Basic Income Can Reduce Food Insecurity and Improve Health

This article was originally published in the University of Toronto Faculty of Medicine News and the University of Toronto Dalla Lana School of Public Health News November 16, 2016.


By: Jim Oldfield, Writer, Office of Communications, Faculty of Medicine, University of Toronto

Advancing Food Insecurity Research in Canada conference logoOntario plans to roll out a pilot project on guaranteed annual income early next year. The goal of the project, according a recent report by former senator and current master of Massey College Hugh Segal, is to test whether a basic income can produce better outcomes for recipients and lower costs for government than the province’s current mix of social programs.

Two of the pilot’s key measures will be health and health care costs, and Segal’s report ties both to the growing problem of food insecurity, among other factors. Professor Valerie Tarasuk was one of many experts Segal consulted for his report. She is a professor in the Dalla Lana School of Public Health and the Department of Nutritional Sciences, and she has studied food insecurity for over 20 years.

Ahead of this week’s food insecurity conference at U of T, Tarasuk spoke with Faculty of Medicine writer Jim Oldfield about Segal’s report, the devastating effects of food insecurity and how quickly a guaranteed income can make a difference for people who need it.

What was your reaction when you read Segal’s report?
One of the really wonderful things about Hugh’s report is that it names food insecurity as an outcome to look at. That’s fantastic, because research by us and others shows that low income means a greater probability of food insecurity. Moreover, the more extreme the food insecurity, the more toxic it is for health. So by the time a person is living with severe food insecurity they’re burning up well over double the health care dollars of the rest of us. Food security is absolutely intertwined with income, and both are very tightly tied to health care spending. There are four million people in this country living with some form of food insecurity; it’s a major public health problem, so I’m very glad it gets attention in this report.

How does food insecurity affect health?
Well, it’s devastating for mental health and physical health, and that’s true across the life cycle. Adults with chronic diseases like diabetes or HIV are less able to manage their conditions. They’re more prone to complications and negative outcomes, and they have higher mortality rates. Household food insecurity affects one in six Canadian children, and as result they are at much higher risk for asthma, depression and other diseases. Although we’ve only monitored food insecurity systematically in Canada for 10 years, it’s been a persistent problem much longer than that. The encouraging thing is that a lot of good evidence shows it doesn’t need to be that way.

Valerie Tarasuk

So what would a basic income do for food insecurity?
A basic income won’t let people fall below a certain income level, and it very effectively limits food insecurity. The connection on that is very strong. Studies have also shown that improving incomes produces very definite changes in food security over a short period of time. In Newfoundland and Labrador, food insecurity among social assistance recipients dropped by almost half over five years, starting within a year of increases to income supports. Our group PROOF recently found that food insecurity went from 40 to 16 per cent among low-income adults who became eligible for old-age security at 65. So a secure and decent income can largely cut off food insecurity — and to a degree that increases in minimum wage, subsidized housing or small increases to welfare payments don’t do.

What are the arguments against basic income?
There are two big criticisms of basic income. One is that we can’t afford it, and the other is that it creates a disincentive to work. Yes, it will cost money, but it’s important for Ontarians to get their heads around the trade-offs. Given the effects of food insecurity on health, I think we can’t afford not to do it. That said, we need more data on exactly how a basic income can reduce health-care and administrative social assistance costs, whether it limits encounters with the justice system and how it affects kids’ performance in school, among other things. Hopefully the pilot will answer some of those questions. As for the disincentive to work, that’s debatable. But it’s important to know that over half of families living with food insecurity in Ontario have jobs — the problem is with the quality and security of their employment and income. We have an opportunity in Ontario to make an important choice on the issue of basic income, and I hope the debate on it over the next few weeks reflects a true understanding of its costs and benefits.

Food Insecurity in Poor Canadian Seniors is Greatly Reduced when Guaranteed Annual Income Kicks in

In a new PROOF research article published in Canadian Public Policy, Lynn McIntyre, Daniel Dutton, Cynthia Kwok, and Herb Emery show that guaranteed annual income is effective in decreasing food insecurity among low income seniors in Canada. Learn more in the press release below.

FOR IMMEDIATE RELEASE

Food Insecurity in Poor Canadian Seniors is Greatly Reduced when Guaranteed Annual Income Kicks in

Old Age Security and Guaranteed Income Supplement identified as a key driver of substantial decreases in food insecurity among the poorest seniors in Canada.

Canadian Public Policy cover

The low prevalence of poverty among Canadian seniors has been attributed to a guaranteed annual income: the Old Age Security program and its supplement for those with low incomes. One measure of extreme poverty is food insecurity. This study authored by Lynn McIntyre, Daniel Dutton, Cynthia Kwok, and Herb Emery, shows that guaranteed annual income is effective in decreasing food insecurity among low income seniors in Canada. Turning 65 and being eligible for this funding is associated with, on average, a 15 percentage point drop in food insecurity compared to baseline.

The authors use seven years of national-level data from the Canadian Community Health Survey to examine food insecurity prevalence among those aged 55 to 74. Focusing on low income single-person households (<$20K / year) reflected a statistically significant drop in those who were food insecure after the age of 65, coupled with a shift in source of income from wages or from conditional public assistance (e.g., workers’ compensation or welfare) to public pensions. As a result, the prevalence of food insecurity was cut nearly in half. This effect was most beneficial for those with low income and low wealth, indicated by not owning a home.

Low income home owners continued to experience low food insecurity levels throughout the observation period, which is intuitive since they could absorb short term shocks to their household budget by borrowing. In contrast, low income renters seemed to have the greatest benefits from the guaranteed annual income and approaching the level of home owners. Since this analysis was limited to those earning <$20K / year, these decreases in food insecurity are determined not only by the amount of money individuals receive but also the stability of the funding; none of the individuals in this study were significantly enriched by this policy yet the drop in food insecurity was sizable.

Food insecurity leads to higher health care costs and utilization, over and above regular poverty indicators. This study demonstrates that even small amounts of guaranteed annual income can have a potentially important impact on poverty and, in turn, costs borne by the rest of society. The current Liberal federal government overturned a policy change instated by the previous government changing the age of eligibility for Old Age Security from 65 to 67. The issue remains as to whether using an age-based demogrant is appropriate, and future work could identify alternative funding models that address poverty before individuals are eligible for Old Age Security.

Daniel J. Dutton is a post-doctoral fellow at the University of Lethbridge’s Prentice Institute for Global Population and Economy. His training is in population health and economics and he has a special interest in how policy can change population-level health outcomes. In the past he worked for the Ontario Ministry of Finance before moving to Alberta for his Ph.D.

“Reduction of Food Insecurity among Low-Income Canadian Seniors as a Likely Impact of a Guaranteed Annual Income” by Lynn McIntyre, Daniel J. Dutton, Cynthia Kwok, and J.C. Herbert Emery is available online, open access, for a limited time: http://bit.ly/CPP423d.

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[PDF version of Press Release] This press release originally released by University of Toronto Press.

Media Contacts:

Daniel Dutton
Post-Doctoral Fellow
University of Lethbridge
daniel.dutton@uleth.ca
http://www.uleth.ca/communications
https://twitter.com/ulethbridge

Lauren Naus
Marketing Specialist
University of Toronto Press
lnaus@utpress.utoronto.ca
www.utpjournals.press/loi/cpp
www.twitter.com/utpjournals

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New Publication: Legislation Debated as Responses to Household Food Insecurity in Canada, 1995–2012

Legislation Debated as Responses to Household Food Insecurity in Canada, 1995–2012
McIntyre L, Lukic R, Patterson P, Anderson L, Mah C (2016)
Journal of Hunger & Environmental Nutrition, Published online
[Abstract]

This study reviewed Hansard records for 4 jurisdictions – British Columbia, Nova Scotia, Ontario, and the federal government – between 1995-2012 to examine the policy proposals put forth to address household food insecurity and how they were debated in legislation. Although legislators debated a variety of policy actions and acknowledged that inadequate income causes food insecurity, legislative proposals and tabled bills primarily focused on food-based charity responses, contributing to the validation of food banks as a policy response.

Of the 4 bills that received royal assent during the studied time period, only one had the explicit intent to address food insecurity – a bill to reduce the liability for unknowingly harmful food donations in British Columbia. 2 assented bills in British Columbia and Nova Scotia focused public health and health promotion and were criticized by some members for not addressing underlying issues to health, like food insecurity. An assented bill to regulate food labeling in Ontario schools received similar criticism for failing to address the component of poverty when discussing children’s health. At the federal level, no legislation intended to directly address food insecurity or contribute to its reduction was tabled.

Despite a growing literature on the the downloading of the responsibility for food insecurity from the public to the charitable sector, and an awareness among legislators that inadequate incomes causes food insecurity, little has been done to address this issue through income-based policies.

Monitoring Food Insecurity around the World and in Canada

UN FAO Voices of the Hungry reportThe United Nations Food and Agriculture Organization (FAO) recently released food insecurity rates for 146 countries as part of their Voices of the Hungry project. The data were collected through the inclusion of their new Food Insecurity Experience Scale (FIES) survey on the 2014 Gallup World Poll, producing the first set of comparable, nationally representative data on food insecurity around the world. The FAO estimate puts the prevalence of food insecurity in Canada at 8.0% in 2014. For other high-income countries like the United States, the UK, Australia, France, Germany, and Sweden, the rates were 10.2%, 10.1%, 10.6%, 6.9%, 4.3%, and 3.1% respectively.

While the FAO estimates provide valuable insight into how the prevalence of food insecurity differs across countries, there are some important differences between the FAO’s estimate of food insecurity in Canada and the estimates that PROOF has been reporting, drawing on data from Statistics Canada’s Canadian Community Health Survey (CCHS).

Statistics Canada has been monitoring food insecurity since 2005 through the Household Food Security Survey Module (HFSSM). It is administered on the CCHS, which surveys a nationally-representative sample of about 60,000 individuals each year. Whereas the Gallup World Poll collected data on food insecurity in high income countries like Canada using phone interviews with samples of approximately 1000 individuals selected from random digit dialing or national lists, Statistics Canada uses the more complex method of multi-stage probability sampling to create a sample representative at the provincial, territorial, and national levels. The large, population-representative samples in CCHS provide reliable annual data on food insecurity in Canada. The data has enabled researchers to chart changes in rates over time, identify population subgroups at particular risk of food insecurity, and examine the underlying causes and health implications of household food insecurity.

The HFSSM consists of 18 questions on experiences of food insecurity in a household over the previous 12 months, ranging from worrying about running out of food to going whole days without eating. These questions distinguish between the experiences of adults and those of children. Depending on the number of affirmative responses, households are classified as food secure or marginally, moderately, or severely food insecure. The FIES has 8 similar questions, but in order for it to be included on the 2014 Gallup World Poll, the questions referred specifically to the individual respondent’s experience of food insecurity over the previous 12 months, and only adults were surveyed. So, the FAO’s estimates of food insecurity are based solely on data about adults’ experiences.

Although the determination of food insecurity, whether assessed using the FIES and HFSSM, is based on the number of affirmative responses, calculation of the food insecurity prevalence rates that appear in the FAO report was more complicated. Rather than applying a discrete classification scheme for food security based on raw scores from the survey, the analysts calibrated individual measures to a global reference scale to allow for comparisons between countries. The FAO prevalence estimates are roughly comparable to the prevalence of moderate and severe food insecurity as these terms have been defined by Health Canada, but they are by no means identical.

Household Food Insecurity in Canada, 2014The food insecurity prevalence estimate presented for Canada in the Voices of the Hungry report cannot be compared to the estimates in our report, Household Food Insecurity in Canada, 2014, because we do not have national data on food insecurity for 2014 in CCHS. The HFSSM was not mandatory in 2013 and 2014, and Yukon, British Columbia, Manitoba, and Newfoundland and Labrador chose not to measure food insecurity those years. The most recent national estimate derived from CCHS data is from 2012 when 8.6% of Canadian households were moderately or severely food insecure. However, a more comprehensive estimate of household food insecurity in Canada for 2012 is the national prevalence of 12.6%, which includes marginally food insecure households.

In sum, while the FAO’s Voices of the Hungry project is a valuable first step in generating information on food insecurity across a broad spectrum of countries that do not routinely monitor this problem, the estimate of food insecurity for Canada that comes from this survey should not be considered interchangeable with the estimates PROOF is deriving from CCHS data. The food insecurity estimates from CCHS are based on much larger, more representative samples, using a more comprehensive assessment of food insecurity in the household. Moreover, with CCHS, we are able to assess not only the prevalence of moderate and severe food insecurity in Canada, but also the prevalence of marginal food insecurity. This is important given research demonstrating the increased vulnerability of people in marginally food insecure households to poor health. Thus while the FAO results provide a snapshot of where Canada sits in relation to other high income countries, the food insecurity data from CCHS are much better suited to ongoing monitoring and research to understand the causes and consequences of food insecurity in Canada.

More information:

Voices of the Hungry website

Methods for estimating comparable prevalence rates of food insecurity experienced by adults throughout the world (PDF)

Household Food Insecurity in Canada, 2014 (PDF)

Household Food Insecurity in Canada, 2012 (PDF)

Video: The full story of Food (In)security – Valerie Tarasuk’s presentation at Closing the Gap

Upstream‘s conference, Closing the Gap: Action for Health Equity, brought together Canada’s social determinants of health leaders and decision makers to discuss how we can equitably improve the social conditions that determine good health.

At Closing the Gap, PROOF Principal Investigator Valerie Tarasuk presented on food insecurity in Canada and what we’ve learned from over a decade of monitoring and research.

New Publication: Household Food Insecurity in Canada: Problem Definition and Potential Solutions in the Public Policy Domain

Household Food Insecurity in Canada: Problem Definition and Potential Solutions in the Public Policy Domain
McIntyre L, Patterson P, Anderson L, Mah C (2016)
Canadian Public Policy, 42(1), 83-93
[Abstract]

This study investigated the discussion of food insecurity in Canadian politics by examining federal and provincial Hansard records. The researchers found that legislators tied food insecurity to food banks, despite evidence that food banks are unable to address the problem and that food bank statistics greatly underestimate it. While the discussion around inadequate income, the root cause of food insecurity, is promising, it appears that it is not the primary focus of political discourse around solving food insecurity.

For more information, visit Laura Anderson’s blog post, “Political Talk about Food Insecurity in Canada“, for the UTP Journal Blog.

See also:

Political rhetoric from Canada can inform healthy public policy argumentation
Patterson P, McIntyre L, Anderson LC, Mah CL (2016)
Health Promotion International, Published online ahead of print
[Abstract]

Food bank stats don’t tell the story of food insecurity

This article on the need to shift away from food bank statistics for discussing food insecurity was written for Upstream‘s series focused on food insecurity in Canada. Read their introductory article on this serious public health issue and see the rest of the articles in the series.


‘Food insecurity’ refers to the inadequate access to food because of financial constraints — and it’s a larger problem in Canada than most realize.

Since 1997 Food Banks Canada has released annual reports called ‘Hunger Count’ documenting the food bank usage. These reports have received wide media attention and are now a common point of reference when we discuss Canadian food insecurity, but they barely scratch the surface of the problem.

Food bank stats significantly understate the prevalence of food insecurity. We know this because Statistics Canada has been monitoring the problem nationally for almost a decade through the Canadian Community Health Survey (CCHS). With its rigorous methods and large sample size this survey provides reliable health data at the provincial, territorial and national levels. It reveals more than four million Canadians were food insecure in 2012 — the most recent national estimate we have.

Food Banks Canada surveys its members every March to estimate use. In 2012 they estimated that only 882,188 people used food banks that month. The stark difference between the results of the CCHS and Food Banks Canada shows there’s a much larger problem than we’ve understood. Food insecurity in Canada is a national crisis.
Bar graph of food bank use in March vs food insecurity prevalence for years 2007, 2008, 2011 & 2012, demonstrating the much greater number of food insecure households than food bank users

Food bank stats also fail to capture changes in food insecurity over time. While the Hunger Count report draws attention to annual differences in food bank use in each province, food bank use actually appears relatively stable over time in comparison to the trends in food insecurity revealed by population stats. From 2007 to 2011 for example, we saw a steady decline in food insecurity in Newfoundland and Labrador, and a steady increase in Nova Scotia. But neither trend could be seen in food bank statistics.

“Many felt visiting a food bank wasn’t something a ‘person like them’ they should be doing.”

Our research group’s study on low income families in Toronto found almost all of those surveyed experienced food insecurity, yet only 23 percent actually used food banks. When we asked ‘why?’ it became clear there was a disconnect between how families thought about their actual needs, and what services the food banks were offering.

Many felt visiting a food bank wasn’t something a ‘person like them’ they should be doing, or something that could help them out of their situation. By the time families are food insecure they face much more than a lack of food. They are likely behind on bill payments, rent and other basic necessities. If they are also dealing with chronic illness, they may be foregoing critical expenses like medication too.

Turning to a food bank for help was an act of desperation. But even with this assistance, most families remained food insecure. This finding is consistent with other research in Canada — showing it takes substantial improvements to a household’s financial circumstances, to shift them out of food insecurity.

Food bank stats are a poor barometer of food insecurity because they don’t describe the size of the problem or how it’s changing over time. On the other hand the CCHS allows us to accurately measure the extent of food insecurity and systemically investigate its causes and consequences. Since we began monitoring, we’ve learned food insecurity is a serious public health issue that impacts physical, mental and social health — and healthcare costs, too.

“Even with this assistance, most families remained food insecure.”

We also have a growing body of evidence showing the prevalence of food insecurity is responsive to changes in social policies. Yet there have been no public policies introduced so far, with the explicit goal of reducing food insecurity. We must shift the conversation from food banks toward insights from population stats, and upstream approaches to address food insecurity in Canada.

5 Things Canadians Need to Know About Food Insecurity

Here are 5 things you should know about food insecurity in Canada.

This article was written by Dr.Tarasuk and Carolyn Shimmin, a knowledge translation coordinator with EvidenceNetwork.ca, and has appeared in The Globe and MailHuffington Post, Policy OptionsOttawa Life, The Hill TimesThe Province, The Battlefords News-OptimistTroy Media, and NetNewsLedger.


Over 4 million Canadians, including 1.15 million children experience some level of food insecurity. For many Canadians, food plays a central role in the holiday festivities. But for those experiencing food insecurity, a bountiful feast will not be in the cards this year. Over four million Canadians, including 1.15 million children experience some level of food insecurity.

Food insecurity, also known as ‘food poverty,’ can cause significant anxiety over diminishing household food supplies and result in individuals modifying their eating patterns — adults skipping meals so children can eat or sacrificing quality food choices for cheaper, less healthy options, for example. Food insecurity also often results in physical hunger pangs, fatigue and lack of concentration and productivity at school, work or play.

Then there are the social impacts of food insecurity that most of us wouldn’t consider, such as not being able to invite friends and family to dinner or being unable to afford to meet people for coffee. Food poverty can also create stress and conflict in family relationships and meals are often not a happy gathering opportunity.

Here are five things Canadians need to know about food insecurity:

1. Food insecurity significantly affects health

Evidence shows that among children, food insecurity is associated with poorer physical and mental health outcomes, including the development of a variety of long-term chronic health conditions such as asthma and depression.

For adults, research shows that food insecurity is independently associated with increased nutritional vulnerability, poor self-rated health, poor mental, physical and oral health and multiple chronic health conditions including diabetes, hypertension, heart disease, depression, epilepsy and fibromyalgia. Studies also show that food insecurity impacts a person’s ability to provide self-care and manage chronic health conditions.

Evidence also shows the health impact of food insecurity exists on a gradient – meaning adults in more severely food-insecure households are more likely to report chronic health conditions as well as receive diagnoses of multiple health conditions.

2. Household food insecurity is a strong predictor of healthcare utilization and costs

A study in Ontario found that among adults, total healthcare costs — including inpatient hospital care, emergency department visits, physician services, same-day surgeries and home care services — increase significantly with the level of household food insecurity.

In other words, food insecurity costs us all through increased healthcare use. Compared with adults in food-secure households, annual healthcare costs were, on average 16 per cent (or $235) higher for adults in households with marginal food insecurity, 32 per cent (or $455) higher among those with moderate food insecurity and 76 per cent (or $1092) higher among those with severe food insecurity.

3. Food bank use is a poor indicator of food insecurity

Food Banks Canada recently estimated food bank use for a twelve month period at 1.7 million people, yet the number of food insecure individuals living in Canada is more than double this estimate. The main reason for this discrepancy is that most people struggling to afford the food they need do not turn to charities for help. The evidence suggests that using food banks is a last resort. Because food banks rely on donated food, both the amount and type of food available for distribution is limited, and agencies are unable to provide for everyone in need.

4. An adequate and secure level of household income is strongly linked to food security

It is perhaps surprising, but households reliant on wages and salaries make up the majority of food insecure households in Canada at 62 per cent. Households whose main source of income was either pensions or dividends and interest had the lowest rate of food insecurity in 2012 at seven per cent — compared to 11 per cent for people in the workforce and 70 per cent for people on social assistance (i.e., welfare and disability support programs). Researchers suggest the low rate of food insecurity among Canadian seniors reflects the protective effects of our public pension system.

5. Relatively modest increases in income have been found to lessen food insecurity among low-income families

Studies have shown that improved incomes and changes in employment can reduce food insecurity. An example of this can be found in Newfoundland and Labrador where evidence shows that from 2007 to 2012 the rate of food insecurity among households living on social assistance in this province fell from a staggering 60 per cent to 34 per cent. During this time period, the Newfoundland government made several changes to improve the circumstances of people living on social assistance, including increasing benefit levels and indexing them to inflation (until 2012).

Let’s not let another year go by without addressing food insecurity in Canada. In a country as rich as ours, there’s no reason anyone should go hungry.

New Publication: Changes in household food insecurity rates in Canadian metropolitan areas from 2007 to 2012

Changes in household food insecurity rates in Canadian metropolitan areas from 2007 to 2012
Sriram, U., & Tarasuk, V. (2015).
Can J Public Health,106(5), e322-e327.
[Abstract] [Full Text]

This study investigated the prevalence of household food insecurity in census metropolitan areas and the effect of various local economic factors on changes in these rates. Examining data from the 2007-2012 Canadian Community Health Survey, the researchers found peak unemployment rates to be associated with the prevalence of food insecurity. These results ​support a growing literature that identifies employment conditions as central problem​s​ ​of food insecurity ​and suggest that policy initiatives to improve these conditions ​could reduce food insecurity.