‘Food sovereignty is an affirmation of who we are as Indigenous Peoples and a way, one of the most surefooted ways, to restore our relationship with the world around us.’
Winona LaDuke
For thousands of years, Indigenous Peoples around the world have been guardians of thriving homelands, waters and natural resources(Reference Lemke and Delormier1). Highly developed management systems have evolved from the intimate relationship with Land and local ecosystems, sustaining the health and well-being of Indigenous societies since time immemorial(Reference Kuhnlein, Erasmus and Spigelski2). The ontological basis of food in Indigenous cultures is grounded on the sacred value that stems from the ethical relationships among the Community, the environment, animals, plants, traditional knowledges and the cosmos(Reference Kneen3). Indigenous perspectives to food honour the social, cultural, spiritual, economic, environmental and political significance of Indigenous foodways, with important implications for respecting, protecting and fulfilling Indigenous rights(Reference Gomez4). The experience of hunger constitutes an unacceptable violation of basic human rights(5). In the case of Indigenous populations, such violation is rooted in historical processes of Land dispossession, environmental degradation, loss of biodiversity, centralisation of power and structural socioeconomic inequities(Reference Lemke and Delormier1,Reference Bogdanova, Andronov and Morell6) . While these phenomena have been in motion since the establishment of settler colonial states on Indigenous Lands, the neoliberal logics of over-exploitation of natural resources(Reference Levi and Robin7) and, more recently, the COVID-19 pandemic have aggravated both acute and chronic circumstances of food insecurity within Indigenous Communities(Reference Power, Wilson and Best8–Reference Burnette, Clark and Rodning10), which has implications for oral health. Despite these adverse realities, Indigenous Peoples have shown immense endurance and resistance in protecting Land sovereignty and knowledges associated with Indigenous foodways(Reference Greenwood and Lindsay11,Reference Edelman, Weis and Baviskar12) .
Meanings attributed to notions of food security and food sovereignty are often overlapping (such as the importance of cultural foods) and used interchangeably by activists(13). The FAO defines food security as a situation when ‘all people, at all times, have physical and economic access to sufficient, safe, nutritious food to meet their dietary needs and food preferences…’ (14). The concept is centred on five pillars encompassing aspects related to food availability, accessibility, adequacy, acceptability and agency(Reference Tétart15). Critical perspectives to food security provide an opportunity to interrogate the dominance of neoliberal discourses and globalised economic models centred on farming productivity and international trade as the main strategies to address hunger and other forms of malnutrition worldwide(Reference Chappell, Wittman and Bacon16). A technocratic understanding of food security focused on adequacy of supplies and nutritional content has been adopted particularly by international entities(13). Acknowledging aspects related to the wider food, cultural, social and political environments is essential to broadening the debate around food security beyond nutritional deficit and access to healthy food. Food sovereignty offers an alternative paradigm that recognises Indigenous Peoples’ right to self-determination and supports biodiversity conservation and diversified local food production systems(Reference Kepkiewicz and Dale17). Indigenous food sovereignty, specifically, is understood as a movement that aims to reconnect Indigenous Peoples with their foodways through four principles: (1) the recognition that food is sacred and the responsibility that Communities have in maintaining relationships with Lands, waters and beings; (2) daily Community participation in food systems; (3) Indigenous rights to self-determination and therefore the right to determine healthy and culturally relevant food systems and (4) the ability of Indigenous Communities to shape food-related policies(Reference Garcia, de Garcia Alves Feitosa and de Menezes18). While there is a growing debate around distinctions between definitions of food security and food sovereignty, we understand these concepts as complementary rather than antagonistic.
Indigenous foodways, culture, sovereignty and health are intimately connected. For Indigenous Peoples, the health inequities associated with food insecurity (e.g. hunger, malnutrition, obesity, diabetes and other chronic conditions) are largely driven by processes of environmental dispossession, that is, disrupted access to Land and decline of traditional food systems(Reference Richmond and Ross19–Reference Weiler, Hergesheimer and Brisbois21). However, the dialog between the food sovereignty agenda and health equity research has been limited(Reference Sheiham and Watt22). Moreover, the dental literature has systematically failed to acknowledge the influence of power (Indigenous sovereignty in the context of Indigenous Peoples) in the determination of oral health inequities(Reference Dent, Berger and Griffin23). Although oral health (or, the absence of oral disease and pain) shares common risk factors with other chronic diseases related to food insecurity, there is a paucity of literature exploring these relationships in depth. In particular, low availability of nutritious food and high consumption of sugary and cariogenic foods are a common risk factor of several chronic conditions and contributes to the development of dental caries(Reference Ronderos, Pihlstrom and Hodges24). As a manifestation of social inequities, food insecurity has been reported to contribute to periodontal disease through physiological pathways(Reference Desmarais and Wittman25,26) . An exploration of the relationship between food sovereignty and food security aligns with traditional practices of Indigenous Communities and provides new opportunities for strengthened oral health and well-being. Food sovereignty has been identified in the literature as a mechanism to address food-related issues common in many disadvantaged Communities(Reference Munn, Stern and Aromataris27). Aspects relating to food security such as availability of nutritious food are a common risk factor of several chronic conditions and oral diseases(Reference Ronderos, Pihlstrom and Hodges24). As a manifestation of social inequities, food insecurity has been reported to contribute to periodontal disease through physiological pathways(Reference Desmarais and Wittman25,26) .
Self-determination is a critical aspect of equitable health for Indigenous Peoples(Reference Munn, Peters and Stern28). Exploring opportunities that support self-determination and increase experiences of equitable health, therefore, warrant attention. This scoping review aimed to synthesise existing literature and evidence that contributes to the current understanding of the relationship between food sovereignty and/or food security and oral health for global Indigenous Communities. Specifically, we aimed to answer the following questions: (1) What evidence exists to explain the relationships between food sovereignty and/or food security and oral health for Indigenous Communities, globally?; (2) In what ways has food sovereignty and/or food security impacted oral health for Indigenous Communities, globally? and (3) What solutions for oral health equity at the nexus of food sovereignty and/or food security have been suggested?
Methods
While systematic reviews are considered the highest level of evidence for a range of purposes across many fields, there are instances where systematic reviews are unable to meet research aims(Reference Nath, Poirier and Ju29). Scoping reviews are useful when determining coverage of emerging evidence on a given topic(Reference Nath, Poirier and Ju30). This scoping review therefore aimed to explore the evidence base related to the relationship between food security or food sovereignty and oral health. While several systematic reviews on Indigenous oral health exist(Reference Poirier, Soares and Sethi31–Reference Levac, Colquhoun and O’Brien33), a search of PubMed, the International prospective register of systematic reviews (PROSPERO) and the Joanna Briggs Systematic Review Register revealed no existing reviews that explicitly explore the relationship between food security and/or sovereignty with oral health outcomes for Indigenous Communities. This scoping review has been registered with the Joanna Briggs Systematic Review Register and in accordance with methodological recommendations for scoping reviews(Reference Poirier, Soares and Tait34,Reference Foster and Deardorff35) , and the protocol(Reference Bourke36) was published and made publicly available with the Centre for Open Science(37). This review was conducted and is reported in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines extension for scoping reviews (Appendix 1).
Positionality
In accordance with the rejection of emergence and objectivity and embracing of researcher influence and subjectivity on findings commonplace in qualitative methodologies, we would like to acknowledge the positionality and influence of those involved in this research process(Reference Cidro, Adekunle and Peters38). As a mixed Indigenous and non-Indigenous research team from Canada and Australia, we approach this work with vested interest in finding pathways that strengthen Indigenous well-being and mirror Community values. Due to our backgrounds in oral health and nutrition, the research team aimed to explore opportunities where increasing food security or food sovereignty has benefits for oral health, in alignment with holistic understandings of Indigenous well-being(Reference Page, McKenzie and Bossuyt39).
Identifying articles for inclusion
The search strategy was designed in partnership with research librarians and aimed to locate both published and unpublished evidence across four databases: PubMed, Scopus, Web of Science and ProQuest Central. Databases were searched in May 2022 with no restrictions on publication year, language or geographic location. Keywords and indexed terms relating to ‘Food security’ or ‘Food sovereignty,’ ‘Indigenous Peoples,’ and ‘Oral health’ were compiled into a search string, first developed for PubMed and then adapted as per the design of the remaining databases (Appendix 2). Following the removal of duplicate records, two independent reviewers screened titles and abstracts of records identified in the search utilising Covidence (https://www.covidence.org/, Veritas Health Innovation Ltd, Melbourne, Australia). Articles considered suitable by either reviewer progressed to full-text review, where records were screened critically against the inclusion and exclusion criteria (Table 1). Anthropological articles that utilised human remains to determine changes in dentition were excluded from this review. Studies that only mentioned food security or sovereignty as a risk factor or covariate for oral health but did not explicitly discuss the relationship between these factors were not included, this was determined during full-text screening. All disagreements between reviewers were discussed amongst the research team. Critical appraisals were not performed on articles included in this review, in accordance with scoping review methodologies, as the aim did not relate to the production of critically appraised guidelines or recommendations(Reference Nath, Poirier and Ju30).
Table 1 Inclusion and exclusion criteria
Data extraction and synthesis
Data were extracted into a piloted extraction form by two reviewers. Two articles were completed by both reviewers to reduce selection bias and ensure inter-rater reliability. Extracted data included author name, year, country, study aim, study design, population characteristics, summary of findings, relationship between food and oral health explored, rationale for this exploration, definition of food security or food sovereignty, measurement of food security or food sovereignty, definition of oral health, measurement of oral health, conclusion about the relationship explored and any recommendations. Data extracted from the included articles were categorically synthesised, tabulated and narratively described in accordance with the relationship between food security or food sovereignty and oral health explored.
Results
The search identified 369 articles. After the removal of 105 duplicates, 264 unique records remained eligible for inclusion in this scoping review. Following title and abstract screening, 54 records were retrieved in full and assessed against the inclusion criteria during full-text review. Forty-one articles were deemed ineligible for inclusion during this process, primarily due to a failure to consider both an aspect of oral health in combination with either food sovereignty or food security (Fig. 1).
Fig. 1 PRISMA 2020 flow diagram(Reference Soares, Mota and Mialhe42)
Study characteristics
The articles included in this review were published between 2014 and 2022. Four articles were from Canada(Reference Soares, de Almeida Carrer and Biazevic43–Reference Gracey and King46), two were from Brazil(Reference Richmond, Kerr and Neufeld47,Reference Booth and Pollard48) and one article was from each of Ecuador(Reference Skinner, Pratley and Burnett49), Australia(Reference Lindberg, McKenzie and Haines50) and Mexico(Reference Nursey-Bray, Palmer and Smith51). Papers explored the relationships between food security or food sovereignty and oral health for First Nation(Reference Soares, de Almeida Carrer and Biazevic43–Reference Gracey and King46), Métis(Reference Soares, de Almeida Carrer and Biazevic43,Reference Gracey and King46) , Inuit(Reference Gracey and King46), Kichwa(Reference Skinner, Pratley and Burnett49), Yalsihón(Reference Nursey-Bray, Palmer and Smith51), Dzilam(Reference Nursey-Bray, Palmer and Smith51), Aboriginal(Reference Lindberg, McKenzie and Haines50), Kaingang(Reference Richmond, Kerr and Neufeld47,Reference Booth and Pollard48) and Guarani(Reference Booth and Pollard48) Communities. Included articles ranged in design; five were qualitative studies(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Booth and Pollard48,Reference Lindberg, McKenzie and Haines50) , four were cross-sectional(Reference Lizama and Cucina45–Reference Richmond, Kerr and Neufeld47,Reference Nursey-Bray, Palmer and Smith51) and three utilised Community-based participatory research approaches(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Skinner, Pratley and Burnett49) (Table 2).
Table 2 Characteristics of included studies
Synthesis of evidence
The concepts of food security, food sovereignty and oral health were conceptualised and measured in a variety of ways amongst included articles. Six focused on food security, of which three did not provide a definition(Reference Soares, de Almeida Carrer and Biazevic43,Reference Gracey and King46,Reference Lindberg, McKenzie and Haines50) , one discussed food insecurity in terms of access(Reference Patel, Durey and Naoum44) and two referenced the FAO of the UN definition of food security(Reference Lizama and Cucina45,Reference Richmond, Kerr and Neufeld47) . Food security was measured through qualitative experiences(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Lindberg, McKenzie and Haines50) , the Brazilian Household Food Insecurity Measurement Scale(Reference Richmond, Kerr and Neufeld47) and a single questionnaire item regarding difficulty purchasing food for children due to expenses(Reference Gracey and King46). Four articles considered food sovereignty, all of which conceptualised food sovereignty in terms of loss of traditional foods and transitions away from subsistence practices(Reference Lizama and Cucina45,Reference Booth and Pollard48,Reference Skinner, Pratley and Burnett49,Reference Nursey-Bray, Palmer and Smith51) . Two articles measured food sovereignty through qualitative experiences(Reference Booth and Pollard48,Reference Skinner, Pratley and Burnett49) , and one utilised a non-standardised dietary questionnaire(Reference Nursey-Bray, Palmer and Smith51). Oral health was considered in relation to early childhood caries (ECC)(Reference Soares, de Almeida Carrer and Biazevic43,Reference Gracey and King46,Reference Skinner, Pratley and Burnett49) , dental caries(Reference Patel, Durey and Naoum44,Reference Lizama and Cucina45,Reference Nursey-Bray, Palmer and Smith51) , oral health-related experiences(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Lindberg, McKenzie and Haines50) and oral health-related quality of life(Reference Richmond, Kerr and Neufeld47). These oral health components were measured through clinical dental examinations(Reference Gracey and King46,Reference Richmond, Kerr and Neufeld47,Reference Skinner, Pratley and Burnett49,Reference Nursey-Bray, Palmer and Smith51) , qualitative experiences(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Booth and Pollard48) and the Oral Health Impact Profile-14(Reference Booth and Pollard48).
Impact of food security and food sovereignty on oral health
Included studies described the impacts of food security and food sovereignty on oral health for Indigenous Peoples through a range of mechanisms (Fig. 2). Cost of living, poverty and socio-economic position were related to food insecurity at an individual level but also a Community level(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Skinner, Pratley and Burnett49,Reference Lindberg, McKenzie and Haines50) . Financial circumstances and food security were also associated with one’s ability to attend dental appointments or purchase oral hygiene products(Reference Soares, de Almeida Carrer and Biazevic43,Reference Lindberg, McKenzie and Haines50) . For the Algonquin Community of Rapid Lake within Canada, a lack of basic infrastructure to purchase and store healthy foods challenged the ability to maintain food security, as articulated by one participant: ‘There are no stores, grocery stores, in the reserve. And when your baby is hungry and you have no milk, powdered juice is fast. It’s not because you don’t know (that powdered juice is bad for oral health)’ (Reference Patel, Durey and Naoum44). Kichwa families in Ecuador reported ubiquitous challenges in preserving their traditional and healthy foodways, particularly in the face of food insecurity combined with the increased accessibility of processed foods(Reference Skinner, Pratley and Burnett49); parents of children with good oral health posited that ‘I make them eat (traditional foods)’(Reference Skinner, Pratley and Burnett49). Food insecurity was understood as a systemic factor that affects oral health for Indigenous Peoples within Canada(Reference Soares, de Almeida Carrer and Biazevic43,Reference Patel, Durey and Naoum44,Reference Gracey and King46) , Australia(Reference Lindberg, McKenzie and Haines50) and Brazil(Reference Richmond, Kerr and Neufeld47). More specifically, early childhood oral health was found to be compromised by lack of quality nutrition,(Reference Soares, de Almeida Carrer and Biazevic43,Reference Gracey and King46) and higher impact of oral health on quality of life was both associated with food insecurity(Reference Richmond, Kerr and Neufeld47). Food insecurity also constrained the ability of Community members to make optimal nutritional choices to maintain oral health(Reference Lindberg, McKenzie and Haines50). In the context of food insecurity, the cumulative burden of dental caries across the lifespan, and the lifelong impacts of sugars in dentition were considered as potentially contributing to high prevalence of carious lesions and tooth loss throughout the lifecourse(Reference Richmond, Kerr and Neufeld47). Critically, the impact of food insecurity was understood as a societal structural risk outside of individual or family control(Reference Gracey and King46).
Fig. 2 Conceptual model of the impact of food security and food sovereignty on oral health for global Indigenous Communities
A general trend across studies was the impact of colonisation and globalisation on a loss of traditional Lands, decreased consumption of traditional foods and increased reliance on store bought and highly processed foods. All factors surmounted in a foundational shift away from subsistence lifestyles and food sovereignty for Indigenous Communities in Ecuador(Reference Skinner, Pratley and Burnett49). Exploitation of Indigenous Lands, combined with violence from non-Indigenous agribusinesses, undermined food sovereignty and deprived Kaingang families of their Indigenous foodways in Brazil(Reference Richmond, Kerr and Neufeld47). Food availability was a concern for Aboriginal Communities in Australia, particularly with increasing impacts of climate change on Indigenous foodways(Reference Lindberg, McKenzie and Haines50). Rapid expansion of refined carbohydrate consumption was related to the density of refined sugars in a globalised, Western diet(Reference Lindberg, McKenzie and Haines50,Reference Nursey-Bray, Palmer and Smith51) . Increased occurrence of dental caries was identified as an external element produced by the Western way of life among Kaingang and Guarani Communities within Brazil; ‘White food causes White disease’ (Reference Booth and Pollard48). Similarly, one Aboriginal Community member within Australia shared, ‘Long time ago, they used to drink tea from their own fields… yeah in the days 60s and 70s, we never worried about things like sweets, we used to hunt for bush food but this time lately everything is sweet now… everything is changing’ (Reference Lindberg, McKenzie and Haines50). Participation in the global economy and improved socio-economic position was regarded as having the possibility of leading to a sedentary lifestyle, reliant on foods that are not beneficial for oral health and may have previously been inaccessible(Reference Nursey-Bray, Palmer and Smith51). Among Kichwa and Maya families in Ecuador and Mexico, lower socio-economic position was related to stronger oral health outcomes, due to the ability of families to maintain more traditional food practices despite lower access to resources, including dental services(Reference Skinner, Pratley and Burnett49,Reference Nursey-Bray, Palmer and Smith51) . These findings clearly indicate an interconnected relationship between foodways and oral health and offer hope that optimal oral health does not necessarily require a high income or high education but rather, the ability to retain traditional practices to enforce healthy decisions(Reference Skinner, Pratley and Burnett49,Reference Nursey-Bray, Palmer and Smith51) . Indigenous foodways play an integral role in culture and identity, as such loss of food sovereignty is a form of cultural discontinuity that not only impacts oral health and overall well-being but also the collective cultural well-being among Communities(Reference Booth and Pollard48,Reference Lindberg, McKenzie and Haines50) . Decreased access of traditional foods erodes strong connections with foodways and moves Indigenous Communities towards a system lacking distinct cultural ties and values(Reference Lindberg, McKenzie and Haines50). In Brazil, the adoption of Western diets was understood by Indigenous Peoples as a threat to the well-being of an individual, with important impacts on oral health status(Reference Booth and Pollard48).
Synthesis of recommendations
Recommendations within the included articles existed at family, Community and organisational levels. At the family level, support for land ownership was suggested as a means of maintaining Indigenous foodways. For non-land owning families, provision of healthy fruits and vegetables at affordable prices in local shops was suggested(Reference Skinner, Pratley and Burnett49). Further, parenting programs that promote effective parenting skills, including communication was recommended(Reference Skinner, Pratley and Burnett49). At the Community level, initiatives to establish and maintain Community gardens were suggested to help strengthen food security with healthy foods from gardens being distributed to families in Communities(Reference Patel, Durey and Naoum44). Findings echoed the importance of promoting consumption of traditional foods directly from the land, rather than reliance on stores, for improved oral health, food security and collective well-being(Reference Patel, Durey and Naoum44,Reference Booth and Pollard48) . Community and land-based initiatives are an important strategy of resisting colonisation and globalisation of Indigenous foodways and are an important way of maintaining food sovereignty and cultural identity(Reference Lizama and Cucina45,Reference Booth and Pollard48,Reference Lindberg, McKenzie and Haines50) . Community health services could carry large quantities of oral hygiene supplies to combat accessibility issues as well as promote oral health in a culturally secure manner(Reference Patel, Durey and Naoum44,Reference Skinner, Pratley and Burnett49) . At an organisational level, policies could be better positioned towards improving access to dental services, oral health information and transportation services; this could offset the impacts of poverty and food insecurity on receiving dental care(Reference Soares, de Almeida Carrer and Biazevic43). Economic incentives could motivate local businesses to advertise and sell more traditional foods(Reference Skinner, Pratley and Burnett49). Political actors could increase funding allotment and promotion of family, school and Community gardens which support Indigenous foodways(Reference Skinner, Pratley and Burnett49).
Discussion
Due to the experiences of colonisation(Reference Poirier, Hedges and Jamieson52), globalisation(Reference Levi and Robin7), environmental dispossession(Reference Swinburn, Kraak and Allender20) and oral health inequities(Reference Poirier, Soares and Sethi31,Reference Arksey and O’Malley32) by Indigenous Peoples around the world, combined with the integral role of food in Indigenous culture and identity(Reference Booth and Pollard48,Reference Wilson, Wilson and Delbridge53) , this scoping review aimed to collate evidence related to the relationship between food sovereignty and/or food security and oral health for Indigenous Communities. Subsequently, this review sought to conceptualise the ways in which food sovereignty and food security impact oral health for Indigenous Communities and explore potential recommendations at this nexus. Through the use of scoping review methodologies, evidence from nine articles across five colonised countries and with nine Indigenous Communities were synthesised into seven mechanisms of impact. Food security impacted dental caries, ECC, oral health-related quality of life and oral health-related experiences, whereas food sovereignty impacted dental caries and ECC.
Loss of Indigenous foodways, and subsequently Indigenous food sovereignty, is an intentional result of both colonisation and neoliberalism. The centrality of diet in cultural identity, as evidenced within this review, provides further evidence that supports the understanding that living colonial legacies, policies and institutions deliberately interrupt Indigenous wellbeing. These trends in disruption of Indigenous foodways can be considered as an outcome of social structures, characterised by racism, colonialism, social inequities and poverty, that are systematically exerted(Reference Blanchet, Batal and Johnson-Down54). Forced reliance on Western foods, loss of food sovereignty and pervasiveness of food insecurity is therefore, a form of structural violence against Indigenous Peoples(Reference Blanchet, Batal and Johnson-Down54–Reference Brimblecombe, Maypilama and Colles56). Considering this in combination with the biomedical and neoliberal context of dentistry, creates a complex feedback loop where the influences between intrinsic, extrinsic and systemic elements is difficult to map, particularly when Western, colonial ideologies are clothed in normality(Reference Booth and Pollard48). It is also critical to consider the future of Indigenous foodways amidst increasing impacts of climate change on traditional Lands, foods and animals. In many instances, Indigenous Peoples are already suffering from climate change impacts, despite having contributed little to the contemporary climate crisis(Reference Poirier, Sethi and Hedges57); but Communities are adapting and resisting, as they have for millennia.
The majority of articles included in this review focused on describing experiences of food insecurity or loss of food sovereignty rather than promoting pathways to reclaiming Indigenous foodways. Similar narratives are also typically described in oral health literature, whereby disease occurrence is documented but solutions towards improved oral health is not explored(Reference Jamieson58). A shift towards works that supports improved (oral) health and wellbeing through pathways that support self-determination, such as Indigenous food sovereignty, is necessary(Reference Kyoon-Achan, Schroth and DeMaré59). Reclamation of healthy lifestyles and practices is a sustainable way to improve health outcomes for Indigenous Communities, rather than continuing extractive practices of research that fail to build healthier outcomes. There has been success in utilising land-based practices such as food sovereignty, for improving experiences of diabetes, spiritual well-being and cultural connectedness(Reference Naidu, Macdonald and Carnevale60–Reference de Souza, Bilodeau and Gordon62). No articles focused on the opportunity that the nexus between food sovereignty, food security, and oral health provides for a common risk factor approach that would have significant benefits for Indigenous well-being and cultural identity(Reference Booth and Pollard48,Reference Lindberg, McKenzie and Haines50) . There remains a unique opportunity, through Community driven and controlled initiatives to empower resistance to industrialised foodways, strengthen food security and improve overall well-being, including oral health: ‘a refocus on traditional foods in practice and policy could further serve to reinforce the longstanding traditional social and cultural values of food and assist in regaining a sense of life in balance’ (63). Initiatives such as Community gardens, as recommended by articles included in this review(Reference Patel, Durey and Naoum44,Reference Booth and Pollard48) , as well as seed libraries, Community kitchens and increased roles of Land governance are necessary to establish pathways to self-determination of food and wellbeing for Indigenous Communities, as enshrined in the United Nations Declaration on the Rights of Indigenous Peoples(Reference Munn, Peters and Stern28).
Strengths and limitations
This review considered the impact of food security and food sovereignty in relation to Indigenous oral health, where Indigenous foodways are considered essential to an Indigenous-defined understanding of well-being(Reference Page, McKenzie and Bossuyt39). This is the first evidence mapping the impact of food security and food sovereignty on Indigenous oral health outcomes, measured through clinical dental examinations, qualitative evidence and questionnaires. The articles included in this review largely failed to utilise a strength-based approach to improving food security or food sovereignty. Future work must therefore centre on Indigenous-led initiatives and share stories of strength and resilience to inspire grassroot movements in this space. Although the authors made all attempts to limit publication bias by including all locations, languages and types of articles, limitations remain. Although designed in a broad manner, our search strategy did not include all individual population group names of Indigenous Communities; as such, relying on MeSH headings may not identify all articles eligible for inclusion in this review. Scoping reviews fail to represent knowledges and stories not contained within published literature. As such, critical Community perspectives and initiatives are likely underrepresented, and the findings presented herein likely only represent a portion of the ways in which Indigenous Communities are strengthening their experiences of oral health through resistance and reclamation of Indigenous foodways.
Conclusion
Initiatives to strengthen food security and food sovereignty for Indigenous Communities provide an opportunity to improve experiences of oral health, collective well-being, and cultural identity. This nexus is a largely untapped area that has the potential for meaningful change within Communities as well as translatable outcomes. In accordance with the evidence generated by this review, we propose the following strategies for future directions: (1) integration of Indigenous perspectives on oral health, wherein traditional practices are integrated into oral health promotion and dental interventions, which includes strengthening Indigenous food sovereignty; (2) moving beyond a deficit narrative of food insecurity as well as cultural, social and ecological losses related to traditional foods to exploring and documenting strength-based narratives and interventions that have tangible impacts for Communities; and most importantly, (3) designing oral health interventions from a holistic standpoint that amplify Indigenous rights to self-determination and honour Indigenous ways of knowing, being and doing.
Acknowledgements
The research team would like to acknowledge all Indigenous Peoples and Communities, across the world, whom they have had the opportunity to learn from. It is these experiences and relationships that drive our work and inquiry into pathways that demand health equity for Indigenous Peoples.
Financial support
This research did not receive any specific funding.
Conflict of interest
The authors declare they have no competing interests.
Authorship
Conceptualisation, B.F.P., L.J. and H.T.N.; data curation, B.F.P. and S.S.; formal analysis, B.F.P. and G.S.; investigation, J.H. and L.J.; methodology, B.F.P. and G.S.; project administration, L.J.; supervision, J.H., H.T.N. and L.J.; visualisation, B.F.P.; writing – original draft preparation, B.F.P.; writing – review and editing, B.F.P., G.S., S.S., J.H., H.T.N. and L.J. All authors have read and agreed to the published version of the manuscript.
Ethics of human subject participation
An ethics statement is not applicable because this study is based exclusively on published literature.
Supplementary material
For supplementary material accompanying this paper visit https://doi.org/10.1017/S1368980024001198
Open access
