THUNDER BAY DISTRICT HEALTH UNITTHUNDER BAY DISTRICT HEALTH UNIT

Food Security and the Early YearsFood Security and the Early Years

Kim McGibbon, MScCH, RDPublic Health DietitianKim.mcgibbon@tbdhu.com

Best Start Conference October 19th, 2010

Kim McGibbon, MScCH, RDPublic Health DietitianKim.mcgibbon@tbdhu.com

Best Start Conference October 19th, 2010

Outline for WorkshopOutline for Workshop

• What is the impact of food insecurity

• Strategies – What are families doing, how can we help

• What programs and services offered & how to start them

• Resources

• What is the impact of food insecurity

• Strategies – What are families doing, how can we help

• What programs and services offered & how to start them

• Resources

What does the term “food security” mean to you?

What does the term “food security” mean to you?

“Food Security”“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.

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

CCHS:2004 Key FindingsCCHS:2004 Key Findings

• 90.8% of households were food secure

• 9.2% of households were moderately or severely food insecure (1.1 million

households)

• 5.2% of households with children were food insecure (700,000)

• 90.8% of households were food secure

• 9.2% of households were moderately or severely food insecure (1.1 million

households)

• 5.2% of households with children were food insecure (700,000)

Who are the food insecure? Who are the food insecure?

Those with the highest rates of poverty are most at risk:

• lone parents (female headed households)

• homeless people• Aboriginals

Those with the highest rates of poverty are most at risk:

• lone parents (female headed households)

• homeless people• Aboriginals

Aboriginal & Non-AboriginalAboriginal & Non-Aboriginal

02468

101214161820

Canada AboriginalHouseholds

Non-Aboriginal

Households

% ModeratelyFood Insecure

% SeverelyFood Insecure

02468

101214161820

Canada AboriginalHouseholds

Non-Aboriginal

Households

% ModeratelyFood Insecure

% SeverelyFood Insecure

Canadian Community Health Survey (CCHS) 2004: Income-Related Household Food Security in Canada

The likelihood of food insecurity

increases as the adequacy of income

declines.

The likelihood of food insecurity

increases as the adequacy of income

declines.

05

1015202530354045

% food insecure

lowest lowmiddle

middle uppermiddle

highest

INCOME ADEQUACY

05

1015202530354045

% food insecure

lowest lowmiddle

middle uppermiddle

highest

INCOME ADEQUACY(Ledrou & Gervais, Health Reports 2005)

Households whose major source of income is

social assistance are particularly vulnerable.

Households whose major source of income is

social assistance are particularly vulnerable.

Major source of income

Odds (95% CI) of reporting food insecurity

Odds (95% CI) of reporting compromises in food intake

Employment 1.0 1.0

Social assistance 3.1 (2.3 - 4.0) 3.4 (2.6 – 4.5)

EI, Worker’s Comp, CTB, support/alimony

1.7 (1.2 – 2.6) 1.8 (1.1 – 2.8)

Seniors’ benefits 0.9 (0.7 – 1.5) 1.0 (0.8 – 1.4)

Other 1.0 (0.7 – 1.5) 1.1 (0.7 – 1.6)

(Che & Chen, Health Reports, 2001)

Household food insecurity: a managed process:Household food insecurity: a managed process:

1. food anxiety

2. compromises in food quality

3. compromises in food quantity-> “hunger”

1. food anxiety

2. compromises in food quality

3. compromises in food quantity-> “hunger”

Food Insecurity Can Lead To…Food Insecurity Can Lead To…

• Poorer health status

• Decreased immunity

• Increased family stress, depression, and feelings of deprivation

• Increased absenteeism from work & school

• Decreased ability to concentrate learn & work

• Poorer health status

• Decreased immunity

• Increased family stress, depression, and feelings of deprivation

• Increased absenteeism from work & school

• Decreased ability to concentrate learn & work

Food Insecurity Can Lead To…Food Insecurity Can Lead To…

• Decreased intakes protein and energy

• Inadequate intakes of several nutrients

• • Behavioural and psychsocial dysfunction

• Cognitive developmental deficits

• Decreased intakes protein and energy

• Inadequate intakes of several nutrients

• • Behavioural and psychsocial dysfunction

• Cognitive developmental deficits

Insights from Canadian research:Insights from Canadian research:

• Dietary intakes worsen as food insecurity worsens

• Intakes of food insecure mothers consistently worse than children’s

• For children little indication of nutrient inadequacies

• Adolescents and adults noted nutrient inadequacies for Protein, Vitamin A, Thiamin, Riboflavin, Vitamin B6 & 12, folate, magnesium and phosphorus

• Dietary intakes worsen as food insecurity worsens

• Intakes of food insecure mothers consistently worse than children’s

• For children little indication of nutrient inadequacies

• Adolescents and adults noted nutrient inadequacies for Protein, Vitamin A, Thiamin, Riboflavin, Vitamin B6 & 12, folate, magnesium and phosphorus

Canadian IntakeCanadian Intake• Fewer servings vegetables and fruit

and milk products of 1-3 year old children in food insecure households

• Lack of food choice & monotony of diet; lack of control over food situation

• Higher energy density associated with HFISec for females 19-50

• Higher proportion energy from carbohydrates

• Less vegetables, fruit and milk products in many age categories

• Fewer servings vegetables and fruit and milk products of 1-3 year old children in food insecure households

• Lack of food choice & monotony of diet; lack of control over food situation

• Higher energy density associated with HFISec for females 19-50

• Higher proportion energy from carbohydrates

• Less vegetables, fruit and milk products in many age categories

Insights from Canadian research: cont’dInsights from Canadian research: cont’d

• Increased risk Type II diabetes• Obesity not consistently

associated with food insecurity – highest association among women in marginally food insecure

• Associated with depression in adults and children

• Increased risk Type II diabetes• Obesity not consistently

associated with food insecurity – highest association among women in marginally food insecure

• Associated with depression in adults and children

“We want to follow Canada’s Food Guide but it is impossible”

“Who in their right mind can run off and buy eggs and milk and cheese and all that stuff? I mean, those are the things that children are supposed to eat every day, but those are not the things that children eat if their families are on a fixed income because nobody can afford it.”

“We want to follow Canada’s Food Guide but it is impossible”

“Who in their right mind can run off and buy eggs and milk and cheese and all that stuff? I mean, those are the things that children are supposed to eat every day, but those are not the things that children eat if their families are on a fixed income because nobody can afford it.”

The Reality

PregnancyPregnancy• Several micronutrient intakes increase during

pregnancy (Vit. D, folic acid, iron)

• Effects of deficiency on child may be unreversible (i.e. NTD’s)

• Common concerns: miscarriage, impaired intrauterine growth, reduced birth weight

• Impaired status in utero may impact development of chronic diseases later in life

• Multimicronutrient supplements increase birth weight (more than Fe,FA alone)

• Several micronutrient intakes increase during pregnancy (Vit. D, folic acid, iron)

• Effects of deficiency on child may be unreversible (i.e. NTD’s)

• Common concerns: miscarriage, impaired intrauterine growth, reduced birth weight

• Impaired status in utero may impact development of chronic diseases later in life

• Multimicronutrient supplements increase birth weight (more than Fe,FA alone)

LactationLactation

Supplementation to under-nourished moms:

• Produce more milk• Mothers lose less weight• Extend period of exclusive

breastfeeding• Prevalence of iron deficiency in Can

women 19-50 >10% - linked to dec. BF continuation rates

Supplementation to under-nourished moms:

• Produce more milk• Mothers lose less weight• Extend period of exclusive

breastfeeding• Prevalence of iron deficiency in Can

women 19-50 >10% - linked to dec. BF continuation rates

Household income strategies

to avoid hunger:

Household income strategies

to avoid hunger:

• Increase the supply of money– odd jobs, giving up services such as

the phone, selling possessions, borrowing money, use coupons, return bottles

• Juggle the budget– delaying bill payments, purchasing

food on credit, borrow food, sending kids to relatives, food banks

• Increase the supply of money– odd jobs, giving up services such as

the phone, selling possessions, borrowing money, use coupons, return bottles

• Juggle the budget– delaying bill payments, purchasing

food on credit, borrow food, sending kids to relatives, food banks

Household food strategies

to avoid hunger:

Household food strategies

to avoid hunger:

• Comparison shopping, buy on sale

• Altering recipes to “stretch” the meal

• Serve low cost meals few ingredients

• Serve only food that the family likes

• Cut portion sizes

• Mothers go hungry first

• Comparison shopping, buy on sale

• Altering recipes to “stretch” the meal

• Serve low cost meals few ingredients

• Serve only food that the family likes

• Cut portion sizes

• Mothers go hungry first

Relationship between household food expenditure patterns and per capita income in Canada- based on data from the 1996 Family Food Expenditure Survey.

Per capita income ($)

Ave

rag

e w

ee

kly

qu

an

tity

pu

rch

ase

d (

kg)

0 20000 40000 60000 80000

02

46

81

0

Veg & FruitMilkOtherGrainMeat

Vegetables & fruit

Milk products

Meat, fish, poultry, etc

Grain products

Other foods

(Ricciuto, Tarasuk & Yatchew, Eur J Clin Nutr in press))

Assessing Strengths and NeedsAssessing Strengths and Needs

Look at the situation given. Using the Tool “Issues that influence food intake” assess strengths and challenges

Questions:1. What is making this person/family

food insecure?2. What strategies can be undertaken

to improve their situation?

Look at the situation given. Using the Tool “Issues that influence food intake” assess strengths and challenges

Questions:1. What is making this person/family

food insecure?2. What strategies can be undertaken

to improve their situation?

Community Food SecurityCommunity Food Security

• All community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes community self-reliance, social justice, and democratic decision-making.

Hamm and Bellows, 2002

• All community residents obtain a safe, culturally acceptable, nutritionally adequate diet through a sustainable food system that maximizes community self-reliance, social justice, and democratic decision-making.

Hamm and Bellows, 2002

Community Food SecurityCommunity Food Security• Community development strategy

• Encompass basic principles of anti-hunger with a broader scope– long-term, systematic and comprehensive

approaches to address FS for everyone

• Includes all food chain activities– natural resources & agriculture, processing

and distribution, nutrition & health to public policy

• Promotes sustainable agriculture

• Community development strategy

• Encompass basic principles of anti-hunger with a broader scope– long-term, systematic and comprehensive

approaches to address FS for everyone

• Includes all food chain activities– natural resources & agriculture, processing

and distribution, nutrition & health to public policy

• Promotes sustainable agriculture

Community Food Security ContinuumCommunity Food Security Continuum

Stage 1 Short-term Relief

Stage 2 Capacity Building

Stage 3 Redesign

Food BankSoup Kitchen

Community GardenCommunity KitchenFood Buying Club

Food PolicySocial Advocacy

Capacity Building Strategies

Capacity Building Strategies

Community Kitchens...Community Kitchens...

• are small groups

of people who get together to cook healthy, economical meals to take home to their families.

• are small groups

of people who get together to cook healthy, economical meals to take home to their families.

School Breakfast Programs...School Breakfast Programs...

make sure that every child starts the school day with a nutritious meal.

make sure that every child starts the school day with a nutritious meal.

Gleaning...Gleaning...

allows individuals and families to pick crops from farmer’s fields that would otherwise not be used or sold, at no cost to them.

allows individuals and families to pick crops from farmer’s fields that would otherwise not be used or sold, at no cost to them.

Good Food BoxGood Food Box

•The Good Food Box is a program for families and individuals who want to purchase high-quality, fresh, local produce at a lower price •Family box for $20 or an individual box for $12.

•Boxes are ordered and paid for by the first Thursday of each month.

•Food is packed and distributed from a main site to local host sites for pick up the second last Thursday of each month.

Community Gardens...Community Gardens...

allow people to grow their own fresh, healthy produce and reduce their food costs.

allow people to grow their own fresh, healthy produce and reduce their food costs.

ResourcesResources

www.nwofood.caBooks, Pamphlets and Videos • Community Kitchens and

Cooking On a Budget• School Meal & Snack Programs• How to set up Gleaning and

Good Food Box Programs• Community Gardens

www.nwofood.caBooks, Pamphlets and Videos • Community Kitchens and

Cooking On a Budget• School Meal & Snack Programs• How to set up Gleaning and

Good Food Box Programs• Community Gardens