Abstract
BackgroundHousehold food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households’ vulnerability to food insecurity is limited.MethodsData from the 2011–12 Canadian Community Health Survey were used to determine predictors of household food insecurity among a nationally-representative sample of 120,909 households. Household food insecurity over the past 12 months was assessed using the 18-item Household Food Security Survey Module. Households were classified as food secure or marginally, moderately, or severely food insecure based on the number of affirmative responses. Multivariable binary and multinomial logistic regression analyses were used to determine geographic and socio-demographic predictors of presence and severity of household food insecurity.ResultsThe prevalence of household food insecurity ranged from 11.8% in Ontario to 41.0% in Nunavut. After adjusting for socio-demographic factors, households’ odds of food insecurity were lower in Quebec and higher in the Maritimes, territories, and Alberta, compared to Ontario. The adjusted odds of food insecurity were also higher among households reliant on social assistance, Employment Insurance or workers’ compensation, those without a university degree, those with children under 18, unattached individuals, renters, and those with an Aboriginal respondent. Higher income, immigration, and reliance on seniors’ income sources were protective against food insecurity. Living in Nunavut and relying on social assistance were the strongest predictors of severe food insecurity, but severity was also associated with income, education, household composition, Aboriginal status, immigration status, and place of residence. The relation between income and food insecurity status was graded, with every $1000 increase in income associated with 2% lower odds of marginal food insecurity, 4% lower odds of moderate food insecurity, and 5% lower odds of severe food insecurity.ConclusionsThe probability of household food insecurity in Canada and the severity of the experience depends on a household’s province or territory of residence, income, main source of income, housing tenure, education, Aboriginal status, and household structure. Our findings highlight the intersection of household food insecurity with public policy decisions in Canada and the disproportionate burden of food insecurity among Indigenous peoples.
Highlights
Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households’ vulnerability to food insecurity is limited
While household food insecurity clearly reflects material deprivation, the problem is important in its own right because food insecurity has adverse effects on health that are independent of other measures of low socioeconomic status
Because food insecurity is assessed at the household level, we focused on variables measured at this level: before-tax household income, main source of income, household structure, highest level of education in the household, home ownership, urban versus rural residence, and province or territory of residence
Summary
Household food insecurity is a potent social determinant of health and health care costs in Canada, but understanding of the social and economic conditions that underlie households’ vulnerability to food insecurity is limited. In Canada, demands for charitable food assistance began to escalate in the 1980s [10], and population-level assessment of food insecurity commenced in the 1990s [11], with systematic measurement introduced in 2004 [12]. In Canada, household food insecurity is associated with heightened nutritional vulnerability [16], increased risk of numerous physical and mental health problems [17,18,19,20,21,22,23,24,25], higher mortality rates [26], and higher health care costs [16, 27], independent of income, education, and other social determinants of health. Consistent with evidence from the U.S [28,29,30,31,32], the relationship between food insecurity and health in Canada is graded, with more severe food insecurity associated with greater likelihood of negative health outcomes [20, 22, 25, 26] and higher health care costs [16]
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