Household Food Insecurity in Canada - Alberta

Top Clln Nutr
Vol. 20, No. 4, pp. 299-312
© 2005 Uppincott Williams & Wiikins, Inc.
Household Food Insecurity
in Canada
Valerie Tarasuk, PhD
Food insecurity became recognized as a problem in Canada in the early 1980s when community
groups began to establish charitable food assistance programs in response to concerns that people
in their midst were going hungry. Since then, the number of Canadians affected by food insecurity
has grown, but food charity remains the primary response. Children's feeding programs, prenatal
nutrition programs, and a number of smaller scale, community development programs have also
been instituted. However, growing recognition of the limitations of these efforts to address food
problems rooted in chronically inadequate household incomes has led to a renewed emphasis on
advocacy for social policy reforms. Key words: Canada, food banks, food insecurity
H
OUSEHOLD FOOD INSECURITY is increasingly being recogtiized as a serious
public health concerti in Canada. The problem can be broadly defined as the limited,
inadequate, or insecure access of individuals and households to sufficient, safe, nutritious, and personally acceptable foods to meet
their dietary requirements for a productive
and healthy life. Although related to the concept of community food security,'-^ household or individual food insecurity can be differentiated by the focus on problems of food
access rather than concerns related to the organization of our food system.* This article begins with an examination of what is known
about the problem of food insecurity for individuals and families in Canada and what we
have come to understand about the condi-
tions that give rise to this problem. Despite extensive documentation of the inextricable link
between food security and income adequacy,
local responses to food insecurity have generally focused more on food provisioning and
food-related behaviors than on income issues.
These responses and the growing emphasis
on advocacy for improvements to Canada's social safety net as an essential strategy to address problems of food insecurity in this country are discussed.
THE SCOPE OF THE PROBLEM
Food insecurity became recognized as a
problem in Canada in the early 1980s when
communities began to establish ad hoc charitable food assistance programs in response to
concerns that people in their midst were going hungry.^ These programs took the form of
From the Department of Nutritional Sciences,
"food banks," extragovernmental community
Faculty of Medicine, University of Toronto, Toronto,
organizations
that collect donated foodstuffs
Ontario, Canada.
and redistribute them to the "needy." They
Corresponding author: Valerie Tarasuk, PhD, Depart- rapidly proliferated through the 1980s and
ment of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, M5S 3E2 Canada 1990s and today, a total of 550 exist.^ Since
(e-mail: valerie.tarasuk@utoronto.ca).
their inception, food banks have constituted
the primary response to problems of house*An excellent discussion of the differences between comhold
food insecurity in Canada. The steady intnunity food security and household or individual food increase in food bank usage, illustrated in Fig 1,
security as these concepts have evolved in a North Atnerhas been widely regarded as an indication of
ican context is presented by Power.'
299
300
TOPICS IN CUNICAL NUTRITION/OCTOBER-DECEMBER 2005
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
0
1989 1997 1998 1999 2000 2001 2002 2003 2004
Figure 1. Number of Canadians using food banks
in 1 month: March 1989-2004. From Wilson
and Tsao'' and Canadian Association of Food
the worsening problems of food insecurity. In
1989, the Canadian Association of Food Banks
released its first estimate of food bank usage
nationally (called a "HungerCount'), reporting that 378,000 Canadians used food banks
in March of that year.^ Fifteen years later, this
number has more than doubled, with 841,640
Canadians using food banks in March 2004.'
Expressed as a percentage of the population,
food bank usage ranged from less than 2%
of the population in Alberta and the Northwest Territories to 5.67% of the population in
Newfoundland.
Food insecurity: limited, inadequate, or
insecure access of individuals and
households to sufficient, safe, nutritious,
and personally acceptable food to meet
their dietary requirements for a productive
and healthy life
HungerCount: Annual survey of food bank
usage conducted by the Canadian
Association of Food Banks
NLSCY: National Longitudinal Survey of
Children and Youth
NPHS: National Population Health Survey
CCHS: Canadian Community Health Survey
With the inclusion of indicator questions
on several recent national surveys, it is now
evident that food bank utilization statistics
have grossly underestimated the prevalence
of household food insecurity in Canada.^""
These surveys and the food security ques-
tions they included are summarized in Table 1.
Although the use of different questions on
different surveys thwarts the examination of
trends in food insecurity over time, where
comparisons are possible, the data support
the inference from food bank statistics that
household food insecurity is growing. As discussed more fully later in this article, national
survey results have also served to pinpoint the
conditions that give rise to food insecurity in
Canada.
The first national survey to include any
questions about food insecurity was the National Longitudinal Survey of Children and
Youth (NLSCY), which began in 1994 with
a sample of almost 23,000 randomly selected
Canadian families having newborns to children aged 11 years.'' Survey respondents
were asked if their child had "ever experienced being hungry because the family had
run out of food or money to buy food," and if
so, how^ often, and how did they cope with
feeding their child when this happened. Perhaps, because child hunger typically arises
in the context of relatively severe household
food insecurity and the reporting of this phenomenon is highly stigmatized, the observed
prevalence of this problem was low, affecting an estimated 1.2% of families in 1994.'^
A slight increase in prevalence was documented in 1996, with 1.6% of households
with children younger than 13 years reporting child hunger, although this increase was
not considered statistically significant.'^ Important though, in this same year questions
about household food insecurity began to appear on a much larger survey of Canadian
households, the National Population Health
Survey (NPHS). From the 1996-1997 NPHS,
4% of Canadians were estimated to be food
insufficient." The 1998-1999 NPHS included
3 indicator questions to assess worry about
not having enough to eat, compromise in
quality or variety of food eaten, and not having enough to eat (Table 1), as well as a
more extensive supplement to assess households' experiences of food insecurity.'° The
NPHS was replaced in 2000 by the Canadian
Community Health Survey, but the first cycle
of this survey included the same 3 indicator
Household Food Insecurity in Canada
301
Table 1. Food insecurity as measured on national population surveys in Canada
Survey
1994 National Longitudinal
Survey of Children and
Youth
1996 National Longitudinal
Survey of Children and
Youth
1996-1997 National
Population Health Survey
1998-1999 National
Population Health Survey
2000-2001 Canadian
Community Health Survey
Questions
Has your child ever experienced being hungry
because the family had run out of food or
money to buy food?
Has your child ever experienced being hungry
because the family had run out of food or
money to buy food?
Over the past 12 months, did your household
ever run out of money to buy food?
If yes, which of the following best describes
the food situation in your household?
Always enough food to eat
Sometimes not enough food to eat
Often not enough food to eat
In the past 12 months, did you or anyone else
in your household
not eat the quality or variety of foods you
wanted to eat because of a tack of money?
worry that there would not be enough to eat
because of a lack of money?
not have enough food to eat because of a lack
of money?
Response options: yes, no
In the past 12 months, did you or anyone else
in your household
not eat the quality or variety of foods you
wanted to eat because of a lack of money?
worry that there would not be enough to eat
because of a lack of money?
not have enough food to eat because of a lack
of money?
Response options: often, sometimes, never
questions (with a slight modification to the
response categories).''' The proportion of
households responding affirmatively to at
least 1 of the 3 items rose from 10.4% in 19981999^ to 14,7% in 2000-2001.'"* The proportion that indicated compromises in dietary
quality (defined as not having enough to eat
or not having the desired quality and variety of
foods because of a lack of money) rose from
8.4% in 1998-1999^ to 12.9% in 2000-2001
(S Kirkpatrick, March 25, 2004), More investigation is required to understand what underlies the apparent increase.
Estimated
prevalence, %
1,2'2
1,6"
4,0"
10,4»
14,7"*
It should be noted that the population
surveys described here have omitted some
particularly vulnerable population subgroups:
Aboriginals* on reserves, persons living in
the Yukon and Northwest Territories and remote areas of Quebec and Ontario, and homeless people. Recent studies in 3 northern.
Aboriginal communities have documented
*The term "Aboriginat" refers to the original inhabitants of Canada, encompassing Indian, Metis, and Inuit
peoples,""
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TOPICS IN CUNICAL NUTRITION/OCTOBER-DECEMBER
prevalences of food insecurity in excess of
60%,'^"'^ findings that reflect the extraordinarily high rates of poverty and high food
costs in these communities,'^ Reports of
food scarcity and deprivation among homeless groups also abound.^""^^ Although homeless groups and Aboriginal persons living in
remote communities likely comprise a small
proportion of the Canadian population, given
their extreme vulnerability, the population
prevalence estimates cited here must be regarded as understatements of the true extent
of food insecurity in Canada,
THE EXPERIENCE OF FOOD INSECURITY
Qualitative and quantitative compromises
in food intake are clearly integral to individuals' experiences of this phenomenon,^^""
but the nutritional implications of food insecurity in a Canadian context remain poorly understood because we lack population data on
household food security and dietary intake. To
date, dietary assessments have been limited to
small samples of individuals in particularly vulnerable circumstances (ie, low-income, loneparent women and children^^'^; food bank
users^"*"'^; homeless youth^^). In some cases,
very high prevalences of nutrient inadequacies have been documented. For example,
more than half of the 261 homeless youth interviewed by Tarasuk et aP^ consumed inadequate amounts of folate, vitamins A and C,
zinc, and magnesium, and more than half of
the young women in this sample also had inadequate intakes of iron and vitamin B12. In
their study of 141 lone-parent, low-income
women in the Atlantic provinces, Mclntyre
et aP^ found that most w^omen had inadequate
intakes of folate and vitamin C and more than
one third had inadequate intakes of iron and
vitamins A and B6, In contrast, the children in
these households exhibited adequate intakes
of most nutrients, with estimated prevalences
of inadequacy in excess of 3%, only for folate,
zinc, and vitamin A. Thefindingssuggest that
women compromised their own nutritional
intake to preserve the adequacy of their children's diets,'' as has been reported in several earlier examinations of food management
2005
practices in the context of household food
insecurity, ^^'^^'^ In the absence of population
data, however, it is impossible to know the extent to which the dietary intakes of Canadian
adults and children are compromised in the
context of food insecurity.
The relationship between household food
insecurity and the risk of overweight or obesity in Canada remains controversial, with
contradictory findings emerging from 2 recent analyses of cross-sectional survey data.
Working with data from the 1998-1999 NPHS,
Che and Chen^ reported that adults in foodinsecure households were 1,5 times more
likely to be obese (defined as body mass
index > 30), Vozoris and Tarasuk^' subsequently examined this question using data
from the 1997-1998 NPHS. Because this cycle
of NPHS included a much larger sample than
the 1998-1999 cycle, they were able to stratify the analysis by gender and examine food
insufficiency in relation to a broader range of
body mass index categories, while adjusting
for a number of potentially confounding variables. In contrast to Che and Chen, Vozoris
and Tarasuk found no relation between household food insufficiency and body w^eight for
women, and significantly decreased odds of
overweight among men in food-insufficient
households. More research is clearly needed
to understand how household food insecurity
affects body weight in the Canadian context.
Given the limitations of cross-sectional survey
data, it is important to obtain longitudinal data
on adults' weights and food security status to
address this question.
While the specific effects of household
food insecurity on individuals' dietary intakes and risks of underweight and overweight remain to be characterized, inadequate income clearly poses a major barrier
to healthy eating.'*" Given that many of the
healthful dietary choices being currently advocated (eg, specially formulated high-fibre
or low-fat foods; margarines low^ in saturated
or trans fatty acids; low-fat dairy products)
represent increased food costs,^'"*^ economic
constraints on food selection can affect diet
quality. Insofar as food insecurity is associated
with dietary compromises, it can impede the
Household Food Insecurity in Canada
management of chronic diseases in which nutrition is implicated. This is of particular concern given the evidence that individuals in
food-insufficient households are more likely
to report heart disease, diabetes, high blood
pressure, and food allergies than those in foodsufficient households." Food insecurity must
also pose a risk in pregnancy, although again
there has been little systematic examination
of this problem or its impact in Canada.
Individuals in households characterized by
food insecurity appear to be more likely to suffer from poorer physical, mental, and social
health than do those in more food-secure situations. Several Canadian studies have documented significant relationships between indicators of household food insecurity and the
likelihood of individuals reporting poor or
fair self-rated health^" and multiple chronic
health conditions.^"'^ In the 1994 NLSCY,
for example, caregivers in families reporting
child hunger were more likely to rate their
health poorly and to report having at least
one chronic health condition when compared
to caregivers in families not reporting child
hunger.'^ The health of children who experienced hunger was also reported to be worse
than the health of children who did not experience hunger.'^ Examination of a more
comprehensive array of health measures in
the 1996-1997 NPHS revealed that individuals in households characterized by food insufficiency had significantly higher odds of
poor or fair self-rated health, poor functional
health, restricted activity, multiple chronic
conditions, major depression, distress, and
poor social support.'^ The findings persisted
even after controlling for the potentially confounding effects of age, sex, education level,
and the adequacy of household income. Given
the broad spectrum of health indicators for
wliich associations ^vere observed, it seems
unlikely that the effect of household food insecurity on individuals' health is conditionspecific. Rather, it would appear that food insecurity is one dimension of a more pervasive
vulnerability to a range of physical, mental,
and social health problems among individuals in households struggling with economic
constraints.''
303
Irrespective of the nutritional or physical
health consequences of a chronically compromised diet, the social exclusion that underscores food insecurity makes it relevant to
broader discussions of population health. Social exclusion is integral to the experience
of food insecurity because those affected are
forced to adopt food consumption patterns
and employ a variety of strategies to acquire
food or money for food that fall outside social
norms.'^'"''''-'"^ The sizable but largely invisible work of feeding one's family''^ is made
even more difficult when this work must
occur in the context of financial resource
constraints.^"'^ In a study of Quebec famiUes,
Hamelin et al" documented alienation in relation to household food insecurity, describing the profound feelings of poweriessness,
guilt, and shame associated with this condition. Consistent with these findings, many
w^ho seek assistance from food banks speak
of the shame and humiliation associated with
this action.'"'''-^^'^^ Street youth also speak
about the loss of dignity associated with having to panhandle or beg for money
THE CONDITIONS THAT GIVE RISE TO
PROBLEMS OE EOOD INSECURITY
AMONG CANADIAN HOUSEHOLDS
Despite the limited measures of food insecurity included on national surveys, iinalyses
of survey data have greatly expanded our
understanding of the conditions that give rise
to household food insecurity in Canada. As
the adequacy of household income deteriorates, the likelihood that a household will
report some experience of food insecurity
increases dramatically.^"'^ Furthermore,
households with the lowest incomes report
more severe food insecurity than do those
in less deprived circumstances,'" and among
low-income households, changes in financial
circumstances appear to predict changes in
food security status." Within low-income
households, food security appears to be
extraordinarily sensitive to the ebb and flow
of household resources and the financial
pressures on these resources. An analysis of
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TOPICS IN CUNICAL NUTRITION/OCTOBER-DECEMBER
the dynamics of child hunger among households in the NLSCY cohort over 1994-1996
revealed 3 factors that appeared to plummet
families into a state of food insecurity where
child hunger was reported: the addition of
"one more mouth to feed" (ie, one or more
siblings added to the family, change in the
number of parents in the household); job
loss; and health problems.'' Only one change
predicted which of the families moved out of
severe food insecurity (as indicated by reporting child hunger on the first cycle of NLSCY
but not on the second): the mother got a
full-time job and the family's income rose
accordingly.'^ These results are consistent
with other research suggesting that problems
of household food insecurity are primarily
problems offinancialinsecurity.^ "'^''^^
While the adequacy of household income
is by far the strongest predictor of household food insecurity, some other household
characteristics have been repeatedly linked to
this problem. Households who depend on social assistance for their incomes appear particularly vuhierable.^-'^'^ In the 1998-1999
NPHS, 58% of those whose major source of income was social assistance reported some experience of food insecurity,^ Consistent with
this observation, social assistance recipients
consistently comprise more than half of those
who seek charitable food assistance from food
banks.^ The extraordinary vulnerability of social assistance recipients to food insecurity
can be explained by the low benefit levels,
lack of in-kind supports, and loss of assets
among households on these programs.^'•^''
Income-expense comparisons indicate that,
for many, welfare incomes are insufficient to
cover the costs of basic needs for food, shelter, and other essentials.^^'^'' Lone-parent families, those who rent rather than own their
dwellings, and Aboriginal families living offreserve also appear to be overrepresented
among the food insecure in
^"'^
RESPONSES TO FOOD EVSECURITY
While problems of household food insecurity appear clearly lodged in problems of fi-
2005
nancial insecurity, responses to date have not
focused on income issues. Rather, food charity has been the dominant response. In addition to food batiks, children's feeding programs have been established, at least in part,
in response to perceived problems of child
hunger. Furthermore, since the early 1990s,
a number of smaller scale, community-based
programs have been initiated. These include
alternative food distribution networks to increase families' access to lower cost foods
and targeted education programs to enhance
low-income households' skills in the acquisition and preparation of nutritious, low-cost
foods,^^-'^ In general, these responses have
been focused on food or food-related behaviors, and many have arisen as ad hoc, locallevel initiatives. What follows is a brief examination of these directions in response,
FOOD BANKS, THE PRIMARY RESPONSE
Although the food banks started in the early
1980s were initially construed as temporary
food relief operations necessitated by an economic recession, demands for charitable food
assistance did not abate as the economy improved. Instead, more and more food banks
were established, and food bank utilization
steadily climbed over the next 2 decades,^
Today, there can be little debate that food
banks have become institutionalized. It is also
apparent that the need for their services is
not contingent upon fluctuations in the Canadian economy. Rather, the proliferation and
rapid entrenchment of these extragovernmental, community-based food charities appear to
stem from a fundamental shift in Canadian
social policy'^'^^"^' Over the past 2 decades,
persistently high rates of poverty, unemployment, and underemployment in Canada have
been accompanied by the termination or erosion of a number of publicly funded supports
designed to lessen financial hardships for
particularly vulnerable groups. This has included major changes to the way in which
social assistance ("welfare") and unemployment insurance programs are delivered and
the levels of support they provide, as well as
retractions in investments in social housing.
Household Food Insecurity in Canada
While these changes could be seen simply as
consequences of the changing economic climate and increased emphasis on free trade
and competitiveness in the global market, it is
important to recognize that the shift in Canadian social policy reflects a shift in dominant
political values,^'^"''^ Similar changes in social
policy have been documented in conjunction
with the growing problem of food insecurity
in several other Western nations.*"^
In the context of such fundamental changes
to social policy in Canada, food banks have
been referred to as one element of the "privatization of social services." (The entrenchment of food banks has also been cited as
evidence of the erosion of one of the most fundamental human rights—the right to food,^)
Given the interrelationship between the rise
in the number of food banks and the unravelling of the "social safety net," it is significant that food banks typically operate without government funding. Indeed, most do
not even receive funding from major charities like the United Way.^"* Instead, they rely
heavily on volunteer labor, donated equipment and facilities, and food donations, "Food
drives," the active solicitation of food donations from the public, have become a routine
part of life in communities across the country. However, in many regions, the bulk of
food distributed is donated by food producers, processors, and retailers; much of this is
"surplus food," donated because it cannot be
retailed. Although corporations in Canada receive no special tax benefits for these donations, they save disposal costs and garner corporate goodwill through their participation,^'
Many food banks endeavor to improve the nutritional quality of foods available for distribution by soliciting particular kinds of donations
from the public and by soliciting cash donations to fund the purchase of foods of high
nutritional value, but these strategies are limited by their reliance on the charity of donors.
Some food banks have also developed partnerships with producers to obtain particular
foods (eg, fluid milk from the dairy producers), but this strategy is also limited because it
requires corporations to forego profits by donating saleable items.
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Despite their continued efforts to raise
donations, food bank operators have long
reported that demands for food assistance
exceed available supplies. Evaluations of the
assistance provided by food banks confirm
the limited quantity and nutritional quality of
food available for distribution,'^"'^ The supply
limitations that come from a reliance on donations necessitate restrictions on both the frequency with which any one household can receive assistance and the amount and selection
of foods it receives,® Currently, most food
banks aim to provide a 4-day supply of food to
clients, but fewer than 25% have policies permitting clients to receive this assistance more
than once a month.' In their struggle to balance supply and demand, many food banks
have had to implement further restrictions
on the amount of food they give and the frequency of use permitted.'''"'' A few food banks
have reported having to turn people away because of a lack of food,'
Despite structural limitation that make it
impossible for food banks to effectively respond to the food needs of those who are food
insecure,''^ they remain the primary response
to food insecurity in Canada, Population surveys indicate that 20% to 35% of food-insecure
households make use of charitable food assistance programs,^"" and there is some evidence to suggest that those who seek food
assistance may be in more dire straits than
those who do not,'" Client surveys confirm
the food insecurity that underpins food bank
use, but these surveys also indicate that many
clients receive insufficient food assistance to
meet their needs,'''-''^''^''^ One study of families using food banks in Toronto found that
57% reported some level of absolute food deprivation (ranging from skipping or cutting
the size of meals to going whole days without eating) over the previous 30 days, despite
at least one visit to a food bank during this
period and a myriad of other efforts to augment scarce household resources,''^" Problems of unmet needs are often invisible because of the ways in which charitable food
distributions are typically managed,''^ Even if
the full extent of clients' food needs was recognized, food banks would be very unlikely to
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TOPICS IN CUNICAL NUTRITION/OCTOBER-DECEMBER
have sufficient resources to meet these needs,
given their reliance on donations.
OTHER RESPONSES TO FOOD
INSECURITY
Growing concerns about the adequacy and
appropriateness of food banks as a response
to household food insecurity, coupled with
the recognition of household food insecurity
as a widespread and persistent problem, have
spurred public health departments and community service organizations across the country to search for alternative responses. Many
have initiated small-scale programs to address
perceived needs at the local level, often drawing on principles of health promotion or community development. These programs have
arisen in the context of persistent questions
about how health professionals' responsibilities to address this problem should be circumscribed, and w^here the capacity lies for
health and nutrition-oriented interventions
to contribute.2''''*«'7o-77
Some programs, framed as "alternatives
to food banks," have been designed to provide more lasting solutions to problems of
food insecurity through the application of
more participatory, community development
strategies,^'' The programs typically endeavor
to improve food security through the promotion of enhanced food skills and alternative food production and acquisition strategies that are often designed to also foster
a more locally sustainable food system. Examples include community kitchens, targeted nutrition education programs, community gardens, food-buying clubs, farmers'
markets, and alternative food distribution
networks,'^'^ Some programs target lowincome groups, but others appeal to the community as a whole. Individual programs may
compete for and receive small amounts of
project funding from governments, but funding is typically time-limited and project-based.
Although they may be part of a local food
policy,'^'^® these community development initiatives have typically not been part of some
2005
coherent national or provincial food security
strategy.
In contrast, in recent years government
support to prenatal programs and child nutrition programs that target (or at least include) individuals from families vulnerable to
food insecurity has increased. Although there
have long been prenatal nutrition programs,
since 1994 the federal government has been
providing funding for community groups to
offer or enhance prenatal nutrition support
programs for low-income, high-risk pregnant
women through the Canada Prenatal Nutrition Program.^^ A community development
approach is used in program delivery, with
programs tailored to clients' needs, but most
programs provide participants with food and
vitamin supplements, breast-feeding support,
and one-on-one nutrition counselling,^'' An estimated 44,650 women participated in the
Canada Prenatal Nutrition Program in 20012002,^'* but it is unclear how this relates to
the total number of eligible women. In addition to the increased availability of federal
funding for prenatal nutrition programs, several provincial governments are now providing funding for school meal programs that, to
some extent, appear to stem from concerns
about hunger among children in low-income
communities.^' It is important to emphasize
that the prenatal and child nutrition programs
described here have multiple goals. However,
insofar as both provide free or lo'w-cost food
to their low-income participants, they can
be seen, at least in part, as public policy responses to food security-related concerns,^'
To date, there have been few evaluations
of community-based food and nutrition programs from the perspective of their impact on
problems of household food insecurity. The
sole exception is children's feeding programs;
these have been the subject of considerable
controversy, with some research suggesting
that the programs may actually exacerbate
rather than reduce nutrition inequities,^^"®'
While it is beyond the scope of this review to
present an in-depth analysis of any single program, a critical examination of 2 key features
that characterize several of these initiatives is
Household Food Insecurity in Canada
presented: (1) the rote of nutrition education
and enhanced food skills in improving household food security and (2) the contribution of
small-scale food subsidies and nutrition supplement programs to food security.
Although public health nutrition interventions for low-income groups have traditionally
taken the form of educational programs designed to enhance nutrition knowledge and
improve food shopping and preparation skills,
the relevance of nutrition education initiatives to current problems of food insecurity
is highly questionable. Examinations of the
food management practices of low-income
families have typically revealed high levels of
skill and resourcefulness among those who
are continually challenged to "make ends
meet"^^'^^'^'*'^^'^*' One empirical examination
of at-home food preparation activity among a
sample of 153 w^omen in lo'w-income, foodinsecure households reported that 97% of
the women had consumed food prepared at
home, from scratch, at least once over 3 days
of observation and 57% had done so on each
day.^^ Women in households characterized by
more severe food insecurity engaged in less
complex food preparation, but they were no
less likely than other women to prepare food
from scratch.^^ The findings lend support to
other research foregrounding the very limited
extent to which skilled food selection and
preparation can compensate for the chronically inadequate incomes of families who are
vulnerable to food insecurity. ^^•^'*'^^'^^
A second feature of many of the programs described here is their provision of free
or low-cost food to low-income households
or individuals. This may occur through the
provision of meals or snacks to children in
school nutrition programs, the provision of
free meals and food vouchers to women participating in prenatal nutrition programs, the
subsidization of food prepared in community
kitchens, or the subsidization of costs associated with community gardening, for example.
Insofar as any of the initiatives enable lowincome households to allocate a lesser proportion of their income to food purchases,
they may relieve some of the financial pres-
307
sures on the household and thus lessen the
likelihood of severe food insecurity. However, this effect is limited by the size of the
subsidies. One examination of the incometransfer potential of individuals' participation in a prenatal or child nutrition program
found that program participation made only
a small contribution to a household's overallfinancialsituation, suggesting that the programs w^ould be very unlikely to alleviate—
let alone eradicate—household food insecurity that w^as rooted in income inadequacy."'
This analysis can be extended to consider
the case of interventions designed to improve low-income households' access to affordable, locally grown, fresh fruits and vegetables. Two such initiatives are the creation
of farmers' markets in low-income neighborhoods and the development of alternative
food distribution schemes, such as the "Good
Food Box," a program whereby each month
participants prepay and then pick up a box
of fruits and vegetables from a central depot in their neighborhood.^^ Insofar as these
programs make it more convenient for lowincome households to purchase fresh fruits
and vegetables, assuming they can afford to
purchase such foods at all, the quality of
their diets may improve. Some financial savings may be realized if the produce is sold at
prices below^ those that a household would
normally pay, or if the initiatives spare families
from spending money on transportation to
reach food retail outlets elsewhere. However,
the sum total of these savings is likely to be
small, raising questions about the likelihood
that such initiatives will have much impact on
the problem of household food insecurity.
The competing nature of expenditures in
households with scarce resources also needs
to be considered in gauging the potential impact of interventions on household food security. When resources are so limited that household food security has been compromised,
the existing research would suggest that expenditures on other desired goods and services have also been compromised."-'^''' Under these circumstances, small increments in
disposable income w^Ul not necessarily result
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TOPICS IN CUNICAL NUTRITION/OCTOBER-DECEMBER
2005
Table 2. Web-based resources on household food insecurity in Canada
http://ww^v.dietitians.ca/news/
highlights-positions
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Dietitians of Canada has a position paper on individual and
household food insecurity in Canada
Canadian Association of Food Banks conducts an annual survey
of food bank use in Canada and occasionally releases position
papers on policy issues of particular relevance to problems of
food insecurity and hunger
National Council of Welfare monitors poverty rates and ^vellare
programs in Canada, producing regular reports on welfare
incomes in relation to poverty lines and average incomes as
well as policy analyses and public statements on policy
developments of particular relevance to poverty and welfare
in Canada
in increased expenditures on food. A household may decide it is more important to allocate the additional funds to meet other financial demands (eg, accumulated debts for rent
or utilities). Household food security is embedded in the overallfinancialsecurity of the
household; this needs to be recognized in the
design and evaluation of programs intended
to alleviate food insecurity.
Given this backdrop, it is not surprising
that advocacy for improvements to the social
safety net is a major component of the work
of the Canadian Association of Food Banks.
Its annual "HungerCounts" is now routinely
accompanied by thoughtful analyses of public policy issues that affect household food
security and clear, well-articulated positions
on the changes required to redress problems
CONCLUSIONS
Strategies initiated to address household
food insecurity in Canadian communities,
whether focusing on the provision of charitable food assistance or community development programs to enhance food skills and
facilitate greater access to locally grown produce, have typically embraced an understanding of food insecurity as a food problem in
need of a food solution.^'' Yet, analyses of
the conditions that give rise to food insecurity consistently highlight the inextricable link
between food security and income adequacy
(Table 2). As the measurement and monitoring of food insecurity in Canada improves, we
seem destined to amass more and more evidence of this link. It also seems apparent that
ad hoc, community-based programs that focus on food and food-related behaviors cannot solve problems of food insecurity that are
rooted in income inadequacy, even though
these programs may have other merits.
"The position of Dietitians of Canada (DC) is
that all Canadians must have food security.
Recognizing that food security is a social
determinant of health, DC recommends a
population health approach to food
security: that is, an approach that seeks to
reduce health inequities through the
pursuit of social justice. A population
health approach addresses the root cause
of individual and household food
insecurity—poverty—through
improvements to the social safety net. DC
strongly encourages dietitians to educate
themselves about the issues and processes
to achieve food security through social
change, to use empowering strategies in
community-based food programming, to
conduct and apply research, and to
participate in coalitions that advocate to
create the conditions in which all
Canadians can achieve food security.""'
Household Food Insecurity in Canada
Advocacy for public policy changes is
also central to the Dietitians of Canada's
current position on food security.^-^^ This
position paper includes a number of very
concrete recommendations for advocacy activities, suggesting among other things that dietitians "work in coalitions with others, including community-based organizations and
anti-poverty advocates, to advocate for policies to reduce poverty" and "conduct and
publicize research supporting policies to
strengthen the social safety net."®^ Importantly, such recommendations are grounded
in a careful examination of key policy issues underpinning problems of poverty in
Canada, and the call for a much greater
emphasis on advocacy in response to food insecurity is buttressed by examples of some recent, successful advocacy campaigns for policy reforms. Since a 1995 survey of Canadian
dietitians' perspectives on food security highlighted their need for greater skill and training to undertake effective advocacy,^'•^•^ there
have been a number of initiatives to help fill
this void. One excellent example is the work-
309
book recently developed by the Nova Scotia
Nutrition Council^" to help groups take a
more effective, participatory approach to advocacy for policy changes. The Dietitians of
Canada's position paper also highlights the
importance of reflexive practice and continuing education for dietitians, suggesting that
professional development is a core component of the organization's position on food
security.
In conclusion, the strong focus on advocacy emerging within leading organizations
like the Canadian Association of Food Banks
and the Dietitians of Canada speaks to an
increasing clarity about the root causes of
household food insecurity in Canada and the
urgent need for more effective responses to
this problem. While the origins of current
concerns about household food insecurity in
Canada have long been understood to reside
in the fundamental shifts in social policy that
occurred during the 1980s and early 1990s,
there now appears to be a growing consensus
that the solutions to this problem must also reside in social policy reform.
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