New Publication: Severe food insecurity associated with mortality among lower-income Canadian adults approaching eligibility for public pensions: a population cohort study

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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New Publication: Maternal Food Insecurity is Positively Associated with Postpartum Mental Disorders in Ontario, Canada

Background

Household food insecurity has been associated with pregnancy complications and poorer birth outcomes in the United States and with maternal mental disorders in the United Kingdom, but there has been little investigation of the effects of food insecurity during this life stage in Canada.

Objectives

Our objective was to examine the relationship between the food insecurity status of women during pregnancy and maternal and birth outcomes and health in infancy in Canada.

Methods

We drew on data from 1998 women in Ontario, Canada, whose food insecurity was assessed using the Household Food Security Survey Module on the Canadian Community Health Survey, cycles 2005 to 2011–2012. These records were linked to multiple health administrative databases to identify indications of adverse health outcomes during pregnancy, at birth, and during children’s first year of life. We included women who gave birth between 9 months prior and 6 months after their interview date, and for whom infant outcome data were available. Multivariable Poisson regression models were used to compare outcomes by maternal food security status, expressed as adjusted relative risks (aRR) with 95% CIs.

Results

While pregnant, 5.6% of women were marginally food insecure and 10.0% were moderately or severely food insecure. Food insecurity was unrelated to pregnancy complications and adverse birth outcomes, but 26.8% of women with moderate or severe food insecurity had treatment for postpartum mental disorders in the 6-month postpartum period, compared to 13.9% of food-secure women (aRR, 1.86; 95% CI, 1.40–2.46). Children born to food-insecure mothers were at elevated risk of being treated in an emergency department in the first year of life (aRR, 1.18; 95% CI, 1.01–1.38).

Conclusions

Maternal food insecurity during pregnancy in Ontario, Canada, is associated with postpartum mental disorders and a greater likelihood of infants being treated in an emergency department.

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New Publication: Who Is Food Insecure? Political Storytelling on Hunger, Household Food Choices, and the Construction of Archetypal Populations

Food insecurity, inadequate access to adequate food due to economic constraints, affects one in eight households. Food insecurity is a serious structural problem affecting health, but dedicated policy action has been limited. In this study, we analyzed causal stories in Canadian political discussion about household food insecurity in provincial and federal Hansard records over two decades. Specifically, we examined patterns of archetypes – dominant characterizations of individuals and populations who experience food insecurity – and how these were used to convey a collective consciousness about ‘model’ food-insecure persons or groups. Archetypes aligned only with selected evidence of populations actually experiencing food insecurity.

New Publication: Food Insecurity Is Associated With Higher Health Care Use And Costs Among Canadian Adults

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.

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More Canadians are food insecure than ever before – and the problem is only getting worse

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?

  1. 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.

  1. 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.

  1. 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.

For more information, see the Food Insecurity in Canada, 2017-18 report

Publication: Homeownership status and risk of food insecurity: examining the role of housing debt, housing expenditure and housing asset using a cross-sectional population-based survey of Canadian households

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.

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Publication: Association between household food insecurity and mortality in Canada: a population-based retrospective cohort study

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.

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Opportunity: Post-Doctoral Fellowship In the Epidemiology of Food Insecurity

Dr. Valerie Tarasuk at the Department of Nutritional Sciences, University of Toronto and Dr. Marcelo Urquia at the Manitoba Centre for Health Policy (MCHP), University of Manitoba invite applications for two post-doctoral fellowships in the Epidemiology of Food Insecurity and Health. The successful applicants will join a Canadian Institutes of Health Research (CIHR)-funded multidisciplinary team of accomplished researchers in Manitoba, Ontario and the US, with an interest in studying the determinants of household food insecurity and its implications for health and well-being. The research approach involves the analysis of large and unique linked health and social administrative databases and dietary intake surveys housed at the Statistics Canada Research Data Centres. The postdoctoral fellows will be based in Toronto or Winnipeg and jointly supervised by Drs. Valerie Tarasuk and Marcelo Urquia.

The ideal candidates will have the experience and expertise to take advantage of the opportunity to access novel and rich data to build a highly productive applied research portfolio. The fellows will be able to attend seminars, colloquia, and other regularly scheduled research activities at the partner institutions, and present in domestic and international conferences.

Term:

This full-time temporary position is for one (1) year, with the possibility of extension subject to satisfactory performance evaluations.

Salary:

Competitive salary equalling or exceeding CIHR fellowship stipends, plus benefits. Actual salary will depend on the candidate’s experience, qualifications and progress.

Minimum qualifications:

  • PhD, ScD, DrPH, or an equivalent doctoral degree in epidemiology, biostatistics, nutritional sciences, public health, economics, or related fields, completed within the last 5 years
  • Experience conducting statistical analyses with large databases using SAS or Stata

Preferred qualifications:

  • Track record of research productivity
  • Track record of, or strong potential for, independent funding
  • Knowledge of food insecurity, social determinants of health, poverty and social policy

Duties:

  • Conduct data analyses at the Statistics Canada Research Data Centre.
  • Lead and co-author manuscripts for peer-reviewed journals
  • Critically contribute to the team efforts
  • Actively participate in knowledge-transfer activities
  • Perform limited administrative tasks
  • Apply to external funding sources as eligible

To apply:

Please send your application to Dr. Valerie Tarasuk (Valerie.tarasuk@utoronto.ca) as a single PDF file. Application materials include i) a one-page cover letter describing career goals, research interests, and reasons for applying; ii) your CV and graduate degree transcripts; iii) a reprint of your most significant first-author publication; iv) contact information for three (3) references; and v) proof of proficiency in English for candidates whose original language is not English, if applicable.

Review of applications will begin on March 1, 2020. Expected start date is May 1 2020 or shortly thereafter, although this timing is flexible. The positions will remain open until suitable candidates are found.

All applications are welcome but only potential candidates will be contacted.

The University of Toronto is strongly committed to diversity within its community and especially welcomes applications from racialized persons / persons of colour, women, Indigenous / Aboriginal People of North America, persons with disabilities, LGBTQ persons, and others who may contribute to the further diversification of ideas.

Publication: Money speaks: Reductions in severe food insecurity follow the Canada Child Benefit

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.”

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