Research has linked food insecurity to mental health problems, though little is known about this relationship among Canadian youth. We investigate the association between food insecurity severity and mental illnesses in a nationally representative youth sample.
The prevalence of food insecurity among adults over 65 in Canada is less than half of that among adults approaching 65, possibly due in part to the public pension universally disbursed from the age of 65. Given research associating food insecurity with higher risk of premature mortality, our objective was to determine the likelihood that food-insecure adults with incomes below the national median would live past 65 to collect the public pension.
We linked respondents of the Canadian Community Health Survey 2005–15 to the death records from the Canadian Vital Statistics Database 2005–17. We assessed household food insecurity status through a validated 18-item questionnaire for 50,780 adults aged 52–64 at interview and with household income below the national median. We traced their vital status up to the age of 65. We fitted Cox proportional hazard models to compare hazard of all-cause mortality before 65 by food insecurity status while adjusting for individual demographic attributes, baseline health, and household socioeconomic characteristics. We also stratified the sample by income and analyzed the subsamples with income above and below the Low Income Measure separately.
Marginal, moderate, and severe food insecurity were experienced by 4.1, 7.3, and 4.5% of the sampled adults, respectively. The crude mortality rate was 49 per 10,000 person-years for food-secure adults and 86, 98, and 150 per 10,000 person-years for their marginally, moderately, and severely food-insecure counterparts, respectively. For the full sample and low-income subsample, respectively, severe food insecurity was associated with 1.24 (95% CI: 1.06, 1.45) and 1.28 (95% CI: 1.07, 1.52) times higher hazard of dying before 65 relative to food security. No association was found between food insecurity and mortality in the higher-income subsample.
Severely food-insecure adults approaching retirement age were more likely to die before collecting public pensions that might attenuate their food insecurity. Policymakers need to acknowledge the challenges to food security and health faced by working-age adults and provide them with adequate assistance to ensure healthy ageing into retirement.
Description: Food insecurity predicts poorer health, yet how it relates to health care use and costs in Canada remains understudied. Linking data from the Canadian Community Health Survey to hospital records and health care expenditure data, we examined the association of food insecurity with acute care hospitalization, same-day surgery, and acute care costs among Canadian adults, adjusting for sociodemographic characteristics.
Compared with fully food-secure adults, marginally, moderately, and severely food-insecure adults presented 26 percent, 41 percent, and 69 percent higher odds of acute care admission and 15 percent, 15 percent, and 24 percent higher odds of having same-day surgery, respectively.
Conditional on acute care admission, food-insecure adults stayed from 1.48 to 2.08 more days in the hospital and incurred $400–$565 more per person-year in acute care costs than their food-secure counterparts, with this excess cost representing 4.4 percent of total acute care costs. Programs reducing food insecurity, such as child benefits and public pensions, and policies enhancing access to outpatient care may lower health care use and costs.
Today, PROOF, an interdisciplinary research program investigating household food insecurity in Canada, provides a long-awaited look into the current state of food insecurity in this country.
Drawing on data for 103,500 households from Statistics Canada’s 2017-18 Canadian Community Health Survey, we found that 1 in 8 households were food insecure. This represents 4.4 million people, the largest number recorded since Canada began monitoring food insecurity. And this number is an underestimate. The survey sample does not include people living on First Nations reserves, people in some remote northern areas, or people who are homeless – i.e., three groups at high risk of food insecurity.
What is food insecurity?
Household food insecurity refers to the inadequate or insecure access to food due to financial constraints. The experiences assessed to determine a household’s ‘food security status’ range from concerns about running out of food before there is more money to buy more, to the inability to afford a balanced diet, to going hungry, missing meals, and in extreme cases, not eating for whole days because of a lack of food and money for food.
Taken at face value, these questions suggest that food insecurity is a food problem – resolvable by programs that provide food for free or make it more accessible and affordable. But this misses the bigger picture. The deprivation experienced by food-insecure households is not limited to food. By the time people are struggling to put food on the table because of a lack of money, they are having trouble meeting all kinds of other expenses. Food-insecure households compromise spending on all kinds of necessities, including housing and prescription medications.
Who is food insecure?
Those most at risk are households with low incomes and limited assets (indicated on this survey by renting rather than owning your housing). Indigenous and Black households are disproportionately impacted by food insecurity, a finding reflective of the potent effects of colonialism and structural racism in Canada.
About 60% of households who report their main source of income as social assistance were food insecure. While not new, the finding is a stark reminder of the inadequacy of our ‘income support program of last resort’. Many of those who manage to qualify for income assistance cannot meet their basic needs. Almost one-third of those households reliant on Employment Insurance (EI) or Workers’ Compensation were also food-insecure, raising questions about the adequacy of these supports.
While the risk of food insecurity is greatest for households reliant on social assistance, EI or Workers’ Compensation, it is important to note that two-thirds of the households reported their main source of income as salaries or wages. Food insecurity is a serious problem for working Canadians.
Food-insecure households’ main source of income
Although 84% of people affected by food insecurity live in either Ontario, Quebec, Alberta, or British Columbia, there are clear geographic disparities in food insecurity rates. Food insecurity is much more prevalent in Nunavut than any other part of Canada. 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). The lowest prevalence of household food insecurity was 11% in Quebec. In fact, Quebec was the only place in Canada where the prevalence of food insecurity fell significantly between 2015-16 and 2017-18.
Household Food Insecurity by Province and Territory
Data source: Statistics Canada, Canadian Community Health Survey (CCHS), 2017-18.
Food insecurity is more common among households with children than those without. 17% of children under 18, or more than 1 in 6, lived in a family that experienced food insecurity. Across Canada, this rate ranged from a low of 15% in British Columbia to a high of 79% in Nunavut. The families most at risk were those headed by lone-parent women; one-third were food-insecure.
Food insecurity is a health problem.
It matters that 1 in 8 Canadian households were food-insecure in 2017-18 because such deprivation has profound negative effects on people’s health. The research on the relationship between food insecurity and health is unequivocal. Among children, exposure to severe food insecurity has been linked to the subsequent development of a variety of chronic health conditions, including asthma and depression. Adults in food-insecure households have higher rates of a wide variety of chronic diseases, including mental health problems, arthritis, asthma, and diabetes. They are also more likely to die prematurely. By our best estimate, adults in severely food-insecure households in Canada die 9 years sooner than the rest of us.
Because of its toxic effects on health, household food insecurity also places a substantial burden on our health care system.
How can we solve this problem?
We must address its root causes – food programs are not the solution.
The persistently high prevalence of household food insecurity across Canada highlights the need for more effective, evidence-based responses. To date, there have been lots of federal, provincial, territorial, and local initiatives to support community food programs, including the federal government’s Local Food Infrastructure Fund launched last year. But food programs can’t fix the problem of household food insecurity that has been documented in this report.
Governments must re-evaluate the adequacy of income supports and protections for low-income Canadians.
Tackling the conditions that give rise to food insecurity means re-evaluating the adequacy of the income supports and protections that are currently provided to very low-income, working-aged Canadians and their families. For example, our recent study of the Canada Child Benefit suggests that this new federal benefit reduced severe food insecurity among low-income families with children, but it did not make them food-secure. The high rate of food insecurity among families with children points to a need to review the benefit amounts for low-income families (i.e., those most vulnerable to food insecurity) to ensure that they are adequately supported to meet basic needs. Other federal programs like the Canada Workers Benefit also need to be reviewed to ensure that they are as effective as they can be in protecting low-income Canadians from food insecurity.
Governments must design programs and policies in ways that ensure that vulnerable, low-income households have sufficient funds to make ends meet.
While federal leadership is imperative, provincial and territorial governments’ engagement in policies to reduce food insecurity is also critical. Given that the provinces and territories are responsible for health care, they bear the costs of food insecurity insofar as it increases people’s needs for health services. There are clear differences in food insecurity prevalence across the provinces and territories and within some jurisdictions (notably Quebec) over time. The effects of specific provincial/territorial policies on food insecurity rates warrant much more evaluation. What is known suggests that provincial and territorial government actions matter. Many important policy levers rest with the provinces and territories. They are responsible for social assistance, they set minimum wages and employment standards, they deliver social housing programs, they levy taxes and deliver tax credits, and many provide child benefits.
It’s time to recognize food insecurity is a serious public health problem in Canada, a problem that is only getting worse. Without deliberate, evidence-based policy interventions by federal, provincial and territorial governments, this problem will continue to fester.
Studies have repeatedly found a strong, independent relationship between owning a home and lower vulnerability to food insecurity in Canada and elsewhere, but the reasons for this relationship are poorly understood. This aimed to examine the influence of housing asset, housing debt and housing expenditure on the relationship between homeownership status and food insecurity in Canada through examining cross-sectional data on food insecurity, housing tenure and expenditures, home value, income and sociodemographic characteristics derived from the 2010 Survey of Household Spending. Food insecurity prevalence was highest among market renters, followed by homeowners with a mortgage and mortgage-free homeowners. Substantial disparities in food insecurity exist between households with different homeownership status and housing asset level. Housing policies that support homeownership while ensuring affordable mortgages may be important to mitigate food insecurity, but policy actions are required to address renters’ high vulnerability to food insecurity.
Research drawing on a population-based sample of Canadian adults showed that those living in food-insecure households were more likely to die prematurely than their food-secure counterparts across all causes of death. Among adults who died prematurely, those experiencing severe food insecurity died nine years earlier than their food-secure counterparts. There is a graded positive association between household food insecurity status and hazard of premature mortality. This research shows that the markedly higher mortality hazard of severe food insecurity highlights the importance of policy interventions that protect households from extreme deprivation.
The rate of severe food insecurity dropped by one-third among low-income families after the introduction of the Canada Child Benefit (CCB) in 2016, researchers from the University of Toronto have found.
The study is the first to look at the CCB’s impact on food insecurity, defined as the inadequate or insecure access to food due to financial constraint.
“Our study results are yet another piece of evidence that improving household incomes reduces food insecurity,” says Valerie Tarasuk, a researcher at U of T’s Joannah & Brian Lawson Centre for Child Nutrition and the senior author on the study.
“If you give poor families more money, they spend it on basic necessities like food – and the more desperate they are, the more likely they are to do this.”
The journal Preventive Medicine published the results, which also reveal that while the benefit disproportionately affected low-income families, it did little to eradicate food insecurity altogether.
The muted effect is not surprising, the researchers say.
“I think the impact on family food insecurity was limited because the benefit was not designed with this outcome in mind,” says Tarasuk, a professor in the department of nutritional sciences in the Faculty of Medicine who is cross-appointed to the Dalla Lana School of Public Health. “To have a stronger impact on food insecurity, the government would need to put more money in the hands of the lowest-income families, which would be completely consistent with the intent of their federal poverty reduction strategy.”
Household food insecurity, the inadequate access to food due to financial constraints, affects 4 million Canadians and is closely linked to poor health.
Almost half of adults who report not following drug prescriptions because of the cost are food insecure. The more severe their household food insecurity is, the greater the probability that adults will fail to take medications as prescribed because of the cost. This may lead to worsening health and greater use of health care services. Measures to reduce or eliminate out-of-pocket costs for prescription medications, while not a solution to household food insecurity, could improve food-insecure adults’ adherence to drug prescriptions.
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.
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.
[PDF version of Press Release] This press release originally released by University of Toronto Press.