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Dr. Catherine Mah is taking aim at social impacts on food purchasing and diet

Posted by Mathieu Hebert, Dal Health freelance writer on January 25, 2024 in News
Dr. Mah's work examines how social and economic influences shape our health and what we choose to eat.
Dr. Mah's work examines how social and economic influences shape our health and what we choose to eat.

Dr. Catherine Mah is the Canada Research Chair in Promoting Healthy Populations and Full Professor in the School of Health Administration. Her recent research focuses on the role of the consumer food environment in food availability and affordability, social equity, and population diet. She teaches fifth and sixth year classes on epidemiology and health policy in the School.

She received her MD from the University of Calgary in 1998, became a pediatric Fellow of the Royal College of Physicians of Canada in 2002, and received her PhD in Health Services Research and Health Policy from the University of Toronto in 2009.

Throughout her career, she has devoted herself to advancing our understanding of social and economic relations, how they shape the health and diet of the population, and how this knowledge might support public policy design.

During the COVID-19 pandemic, she led the CELLAR (COVID-related Eating Limitations and Latent dietary effects in the Atlantic Region) study, which examined purchasing and diets among Atlantic Canadians. The project was funded by the Canadian Institutes of Health Research (CIHR). More recently, Dr. Mah’s graduate students conducted a 2021 Canada-wide study that used web scraping tools to analyze food price data from across the country. Digital price data has been a major concern on the radar for economic monitoring and policy; the observational study sought to create a ‘digital national nutritious food basket,’ a way to explore digital monitoring of the cost of eating healthy in Canada for population health purposes.

“There are many vectors across which socioeconomic disparities in health are increasing, and food affordability is a cross-cutting one,” Dr. Mah said. “Food affordability, for legislators, is often referred to as a ‘pocketbook’ issue: a theory that individuals and households ought to be targeted by public policy on the basis of where their personal economic interests lie. But individuals and social groups are made different from each other by our politics, our institutions, and our culture, which constrain the economic choices available to us. Social inequity is one of our biggest health risks. Our team is examining the role of the consumer food environment in those inequities.”

Dr. Mah’s lab found that digital data tools eased the process of standardizing and scaling consumer food price audits frequently conducted by local public health units and nutrition teams, so that the interjurisdictional differences in the cost of a nutritious basket of food could be compared across retail chains, provinces and territories, and life-course nutrition needs, and which could support more rapid and reliable cross-jurisdictional public health assessments. Through their analysis the team also detected that the cost of the nutritious food basket was similarly patterned, but substantially higher, than federal statistics estimated, with costs differing from $4,200 to $6,000 more per year.

“Food affordability is a determinant of health. Right now… it has become a divisive political hot potato,” Dr. Mah said. “And I’m not interested in science that's chasing hot potatoes. I'm interested in whether our policies and institutions do enough in the short and long term, to promote health and prevent disease, and enable communities to flourish. I am interested in health research that proactively reorients and strengthens our fundamental understanding of how the benefits from societal progress may accrue.”

Her latest endeavours are Canada’s first national population-based study of diet costs led by one of her CIHR-funded doctoral trainees, and an upcoming study of food purchases and consumption among hospital staff.

The hospital study will be led by Dr. Mah, serving as one of three principal investigators.

Named PRICES, the study aims to prospectively learn from the purchasing and dietary behaviours of hospital staff in Nova Scotia during a five-year period. Dr. Mah and her team hope to create a better understanding of dietary choices.

“Evidence from a group of organizational workers over a longer period of time helps us assess many more of the ins and outs of how they use the workplace consumer food environment in relation to their household budget, as well as how it contributes to their diet,” Dr. Mah said in an interview.

Many working in health care will often work lengthy shifts, extending beyond 12 hours. Workforce health and wellbeing is a major concern for health policy. In 2022, 31.7 per cent of full-time nurses and 18.2 per cent of support workers in Canada worked overtime, according to Statistics Canada. These extended working hours mean that workers rely on on-site retail services, delivery services, or packed food for meals while spending so much time away from home.

CIHR is contributing $661,726 to the study through a project grant. The funding will help sustain the study over its five-year period.

The study aims to recruit workers from across the organization, including practitioners, communication, managerial, support and even cafeteria staff themselves.

PRICES calls on the expertise of more than just Dr. Mah. Other Dalhousie scientists working as principal investigators on the study include Dr. Mohammad Hajizadeh, Associate Professor and Canada Research Chair in Health Economics, and Dr. Leah Cahill, Associate Professor and Howard Webster Department of Medicine Research Chair.

Dr. Hajizadeh specializes in health economics and health equity, with his latest research assessing the impact of public policies such as seniors’ pensions, contributing a theoretical and practical economic lens to the project. Dr. Cahill, a nutritional epidemiologist and registered dietitian, has expertise with well-known worker cohorts such as the Nurses’ Health study, as well as frontline dietary assessment.

In addition, some investigators contributing to the study team are past Nova Scotia Health collaborators with Dr. Mah, researchers at the University of Queensland and Memorial University, as well as doctoral students at Dalhousie, whose thesis work focuses on food affordability and consumer environments.

The hope for the study isn’t necessarily to make cafeteria recommendations. According to Dr. Mah, the study, first and foremost, draws from the long traditions of study on worker health and consumption, both financial and dietary, to inform policy.

“Transdisciplinary problems require transdisciplinary solutions,” Dr. Mah said. “We hope to combine our collective strengths in new ways.”

Learn more about the study.