Healthy Cities in the SDG Era Podcast: Zero Hunger

In episode 7 of the Healthy Cities in the SDG Era podcast, Dr. Valerie Tarasuk, spoke with host Dr. Erica Di Ruggiero about food insecurity in Canada in the context of the Sustainable Development Goals (SDG), a set of 17 goals tackling social, economic, and environmental challenges for UN Member States to deliver on by 2030. Sustainable Development Goal 2 is Zero Hunger, meaning Canada has committed to ending hunger and ensuring all Canadians have access to food. Later in the episode, Dr. Erica Di Ruggiero also speaks with PhD Candidate, Allison Daniel, about SDG 2 in the global context.

Listen to the full episode here and check out our highlights below:


Canada has been monitoring food insecurity, the inadequate or insecure access to food due to financial constraints, for over 15 years. In the most recent national estimate from 2017-2018, over 4.4 million Canadians lived in food-insecure households.

Differentiating “food insecurity” from “food security”

As Dr. Tarasuk describes, food insecurity monitoring and statistics refer to a very specific problem of households not being able to afford enough food. It’s not the opposite of “food security”, which has broader definitions like the FAO’s – when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life – that can encompass other issues like food safety, culturally appropriate foods, retail issues, food production, food systems, or sustainability. While these issues are important, they are not the same as food insecurity. It is crucial to distinguish between these issues when discussing food insecurity statistics and potential solutions.

At its core, food insecurity is about inadequate economic resources and the inability of our current landscape of employment and social protections to enable households to have enough money to make ends meet. If we want to eliminate and prevent food insecurity, we need to make sure Canadians have adequate and secure incomes.

How food insecurity identifies extreme material deprivation

Food insecurity is measured in Canada using a well-studied set of 18 questions about households’ experiences, ranging from worrying about running out of food to going whole days without eating, all due to a lack of money. The measure asks about food but can tell us more about a household’s experience of deprivation.

By the time somebody doesn’t have enough money to feed themselves and their family, food is far from the only basic need they are compromising. They are likely to be struggling with other expenses like rent, utilities, or prescription medicine.

The measurement of such an extreme experience adds to our understanding of poverty in Canada beyond comparisons of income with a poverty line. It identifies vulnerability to extreme material deprivation and severe detriment to both physical and mental health as a result of households’ overall financial circumstances.

What food insecurity tells us about economic inequality and systemic racism

“Those most at risk of food insecurity are people who are low income, particularly working aged adults and their families, but on top of that what we’ve got in Canada is a very, very unsettling story of higher rates of food insecurity amongst households identified as Indigenous or Black”

When we look at the relationship between race and food insecurity, we see that Indigenous and Black households are more likely to be food-insecure, even after accounting for socioeconomic factors like household income, homeownership, education, and household composition. The disproportionate rates of food insecurity among these groups points to ways systemic racism and colonialism underlie economic inequality and food insecurity in Canada.

New research on racial disparities in food insecurity for Black households has begun to unearth how public policies and protection may not be equitably provided to all Canadians. Moving forward, greater collection of race-based data is essential to expose the systemic problems in Canada, like discrimination in the administration of public policies, and ensure proposed solutions benefit Canadians equitably.

Pandemic responses under the guise of “addressing food insecurity”

Dr. Tarasuk discusses how the recent federal investments of hundreds of millions towards funding food charity through the Emergency Food Security Fund as a response to food insecurity are misguided. Most food-insecure households don’t use food charity and even those that do don’t become food secure. There is no evidence that food charity can resolve food insecurity.

By recognizing food insecurity as a problem in serious need of action, the government is acknowledging the gaps in the existing social safety net. However, the decision to focus on funding food charity further entrenches charity as Canada’s primary response, which has been the case for four decades, despite the body of evidence that we need to ensure households have adequate and secure income to prevent food insecurity.

What the government should be doing to tackle food insecurity

“There is a growing body of evidence that says, first and foremost, we need to make sure people have adequate secure incomes. That’s how we protect ourselves from food insecurity”

The success of Canada’s Old Age Security and Guaranteed Income Supplement programs at insulating seniors from poverty and food insecurity demonstrates the potential of expanding a guaranteed annual income to working-aged adults to reduce food insecurity. Policies like increased social assistance, increased minimum wage, better employment standards, broader protections for the unemployed, and increased income support for struggling families would move the needle on food insecurity by reaching those most at-risk.

The unrealized potential of the Canada Child Benefit

“The mere fact that somebody has a child in their household, someone under the age of 18 in a household, is enough to increase the risk of food insecurity in this country…is outrageous”

Our analysis of the Canada Child Benefit (CCB) found a slight reduction in severe food insecurity for low-income households, but it did nothing to reduce the prevalence of food insecurity amongst families with children overall. The CCB is a clear example of a policy that could be easily improved to protect families from food insecurity by re-targeting the benefit to provide more money to low-income families.

About:
Healthy Cities in the SDG Era is a podcast about the Sustainable Development Goals (SDGs), and how research conducted by faculty and students at the University of Toronto is helping to achieve them. It is co-hosted by Dr. Erica Di Ruggiero, Director of the Centre for Global Health, and Ophelia Michaelides, Manager of the Centre for Global Health, at the Dalla Lana School of Public Health, University of Toronto, and produced by Elizabeth Loftus. Audio editing is by Anwaar Baobeid. Music is produced by Julien Fortier. It is made with the support of the School of Cities at the University of Toronto.

PROOF discusses food insecurity in Canada on Rights Not Charity Podcast

PROOF principal investigator, Dr. Valerie Tarasuk, recently discussed food insecurity in Canada with the Global Solidarity Alliance for Food, Health and Social Justice as part of their Rights Not Charity podcast series. Through Canada’s monitoring of food insecurity over the past 15 years, it’s become clear that our social safety net needs to be strengthened to protect Canadians from being food-insecure.

Show highlights:

  • How food insecurity is defined and measured in Canada
  • The extent of household food insecurity in Canada and who is most impacted
  • How food insecurity is rooted in social and economic disadvantage, systemic racism, and the legacy of colonialism
  • What food insecurity says about Canada’s social safety net and the need to strengthen it so that it is accountable for ensuring all Canadians have enough money to afford basic needs

“So we’ve got these lightning rods, like the fact that the mere presence of a child under the age of 18 in a household is enough to trigger an increased risk of food insecurity. Or the receipt of social assistance or employment insurance benefits is enough to increase risk. Those tell us that the safety net isn’t as good as it needs to be.”

Listen to the episode (9 min 38 sec) below:

Read the full transcript at: https://rightsnotcharity.org/2021/07/what-does-hunger-look-like-in-canada/

About:
The Global Solidarity Alliance for Food, Health and Social Justice (GSA RightsNotCharity) is an alliance of individuals and organizations across Canada, the US, and the UK that advocates for the realization of the right to food.

The Guardian Op-ed – P.E.I. made history by setting a timeline for eliminating food insecurity: Here’s how they can achieve it.

Read our new op-ed, “P.E.I. made history by setting a timeline for eliminating food insecurity: Here’s how they can achieve it.“, by Jennifer Taylor, PhD, RD, Professor at the University of Prince Edward Island; Tim Li, MSCom, PROOF Research Program Coordinator; and Valerie Tarasuk, PhD, Professor at the University of Toronto and principal investigator of PROOF.

In this op-ed, we discuss the significance of the food insecurity reduction targets set by the new Poverty Elimination Strategy Act and 4 evidence-based actions that the PEI government can pursue to reach these targets. We highlighted this historic bill in our previous blog post, “Prince Edward Island: The first jurisdiction to set explicit targets for reducing food insecurity“.


During the spring sitting, the P.E.I. legislature unanimously passed the Poverty Elimination Strategy Act, which lays out a timeline for reducing and eliminating poverty by 2035 and eliminating food insecurity by 2030. That means that, by 2030, every household in P.E.I. will be able to access the food they need.

What does it mean to be food-insecure? When Statistics Canada measures food insecurity, they are identifying households who have experienced insecure or inadequate access to food due to a lack of money. These experiences range from worrying about running out of food, to children not eating for whole days. As researchers in food insecurity and nutrition, we’ve learned a lot about this problem and ways to reduce it from the Statistics Canada data.

Continue reading at The Guardian.

New Research & Fact Sheet – Provincial Policy Levers to Reduce Household Food Insecurity

Screenshot of fact sheet: Provincial Policy Levers to Reduce Household Food Insecurity

Download the fact sheet here: https://proof.utoronto.ca/wp-content/uploads/2021/05/PROOF_FACTSHEET_Provincial-policies-052021.pdf

PROOF has recently published a new study in the journal, Preventive Medicine, looking at the roles of provincial policy and economic environment on food insecurity. This new PROOF fact sheet and video summarizes some of the findings from this study.


For more information about this research, please see:

Men, F., Urquia, M.L., Tarasuk, V., 2021. The role of provincial social policies and economic environments in shaping food insecurity among Canadian families with children. Preventive Medicine 148, 106558. https://www.sciencedirect.com/science/article/pii/S0091743521001420

To see our other factsheets on food insecurity in Canada, visit https://proof.utoronto.ca/resources/fact-sheets.

New Video – How to tackle food insecurity in Canada


Visit https://proof.utoronto.ca/whiteboard/ for the video transcript and references.

Written and animated by: Natalie Klein, MPH
Supervised and edited by: Dr. Valerie Tarasuk
Video support provided by: Tim Li, MSCom

Tell your federal, provincial, or municipal leaders what we know for sure:

That food charity is not the answer to a problem rooted in income insufficiency.
That it is unacceptable that there are food insecure households in a country as rich as ours.
That we do not want federal funding of food banks, we want the government to explore, evaluate and implement sustainable income solutions to food insecurity.
Send them letters using this template created by the Ontario Dietitians in Public Health: https://www.odph.ca/what-can-you-do

New Research – Food insecurity amid the COVID-19 pandemic: food charity, government assistance and employment

Image of a 3D dollar sign with cutouts in the shape of a COVID-19 virus.

Our new study, “Food insecurity amid the COVID-19 pandemic: food charity, government assistance and employment”, published in Canadian Public Policy, looks at the face of food insecurity in the early days of the pandemic as it relates to employment and the new federal funding for food charity. We analyzed data from Statistics Canada’s Canadian Perspective Survey Series 2 (CPSS-2), an online survey of all ten provinces in May 2020.

Simply having a job does not protect someone from food insecurity. Before the pandemic, 65% of food-insecure households relied on wages and salaries as their main source of income in 2017-2018. Which workers were most vulnerable to food insecurity when the pandemic hit?

People who continued to work outside the home (e.g., essential workers), those who had been working from home before the pandemic and continued to do so (e.g., customer service representatives), those who thought job loss was imminent, and those who stopped working due COVID-related business closure or layoffs. Also at very high risk of food insecurity were working-aged people outside the workforce entirely.

Previous research on the relationship between employment and food insecurity established that households relying on low-wage, part-time, temporary, or precarious jobs, or a single wage earner for multiple people were especially vulnerable. The job disruptions brought on by the pandemic may further exacerbate these households’ financial hardship and food insecurity.

This study also found that only 7.4% of the food-insecure households made use of food charity in the past 30 days. This is a stark reminder of the wide disconnect between food insecurity and food bank use that existed before the pandemic. It calls into question the federal government’s decisions to allocate an unprecedented $250 million to charitable food assistance programs in 2020 in the name of addressing food insecurity during the pandemic and an additional $140 million as part of the 2021 Federal Budget. These policy decisions further entrench food charity as Canada’s main response to this serious public health problem despite there being no evidence that food charity can move households out of food insecurity.

Image of skyscrapers with words "food insecurity" on them. A small truck with a short ladder labelled "food bank" is on the road, representing the disconnect between food insecurity and food bank use.

Read the paper here at Canadian Public Policy.

Men F, Tarasuk V. Food insecurity amid the COVID-19 pandemic: food charity, government assistance and employment. Canadian Public Policy 2021;Published online. Available from: https://www.utpjournals.press/doi/abs/10.3138/cpp.2021-001

Prince Edward Island: The first jurisdiction to set explicit targets for reducing food insecurity

Text: Food insecurity in Prince Edward Island. Based on the most recently available data from 2017-2018: 14.0% of households were food-insecure. 19.2% of children under 18 lived in food-insecure households. Background: Silhouette of PEI map

Map of PEI modified from NordNordWest under CC BY-SA 3.0 via Wikimedia Commons

Earlier this month, MLAs in PEI unanimously passed the first bill in Canada that sets explicit and binding targets for food insecurity reduction. The Poverty Elimination Strategy Act, tabled by Green MLA Hannah Bell, establishes targets for reducing the rates of poverty, food insecurity, and chronic homelessness on the Island.[1]

Targets established by the Poverty Elimination Strategy Act[1]

By 2025:

  • Reduce the PEI poverty rate for 2018 by 25% among all persons.
  • Reduce the PEI poverty rate for 2018 by 50% among children under 18 years of age.
  • Reduce food insecurity among all persons by 50%,
  • Reduce food insecurity among children to 0%,
  • Reduce chronic homelessness among all persons to 0%

By 2030:

  • Reduce the PEI poverty rate for 2023 by 50% among all persons.
  • Reduce the PEI poverty rate for 2023 by 100% among children under 18 years of age.
  • Reduce food insecurity among all persons to 0%

By 2035:

  • Reduce the PEI poverty rate for 2029 by 100% among all persons.

By passing this bill, the government commits to eliminating food insecurity among children and halving the provincial rate of food insecurity by 2025. The goal is to eliminate food insecurity in PEI entirely by 2030.[1]

While federal, provincial, and territorial governments have all committed to poverty reduction strategies, only some have any specific, measurable targets (Federal, British Columbia, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, and now PEI). Other than PEI, none have declared food insecurity reduction targets or commitments to fully eliminate poverty.

The next steps for PEI should be to re-evaluate their poverty reduction plans and ensure that the actions taken are evidence-based and move them towards these targets.

Statistics Canada measures food insecurity using the Household Food Security Survey Module (HFSSM) on the Canadian Community Health Survey (CCHS). The HFSSM consists of 18 questions about the experiences of food insecurity, ranging from worrying about running out of food to going whole days without eating, due to financial constraint.

Food insecurity in PEI

Based on the most recently available data, 14.0% of households in PEI were food-insecure in 2017-2018. This represents approximately 18 900 Islanders.[2]

Households with children under 18 years old are more vulnerable to food insecurity than those without children. In PEI, 19.2% of children lived in food-insecure households. This means that almost 1 in 5 children in the province were in families who could not always afford the food they needed.[2]

Text: 1 in 5 children in PEI live in food-insecure households. Graphic: 5 symbols of children with 1 coloured in red.

Food insecurity is a very serious public health problem. It negatively impacts the health of both children and adults. Research has shown that the health effects of food insecurity go far beyond nutrition and include a wide range of physical and mental health problems.[3][4][5][6] This means food insecurity is also a costly problem for provinces and territories because the health care needs of people who are food insecure place a tremendous burden on our healthcare system.[7]

The need for income-based interventions to reduce food insecurity

The only intervention that has ever been shown to move the needle on food insecurity is income. Research has found reductions in food insecurity where federal or provincial policies have improved the financial circumstances of vulnerable households.[8][9][10]

To reach the target of eliminating food insecurity among children in the next 5 years, all the evidence points to enacting policies and programs that ensure families have enough money to make ends meet.[9][11][12]

There are many ways that provincial policies impact the adequacy and stability of families’ incomes, and therefore food insecurity . Provincial governments 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.

The key to reaching targets for food insecurity reductions are policies that impact households reliant on employment income. These households make up the majority (63.7%) of the food-insecure on the Island.[2] Households relying on low-wage jobs, part-time, temporary, or precarious work, or a single wage earner for multiple people are the most vulnerable.

Reductions in the provincial income tax rate for low-income households and increases to minimum wage could both help reduce food insecurity for these households.[13] PEI increased their minimum wage to $13 per hour earlier this month.[14]

A second important focus for provincial action to reduce food insecurity is social assistance. Across Canada, households relying on social assistance are very likely to be food-insecure. This is especially the case in PEI, where 85.6% of households relying on social assistance were food-insecure in 2017-2018.[2] Evidence from both British Columbia and Newfoundland and Labrador have demonstrated that improvements to social assistance can reduce food insecurity for these households.[8][15]

In a 2018 review of PEI’s social assistance, the Auditor General drew attention to the limited increases in assistance rates and delays in planned increases.[16] Since 2018, PEI has increased social assistance rates, income exemptions, and liquid asset exemptions, to provide those receiving social assistance with more income.[17][18][19]

Increases to minimum wage and social assistance incomes are steps in the right direction given what we know about the need for adequate incomes to reduce food insecurity. It remains to be seen how much these measures improve Islanders’ financial circumstances and affect food insecurity rates, but the new targets provide an important benchmark for assessing the impact and identifying next steps.

Lessons from Newfoundland and Labrador

The only time any jurisdiction has had a major decline in their rate of food insecurity over the past 16 years of monitoring was in Newfoundland and Labrador from 2007 to 2012. The province went from having the highest rate among the provinces in 2007 to having the lowest in 2011 and sustained some of its reductions in 2012.[8]

This decline followed the introduction of a new poverty reduction strategy, one that included eliminating and lowering provincial income taxes for the lowest and mid-low income households, increasing the minimum wage by $4 per hour over 4 years, increasing social assistance rates with indexation to inflation, and increasing liquid asset and income exemptions for social assistances recipients, among other initiatives.[20]

Unfortunately, the tremendous reduction in food insecurity that Newfoundland and Labrador achieved between 2007 and 2012 has not been sustained. In 2017-2018, after 4 years of not measuring food insecurity, Newfoundland and Labrador’s rate had risen substantially.[2] This shift highlights the importance of provinces continually monitoring their food insecurity rates, understanding how their policies and programs affect this problem, and maintaining the interventions that protect households from food insecurity.

An important step forward

PEI takes an important step forward by setting explicit targets for food insecurity reduction. These new targets hold the government accountable for re-evaluating the adequacy of existing supports and introducing new policies that allow all Islanders to make ends meet.  Other provinces and territories should follow their lead and make legislative commitments to reducing food insecurity.


For more information on food insecurity in Canada, see our latest report, Household food insecurity in Canada, 2017-18.

References

  1. Bell H. Poverty Elimination Strategy Act. Bill 107, Prince Edward Island Legislative Assembly (66th General Assembly), 2nd session. 2021. Available from: https://docs.assembly.pe.ca/download/dms?objectId=6a67d1df-3aff-4013-8b78-73fa0dce07f4&fileName=bill-107.pdf
  2. 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/
  3. Tarasuk V, Mitchell A, McLaren L, McIntyre L. Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. The Journal of Nutrition. 2013;143(11):1785–93. Available from: https://doi.org/10.3945/jn.113.178483
  4. 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
  5. 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
  6. 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
  7. 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
  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. 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
  10. 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
  11. 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
  12. Ionescu-Ittu R, Glymour MM, Kaufman JS. A difference-in-differences approach to estimate the effect of income-supplementation on food insecurity. Preventive Medicine. 2015;70:108–16. Available from: https://www.sciencedirect.com/science/article/pii/S0091743514004605
  13. 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
  14. Government of Prince Edward Island. Minimum Wage Order (Board and Lodging) [Internet]. Prince Edward Island. 2015;Available from: https://www.princeedwardisland.ca/en/information/economic-growth-tourism-and-culture/minimum-wage-order-board-and-lodging
  15. 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
  16. MacAdam J. Report to the Legislative Assembly 2018 [Internet]. Charlottetown, PE: Office of the Auditor General; 2018. Available from: https://www.assembly.pe.ca/sites/www.assembly.pe.ca/files/2018-AG-ar.pdf
  17. Government of Prince Edward Island. Social Assistance Renewal [Internet]. Prince Edward Island. 2018;Available from: https://www.princeedwardisland.ca/en/information/family-and-human-services/social-assistance-renewal. Accessed 2021-04-20.
  18. Government of Prince Edward Island. New initiatives to help all Islanders participate and thrive [Internet]. Prince Edward Island. 2018;Available from: https://www.princeedwardisland.ca/en/news/new-initiatives-help-all-islanders-participate-and-thrive. Accessed 2021-04-20.
  19. Government of Prince Edward Island. Social assistance rates increasing across the Island [Internet]. Prince Edward Island. 2019;Available from: https://www.princeedwardisland.ca/en/news/social-assistance-rates-increasing-across-the-island. Accessed 2021-04-20.
  20. Newfoundland and Labrador. Reducing poverty: an action plan for Newfoundland and Labrador. St. John’s, Nfld: Government of Newfoundland and Labrador; 2006. Available from: https://www.deslibris.ca/ID/205006

PROOF investigator appointed to Order of Canada

Lynn McIntyre Portrait

Lynn McIntyre, Professor Emerita of Community Health Sciences, Cumming School of Medicine, University of Calgary, and a founding PROOF investigator, has been appointed to the Order of Canada for her influential research on health equity and food insecurity, and for her contributions to public health policies in Canada.

Over her career, Lynn’s research has been focused on influencing policy that will reduce household level food insecurity in Canada. Her most recent work examined the framing of food insecurity in public discourse and policy arenas. Lynn’s preferred policy solution for household food insecurity in Canada has become Basic Income and to this end, she remains actively associated with groups like the Basic Income Canada Network.

Congratulations to Lynn on this momentous achievement!

 

New Research – 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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