A look back at 10 years of PROOF

Image of candles in shape of number ten.
PROOF started in 2011 through a CIHR Programmatic Grant to Tackle Health and Health Equity. The grant was awarded to execute a five-year research program to identify viable and effective policy interventions to reduce household food insecurity in Canada, bringing together a group of multidisciplinary and international researchers from the University of Toronto, University of Illinois, University of Calgary, University of New Brunswick, Dalhousie University, and CAMH.

The name, PROOF, came from the suggestion of the late Cathleen Kneen, a leader in Canada’s food movement, at an early knowledge translation stakeholder meeting. The idea was that the research coming out of this research program would be the “proof” that would drive policy action on this problem. Since then, PROOF has become the leader in food insecurity research.

Over the past ten years, we have:

Popularized food insecurity statistics and revealed the extent of the problem in Canada

In 2013, we released our first annual report on food insecurity statistics in Canada with the goal of making data collected by Statistics Canada more easily accessible to the public and policy makers. Although Statistics Canada has been systematically monitoring food insecurity since 2005, the data were not readily accessible.

Our reports provide a detailed description of the problem, considering geography, racial identity, main source of income, and other household characteristics. We also provide a more comprehensive picture of food insecurity by including marginal food insecurity in estimates, an approach now adopted by Health Canada and Statistics Canada.

A key part of our reports is our estimate of the number of Canadians living in food-insecure households. We introduced this approach to provide an easy way to understand the scale of the problem. The number, which now stands at over 4.4 million with the latest data from 2017-2018, has become a central figure for discussion of food insecurity in this country.[1]

Before our reports, the main point of reference was food bank usage statistics, which we now know seriously understate the scale of the problem.[2] Our work has popularized food insecurity statistics and thanks to it, food insecurity is now one of the indicators for the federal Official Poverty Dashboard.

Advanced understanding of food insecurity as a problem of poverty

Food insecurity has long been characterized as a problem of not having enough food. Our research and knowledge translation work has and continues to help shift the narrative towards understanding food insecurity as a problem of inadequate financial resources. Our research has shown that when households are food-insecure, they spend far less on everything and struggle to meet other basic expenses like prescription medication.[3][4]

Monitoring food insecurity adds to our understanding of the state of poverty in Canada because it is an experience-based measure of material hardship. It takes into consideration the adequacy, security, and stability of incomes, as well as other aspects of a household’s financial circumstances like assets, debt, savings, and costs of living.

By identifying whether households have difficulty affording food, we learn more about their economic wellbeing and hardship than through measures of low income alone.

Food insecurity’s inclusion on the federal Poverty Dashboard speaks to the recognition that it needs to be treated as a poverty issue and that food insecurity monitoring adds to our understanding of poverty in Canada.

Elucidated the socio-demographics of food insecurity in Canada

We’ve identified key predictors of food insecurity: low income, relying on social assistance or Employment Insurance, renting instead of owning home, having children, being Indigenous or Black, and living in the territories.[5] These findings draw attention to major social issues in Canada.

Income supports are the fabric of our social safety net. Yet relying on any public income support, aside from public pensions, means being at greater risk for food insecurity.[5] It raises serious questions about the adequacy of social assistance and Employment Insurance for meeting basic needs.

However, food insecurity is not just a problem of income support programs. By looking at the prevalence of food insecurity by main source of income, it is evident that the majority of food-insecure households rely on employment incomes. Food insecurity is a serious problem for working Canadians.

The disproportionate impact of food insecurity on Indigenous and Black households reflects the potent effects of colonialism and structural racism in Canada. We’ve begun to highlight how anti-Black racism in institutions like the labour and housing markets make Black households more vulnerable to food insecurity.[6]

The situation in Canada’s North is especially dire. In 2017-2018, 57% of households in Nunavut reported some level of food insecurity and almost half of these households were severely food-insecure, meaning that members experienced absolute food deprivation.[1]

Demonstrated that food insecurity in Nunavut has worsened despite the introduction of Nutrition North Canada

The situation in Nunavut is especially concerning because of the exceptionally high rates of food insecurity. Nutrition North Canada is a federal food subsidy introduced to support those living in remote Northern communities. Our finding that food insecurity in Nunavut got worse following Nutrition North Canada’s introduction highlights the need for more effective initiatives to address food insecurity in the North.[7] It also lends support to the long-standing calls for reform from Inuit organizations, community groups, and Senators.

Identified income-based interventions as effective policy solutions to food insecurity

We’ve examined the impact of numerous provincial and federal policies on food insecurity in Canada, including changes to social assistance, child benefits, minimum wage, and our public pension system.[8][9][10][11][12][13] None of these policies were explicitly designed to address household food insecurity, but they had substantial impact on this problem because they improved households’ financial circumstances. The results clearly demonstrate that food insecurity is sensitive to modest increases to the income of very low-income households. When food-insecure households receive additional income, they spend it in ways that improve their food security.

At the provincial level, we determined that policy actions to increase the minimum wage, increase welfare incomes, and lower income taxes for low-income households can reduce the risk of food insecurity.[12] We also charted reductions in food insecurity among recipients of social assistance increases and new child benefits.[8][9][10] The best example is the success of Newfoundland and Labrador’s 2006 poverty reduction strategy in reducing food insecurity between 2007-2012. The province saw unprecedented declines in the prevalence of food insecurity following the strategy, which targeted the depth of poverty through a wide range of interventions.[8]

At the federal level, we found that our public pension system (OAS and GIS) drastically cuts the risk of food insecurity for low-income unattached adults when they become eligible.[13] The finding points to the potential of an income floor to protect Canadians from food insecurity and lends support to calls for a basic income program as an anti-poverty intervention. Although we didn’t see a reduction in the overall prevalence of food insecurity among families with children following the introduction of the Canada Child Benefit, we did find that it reduced severe food insecurity among low-income families.[11]

In order to optimize the impact of major policy interventions like the Canada Child Benefit on household food insecurity, these policies must be designed with deliberate attention to this outcome and the household circumstances that give rise to it.

Explored the policy framing of food insecurity

We have worked to understand why food insecurity has garnered so little policy traction in Canada, despite decades of measurement.[14][15][16][17][18] Our analysis of policy discussions and proposals suggests that politicians recognize that food insecurity is caused by inadequate income but nonetheless focus on food banks and other food programs as Canada’s primary response and sometimes link food insecurity with unrelated policies around food safety and labelling.[15][18]

Reframing discussions to recognize food insecurity as an indicator of pervasive material hardship, and therefore a way for measuring success in poverty reduction, could help shift the policy focus to underlying problems of income inadequacy.[14][16]

P.E.I. recently became the first jurisdiction to legislate targets and a timetable for reducing the prevalence of food insecurity as part of their anti-poverty efforts.

Expanded our understanding of the relationship between food insecurity and health

Food insecurity is a potent social determinant of health in Canada. We’ve continued to document the tremendous toll that it takes on people’s health and wellbeing. Our work has established that the health effects of food insecurity are graded, with severe food insecurity predictive of much more negative health outcomes than marginal or moderate food insecurity. By linking population survey data with health administrative data (e.g., hospital and emergency department records), we’ve been able to show how this toll manifests in greater hospitalization, health care service use, and premature death.[19][22]

The wide range of health conditions associated with food insecurity demonstrate that this is more than a dietary problem. The intersection of food insecurity with mental illnesses is particularly strong,[23][24][25] but we have also found an increased risk of injury.[26] Severely food-insecure adults are not only considerably more likely to die prematurely, but their rates of premature mortality are higher for all causes of death except cancers.[22] These negative health outcomes reflect the broad experience of material deprivation that food insecurity represents.

Uncovered the health care costs of food insecurity in Canada

Our research on health care utilization has also revealed the burden of food insecurity on healthcare costs.[19][20][21] The increased healthcare utilization translates to greater healthcare costs incurred by food-insecure adults, especially the severely food-insecure who face the highest risk of negative health outcomes. The persistence of food insecurity inflates our public health care budgets.

Our research on health care expenditure in Ontario showed that a severely food-insecure adult incurs over twice the annual health care costs of their food-secure counterparts.[20] Most recently, we looked at acute care in Canada and we found that severely food-insecure adults had 69 percent higher odds of acute care admission and stayed in hospital for acute care longer.[19]

Reducing food insecurity could offset considerable public health care expenditures and reduce the burden on health care resources.

The future of PROOF

PROOF continues to advance the research and the public conversation around food insecurity. Looking ahead, we will examine the impact of the pandemic and related policy changes on food insecurity. We will also continue our commitment to make our research accessible to policy makers, civil society, and the public through our knowledge translation efforts.

We are honoured to have supported advocacy efforts by public health professionals, community organizations, and others for the past 10 years.

We hope that through the “proof” we provide and the advocacy happening across the country, we will see governments finally take meaningful action on food insecurity — implementing evidence-based policies that will reduce the prevalence and severity of food insecurity in Canada.


References

  1. Tarasuk V, Mitchell A. Household Food Insecurity in Canada, 2017-2018 [Internet]. Toronto, ON: Research to identify policy options to reduce food insecurity (PROOF); 2020. Available from: https://proof.utoronto.ca/resources/proof-annual-reports/household-food-insecurity-in-canada-2017-2018/
  2. Tarasuk V, Fafard St-Germain A-A, Loopstra R. The Relationship Between Food Banks and Food Insecurity: Insights from Canada. Voluntas 2020;31(5):841–52. Available from: https://doi.org/10.1007/s11266-019-00092-w
  3. St-Germain A-AF, Tarasuk V. Prioritization of the essentials in the spending patterns of Canadian households experiencing food insecurity. Public Health Nutrition 2018;21(11):2065–78. Available from: https://www.cambridge.org/core/journals/public-health-nutrition/article/prioritization-of-the-essentials-in-the-spending-patterns-of-canadian-households-experiencing-food-insecurity/64779603D298DAF755D6A3FC14A800F1
  4. Men F, Gundersen C, Urquia ML, Tarasuk V. Prescription medication nonadherence associated with food insecurity: a population-based cross-sectional study. CMAJ Open 2019;7(3):E590–7. Available from: http://www.cmajopen.ca/content/7/3/E590
  5. Tarasuk V, Fafard St-Germain A-A, Mitchell A. Geographic and socio-demographic predictors of household food insecurity in Canada, 2011–12. BMC Public Health 2019;19(1):12. Available from: https://doi.org/10.1186/s12889-018-6344-2
  6. Dhunna S, Tarasuk V. Black–white racial disparities in household food insecurity from 2005 to 2014, Canada. Can J Public Health 2021;Available from: https://doi.org/10.17269/s41997-021-00539-y
  7. Fafard St-Germain A-A, Galloway T, Tarasuk V. Food insecurity in Nunavut following the introduction of Nutrition North Canada. CMAJ 2019;191(20):E552–8. Available from: http://www.cmaj.ca/lookup/doi/10.1503/cmaj.181617
  8. Loopstra R, Dachner N, Tarasuk V. An exploration of the unprecedented decline in the prevalence of household food insecurity in Newfoundland and Labrador, 2007–2012. Canadian Public Policy 2015;41(3):191–206. Available from: https://utpjournals.press/doi/10.3138/cpp.2014-080
  9. Tarasuk V, Li N, Dachner N, Mitchell A. Household food insecurity in Ontario during a period of poverty reduction, 2005–2014. Canadian Public Policy 2019;45(1):93–104. Available from: https://utpjournals.press/doi/10.3138/cpp.2018-054</li>
  10. Li N, Dachner N, Tarasuk V. The impact of changes in social policies on household food insecurity in British Columbia, 2005–2012. Preventive Medicine 2016;93:151–8. Available from: https://www.sciencedirect.com/science/article/pii/S0091743516303048
  11. Brown EM, Tarasuk V. Money speaks: Reductions in severe food insecurity follow the Canada Child Benefit. Preventive Medicine 2019;129. Available from: https://www.sciencedirect.com/science/article/pii/S0091743519303524
  12. Men F, Urquia ML, Tarasuk V. The role of provincial social policies and economic environments in shaping food insecurity among Canadian families with children. Preventive Medicine 2021;148:106558. Available from: https://www.sciencedirect.com/science/article/pii/S0091743521001420
  13. McIntyre L, Dutton DJ, Kwok C, Emery JCH. Reduction of food insecurity among low-income Canadian seniors as a likely impact of a guaranteed annual income. Canadian Public Policy 2016;42(3):274–86. Available from: https://utpjournals.press/doi/10.3138/cpp.2015-069
  14. McIntyre L, Patterson PB, Mah CL. A framing analysis of Canadian household food insecurity policy illustrates co-construction of an intractable problem. Critical Policy Studies 2018;12(2):149–68. Available from: https://doi.org/10.1080/19460171.2016.1253491
  15. McIntyre L, Lukic R, Patterson PB, Anderson LC, Mah CL. Legislation Debated as Responses to Household Food Insecurity in Canada, 1995–2012. Journal of Hunger & Environmental Nutrition 2016;11(4):441–55. Available from: https://doi.org/10.1080/19320248.2016.1157551
  16. McIntyre L, Patterson PB, Mah CL. The application of ‘valence’ to the idea of household food insecurity in Canada. Social Science & Medicine 2019;220:176–83. Available from: https://www.sciencedirect.com/science/article/pii/S0277953618306506
  17. Mah CL, Knox B, Lynch M, McIntyre L. Who Is Food Insecure? Political Storytelling on Hunger, Household Food Choices, and the Construction of Archetypal Populations. Journal of Hunger & Environmental Nutrition 2020;0(0):1–18. Available from: https://doi.org/10.1080/19320248.2020.1807434
  18. McIntyre L, Patterson PB, Anderson LC, Mah CL. Household Food Insecurity in Canada: Problem Definition and Potential Solutions in the Public Policy Domain. Canadian Public Policy 2016;42(1):83–93. Available from: https://www.utpjournals.press/doi/abs/10.3138/cpp.2015-066
  19. Men F, Gundersen C, Urquia ML, Tarasuk V. Food insecurity is associated with higher health care use and costs among Canadian adults. Health Affairs 2020;39(8):1377–85. Available from: http://www.healthaffairs.org/doi/10.1377/hlthaff.2019.01637
  20. Tarasuk V, Cheng J, de Oliveira C, Dachner N, Gundersen C, Kurdyak P. Association between household food insecurity and annual health care costs. CMAJ 2015;187(14):E429–36. Available from: http://www.cmaj.ca/lookup/doi/10.1503/cmaj.150234
  21. Tarasuk V, Cheng J, Gundersen C, de Oliveira C, Kurdyak P. The relation between food insecurity and mental health care service utilization in Ontario. Can J Psychiatry 2018;63(8):557–69. Available from: http://journals.sagepub.com/doi/10.1177/0706743717752879
  22. Men F, Gundersen C, Urquia ML, Tarasuk V. Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study. CMAJ 2020;192(3):E53–60. Available from: https://www.cmaj.ca/content/192/3/E53
  23. Jessiman-Perreault G, McIntyre L. The household food insecurity gradient and potential reductions in adverse population mental health outcomes in Canadian adults. SSM – Population Health 2017;3:464–72. Available from: https://www.sciencedirect.com/science/article/pii/S2352827316301410
  24. McIntyre L, Wu X, Kwok C, Patten SB. The pervasive effect of youth self-report of hunger on depression over 6 years of follow up. Soc Psychiatry Psychiatr Epidemiol 2017;52(5):537–47. Available from: https://doi.org/10.1007/s00127-017-1361-5
  25. Men F, Elgar FJ, Tarasuk V. Food insecurity is associated with mental health problems among Canadian youth. J Epidemiol Community Health 2021;75(8):741–8. Available from: https://jech.bmj.com/content/75/8/741
  26. Men F, Urquia ML, Tarasuk V. Examining the relationship between food insecurity and causes of injury in Canadian adults and adolescents. BMC Public Health 2021;21(1):1557. Available from: https://doi.org/10.1186/s12889-021-11610-1