Heart and Stroke Foundation of Canada Position Statement

Access to Affordable, Healthy and Nutritious Food (“Food Security”)

FACTS 

• It has been estimated that up to 80% of coronary heart disease and stroke can be prevented through lifestyle, including healthy eating.¹ Healthy eating includes five to ten servings of vegetables and fruit daily, whole grains and eating less saturated fat, trans fat, salt and refined carbohydrates.²  
• Healthy eating is important during pregnancy and contributes to healthy infant and child development and to maintaining muscle mass and strength in seniors.³ 
• Not all Canadians have equal access to the foods necessary to maintain a healthy diet. For example, some Canadians have financial or other barriers, such as remote geography, to accessing the foods they need to lead productive, healthy and active lives.⁴ 
• “Food Security” is defined as the situation when “all people at all times have the economic and physical access to sufficient, safe and nutritious food necessary to meet their dietary needs and food preferences for an active and healthy life”.⁵ A lack of food security (“food insecurity”) due to economic and geographic barriers is a significant determinant of health and an important heart health issue for some Canadians. 
• The 2004 Canadian Community Health Survey (CCHS) found that almost one in ten (9.2%) Canadian households (representing about 2.7 million individuals) were not able to afford the foods needed for a healthy, balanced diet at least once in the previous 12 months.⁶ 
• The CCHS data showed that several categories of low income households have higher rates of food insecurity than the general population. This includes households receiving social assistance, workers compensation or employment insurance benefits, off-reserve Aboriginal households (the survey did not include on-reserve First Nations households), single parent households, and households with one or more children.⁷ 
• A number of studies have shown that low income households do not have enough income to pay for the basic costs of living, including the cost of a nutritious food basket.⁴ Studies of low income households’ monthly incomes and expenses have shown that incomes often fall hundreds of dollars short of expenses^{.8 9} Since many monthly costs are fixed (e.g. housing, transportation) food purchases are often the budget items low income families need to cut back on.¹⁰ This problem becomes more pronounced when global food prices are high. 
• The relationship between socio-economic factors and food security is complex. However, evidence shows that income levels influence the kinds of food choices available to people^.11 As a result, low income Canadians face more restricted choices. 
• The 2004 CCHS found a clear relationship between income level and household food security, with the data showing an increase in food insecurity rates as income declines. The ratio of severe to moderate food insecurity is also higher at the lowest income levels.¹²    
• Women are especially vulnerable, as they make up a disproportionate share of both the low income population and lone parent families. In 2003, 31% of unattached women aged 16 or over were classified as low income. 38% of all families headed by lone-parent mothers had incomes that fell below the after-tax Low Income Cutoff (LICO). This was the case for only 13% of male lone-parent families.¹³
• Children are particularly affected by food insecurity. For example, 700,000 Canadian children (12.5% of the total number of children in Canada) were living in food insecure households in 2006, and children accounted for 41% of the more than 750,000 people in Canada who were assisted by food banks in that year.^{14 15 16} 
• Aboriginal communities and other Canadians in remote locations face very high rates of food insecurity due to the high price, low quality and limited availability of fresh, healthy and nutritious foods.¹⁷ A 2004 survey found that food insecurity rates ranged from 40% to 83% in isolated Aboriginal communities.^{18 19 20 21} 
• Provincial governments regulate the price of alcohol across provinces, but healthy foods such as milk, vegetables, fruits and whole grains are subject to significant regional variation within provinces, often being much more expensive in remote regions. 
• Emerging evidence points to other factors that limit the affordability and availability of healthy foods.  For example, agricultural policies can influence the price of sugars, grains, vegetables and fruit, sometimes creating a situation where high calorie and less nutritious foods are cheaper to buy than healthier foods such as fresh vegetables and fruit.²²  In addition, poor availability of food outlets offering fresh, healthy, and affordable foods in some neighbourhoods and communities, and barriers to the local production and sale of affordable healthy and nutritious foods can influence what Canadians eat.^{23 24 25} 

Recommendations

The Heart and Stroke Foundation of Canada recommends that:

Canadians

1. Support and encourage government policies and programs that will reduce poverty and address other barriers to healthy eating.
2. Support sustainable community programs (such as community kitchens and gardens) that promote the availability and affordability of fresh, locally or regionally grown foods.

Governments

1. Set measurable targets for reducing poverty rates in Canada. For example, the United Kingdom set itself a goal of eliminating child poverty by 2020, with interim targets of reducing child poverty by one quarter by 2004, and one half by 2010.²⁶
2. Coordinate inter-departmental and federal/provincial/territorial policies to reduce poverty, for example:  
   1. Increase the Canada Child Tax Benefit to at least $5,000 per year. 
   2. Eliminate current provincial government claw-backs of the National Child Benefit. 
   3. Adjust provincial income assistance and minimum wage rates to enable households to afford the basic costs of living and the ability to eat a healthy, balanced diet as represented by the National Nutritious Food Basket.²⁷ 
   4. Reform Canada's Employment Insurance program to increase access and payment levels.  

3. Expand and enhance the federal Food Mail program to ensure affordable pricing of nutritious foods across all regions of Canada (especially remote and northern locations).
4. Establish regular, coordinated surveillance of food insecurity with consistent measures to allow monitoring of trends.  
5. Fund intervention and evaluation research to study the impact of policies and programs aimed at reducing poverty, food insecurity, and other barriers to accessing healthy foods.
6. Fund research to improve understanding of agricultural subsidies and pricing policies on costs and affordability of processed or less healthy versus healthy, fresh foods.

Researchers

1. Conduct population health intervention research to assess the impact of policies and programs aimed at:

              i. Reducing poverty

             ii. Enhancing food security

            iii. Improving access to healthy foods

           iv. Improving the health of marginalized and vulnerable populations

2. Examine the impact of community level strategies for increasing access to healthy local foods (e.g., community kitchens, gardens, markets, food policy councils and charters).
3. Conduct research on the relationship between income related food insecurity and geographic and social barriers to healthy eating, such as living in remote communities, gaps in knowledge about nutrition, proximity to grocery stores, food pricing and other issues.  

The information contained in this position statement is current as of:
February 2009

BACKGROUND INFORMATION

Food insecurity is associated with increased rates of heart disease and other illnesses^{28 29} and has been linked to health problems in Aboriginal populations^{30 31 32 33} as well as children in low income families.³⁴

The 2004 Canadian Community Health Survey (CCHS) found that low income Canadian households are more likely to be food insecure than other Canadians. For example, 59.7% of Canadian households receiving social assistance, 33.3% of off-reserve Aboriginal households, and 22.5% of single parent households (24.9% of female single parent households) were considered to be food insecure. Household types with higher rates of food insecurity also included households receiving workers compensation or employment insurance and households with children.³⁵

In Canada, poverty is widely viewed as the root cause of most individual and household level food insecurity. As a result, poverty reduction is a key strategy for addressing food insecurity. According to Statistics Canada about 10.2% of Canadians (3.4 million people) were considered to be in the category of “low income” in 2005. Some 778,000 children (11.7% of the total number of children in Canada) were living in low income families.³⁶ Despite these numbers, Canada does not have a nationally coordinated poverty reduction strategy.

It is often difficult and expensive to access healthy food like fresh fruits and vegetables, whole grains and foods low in saturated fats, trans fats, salt and refined carbohydrates in remote communities, including remote Aboriginal communities.³⁷ These kinds of healthy foods tend to cost more than nutrient poor, energy dense foods. Community level factors such as the location of and transportation to affordable food outlets and the viability of local agriculture have also been identified as potential facilitators and barriers to accessing healthy foods.³⁸

Efforts to increase healthy eating in the population should address the determinants of food insecurity. Federal and provincial governments should include poverty reduction measures as core strategies for increasing healthy eating and wellness in the Canadian population.

Program and policy areas that have been identified as needing change to address poverty and its impact on food security include: minimum wage and income assistance rates, employment insurance, affordable child care and federal child tax benefits, affordable housing and taxation policies.

Food banks are intended as an emergency response to hunger and food insecurity. However, they are not an adequate response to food insecurity because they do not generally provide a nutritious diet (due to the amount and type of food donated).³⁹ Also, they usually limit the number of times people can visit to once per month, and provide enough food to last only between 1 and 5 days.⁴⁰

Action is required to ensure healthy food is accessible in all communities across Canada and to and to address food production, pricing and distribution issues that limit access to fresh and nutritious foods in Canadian communities.

REFERENCES

1. World Health Organization. Facing the Facts: The Impact of Chronic Disease in Canada. 2005. 12 May 2008 <http://www.who.int/chp/chronic_disease_report/media/CANADA.pdf>.
2. British Columbia Provincial Health Officer. Food, Health and Well-Being in British Columbia. Provincial Health Officer’s Annual Report, 2005. 12 May 2008 <http://www.health.gov.bc.ca/pho/annual.html>.
3. Che J and Chen J. Food insecurity in Canadian Households. Health Reports 2001;12(4):11-22.
4. British Columbia Provincial Health Officer.
5. Food and Agriculture Organization of the United Nations. Rome Declaration on World Food Security and World Food Summit Plan of Action. 1996. 12 May 2008 <http://www.fao.org/docrep/003/w3613e/w3613e00.htm>.
6. Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004): Income-Related Food Security in Canada. 2007. 12 May 2008 < http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/income_food_sec-sec_alim_e.html>.
7. Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004).
8. Nova Scotia Participatory Food Security Projects. “Working Together to Build Food Security in Nova Scotia: Participatory Food Costing 2004/2005”. March 2007. 12 May 2008 <http://www.gov.ns.ca/HPP/repPub/2004-05FoodCosting.pdf>.
9. Kerstetter S and Goldberg M. “A Review of Policy Options for Increasing Food Security and Income Security in British Columbia: A discussion Paper”. British Columbia Provincial Health Services Authority. September 2007. 12 May 2008 <http://www.phsa.ca/NR/rdonlyres/76D687CF-6596-46FE-AA9A-A536D61FB038/24932/PHSAreportfoodinsecurityfinal.pdf>.
10. Power E. Individual and Household Food Insecurity in Canada: Position of Dietitians of Canada. 12 May 2008 <http://www.dietitians.ca>.
11. Beydoun MA and Wang Y. How do socio-economic status, perceived economic barriers and nutritional benefits affect quality of dietary intake among US adults? European Journal of Clinical Nutrition 2008;63:303-13. Advance Online Publication March 7, 2007. 12 May 2008 <http://www.nature.com/ejcn/journal/v62/n3/abs/1602700a.html>.
12. Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004).
13. Statistics Canada, Women in Canada The Daily, Tuesday March 7, 2006. 12 May 2008 <http://www.statcan.ca/Daily/English/060307/d060307a.htm>.
14. Health Canada. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004).
15. Canadian Association of Food Banks. HungerCount 2006. 12 May 2008 <http://www.cafb-acba.ca/documents/HungerCount_2006.pdf>.
16. Statistics Canada. 2006 Census. Portrait of the Canadian Population in 2006, by Age and Sex: National Portrait. 12 May 2008 <http://www12.statcan.ca/english/census06/analysis/agesex/NatlPortrait1.cfm>.
17. Power E. Individual and Household Food Insecurity in Canada: Position of Dietitians of Canada.
18. Indian Affairs and Northern Development. Nutrition and food security in Fort Severn, Ontario: Baseline survey for the food mail pilot project. Prepared by Lawn J, Harvey D. Ottawa: Indian Affairs and Northern Development;2004.
19. Indian Affairs and Northern Development. Nutrition and food security in Kugaaruk, Nunavut: Baseline survey for the food mail pilot project. Prepared by Lawn J, Harvey D. Ottawa: Indian Affairs and Northern Development; 2004.
20. Indian Affairs and Northern Development. Nutrition and food security in Kangi: Baseline survey for the food mail pilot project. Prepared by Lawn J, Harvey D. Ottawa: Indian Affairs and Northern Development; 2004.
21. Health Canada. Diabetes among Aboriginal (First Nations, Inuit, and Metis) people in Canada: The evidence. Ottawa: First Nations and Inuit Health Branch, Health Canada; 2001.
22. World Health Organization Regional Office for Europe. Health Trade and Agricultural Sectors must work together against obesity. 12 May 2008 <http://www.euro.who.int/mediacentre/PR/2006/20060516_1>.
23. Slater J. Community Food Security. Position of Dietitians of Canada. 12 May 2008 <http://www.dietitians.ca/news/highlights_positions.asp>.
24. Bertrand L, Therien F and Cloutier MS. Measuring and Mapping Disparities in Access to Fresh Fruits and Vegetables in Montreal. Canadian Journal of Public Health 2008;99(1):6-11.
25. Veugelers PJ, Sithole F, Zhang S, Muhajarine N. Neighborhood characteristics in relation to diet, physical activity and overweight of Canadian children.  International Journal of Pediatric Obesity 2008;3(3):152-9.
26. Minoff E. The UK Commitment: Ending Child Poverty by 2020. Centre for Law and Social Policy 2006. 12 May 2008 < http://www.clasp.org/publications/uk_childpoverty.pdf>.
27. Lawn J. National Nutritious Food Basket, 1998. Health Canada. This document was prepared under contract by the Nutrition and Healthy Eating Unit of the Health Promotion and Programs Branch of Health Canada.
28. Che J and Chen J. Food insecurity in Canadian Households.
29. British Columbia Provincial Health Officer. Food, Health and Well-Being in British Columbia.
30. Indian Affairs and Northern Development. Nutrition and food security in Fort Severn
31. Indian Affairs and Northern Development. Nutrition and food security in Kugaaruk
32. Indian Affairs and Northern Development. Nutrition and food security in Kangi
33. Health Canada. Diabetes among Aboriginal (First Nations, Inuit, and Metis) people in Canada.
34. Dubois L, Farmer A, Girard M, and Porcherie M. Family food insufficiency is related to overweight among preschoolers. Social Science & Medicine 2006;63(6):1503-16.
35. Health Canada, Canadian Community Health Survey 2004
36. Statistics Canada. “Income in Canada in 2005.” 12 May 2008 <http://www.statcan.ca/english/freepub/75-202-XIE/2005000/bfront1.htm>.
37. Power E. Individual and Household Food Insecurity in Canada: Position of Dietitians of Canada.
38. Slater J. Community Food Security. Position of Dietitians of Canada.
39. British Columbia Provincial Health Officer. Food, Health and Well-Being in British Columbia.
40. Canadian Association of Food Banks. “HungerCount 2006”. 12 May 2008 <http://www.cafb-acba.ca/documents/HungerCount_2006.pdf>.

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Last updated February 2009.