Black-white racial disparities in household food insecurity from 2005 to 2014, Canada.

OBJECTIVES: To understand the differential vulnerability to household food insecurity of the Black population as compared with white counterparts in Canada. METHODS: Using data for households with Black and white respondents in pooled Canadian Community Health Survey cycles from 2005 to 2014, the 18-question Household Food Security Survey Module was analyzed (N = 491,400). Bivariate and multivariate logistic and multinomial regression models were run using respondent's race, immigration status, and six well-established predictors of household food insecurity in the general population. Additional multivariable logistic regression models were run, with race interacted with each predictor individually to yield predicted probabilities. RESULTS: The weighted prevalence of household food insecurity was 10.0% for white respondents and 28.4% for Black respondents. The odds of Black households being food-insecure as compared with white households fell from 3.56 (95% CI: 3.30-3.85) to 1.88 (95% CI: 1.70-2.08) with adjustment for household socio-demographic characteristics. In contrast with white households, there was relative homogeneity of risk of food insecurity among Black subgroups defined by immigration status, household composition, education, and province of residence. Homeownership was associated with lower probabilities of food insecurity for Black and white households, but the probability among Black owners was similar to that for white renters (14.7% vs. 14.3%). Black households had significantly higher predicted probabilities of food insecurity than their white counterparts across all main sources of household income except child benefits and social assistance. CONCLUSION: Being racialized as Black appears to be an overriding factor shaping vulnerability to food insecurity for the Black population in Canada. Future research and public policy on food insecurity should seriously consider the role of racism at the systemic and institutional levels.

RéSUMé: OBJECTIFS: Comprendre la vulnérabilité différentielle de la population noire à l'insécurité alimentaire des ménages par rapport à la population blanche au Canada. MéTHODE: À l'aide des données sur les ménages comptant des répondants noirs et blancs dans les cycles combinés de l'Enquête sur la santé dans les collectivités canadiennes de 2005 à 2014, nous avons analysé les 18 questions du Module d'enquête sur la sécurité alimentaire des ménages (N = 491 400). Nous avons exécuté des modèles de régression logistique et multinomiale bivariés et multivariés en utilisant la race des répondants, leur statut d'immigration et six variables prédictives bien établies de l'insécurité alimentaire des ménages dans la population générale. D'autres modèles de régression logistique multivariés ont aussi été exécutés, avec des interactions entre la race et chaque variable prédictive afin de produire des probabilités prédites. RéSULTATS: La prévalence pondérée de l'insécurité alimentaire des ménages était de 10 % pour les répondants blancs et de 28,4 % pour les répondants noirs. Après la prise en compte du profil sociodémographique des ménages, la probabilité d'insécurité alimentaire chez les ménages noirs comparativement aux ménages blancs est passée de 3,56 (IC de 95 % : 3,30-3,85) à 1,88 (IC de 95 % : 1,70-2,08). Contrairement aux ménages blancs, le risque d'insécurité alimentaire était relativement homogène dans les sous-groupes noirs définis selon le statut d'immigration, la composition du ménage, l'instruction et la province de résidence. L'accession à la propriété était associée à une plus faible probabilité d'insécurité alimentaire tant dans les ménages noirs que dans les ménages blancs, mais la probabilité chez les propriétaires noirs était semblable à celle des locataires blancs (14,7 % c. 14,3 %). Les probabilités prédites d'insécurité alimentaire étaient sensiblement plus élevées dans les ménages noirs que dans les ménages blancs pour toutes les sources de revenu des ménages sauf les prestations pour enfants et l'aide sociale. CONCLUSION: Le fait d'être racisé comme une personne noire semble être un facteur déterminant de la vulnérabilité à l'insécurité alimentaire dans la population noire au Canada. Les études et les politiques publiques futures sur l'insécurité alimentaire devraient envisager sérieusement le rôle du racisme à l'échelle systémique et institutionnelle.

An Affront to Her Mana: Young Maori Mothers' Experiences of Intimate Partner Violence.

Young Maori mothers in Aotearoa/New Zealand are disproportionately vulnerable to intimate partner violence (IPV) due to multiple intersecting factors, such as relationship dynamics during youth, pregnancy, and racialized Maori (Indigenous) identity. An enduring legacy of settler colonialism has resulted in Maori being overrepresented as victims and perpetrators of violence. IPV, in particular, leads to adverse social, mental, and health outcomes over time, including those specific to mothers (e.g., postpartum depression, miscarriage). This study analyzed six narrative interviews with young Maori mothers aged 14 to 19 from the E Hine longitudinal maternal health care study. Kaupapa Maori (by Maori, for Maori) was the primary research framework, which allowed for the use of Maori modes of engagement and the centering of Maori women's voices in the research process. Using a thematic and interpretive phenomenological analysis (IPA), we aimed to understand the lived realities of young Maori mothers who have experienced IPV and to examine the extent to which service responsiveness has been culturally safe. Our findings illustrated how IPV manifests in the relationships of these six women. Their stories showed the various ways in which young Maori women resist violence, reclaim their Maori identities, and experience personal transformation during their motherhood journeys despite abuse. We find that whanau (extended family) is both a violence-perpetuating and immensely protective factor. Moreover, there are structural and institutional barriers to culturally safe service responsiveness for young Maori women. These come in the form of racism at the frontlines of government agencies, pervasive victim-blaming, and a lack of earnest decolonial structural change at the institutional level. We conclude that social services must be multisectoral, culturally safe, and specialized for Maori youth and families to support Maori mothers experiencing IPV.

Reaching the Hard to Reach in Thailand: Eliminating Mother-To-Child HIV Transmission.

Thailand is the first country in the Asia-Pacific region to be validated by the World Health Organization as having eliminated mother-to-child transmission (MTCT) of HIV. The Thai government made health-and specifically addressing the HIV/AIDS crisis-a political priority. The Thailand experience, from the emergence of the HIV/AIDS epidemic in the 1980s through the present, provides an important case study of successful MTCT elimination. To eliminate MTCT requires that health interventions reach those who are hardest to reach: the poorest of the poor, geographically distant and rural, and marginalized. This policy report highlights key factors for successfully reaching the hard to reach in Thailand, including the importance of national public policy as well as investments in health care infrastructure, such as access to antenatal care, the creation of effective monitoring and surveillance systems, and strengthening local health capacity. Increased availability and affordability of antiretroviral therapies was also critical to Thailand's success in addressing MTCT. The Thailand case offers important policy lessons for achieving universal health. This policy report draws on secondary research and key informant interviews in Thailand to highlight factors for success in eliminating MTCT of HIV.