1. THUNDER BAY DISTRICT HEALTH UNIT Food Security and the Early Years Kim McGibbon, MScCH, RD Public Health Dietitian Kim.mcgibbon@tbdhu.com Best Start Conference October 19 th, 2010 Kim McGibbon, MScCH, RD Public Health Dietitian Kim.mcgibbon@tbdhu.com Best Start Conference October 19 th, 2010

2. Outline 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

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

4. “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

5. CCHS: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)

6. 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

7. Aboriginal & Non-Aboriginal Canadian Community Health Survey (CCHS) 2004: Income-Related Household Food Security in Canada

8. The likelihood of food insecurity increases as the adequacy of income declines. (Ledrou & Gervais, Health Reports 2005)

9. 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 Employment1.0 Social assistance3.1 (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’ benefits0.9 (0.7 – 1.5)1.0 (0.8 – 1.4) Other1.0 (0.7 – 1.5)1.1 (0.7 – 1.6) (Che & Chen, Health Reports, 2001)

10. 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”

11. 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

12. 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

13. 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

14. Canadian 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

15. Insights 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

16. “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

17. Pregnancy 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)

18. Lactation 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

19. 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

20. 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

21. Relationship between household food expenditure patterns and per capita income in Canada - based on data from the 1996 Family Food Expenditure Survey. Vegetables & fruit Milk products Meat, fish, poultry, etc Grain products Other foods (Ricciuto, Tarasuk & Yatchew, Eur J Clin Nutr in press))

22. Assessing 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?

23. Community 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

24. Community 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

25. Community Food Security Continuum Stage 1 Short-term Relief Stage 2 Capacity Building Stage 3 Redesign Food Bank Soup Kitchen Community Garden Community Kitchen Food Buying Club Food Policy Social Advocacy

26. Capacity Building Strategies

27. 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.

28. School Breakfast Programs... make sure that every child starts the school day with a nutritious meal.

29. 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.

30. Good 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.

31. Community Gardens...

32. Resources www.nwofood.ca Books, 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.ca Books, 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