 years for the non-Aboriginal population. Inuit were the youngest of the three Aboriginal groups, with a median age of 23.

Going forward, Statistics Canada projected the Aboriginal population “would grow faster than the non-Aboriginal population from 2011 to 2036. The Aboriginal population was estimated at 1,502,000 in 2011. In all scenarios considered, it would reach between 1,965,000 and 2,633,000 people by 2036. This would represent an average annual growth of between 1.1% and 2.3%, higher than the 0.9% for the population as a whole. As a result, Aboriginal people would account for between 4.6% and 6.1% of the Canadian population in 2036, compared with 4.4% in 2011.”^Footnote 7

The target population for the Health Canada component of the Program is residents of eligible First Nations and Inuit communities. Until 2015-16, funding was available for 78 communities located in Manitoba, Ontario, Quebec, Newfoundland and Labrador, Yukon, the Northwest Territories and Nunavut. In 2016-17, an additional 33 communities became eligible for the Health Canada component for a total of 111 communities. The new communities are located in Alberta, Saskatchewan, Manitoba, Ontario and Northwest Territories.

The target population for the nutrition education component of the Program administered by PHAC are residents of isolated northern communities that receive the retail subsidy, but fall outside the mandate of Health Canada’s First Nations and Inuit Health Branch. As of 2016-2017, there are 10 such communities, located in Saskatchewan, Quebec and Labrador.

2.3 Context / BackgroundNutrition North Canada replaced the Food Mail Program, which was an airfreight transportation subsidy program operated by Canada Post since the late 1960s. In Budget 2010, the Government of Canada announced funding for a new program model to improve access to affordable healthy food for Northerners. The Nutrition North Canada Program was launched on April 1, 2011. Budget 2014 reaffirmed the importance of the Program, committing to enhanced funding for Nutrition North Canada to improve access to healthy food in the 103 communities it serves and provided a 5% annual compound escalator to offset population growth and growing demand for subsidized items in eligible communities. Budget 2016 proposed to expand the Nutrition North Canada program to all northern isolated communities, increasing the number of communities served from 103 to 121 on October 1, 2016.Nutrition North Canada is a market-driven food subsidy program that seeks to improve access to perishable nutritious food in eligible isolated northern communities. This new program model addresses weaknesses in the former food mail program’s operations, including food eligibility, program awareness, transparency and accountability on shipping and food prices, delivery logistics, and the need for a focus on access to culturally appropriate food in the North.

The Program subsidizes retailers located in isolated northern communities for the high cost of stocking perishable nutritious food in their stores, helping to reduce the price consumers pay and increasing their access to nutritious market foods. People living in 121 isolated northern communities benefit from this Program.

In addition, Health Canada provides funding to support culturally appropriate retail and community-based nutrition education initiatives. These activities aim to increase knowledge of healthy eating and develop skills in the selection and preparation of healthy store-bought and traditional or country foods. Health Canada released a partial year of funds in 2010-2011, prior to the launch of the Program, to support communities in planning for the full implementation of Nutrition North Canada.

In 2016-2017, PHAC became a partner in Nutrition North Canada, managing nutrition education funding to communities that fall outside the mandate of Health Canada’s First Nations and Inuit Health Branch and which previously were not eligible to receive nutrition education funding.

Recent internal audit (2013) and evaluation (2013) recommendations have resulted in a current effort to review and adjust policy related to program eligibility (food and communities) as well as alternatives for how the subsidy could be applied with respect to program sustainability. This work is expected to be completed in 2016-17. Work is also in progress to enhance the existing information database capacity to support various analyses.

2.4  Design and deliveryThe program service need that Nutrition North Canada addresses is: improved access⁸ to nutritious, perishable foods for Northerners in isolated communities. It provides retailers and suppliers registered with the program a subsidy to alleviate the high cost of stocking and supplying eligible items in isolated communities. It also includes activities to encourage nutritious eating, a key component of a healthy lifestyle.Nutrition North Canada uses a market-based approach in addressing food-costs in the eligible communities. As opposed to the Food Mail Program freight subsidy, Nutrition North Canada uses a retail subsidy ⁹. Providing a direct subsidy to retailers and putting the control of the supply chain in their hands  ¹⁰ gives retailers more control over how to ship, and what to ship, based on what is being sold in stores; and allows them to realize efficiencies which should translate into food being more affordable than it would otherwise be.

Under Nutrition North Canada, arrangements to ship food to isolated northern communities are managed by three categories of eligible recipients:

• Northern Retailers: Retailers that operate stores located in eligible communities where eligible items are available for purchase;
• Southern Suppliers: Retailers and wholesalers that operate a business located in Canada where eligible items are available for purchase; that sell eligible products to northern retailers, eligible social institutions, establishments and individuals; and
• Northern Country food processors/distributors: Federally regulated establishments that are registered, inspected and/or licensed by the government and produce food approved-for-export and are located in a community eligible for a subsidy under the program.

Subsidy payments are made to recipients based on the weight of eligible items shipped to eligible communities. When claiming the subsidy, recipients submit invoices and waybills detailing shipment information such as weight by category of eligible items, as well as destination community and recipient (i.e., store, individual, institution). By signing the funding agreements with INAC, Nutrition North Canada recipients are responsible for passing on the subsidies to their customers; providing proof of the nature of shipments; providing information on current profit margins and profit margins over time, providing some visibility for the Program; and for providing data on products shipped and pricing. For direct orders, customers in eligible communities who order eligible items will see the subsidy applied against the weight of the items shipped, which reduce up front the selling price.

To assist in processing recipient subsidy claims, INAC has entered into a contract with a third party claims processor who is responsible for receiving, reviewing and processing recipient subsidy claims and supporting documentation, including invoices and waybills. Once the review is completed, the claim processor recommends to Nutrition North Canada Program the eligible amount of subsidy payment to the recipient.

Subsidy rates are set on a per kilogram basis of eligible foods and vary by community. In general, subsidy rates tend to be higher for communities where operating and transportation costs are currently higher. Until October 1, 2016, eighty-four communities receive the full subsidy amount, while the other 19 are eligible for a nominal subsidy. After October 1, 2016, one hundred and twenty-one communities are eligible for the full subsidy amount. The Minister of INAC considers multiple factors before a decision is made on setting specific community subsidy rates.

Nutrition North Canada subsidizes perishable, nutritious foods, including country or traditional foods that are commercially-processed in the North. Perishable foods can be fresh, frozen, refrigerated, or have a shelf life of less than one year. They must be shipped by air. Country or traditional foods (e.g., arctic char, musk-ox, caribou) must either be commercially-processed in the North and shipped by air to eligible communities (under the country food specific subsidy rate), or shipped by plane from the South by a registered retailer or supplier (in this case they are eligible for the same subsidy as other meats).

Health Canada, through its First Nations and Inuit Health Branch, funds complementary nutrition education initiatives in eligible First Nations and Inuit communities in order to support increased knowledge of healthy eating and development of the skills to choose and prepare healthy foods. In addition, Health Canada provides technical advice to INAC in the review of eligible food items, as well as in overall program implementation.

PHAC, through its Health Promotion and Chronic Disease Prevention Branch, funds complementary nutrition education initiatives in northern in remote communities in order to support increased knowledge of healthy eating and development of the skills to choose and prepare healthy foods.

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