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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.

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In June 2019, APTN National News published and article citing Nunavut MP Hunter Tootoo calling for an inquiry into the ‘Phoenix’ North food program. MP Tootoo referred to PROOF research to emphasize the growing number of houses affected by food insecurity in the territory.

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Tarasuk V, Fafard St-Germain AA, Loopstra R. The relationship between food banks and food insecurity: insights from Canada. Voluntas 2019. doi: doi/org/10.1007/s11266-019-00092-w.

Abstract

Food banks have become the first line of response to problems of hunger and food insecurity in affluent nations. Although originating in the USA, food banks are now well established in Canada, Australia, and some Nordic countries, and they have rapidly expanded in the UK and other parts of Europe in the past two decades. Defined by the mobilization of food donations and volunteer labor within communities to provide food to those in need, food banks are undeniably a response to food insecurity, but their relevance to this problem is rarely assessed. We drew on data from the 2008 Canadian Household Panel Survey Pilot to assess the relationship between food bank use and household food insecurity over the prior 12 months and examine the interrelation between food-insecure households’ use of other resource augmentation strategies and their use of food banks. We found that most food-insecure households delayed bill payments and sought financial help from friends and family, but only 21.1% used food banks. Food bank users appeared to be more desperate: They had substantially lower incomes than food-insecure households who did not use food banks and were more likely to seek help from relatives and friends and other community agencies. Our findings challenge the current emphasis on food charity as a response to household food insecurity. Measures are needed to address the underlying causes of household food insecurity.

Jessiman-Perreault G, McIntyre L. Household food insecurity narrows the sex gap in five adverse mental health outcomes among Canadian adults. International Journal of Environmental Research and Public Health 2019;16(3):1-15.

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Abstract

The sex gap (i.e., the significant difference in an outcome between men and women) in the occurrence of a variety of mental health conditions has been well documented. Household food insecurity has also repeatedly been found to be associated with a variety of poor mental health outcomes. Although both sex and household food insecurity have received attention individually, rarely have they been examined together to explore whether or how these indicators of two social locations interact to impact common mental health outcomes. Using a pooled sample (N = 302,683) of the Canadian Community Health Survey (2005–2012), we test whether sex modifies the relationship between household food insecurity assessed by the Household Food Security Survey Module and five adverse mental health outcomes, controlling for confounding covariates. Although the sex gap was observed among food secure men versus women, males and females reporting any level of food insecurity were equally likely to report adverse mental health outcomes, compared with those reporting food security. Therefore, household food insecurity seems to narrow the sex gap on five adverse mental health outcomes.

Tarasuk VS, Fafard St-Germain AA, Mitchell A. Geographic and socio-demographic predictors of household food insecurity in Canada, 2011-12. BMC Public Health 2019;19. https://doi.org/10.1186/s12889-018-6344-2.

Background
Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households’ vulnerability to food insecurity is limited.

Methods
Data from the 2011–12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity.

Results
The prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households’ odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers’ compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors’ income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity.

Conclusions
The probability of household food insecurity in Canada and the severity of the experience depends on a household’s province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.

McIntyre L, Patterson PB, Mah CL. The application of ‘valence’ to the idea of household food insecurity in Canada. Soc Sci Med 2018; https://doi.org/10.1016/j.socscimed.2018.11.016

Accepted manuscript published online ahead of print

Abstract: Household food insecurity (HFI), lack of access to adequate food due to financial constraint, has been studied extensively in Canada and is well-recognized for its negative impacts on population health. Despite considerable high-level political recognition, the issue has evoked little substantive policy deliberation. We suggest that Béland and Cox’s recently articulated construct of ‘valence’ may be useful in examining why the idea of HFI has motivated little policy response. Valence is defined as the emotional quality of an idea. According to valence theory, ideas with a high emotional intensity, positive valence acquire importance in policy debate, and those with high intensity, negative valence are ‘unthinkable’ as a policy idea. We compiled four datasets in which HFI was discussed (verbatim legislative excerpts, parliamentary committee proceedings, government reports, interviews with HFI policy entrepreneurs), representing different kinds of political forums for debate. We analyzed what was said with respect to the valence of the idea of HFI. We found that discussions about HFI were on the whole generally subdued and of low emotional intensity. High intensity negative valence pronouncements were found among legislators’ statements and parliamentary committee evidence. Regardless of emotional intensity level, speakers usually talked about the idea of HFI in ways that elicited a negative valence. Positive valence in discussion of the idea of HFI was limited and invoked comments about individual aspiration, prosperity, and community spirit. Our findings suggest that the negative valence of HFI is an inherent trait of the idea that makes it unattractive to policy makers. We suggest that HFI may be a better metric than a policy problem and that aspirational goals with positive valence related to poverty alleviation might better use HFI as an outcome rather than the focus of action.

On September 30, Canadian Food Studies released a special issue on building an integrated food policy for Canada. Featured in this issue is Tacking household food insecurity: An essential goal of a national food policy by Naomi Dachner and PROOF Principal Investigator, Valerie Tarasuk. In this publication, authors explore the social epidemiology and health impacts of household food insecurity in Canada, the evidence base for policy intervention, and the role of a national food policy in driving meaningful action on food insecurity across multiple sectors and all levels of government.

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On August 21, 2018, Minister Duclos released Opportunity for All – Canada’s First Poverty Reduction Strategy. The Strategy introduced an Official Poverty Line for Canada and announced targets for poverty reduction based on this measure. As part of the Strategy, the federal government will develop an online dashboard of indicators to publicly track progress on selected measures of poverty. Food insecurity is included as one of these indicators. This inclusion will highlight the importance of regularly monitoring and reporting on data from the Household Food Security Survey Module. Food insecurity’s role in the Strategy is an important step forward in the federal government’s recognition of food insecurity as a measure of material deprivation that is sensitive to social policies aimed at poverty reduction.

The full Strategy document can be accessed here.

Evidence Exchange Network has produced a new research resource to synthesize Tarasuk et al’s paper from the Canadian Journal of Psychiatry, The relation between food insecurity and mental health service utilization in Ontario.