Struggling to put food on the table

Over 1 in 10 households in BC are food insecure, and approximately 1 in 6 children under the age of 18 lives in a food-insecure household.[1]

Food insecurity is not caused by a lack of budgeting, food skills, or cooking knowledge.[2] Simply put, food insecurity is “the inadequate or insecure access to food due to financial constraints.”[3]

The 2016 Priority Health Equity Indicators for British Columbia: Household Food Insecurity Indicator Report showed that the majority of food-insecure households in BC are employed (65%), and a minority (15%) are receiving social assistance.[1] This means that households are worrying about running out of food, making changes to the quality and quantity of foods they eat, or, in the most extreme cases, going without food.[1] Research shows that families may use strategies such as delaying payments for bills or rent or terminating services to make income available for buying food.[4]

Adults who are food insecure are at an increased risk of chronic conditions including diabetes, hypertension, and heart disease; have more difficulty managing their diseases; and face an increased likelihood of depression, distress, and social isolation.[1,5] Among children and youth, food insecurity is associated with micronutrient deficiencies as well as increased risk of chronic conditions such as asthma and depression.[1]

What can physicians do?
Physicians may be inclined to refer patients to food banks, community kitchens, or other charitable food sources; however, a significant portion of the food-insecure population does not use these programs because of stigma, poor accessibility, and other barriers.[4,6,7] 

Unfortunately, food programs are short-term solutions. Food responses cannot significantly impact food insecurity as they cannot address the issue of poverty.[4,6,7]

Physicians can support their patients to overcome barriers, and that can start with screening. The Poverty Intervention Tool developed by the Kootenay Boundary Division of Family Practice is designed to actively support patients who struggle with socioeconomic challenges and to connect patients with supports and services.[8] It outlines three key steps for use:
•    Integrating poverty in patient screening by asking the question “Do you ever have difficulty making ends meet at the end of the month?”
•    Including poverty as a risk factor, since “the health risks associated with poverty are equivalent to hypertension, high cholesterol and smoking.”
•    Asking patients a series of eight questions to assess access to both care and a number of financial resources, such as the child tax benefit, First Nations health benefits, disability assistance, and others.[8]

Physicians may also want to access the information and referral services of bc211, a not-for-profit organization that provides information on community, government, and social services available to individuals and families in BC (www.bc211.ca).

As trusted leaders, physicians are well placed to raise awareness about the issue of food insecurity and to advocate for policy interventions at the provincial and federal level that improve the income of vulnerable individuals and families. Food insecurity rose significantly in BC between 2005 and 2012,[9] and to prevent it from increasing further, action is needed now.
—Tania Morrison, MHSc, RD
Population and Public Health, BC Centre for Disease Control, PHSA
—Melanie Kurrein, MA, RD
Population and Public Health, BC Centre for Disease Control, PHSA

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This article is the opinion of the Nutrition Committee, a subcommittee of Doctors of BC’s Council on Health Promotion, and is not necessarily the opinion of Doctors of BC. This article has not been peer reviewed by the BCMJ Editorial Board.

References

1.    Li N, Dachner N, Tarasuk V, et al. Priority health equity indicators for British Columbia: Household food insecurity indicator report. Toronto, ON: Research to identify policy options to reduce food insecurity (PROOF); 2016. http://proof.utoronto.ca/wp-content/uploads/2016/08/1186-PHS-Priority-he....
2.    PROOF: Policy Options to Reduce Food Insecurity. Food procurement, food skills and food insecurity [fact sheet]. Accessed 15 April 2017. http://proof.utoronto.ca/wp-content/uploads/2017/03/food-procurement-foo....
3.    Health Canada. Household food insecurity in select provinces and the territories in 2009-2010. Last modified 25 July 2012. www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/insecurit/prov_ter-eng.php.
4.    Kirkpatrick SI, Tarasuk V. Food insecurity and participation in community food programs among low-income Toronto families. Can J Public Health 2009:100;135-139.
5.    Vozoris NT, Tarasuk VS. Household food insufficiency is associated with poorer health. J Nutr 2003;133:120-126.
6.    Loopstra R, Tarasuk V. Food bank usage is a poor indicator of food insecurity: Insights from Canada. Soc Policy Soc 2015;14:443-455.
7.    HungerCount 2014. Toronto, ON: Food Banks Canada; 2014. www.foodbankscanada.ca/getmedia/d8b36130-cc83-46ba-8183-d33d484c7591/Hun....
8.    Divisions of Family Practice. Poverty Intervention Tool. Accessed 20 April 2017. www.divisionsbc.ca/CMSMedia/WebPageRevisions/PageRev-10164/BC-Poverty-20....
9.    Li N, Dachner N, Tarasuk V. (2016). The impact of changes in social policies on household food insecurity in British Columbia, 2005-2012. Prev Med 2016:93:151-158.