Food Insecurity

…What is it?

October 16 is World Food Day, a day when people around the world come together to declare their commitment to eradicating hunger in our lifetime. Over 10 per cent of the world’s population is undernourished, with the majority of this population living in developing countries. As such, undernourishment and food insecurity are often thought of as a global health issue that does not significantly affect Canadian families. In fact, 5 per cent of Canadian children and 8 per cent of Canadian adults suffer from food insecurity.

Food security is 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, healthy lifestyle. Low income households are most at risk, particularly those using government assistance as a primary source of income. 23 per cent of low- income households and 40 per cent of households using government assistance report food insecurity. Unfortunately, households with children are at higher risk, especially in single-parent homes. Important community-level risk factors include the cost of food and non-essentials, geographic isolation, lack of transportation, and low food literacy. These community risk factors are reflected in the fact that Canada’s North has the highest rate of food insecurity among regions with 36.7 per cent of the population of Nunavut being food insecure.

…How can we identify it?

Identifying children with food insecurity is important in maintaining overall health and preventing chronic disease. People who suffer from food insecurity are more likely to report poor physical and functional health, long-term disability, chronic medical conditions, diabetes, heart disease, major depression, and poor social support. Children are more likely to have nutrient deficiencies that may result in obesity and developmental problems. Screening for poverty in every patient and maintaining awareness in at risk groups can help to identify those most at risk of food insecurity. A single validated question with very high sensitivity for poverty is “Do you ever have difficulty making ends meet at the end of the month?” Studies also suggest that patients feel comfortable speaking with their physician about income and feel that screening for poverty is important.

…What can we do about it?

Food security can be addressed at a number of levels. Families can access community-specific resources, such as food banks. However, foods are only accessed by 25 per cent of people suffering from food insecurity, have not been shown to prevent ongoing food insecurity, and are associated with significant stigma. Meal drop-in programs face similar challenges.

Community development programs help supply healthy food and support education around healthy eating. Examples of these programs include community gardens, ‘good food boxes’, and community kitchens. Historically, these programs have had difficulty gaining traction with at-risk populations, but help improve geographical access, which has been shown to reduce obesity in children, who live in at-risk communities. In Ontario, a special diet allowance exists that helps to cover the diet for a number of chronic conditions. Additionally, some Canadian cities have school-based lunch programs that support improved nutrition and help to reduce food insecurity for children.

Ultimately, food insecurity is often the outcome of low income in combination with other socioeconomic issues. Therefore, it is important to address the individual’s underlying risk factors for food insecurity. This includes supporting total household income by accessing government support, linking parents with employment services and child care as appropriate, and advocating for patients to participate community food programs.

One in twenty Canadian children suffers from food insecurity that will have long-term negative impacts on their health. By screening every child we encounter at SickKids, we can ensure all of our patients will have the nourishment required to maintain their health and fulfill their full potential.