Examining attitudes towards a proposed sugar-sweetened beverage tax among urban Indigenous adults using a decolonizing lens

Abstract

Background: Taxation of sugar-sweetened beverages (SSB) is a leading public health tool to reduce consumption and associated health outcomes. Compared to other racial/ethnic groups in Canada, off-reserve Indigenous populations consume SSB at higher frequencies and quantities. Indigenous populations are also disproportionately affected by type 2 diabetes and food insecurity, which are attributable to colonial policies. Governments have been called to action by the Truth and Reconciliation Commission to close gaps in these health disparities. Given the regressive nature of a tax on SSB, we need to hear the voices of Indigenous people who are targeted by such a policy. Objectives: The objectives of this thesis were to examine (1) experiences and determinants of purchasing SSB, and (2) the acceptability and anticipated impact of the proposed SSB tax among urban Indigenous adults. Methods: In partnership with the National Indigenous Diabetes Association and Fearless R2W, we conducted 20 semi-structured interviews (Nov 2019-Aug 2020) with Indigenous adults residing in Winnipeg’s NE neighborhood. Interviews were audio recorded, transcribed verbatim, organized in NVivo-12-Pro, and thematically analyzed. Results: All 20 participants (Female=12; Male=8; Two-Spirit=2) consumed SSB on a regular, daily basis at the time of the interview or prior at some point in their lives; three-quarters were unemployed. Objective 1: Participants’ experiences of shopping for SSB were characterized by the overarching theme of balancing on the redline, specifically (1) balancing SSB purchasing constraints and facilitators with savvy shopping approaches and (2) balancing (stereo)typical reactions with resilient coping approaches. Objective 2: Overall, most participants were strongly opposed to a SSB tax because of inter-related themes of (1) government not trustworthy, (2) taxes are ineffective and lead to inequitable outcomes, and (3) Indigenous self-determination critical. Conclusions: Results indicate that SSB represent a considerable expense to urban low-income, Indigenous residents. Finding also reveal that SSB is a source of judgment in predominantly non-Indigenous food-carrying establishments, intersecting racial prejudice and weight stigma. Low support for the tax among urban Indigenous people is characterized by concerns regarding the tax, as well as the policy makers themselves. Findings underscore the importance of Indigenous Peoples’ self-determination in informing and designing health policies that are equitable and non-stigmatizing.