Welcome! We will start the audio at 1pm Eastern . Audio will be broadcast over GoToWebinar automatically and all participant microphones are muted. February 8 th , 2017 1:00 – 2:30 PM Eastern Food Insecurity Measurement in Canada: Interpreting the Statistics Moderator: Craig Larsen Executive Director Chronic Disease Prevention Alliance of Canada Presenters: Valerie Tarasuk, PhD Suzanne Galesloot, MSA, RD Tracy Woloshyn, RD Professor, University of Toronto Public Health Nutrition Provincial Lead Public Health Nutritionist PROOF Principal Investigator Alberta Health Services York Region Public Health @theCDPAC facebook.com/theCDPAC youtube.com/theCDPAC www.cdpac.ca
Moderator Presenters Craig Larsen Valerie Tarasuk Suzanne Galesloot Tracy Woloshyn Executive Director Professor-University of Public Health Nutrition Public Health Nutritionist Chronic Disease Prevention Toronto Provincial Lead York Region Public Health Alliance of Canada PROOF Principal Investigator Alberta Health Services @theCDPAC facebook.com/theCDPAC youtube.com/theCDPAC www.cdpac.ca 7
Food Insecurity Measurement in Canada: Interpreting the Statistics Tracy Woloshyn, RD Suzanne Galesloot, MSA, RD Valerie Tarasuk, PhD Public Health Nutritionist Professor at University of Public Health Nutrition at York Region Public Toronto and principal Provincial Lead at Alberta Health investigator of PROOF Health Services 8
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The health effects of food insecurity ••Poorer birth outcomes Maternal and infant health ••Impaired growth and development ••Poorer development and learning ••Impeded disease management Children ••Increased likelihood of developing asthma, depression, other chronic conditions. ••Compromised physical and mental health ••Poor disease management and heightened Adults odds of negative outcomes (including mortality). 10
Getting the facts straight: Ø What exactly are we monitoring? Ø How many people are food insecure? Ø Is this problem getting better or worse? 11
A BRIEF HISTORY OF FOOD INSECURITY MEASUREMENT IN CANADA 12
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The evolution of food banks and food insecurity measurement: 1994: Measure of child hunger on National 2005: food insecurity Longitudinal Survey of monitoring begins Children & Youth Assorted indicator questions 1997: Annual release of ‘HungerCounts’. 1989: ‘HungerCount’. 1981 : First 1987 :Canadian food bank. Association of Food Banks formed. 1980 1990 2000 14
Household Food Security Survey Module (administered on the Canadian Community Health Survey since 2004) 18 questions, differentiating adults’ and children’s experiences over last 12 months: Worry about not having enough food • Reliance on low-cost foods • Not being able to afford balanced meals • “because there Adults/children skip meals • wasn’t enough Adults/children cut size of meals • money to buy food?” Adults lost weight • Adults/children not having enough to eat • Adults/children not eating for whole day • 15
What exactly are we monitoring? Household food insecurity, as measured in Canada: insecure or inadequate access to food due to financial constraints “ Food security exists 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.” (Canada’s Action Plan on Food Security, 1998) Household food insecurity is not the opposite of food security. 16
Food insecurity is monitored using the Canadian Community Health Survey (CCHS) • Conducted annually by Statistics Canada to monitor the health of the population. • Each 2-year cycle comprises a population- representative survey of 130,000 individuals, 12 years of age and older. • Omits people living on reserves and in institutions, members of the Armed Forces, and people who are homeless. 17
Food insecurity is only mandatory content on alternate cycles of the Canadian Community Health Survey. CCHS cycle Food insecurity measurement? Missing Manitoba, Saskatchewan, New Brunswick, and 2005 Newfoundland and Labrador 2007-2008 National 2009-2010 Missing Prince Edward Island and New Brunswick 2011-2012 National Missing British Columbia, Manitoba, Newfoundland and 2013-2014 Labrador, and Yukon 18
Determining household food insecurity status from the 18-item Household Food Security Survey Module: Food secure Number of questions answered affirmatively? Food insecure 19
Household food insecurity status, as defined by Health Canada (2007): 10 item 8 item Status Interpretation adult scale child scale No or one indication of difficulty 0 or 1 item on either Food secure with income-related food access. scale 2 to 5 2 to 4 Moderate Compromise in quality and/or positive positive food insecurity quantity of food consumed. responses responses Food insecure Indication of reduced food 6 or more 5 or more Severe intake or disrupted eating positive positive food insecurity patterns. responses responses Source: Health Canada, 2007. Income-Related Household Food Insecurity in Canada. 20
Household food insecurity in Canada, 2011-12 Moderate food insecurity Severe food 5.8% insecurity 2.5% Food secure 91.7% 21
Household food insecurity in Canada, 2011-12 Moderate food insecurity Severe food 5.8% insecurity 4.1% of households 2.5% affirmed 1 or 2 items: marginal food insecurity Food secure 87.6% 22
What experiences of food insecurity do marginally food insecure households report? Analysis of responses of marginally food insecure in CCHS 2011-12: Proportion Question affirming Worried food would run out 45.5% Could not afford to eat balanced meals 34.2% Food bought just didn't last and no money to get more 13.1% Relied on a few kinds of low-cost food to feed children 10.7% Any other question 1.8% 23
Relationship between marginal food insecurity and household income: 10% 9% 8% 7% % households 6% classed as marginally 5% food insecure 4% 3% 2% 1% 0% Income adjusted for household size Source: Statistics Canada, Canadian Community Health Survey 2013-2014. 24
Renting dwelling Reliance on social assistance 90% 40% 80% 35% 70% 30% 60% 25% 50% 20% 40% 15% 30% 10% 20% 10% 5% 0% 0% Food secure Marginal food Moderate food Severe food Food secure Marginal food Moderate food Severe food insecurity insecurity insecurity insecurity insecurity insecurity Households with children under 18 led Aboriginal respondent by a female lone parent 60% 18% 16% 50% 14% 40% 12% 10% 30% 8% 20% 6% 4% 10% 2% 0% 0% Food secure Marginal food Moderate food Severe food Food secure Marginal food Moderate food Severe food insecurity insecurity insecurity insecurity insecurity insecurity 25
Average health care costs per person incurred over 12 months for Ontario Average health care costs per person incurred over 12 months for Ontario adults adults (18-64 years of age), by household food insecurity status: (18-64 years of age), by household food insecurity status: $3930 4000 3500 3000 $2806 Prescription drugs 2500 Home care services $2161 $ Same day surgery 2000 Inpatient costs $1608 Physician services 1500 Emergency Other 1000 500 0 secure marginally insecure moderately insecure severely insecure 26 (Tarasuk et al, Canadian Medical Association Journal , 2015)
An expanded definition of household food insecurity status: 10 item adult 8 item child Status Interpretation scale scale No report of income-related No items No items Food secure problems of food access. affirmed affirmed Some indication of worry or Marginal Affirmed no more than 1 an income-related barrier to food insecurity item on either scale adequate, secure food access. Compromise in quality and/or 2 to 4 Moderate quantity of food consumed by 2 to 5 positive positive food insecurity responses adults and/or children due to responses a lack of money for food. Disrupted eating patterns and 6 or more 5 or more Severe reduced food intake among positive positive food insecurity adults and/or children. responses responses 27 (Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2012 . 2014.)
THE MAGNITUDE OF THE PROBLEM 28
CCHS 2011-12: 333,500 severely food insecure households + 759,600 moderately food insecure households = 1,093,200 food insecure households + 536,200 marginally food insecure = 1,629,400 food insecure households 29
From 2007-08 to 2011-12, the problem has gotten worse. Statistically significant difference, p < 0.0001. 1800000 1,629,400 (12.4%) 1600000 1,401,800 (11.3%) 1400000 536200 Number of households 1200000 446000 1000000 800000 759600 626300 600000 400000 200000 329500 333500 0 2007-08 2011-12 severe moderate marginal 30
From 2007-08 to 2011-12, the problem has gotten worse. 1800000 Statistically significant difference, p < 0.0017. 1600000 1400000 Number of households 1200000 1,093,200 955,800 1000000 800000 759600 626300 600000 400000 200000 329500 333500 0 2007-08 2011-12 severe moderate 31
Household Food Insecurity in Canada, 2012 . 32
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