Transcript Deconstructing household food insecurity: insights from

Deconstructing household food insecurity:
insights from Canadian research
Valerie Tarasuk
Professor, Department of Nutritional Sciences
Faculty of Medicine, University of Toronto
PROOF: V Tarasuk (PI, U Toronto), C Gundersen (co-PI, U Illinois), L McIntyre (U Calgary), H
Emery (U Calgary), C Mah (Memorial U), J Rehm (CAMH), P Kurdyak (CAMH), N Dachner
(Coordinator, U Toronto).
Acknowledgement: This research is funded by a programmatic grant from the Canadian
Institutes of Health Research.
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Outline:
• Food banks: the public face of the problem
• Food insecurity monitoring: a different perspective
on the problem
• Relation between food insecurity, nutrition and
health.
• Social policy underpinnings
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Defining the problem:
Household food insecurity:
insecure or inadequate access to food due to financial
constraints
- popularly termed “hunger”
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The evolution of food banks and food insecurity measurement:
1994: Measure of child
hunger on National
Longitudinal Survey of
Children & Youth
2005: food insecurity
monitoring begins
Assorted indicator questions
1989: ‘HungerCount’.
1981: First
food bank.
1980
1997: Annual release of
‘HungerCounts’.
1987:Canadian
Association of
Food Banks
formed.
1990
2000
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Household Food Security Survey Module
(administered on the Canadian Community Health Survey since 2004)
18 questions, differentiating adults’ and children’s experiences
over last 12 months:
•
•
•
•
•
•
•
•
Worry about not having enough food
Reliance on low-cost foods
Not able to afford balanced meals
Adults/children skip meals
Adults/children cut size of meals
Adults/children not having enough to eat
Adult lost weight
Adults/children not eating for whole day
“because
there wasn’t
enough
money to buy
food?”
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Household Food Insecurity in Canada, 2007 - 2012
• 12.6% of households
• over 4 million Canadians
(an increase of > 600,000 since 2007)
Marginal food insecurity
Worry about running out of
food and/or limit food
selection because of lack of
money for food.
Moderate food insecurity
Compromise in quality
and/or quantity of food
due to a lack of money for
food.
Severe food insecurity
Miss meals, reduce food
intake and at the most
extreme go day(s) without
food.
Data Source: Statistics Canada, CCHS,
2007, 2008, 2011, 2012 and 2013.
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Number of people living in food-insecure households in Canada,
2007 - 2012
4,500,000
4,000,000
3,874,000
3,398,500
4,005,000
3,422,900
3,500,000
3,000,000
2,500,000
2,000,000
1,500,000
1,000,000
500,000
0
2007
2008
2011
2012
Data Sources: Statistics Canada, Canadian Community Health Survey (CCHS), 2007, 2008, 2011 and 2012, and Food
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Banks Canada, HungerCount, 2007, 2008, 2011 and 2012.
Number of people living in food-insecure households vs number
reported to be helped by food banks in March of respective year.
4,500,000
4,000,000
3,500,000
3,000,000
2,500,000
Food Insecure
2,000,000
Food Bank Use
1,500,000
1,000,000
500,000
0
2007
2008
2011
2012
Data Sources: Statistics Canada, Canadian Community Health Survey (CCHS), 2007, 2008, 2011 and 2012, and Food
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Banks Canada, HungerCount, 2007, 2008, 2011 and 2012.
Relationship between food insecurity and food bank use?
• Most people affected by food insecurity do not seek
charitable food assistance.
 disconnect between help offered and perceived
needs of food insecure.
 arbitrary nature of charitable service provisioning
renders it inaccessible to many.
• Food bank users are a relatively small, non-representative
subset of food insecure population.
(Hamelin et al, Health Educ Res 2010; Loopstra & Tarasuk, Can Public Policy 2012;
Loopstra & Tarasuk, Soc Pol Soc 2015)
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National prevalence of household food insecurity and poverty (defined as
income < Low-Income Measure), 2007, 2008, 2011, 2012.
16
14
12
10
%
LIM
8
Food insecurity
6
4
2
0
2007
2008
2011
2012
LIM: 50% of median household income, adjusted for household size.
Source: PROOF calculations from CCHS 2007-08, 2011-12 and Statistics Canada. CANSIM. Table 111-0015 Family characteristics,
Low Income Measures (LIM), by family type and family type composition.
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Relationship between food insecurity and household income:
Food insecurity captures
material deprivation.
the product of
• income (size, security, stability)
• assets / home ownership
• access to credit
• expenses (shelter, food,
medications, debt, etc)
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(Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2014. 2016)
FOOD INSECURITY, FOOD AND HEALTH?
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Results from CCHS 2004 - Nutrition
Adults’ fruit and vegetable consumption,
servings per day by food security status
9
8
7
6
servings/day
*
*
*
*
5
*
Food secure
Food insecure
4
3
2
1
0
M 19-30 y
F 19-30 y
M 31-50 y
F 31-50 y
M 51-70 y
F 51-70 y
Age/sex group
Food insecurity here includes only moderate and severe food insecurity.
*Significant difference between food-secure & food-insecure subgroups, p<0.05
(Kirkpatrick & Tarasuk, Journal of Nutrition, 2008: 138: 604-612)
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Results from CCHS 2004 - Nutrition
Adults’ fruit and vegetable consumption,
servings per day by food security status
9
8
7
6
servings/day
*
*
*
*
5
*
Food secure
Food insecure
Recommended
4
3
2
1
0
M 19-30 y
F 19-30 y
M 31-50 y
F 31-50 y
M 51-70 y
F 51-70 y
Age/sex group
Food insecurity here includes only moderate and severe food insecurity.
*Significant difference between food-secure & food-insecure subgroups, p<0.05
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Results from CCHS 2004 - Nutrition
Children’s fruit and vegetable consumption,
servings per day by food security status
9
8
7
6
*
servings/day 5
4
*
3
Food secure
Food insecure
Recommended
2
1
0
1-3 y
4-8 y
M 9-13 y F 9-13 y M 14-18 y F 14-18 y
Age/sex group
Food insecurity here includes only moderate and severe food insecurity.
*Significant difference between food-secure & food-insecure subgroups, p<0.05
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Average SODIUM intake (mg/day), by age, sex and household food security
status:
4500
4000
a
a
3500
a,b
3000
2500
2000
1500
1000
500
0
M9-13
F9-13
M14-18 F14-18 M19-30 F19-30 M31-50 F31-50 M51-70 F51-70
Food secure
Food insecure
a: P < 0.05, comparison of transformed intakes; b: P<0.05, ANOVA adjusted for income, education,
immigrant status, household composition, and current smoking.
Food insecurity here includes only moderate and severe food insecurity.
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Prevalence of nutrient inadequacy by food security status,
individuals ≥ 9 years of age in Canada
70
% inadequate intakes
60
50
40
30
food secure
food insecure
20
10
0
Note: food insecure defined here as ≥ 3 affirmatives on 18-item HFSSM.
(Kirkpatrick et al, Journal of Nutrition, 2015)
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Relation between household food insecurity status and
adults’ self-rated cooking ability
F o o d S e c u re
F o o d In s e c u r e
D o n 't k n o w w h e re to s ta rt w h e n it c o m e s to c o o k in g
C a n d o th in g s s u c h a s b o il a n e g g o r c o o k a g rille d c h e e s e s a n d w ic h
C a n p r e p a re s im p le m e a ls b u t n o th in g to o c o m p lic a te d
C a n c o o k m o s t d is h e s if I h a v e a re c ip e
C a n p re p a r e m o s t d is h e s
F r e q u e n tly p re p a re s o p h is tic a te d d is h e s
Data Source: Statistics Canada Rapid Response
Modules on 2012 and 2013 Canadian Community
Health Survey
(Huisken, Orr & Tarasuk, Canadian Journal of Public Health, forthcoming)
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The health effects of food insecurity:
Summary of observed associations, all independent of income, education,
race/ethnicity and other social determinants of health:
Maternal and
infant health
• Poorer birth outcomes
• Impaired growth and development
Children
• Poorer development and learning
• Impeded disease management
• Increased likelihood of developing asthma,
depression, other chronic conditions.
Adults
• Compromised physical and mental health
• Poor disease management and heightened
odds of negative outcomes (including
mortality).
(See review by Gundersen & Ziliak, Health Affairs, 2015; 34: 1830-1839)
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Prevalence of chronic conditions among Canadian adults, (18-64 years) of age,
by household food insecurity status and sex
Mood or anxiety disorder
Severe food insecurity
Hypertension
Moderate food insecurity
Heart Disease
Women
Marginal food insecurity
Diabetes mellitus
Food secure
Bowel Disorders
Severe food insecurity
Back Problems
Men
Moderate food insecurity
Marginal food insecurity
Arthritis
Food secure
Asthma
0
10
20
30
40
50
% adults reporting condition
(Adapted from Tarasuk V, Mitchell A, McLaren L, & McIntyre L. Journal of Nutrition. 143(11), 1785-93.)
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Average health care costs per person incurred over 12 months for Ontario
adults (18-64 years of age), by household food insecurity status:
$3930
4000
3500
3000
$2806
Prescription drugs
2500
Home care services
$2161
$
Same day surgery
2000
Inpatient costs
$1608
Physician services
1500
Emergency
Other
1000
500
0
secure
marginally insecure
moderately insecure
severely insecure
(Tarasuk et al, Canadian Medical Association Journal, 2015)
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POLICY INSIGHTS ARISING FROM ANALYSES OF
MONITORING DATA
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(Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2014. 2016)
Prevalence of food insecurity by main source of income, 2014
70
60
50
40
%
30
20
Seniors have a
Guaranteed Annual
Income, indexed to
inflation
10
0
Senior's incomes
Employment
severe
Other/none
moderate
EI, Workers'
Comp
Social Assistance
marginal
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(Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2014. 2016)
Probability of food insecurity by age for unattached, low-income adults
(pooled data from the Canadian Community Health Survey, 2007-2013).
0.45
0.40
0.35
Fitted Probability
0.30
0.25
Fitted Probability
Baseline Probability
0.20
Avg post 65 prob
0.15
0.10
0.05
0.00
56
57
58
59
60
61
62
63
64
Age (years)
65
66
67
68
69
70
(McIntyre, Dutton, Kwok & Emery, Canadian Public Policy 2016)
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Probability of food insecurity by age for unattached, low-income adults
(pooled data from the Canadian Community Health Survey, 2007-2013).
0.45
0.40
0.35
Fitted Probability
0.30
0.25
Fitted Probability
Baseline Probability
0.20
Avg post 65 prob
0.15
0.10
0.05
0.00
56
57
58
59
60
61
62
63
64
Age (years)
65
66
67
68
69
70
(McIntyre, Dutton, Kwok & Emery, Canadian Public Policy 2016)
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Prevalence of food insecurity by main source of income, 2014
Low benefit levels +
asset limits + restrictions
on earnings = extreme
vulnerability.
70
60
50
40
%
30
20
10
0
Senior's incomes
Employment
severe
Other/none
moderate
EI, Workers'
Comp
Social Assistance
marginal
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(Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2014. 2016)
Prevalence of food insecurity among households in Newfoundland
and Labrador reporting any income from social assistance.
70%
59.9%
60%
59.2%
57.4%
50%
44.8%
44.0%
40%
33.5%
30%
20%
Provincial actions to reduce poverty
10%
0%
2007
2008
2009
2010
2011
2012
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(Loopstra, Dachner & Tarasuk, Canadian Public Policy, September, 2015)
Summary
• Systematic measurement of food insecurity in Canada has
revealed a very different problem than the one apparent
from food bank utilization statistics.
• Food insecurity is related to dietary intake, but its effects on
health go well beyond nutrition.
• Household food insecurity is a potent determinant of health
and health care spending in Canada.
• This problem is rooted in financial constraints and appears
very sensitive to social policy decisions.
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