Food Insecurity Archives - Ontario Dietitians in Public Health

This document provides background information on Early Childhood Food Insecurity and alPHa Resolution A24-05

Prepared by Ontario Dietitians in Public Health

We acknowledge that this document refers to breastfeeding. Breastfeeding is traditionally understood to involve an individual of the female sex and gender identity who also identifies as a woman and mother. However, it is important to recognize that there are individuals in a parenting and human milk feeding relationship with a child who may not self-identify as such and who may prefer to use the term “chestfeeding” rather than breastfeeding.

Nutrition is fundamental for growth and development in the early years of life (1). Early childhood malnutrition presents a considerable burden to the health care system in Ontario. The long-term effects of malnutrition during early childhood include increased risk of hypertension, dyslipidemia, insulin resistance in adulthood, poor school achievement due to impaired cognitive development and increased risk of mental illness (2). These conditions cost millions of dollars in health care expenditures.

Food insecurity, inadequate or insecure access to food due to household financial constraints, continues to be a serious and pervasive public health problem. While the prevalence of infant-specific food insecurity has not been formally investigated, as no provincial surveillance system exists, it is likely significant considering that nearly 1 in 4 children under the age of six live in a household experiencing food insecurity (3).

In the last year, Statistics Canada data demonstrated that the price of food has increased by 10.6%, rising at a rate not seen since the early 1980s (4). During the same time, the price of infant formula increased 35.5% in Ontario (5). Exclusive breastfeeding is recommended for up to two years and beyond to support healthy growth and development (6), yet many families choose to offer infant formula instead of breastfeeding for a variety of reasons. Women who experience food insecurity tend to stop exclusive breastfeeding sooner than those who are food secure and they tend to struggle more often to maintain an adequate supply of breastmilk (7,8). Medical conditions such as food allergies are another reason one may choose to offer infant formula. For those with a medical diagnosis* requiring the strict avoidance of standard soy and milk proteins, there is no substitute for breastmilk other than specialized infant formula. It is estimated that 5,125 infants and children 0-24 months of age in Ontario have a medical diagnosis requiring strict avoidance of standard soy and milk proteins and must have specialized infant formula to meet their nutrient needs (9). When household food insecurity results in unreliable access to breast milk or formula, both infant health and parental mental health are threatened which can have significant implications for our healthcare system.

*Medical diagnosis can include an IgE mediated food allergy and/or a non-IgE mediated food allergy, such as food protein-induced enterocolitis syndrome (FPIES), food protein-induced enteropathy (FPE), allergic proctocolitis (AP), eosinophilic esophagitis (EoE) and several others. Due to the variability in clinical presentation and lack of validated diagnostic tests, a diagnosis relies on a detailed medical history, physical examination, and a trial elimination of the suspected food allergen.

Provincial interventions that reduce the prevalence of food insecurity, optimize breastfeeding, and improve access to infant formula, including expansion of the Ontario Drug and Benefit program, must be actioned.

References

Britto, P. R., Lye, S. J., Proulx, K., Yousafzai, A. K., Matthews, S. G., Vaivada, T., Perez- Escamilla, R., Rao, N., Ip, P., Fernald, L. C. H., MacMillan, H., Hanson, M., Wachs, T. D., Yao, H., Yoshikawa, H., Cerezo, A., Leckman, J. F., & Bhutta, Z. A. (2017). Nurturing care: promoting early childhood development. The Lancet, 389(10064), 91–102. https://doi.org/10.1016/s0140-6736(16)31390-3
Martins, V. J. B., Toledo Florêncio, T. M. M., Grillo, L. P., Do Carmo P. Franco, M., Martins, P. A., Clemente, A. P. G., Santos, C. D. L., Vieira, M. de F. A., & Sawaya, A. L. (2011). Long-Lasting Effects of Undernutrition. International Journal of Environmental Research and Public Health, 8(6), 1817–1846. https://doi.org/10.3390/ijerph8061817
Li T, Fafard St-Germain AA, Tarasuk V. (2023). Household food insecurity in Canada, 2022. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved from https://proof.utoronto.ca/
Statistics Canada. Consumer Price Index, February 2023. Retrieved 13 April 2023 from https://www150.statcan.gc.ca/n1/daily-quotidien/230321/dq230321a-eng.pdf.
Statistics Canada. Monthly Average Retail Prices for Selected Products. Retrieved March 19 2024 from Monthly average retail prices for selected products (statcan.gc.ca)
Health Canada, Canadian Paediatric Society, Dietitians of Canada, & Breastfeeding Committee for Canada. (2014). Nutrition for healthy term infants: Recommendations from six to 24 months. Canadian Journal of Dietetic Practice and Research, 75(2), 107.
Orr, S. K., Dachner, N., Frank, L., & Tarasuk, V. (2018). Relation between household food insecurity and breastfeeding in Canada. Canadian Medical Association Journal, 190(11), E312–E319. https://doi.org/10.1503/cmaj.170880
Frank, L. (2018). Finding formula: Community-based organizational responses to infant formula needs due to household food insecurity. Canadian Food Studies / La Revue Canadienne Des Études Sur L’alimentation, 5(1), 90. https://doi.org/10.15353/cfs- rcea.v5i1.230
Ontario Dietitians in Public Health and Food Allergy Canada. (2023). Call to Action: ODB Program Amendments to Support Infants and Children with a Medical Diagnosis* Requiring Strict Avoidance of Standard Soy and Milk Proteins. Retrieved from www.odph.ca

Association of Local Public Health Agencies (alPHa) Resolution A24-05, June 2024

TITLE: Early Childhood Food Insecurity: An Emerging Public Health Problem Requiring Urgent Action

SPONSOR: Ontario Dietitians in Public Health

WHEREAS
Provincial action is urgently needed to protect young children 0-24 months of age from the harmful effects of household food insecurity; and

WHEREAS
alPHa’s advocacy efforts have long underscored the need for income-based solutions to food insecurity and have previously resolved on the following areas: A15-04 (Basic Income Guarantee), A18-02 (Minimum Wage that is a Living Wage), A18-4 (Extending the Ontario Pregnancy and Breastfeeding Nutritional Allowance to 24 Months), A18-05 (Adequate Nutrition for Ontario Works and Ontario Disability Support Program Participants and Low Wage Earners), A23-05 (Monitoring Food Affordability); and

WHEREAS
food insecurity is a potent social determinant of health, and infants and young children are particularly susceptible to adverse effects of household food insecurity, including associated parental stress, lower breastfeeding rates, and financial barriers to accessing adequate infant formula, when needed; and

WHEREAS
when food insecurity results in early childhood malnutrition, infants and young children may experience growth faltering, compromised health, and cognitive impairments which may hinder their lifelong potential and result in considerable burden for the provincial health care system; and

WHEREAS
food prices including the price of infant formula have increased over the past year; and

WHEREAS
the Ontario Dietitians in Public Health and Food Allergy Canada has called on the Provincial government to amend the Ontario Drug Benefit program to support infants and children with a medical diagnosis*requiring strict avoidance of standard soy and milk proteins; and

WHEREAS
the Windsor-Essex County Board of Health passed the resolution Food Insecurity Compromises Infant Health in March 2024 in response to a notable local increase in infant food insecurity

NOW THEREFORE BE IT RESOLVED
that the Association of Local Public Health Agencies call on the Provincial government to optimize early growth and development among families most impacted by food insecurity and health inequities, by:

Increasing the Pregnancy and Breastfeeding Nutritional Allowance and the Special Diet Allowance to ensure families reliant on Ontario Works or the Ontario Disability Support Program can afford the products they need to adequately nourish their infants.
Expanding the Ontario Drug Benefit include specialized infant formulas for families whose children (0-24 months) have a medical diagnosis* requiring strict avoidance of standard soy and milk proteins.

AND FURTHER THAT
alPHa continues to advocate for income-related policies to reduce household food insecurity, especially for households with children where prevalence of food insecurity is highest.

Dr. Kwame McKenzie Chief Executive Officer Wellesley Institute

Via email: kwame@wellesleyinstitute.com

May 13, 2024

Dear Dr. McKenzie,

Ontario Dietitians in Public Health (ODPH), the official voice of Registered Dietitians working in the Ontario public health system, is writing to offer feedback on the Wellesley Institute’s policy brief, Time to regulate food prices like a utility. ODPH provides leadership and expertise in public health nutrition practice, including food insecurity, family and child health, school health, and food systems.

ODPH firmly agrees that access to affordable, nutritious food is a health equity issue that requires urgent action, and that policymakers must ensure nutritious food is affordable for all Canadians. However, we disagree that regulation of the cost of foods included in the National Nutritious Food Basket (NNFB) will lead to food affordability for all Canadians who experience food insecurity. This approach is not supported by existing evidence. Moreover, it diverts attention from policy interventions that ensure wages and income supports are sufficient to meet basic needs of Canadians.

As presented in our Position Statement and Recommendations on Responses to Food Insecurity, policy interventions that improve the financial circumstances of vulnerable households are fundamental to effectively address food insecurity. Although the name of the problem implies it, food insecurity is not strictly indicative of food deprivation but rather a symptom of overall financial hardship and pervasive material deprivation.

Households struggling to afford food also struggle to afford other costs of living such as housing, personal care, clothing and transportation.

The policy brief aptly asserts that food and nutrition can be considered optional while other necessities are not − this is precisely why addressing income inadequacy is essential to reducing food insecurity. In other words, the way to address food insecurity is to ensure adequate income for inelastic costs of living. The elasticity of food expenditures means that financial hardships can be detected more sensitively through measurement of food insecurity – if a household is compromising its food spending, they are struggling financially in many ways.

The fact that Statistics Canada has reported 78% of families experiencing food insecurity had incomes above the poverty line does not mean food insecurity is breaking away from poverty, but rather it underscores a problem with relying solely on Canada’s official poverty line, the Market Basket Measure (MBM), to understand Canadians’ financial hardships and inform social policy. As an experience-based measure of material deprivation, household food insecurity captures financial hardship in a way that income-based measures of poverty do not, accounting for the security, stability, and sufficiency of income.

Since 2008, Ontario public health units (PHUs) have been mandated by the Ministry of Health to monitor food affordability. This is achieved by comparing sample single- person and family household income estimates to local rental housing rates combined with the local cost of the Nutritious Food Basket. Food affordability reports by Ontario PHUs (see examples from Huron-Perth, Thunder Bay, Ottawa) and similar reports from other jurisdictions such as British Columbia consistently and repeatedly illustrate that households with low incomes (e.g., minimum wage employment and social assistance) cannot afford the basic costs of living.

The situation is most severe for social assistance recipients where monthly benefits are woefully inadequate. The inadequacy of Ontario Works rates is particularly glaring for single people as demonstrated by the following 2023 food affordability data from selected PHUs.

a includes Basic Allowance ($343) + Maximum Shelter Allowance ($390)

b includes GST/HST tax credit ($26), Ontario Trillium Benefit ($75 or $89 in northern regions), and Climate Action Incentive Payment ($31 or $34 in non-CMA regions)

c cost of the Ontario Nutritious Food Basket, collected by Public Health Unit in May/June 2023

d cost of market rental rates obtained from CMHC data tables (October 2022) or from municipal housing authorities; may or may not include utilities

Ontario Disability Support Program recipients are slightly better off, but in most PHU jurisdictions ODSP rates are still inadequate for just rent and food. In the second half of 2023, ODSP rates increased by 5% and indexing to inflation began. These changes will be reflected in our 2024 analyses.

ODPH’s well-established experience monitoring food affordability demonstrates that regulating the cost of the 61 Nutritious Food Basket items would do little to mitigate food insecurity for individuals and families when income is far below what is needed to pay for market rate rental housing and food costs. Policy interventions shown to reduce food insecurity include income support programs that align with the costs of living and are indexed to inflation (e.g., social assistance and seniors public pensions), adequate minimum wages (e.g., living wages), as well as the prospect of a guaranteed liveable basic income.

ODPH’s recommendations for reducing food insecurity are consistent with those of Dietitians of Canada and are well-supported by PROOF’s policy evaluation research. It is essential that these are the focal point for advocacy to reduce food insecurity.

Thank you for taking the time to review this letter. ODPH would welcome an opportunity to further discuss our position with the Wellesley Institute.

Sincerely,

Laura Abbasi, RD
Co-Chair ODPH Executive

Erin Reyce, RD
Co-Chair ODPH Food Insecurity Workgroup

Mental Health Commission of Canada

350 Albert Street, Suite 1210 Ottawa ON K1R 1A4

Via email: mhccinfo@mentalhealthcommission.ca

April 10, 2024

Re: Feedback on Mental Health and the High Cost of Living policy brief

Dear Katerina Kalenteridis, Nimesha Elanko, Catherine Willinsky, Mary Bartram, and expert reviewers

We are writing to you on behalf of PROOF and Ontario Dietitians in Public Health (ODPH) about your recent policy brief, Mental Health and the High Cost of Living, and our concerns with the presentation of food insecurity as a problem of inadequate food supply, solved through community-level responses.

PROOF is a research program at the University of Toronto studying the health implications of household food insecurity and effective policy interventions to address this serious public health problem. ODPH, the official voice of Registered Dietitians working in the Ontario public health system, provides leadership and expertise in public health nutrition practice, including food insecurity, family and child health, school health, and food systems.

We appreciate that your policy brief prominently featured the relationship between food insecurity and mental health and that it made use of quotes from the commentary by PROOF researchers in PHAC’s journal and PROOF’s 2021 annual report. PROOF researchers have contributed to much of the literature on the association between food insecurity and poor mental health across the life cycle and the implications for mental health care utilization and substance use in Canada.

Food insecurity is tightly linked to poor mental health and increased mental health care use; evidence-based policy action to address food insecurity could help improve Canadians’ mental health and reduce the burden on mental health care resources.

The policy brief comes at a critical time. PROOF’s most recent report shows that food insecurity has reached a new record high in 2022, with 6.9 million Canadians living in a food-insecure household. The problem has garnered wide national attention and policymakers are looking for ways to address food insecurity.

We strongly agree with the importance of considering the mental health implications of broader economic and social policy reforms. However, we are deeply concerned by your policy recommendation for federal decision-makers to “promote and invest in an adequate supply of more affordable, safe, high-quality, and nutritious foods for Canadians with low incomes and mental health concerns”. This recommendation suggests that food insecurity is a problem of inadequate food supply that can be solved through community-level responses. Not only is this not supported by evidence, but it also seriously distracts from the policies that matter most.

The root cause of food insecurity is the inadequacy of household incomes to meet basic needs. As highlighted in ODPH’s Position Statement on Responses to Food Insecurity, the kinds of policies recommended and reviewed in the Policy Landscape section do not address the drivers of food insecurity. Canada does not need policy approaches that further perpetuate food-based responses. Instead, policymakers need to recognize that food insecurity is a highly sensitive indicator of financial hardship and pervasive material deprivation.

The policy interventions that matter for food insecurity are the ones outlined so thoroughly in the Financial Insecurity section — making sure that existing income supports align with the cost of living and are indexed to inflation, increasing minimum wage, and pursuing additional benefits and the prospect of a basic income. These recommendations align with those made by ODPH, Dietitians of Canada, and other public health organizations, and are well-supported by PROOF’s policy evaluation research.

The brief could have reinforced the urgency for these recommendations to be implemented, had it acknowledged that they are the same ones needed to address the high rates of food insecurity.

Instead, it reinforces the misconception that food insecurity can be solved through further support of community food provision. It is more important than ever that advocates are aligned on key messaging and policy recommendations that are evidence-informed and income-based.

We welcome the opportunity to discuss why we feel these changes are important for more effective recommendations around food insecurity, as well as the research on food insecurity and mental health.

Thank you for taking the time to review this letter, and we look forward to your response.

Sincerely,

Valerie Tarasuk, PhD, DSc hc
Principal and founding investigator of PROOF Professor Emeritus, University of Toronto

Erin Reyce, RD
ODPH Food Insecurity Workgroup Co-chair

Situation

In 2022, 2.82 million Ontarians, nearly 19% of households, experienced household food insecurity.¹ The situation undoubtedly worsened in 2023, as food prices and overall inflation rates have continued to rise.²

The health consequences of food insecurity are a huge burden on our province’s healthcare system. Not being able to afford food has serious adverse effects on people’s physical and mental health and the ability to lead productive lives. Ontarians living with food insecurity are at greater risk for numerous chronic conditions including mental health disorders, non-communicable diseases (e.g., diabetes, hypertension and cardiovascular disease), and infections.¹ People who have chronic conditions and are food insecure are more likely to have negative disease outcomes, be hospitalized, or die prematurely.¹ Policies that effectively reduce food insecurity could offset considerable public expenditures on healthcare in Ontario.³

Background

Ontario Dietitians in Public Health (ODPH) is the official voice of Registered Dietitians (RDs) working in Ontario’s public health system. ODPH urges all levels of government to support policies that enhance incomes as the most effective responses to the pervasive and highly prevalent problem of household food insecurity.⁴

Household food insecurity (HFI) is inadequate or insecure access to food due to household financial constraints. HFI is an urgent public health, human rights, and social justice problem that, if not addressed, will continue to have serious consequences to Ontario’s economic progress as well as the health and well-being of Ontarians.

Social assistance recipients in Ontario have an extremely high risk for food insecurity. Seventy percent of Canadian households with social assistance as their main source of income were food insecure in 2022.¹

As stipulated in the Population Health Assessment and Surveillance Protocol⁵ of the Ontario Public Health Standards (2018), public health units (PHUs) are required to conduct surveillance and periodic reporting to the Ministry of Health on food affordability. This is assessed by comparing food and local housing costs to various household incomes. Food affordability monitoring results from PHUs could be utilized to determine the adequacy of social assistance rates, as recommended to the Minister of Health in recent correspondence from the Association of Local Public Health Agencies.

Assessment

The table below illustrates the results of food affordability monitoring by seven selected PHUs in May/June 2023, specifically among single adults receiving Ontario Works (OW). These data clearly indicate the deep inadequacy of current OW rates, with the monthly shortfall ranging from $337 in Windsor-Essex to $872 in Toronto.

Recipients of OW across the province do not have enough money to afford two of the most basic living expenses: housing and food. The inadequacy of OW for single adults as exemplified by these results requires urgent policy action to increase benefit rates.

OW recipients experience a state of poverty which has become progressively exacerbated by rates that have been frozen since 2018⁶ coupled with extraordinary inflation in recent years. The effects of deep poverty make it difficult for OW recipients to focus on anything but basic day-to-day survival that takes time and energy away from job searching. Prolonged periods of receiving OW, with its dangerously inadequate benefits levels, often result in a severe decline in mental and physical health. Unaddressed, declining health can lead to serious disability, making gainful employment unlikely or impossible.⁷

In 2022, the Government of Ontario acknowledged the importance of addressing inadequate social assistance rates, as evidenced by the increase to Ontario Disability Support Program rates by 5%, and the commitment to indexing rates to inflation annually.⁸

Recommendation

As a priority for the 2024 Ontario budget, ODPH strongly urges the Government of Ontario to utilize food affordability monitoring data collected by PHUs to inform necessary increases to Ontario Works rates to reflect basic costs of living and index the rates to inflation.

References:

Li T, Fafard St-Germain AA Tarasuk V. (2023). Household food insecurity in Canada, 2022. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved 19 January 2024 from https://proof.utoronto.ca/.
Statistics Canada. (2024). Latest snapshot of the CPI, December 2023. Retrieved 19 January 2024 from https://www150.statcan.gc.ca/n1/pub/71-607-x/2018016/cpi-ipc-eng.htm.
Tarasuk, V., Cheng, J., De Oliveira, C., Dachner, N., Gundersen, C., & Kurdyak, P. (2015). Association between household food insecurity and annual health care costs. Canadian Medical Association Journal, October 06, 2015 187 (14) E429-E436; Retrieved 06 February 2023 from https://doi.org/10.1503/cmaj.150234.
Ontario Dietitians in Public Health. (2020). Position Statement and Recommendations on Responses to Food Insecurity. Retrieved 06 February 2023 from https://www.odph.ca/upload/membership/document/2021- 04/ps-eng-corrected-07april21_3.pdf.
Ministry of Health and Long-Term Care. (2018). Population Health Assessment and Surveillance Protocol. Retrieved 06 February 2023 from https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Popul ation_Health_Assessment_Surveillance_2018_en.pdf.
Income Security Advocacy Centre. (2023). 22/23 Annual Report. Retrieved 19 January 2023 from https://incomesecurity.org/wp-content/uploads/2023/09/ISAC_anual-report_22-23_En_Web.pdf.
Hamilton Community Foundation. (2015). Vital Signs 2015. Retrieved 06 February 2023 from https://www.hamiltoncommunityfoundation.ca/vital-signs-2015/barriers-to-employment- 2015/#:~:text=Prolonged%20periods%20on%20OW%2C%20with,gainful%20employment%20unlikely%20or %20impossible.
Ministry of Children, Community and Social Services. (2023). Ontario Disability Support Program. Retrieved 22 January 2024 from https://www.ontario.ca/page/ontario-disability-support-program

December 14, 2023 Via Electronic Mail

Senator Percy Mockler, Chair, National Finance Committee
Percy.Mockler@sen.parl.gc.ca

Senator Éric Forest, Deputy Chair National Finance Committee
Eric.Forest@sen.parl.gc.ca

Senator Clément Gignac, National Finance Committee Member Clement.Gignac@sen.parl.gc.ca

Senator Larry W. Smith, National Finance Committee Member
LarryW.Smith@sen.parl.gc.ca

Senator Jean-Guy Dagenais, National Finance Committee Member
Jean- Guy.Dagenais@sen.parl.gc.ca

Senator Rosa Galvez, National Finance Committee Member
Rosa.Galvez@sen.parl.gc.ca

Senator Tony Loffreda, National Finance Committee Member
Tony.Loffreda@sen.parl.gc.ca

Senator Jane MacAdam, National Finance Committee Member Jane.MacAdam@sen.parl.gc.ca

Senator Elizabeth Marshall, National Finance Committee Member Elizabeth.Marshall@sen.parl.gc.ca

Senator Kim Pate, National Finance Committee Member
Kim.Pate@sen.parl.gc.ca

Mireille Aubé, Clerk, National Finance Committee
Mireille.Aube@sen.parl.gc.ca

National Finance Committee
NFFN@SEN.PARL.GC.CA

Dear Chair, Deputy Chair, Members, and Clerk of the National Finance Committee of the Senate of Canada

Ontario Dietitians in Public Health (ODPH), the independent and official voice of Registered Dietitians working in Ontario’s public health system, is writing to urge your support of Bill S-233, An Act to develop a national framework for a guaranteed livable basic income, currently being considered by the National Finance Committee of the Senate. Since 2015, ODPH has strongly supported the concept of a guaranteed livable basic income (GLBI) as an effective policy lever for reducing the pervasive problem of household food insecurity in Canada.¹

Food Insecurity Policy Research (PROOF) defines household food insecurity (HFI) as, “the inadequate or insecure access to food due to financial constraints,” and further states it is a serious public health problem, a marker of pervasive material deprivation, and a matter of public policy.²

In 2022, the rate of HFI in Canada reached an all-time high since its measurement in Canada

began nearly two decades ago. The percentage of households in Canada’s ten provinces

experiencing HFI increased significantly to 17.8% in 2022 from 15.9% in 2021.³ This represents

6.9 million people, including 1.8 million, or 1 in 4, children.³ These estimates do not include people living on First Nations or the territories where rates of HFI are typically high, particularly in Nunavut. The provincial rates of HFI in 2022 varied significantly from a low of 13.8% of households in Quebec to a high of 22.9% of households in Newfoundland and Labrador.³

It is important to examine HFI within the context of household income. Seventy per cent of households with social assistance as their main source of income in Canada report experiencing HFI.³ However, having a job is not necessarily protective, as the majority of households experiencing HFI report employment as their main source of income (60.2%), and these households represented the largest increase in HFI from 2021 to 2022.³ A recent survey by Food Banks Canada found that one of the top reasons people cited for going to a food bank was “low wages or not enough hours of work”.⁴ Other research has highlighted the rise of lower quality employment opportunities, precarious employment and lack of benefits as significant challenges within today’s workforce.⁵ This information provides clear evidence that income policy in Canada must be enhanced to protect working age adults from HFI.

Households struggling to put food on the table also struggle to afford other basic needs. HFI, originally perceived as a “food problem,” is now understood to be a potent marker of material deprivation, rooted in inadequate and unstable incomes that have not kept pace with the costs of living. In 2022, Canadians felt a heavy impact of inflation, as prices for basic needs such as transportation (+10.6%), food (+8.9%) and shelter (+6.9%) rose the most.¹ Prices for food purchased from stores rose 9.8%, the fastest pace since 1981 (+12.0%), after increasing 2.2% in 2021.⁶

Extensive Canadian evidence demonstrates HFI is tightly linked to adverse physical and mental health outcomes above and beyond the influence of other social determinants of health.

Research linking HFI data from population health surveys with administrative health records, has provided strong evidence that food-insecure people are more likely to be hospitalized for a wide range of conditions, stay in hospital longer, and die prematurely (before the age of 83) from all causes except cancer.⁷ A particularly strong relationship exists between food insecurity and poor mental health. The risk of experiencing depression, anxiety disorders, mood disorders, or suicidal thoughts increases with the severity of food insecurity for both adults and youth.⁷ The health consequences of HFI are extremely costly to Canada’s publicly funded healthcare system.⁸ Policies designed with the aim of reducing HFI have potential to offset considerable public expenditures on healthcare for federal, provincial and territorial governments. Health care cost savings estimates need to be considered in the proposed national framework for a GLBI.

For more than three decades, food banks have been the primary response to HFI in Canada. Despite massive investments in a secondary food system for people who cannot afford to obtain food in a socially dignified manner (i.e., buying from food retailers or growers), food banks are struggling more than ever to meet demands as more and more Canadians are unable to afford the basic costs of living. In March 2023, there were almost 2 million visits to food banks across Canada, representing a 32% increase compared to March 2022, and a 78.5% increase compared to March 2019, which is the highest year-over-year increase in usage ever reported.⁴ While food banks can provide temporary food relief, they do not address HFI which is a result of a persistent underlying problem of inadequate income.⁹ Only about one-quarter of households experiencing HFI go to food banks, and for those who do use them, HFI is not resolved.

The only interventions proven to reduce household food insecurity are those that improve the incomes of vulnerable households.⁹ Research on federal and provincial income policies, including public pensions for seniors, social assistance, child benefits, and minimum wage, has documented reductions in food insecurity when these interventions improve the incomes of low- income households.⁹ Research on the impact of Canada’s public pension system for seniors provides the strongest parallel to a GLBI. Reaching the age of eligibility for collecting public pensions has been shown to reduce the risk of food insecurity for low-income, unattached adults by almost 50%.¹⁰

Establishing an income floor for working-aged Canadians and their families, similar to that provided to seniors through public pension programs, would help address the vulnerability of households reliant on employment incomes but still unable to make ends meet, and ensure that working-aged adults not in the workforce also have sufficient incomes to meet basic needs. A recently released report¹¹ outlines a proposal for a province-wide Guaranteed Basic Income (GBI) for Prince Edward Island residents aged 18 to 64, recommending a maximum benefit of 85% of the official poverty line, estimated to be $19,252 for a single adult and $27,227 for a family of two adults in 2022. PEI’s report recommends the GBI be a collaborative federal- provincial program, delivered through the income tax system and jointly financed by both governments, complementing the other income-tested basic income benefits that exist for children (Canada Child Benefit) and seniors (Old Age Security and Guaranteed Income Supplement).

Given the magnitude of HFI in Canada and the significant health consequences and costs associated with it, income-based policy solutions specifically targeting the reduction of HFI in Canada are urgently needed. ODPH urges you to support Bill S-233 as an important step toward framing GLBI in Canada. Thank you for reviewing this information.

Sincerely,

Laura Abbasi, RD
Co-Chair ODPH Executive

Erin Reyce, RD
Co-Chair, Food Insecurity Workgroup

cc. Loretta Ryan, Executive Director, Association of Local Public Health Agencies

1 Available (in English and French) at: https://www.odph.ca/odph-position-statement-on-responses-to-food-insecurity-1.

Accessed 11 December 2023.

2 Food Insecurity Policy Research (PROOF). Understanding Household Food Insecurity [webpage online]. https://proof.utoronto.ca/food-insecurity/. Accessed 11 December 2023.

3 Food Insecurity Policy Research (PROOF). (2023).What are the implications of food insecurity for health and health care?

[webpage online]. https://proof.utoronto.ca/food-insecurity/what-are-the-implications-of-food-insecurity-for-health-and- health-care/. Accessed 11 December 2023.

4 Food Banks Canada. (2023). HungerCount 2023. Available at: https://foodbankscanada.ca/hungercount/. Accessed 11 December 2023.

5 Martin JC and Lewchuk W. (2018) The Generation Effect: Millennials, employment precarity and the 21st Century workplace. McMaster University and PEPSO. Available at: https://pepso.ca/publications. Accessed 12 December 2023.

⁶ Statistics Canada. (2023). Consumer Price Index: Annual review, 2022. Available at: https://www150.statcan.gc.ca/n1/daily-quotidien/230117/dq230117b-eng.htm. Accessed 11 December 2023.

7 Food Insecurity Policy Research (PROOF). (2023). What are the implications of food insecurity for health and health care? [webpage online]. https://proof.utoronto.ca/food-insecurity/what-are-the-implications-of-food-insecurity-for- health-and-health-care/. Accessed 11 December 2023.

8 Tarasuk V. (2017). Implications of a basic income guarantee for household food insecurity. Northern Policy Institute – Research Paper No. 24. Available from: https://www.northernpolicy.ca/upload/documents/publications/reports- new/tarasuk_big-and-foodinsecurity-en.pdf. Accessed 13 December 2023.

9 Food Insecurity Policy Research (PROOF). What can be done to reduce food insecurity in Canada? [webpage online] https://proof.utoronto.ca/food-insecurity/what-can-be-done-to-reduce-food-insecurity-in-canada/. Accessed 11 December 2023.

10 McIntyre L, Dutton D, Kwok C, et al. (2016). Reduction of food insecurity in low-income Canadian seniors as a likely impact of a Guaranteed Annual Income. Canadian Public Policy. 42(3), 274-86. https://doi.org/10.3138/cpp.2015-069. Accessed 11 December 2023.

11 A Proposal for a Guaranteed Basic Income Benefit in Price Edward Island. Available at: https://static1.squarespace.com/static/6414a3fa59a0c71ae167601e/t/655e0165319bf92e4ef6cbd5/1700659869270/fi nal-report. Accessed 12 December 2023.

2023 Federal Pre-Budget Consultation Submission by the Food Insecurity Workgroup

Recommendations

1. That the government increase the Canada Child Benefit (CCB) amount for low-income families.

2. That the government equal CCB amounts for families with children over 6 years old so that they are not receiving less when their children turn 6.

3. That the government create a federal CCB supplement for remote and Northern communities to address the exceedingly high percentage of food-insecure households and elevated costs of living.

Situation

Household food insecurity (HFI) is a prevalent and persistent problem in Canada. The latest statistics indicate 18.4% of people in the ten provinces lived in a food- insecure household in 2022. This amounts to 6.9 million people, including almost 1.8 million children (approximately 1 in 4), living in households that struggled to afford food. This is the highest number and percentage documented since Canada began monitoring HFI in 2004. The situation has undoubtedly worsened in 2023 with extraordinary food inflation over the past year.

Background

Ontario Dietitians in Public Health (ODPH) is the independent and official voice of Registered Dietitians (RDs) working in Ontario’s public health system. Our Position Statement and Recommendations on Responses to Food Insecurity urges all levels of government to support policies that enhance incomes as the most effective responses to the persistent and increasingly prevalent problem of household food insecurity.

HFI is the inadequate or insecure access to food due to household financial constraints. It is a serious public health problem and a potent social determinant of health. Food insecurity has serious implications for the health and wellbeing of Canadians beyond just poor nutrition and diet. The health consequences of food insecurity put a large burden on our health care system and are costly for our public health care budgets.

Initially thought to be a “food problem,” HFI is now understood as an indicator of pervasive material deprivation that elucidates financial hardship in a way that income- based measures of poverty, like Canada’s Official Poverty Line, do not. The deprivation captured by HFI is the product of household income; the stability and security of that income over the year; assets like homeownership; access to financial resources outside of income like savings, credit, or help from family or friends; debt; and costs of living.

The economic well-being or hardship of households can be most sensitively measured by whether they have difficulty affording food, making this measurement an important focus for policy.

There is a large body of evidence showing food insecurity can be reduced through policy interventions that improve the financial circumstances of low-income households. When food-insecure households receive additional income, they spend it in ways that improve their food security.

Since its launch in 2016, the Canada Child Benefit (CCB) has been heralded as a crucial step towards alleviating child poverty and a policy success. On its seventh anniversary in July 2023, the government announced an increase to the CCB to keep pace with inflation. While not specifically designed to reduce HFI, analysis of the CCB through the lens of HFI shows limited impacts. However, if redesigned to explicitly target the rate of HFI, research conducted by Food Insecurity Policy Research (PROOF) demonstrates the program has unrealized potential to do so.

Assessment

A study comparing HFI before and after implementation of the CCB in 2016 revealed there was no change in the overall prevalence of food insecurity for families with children. However, the researchers identified a one-third reduction in severe food insecurity among low-income families. Given severe food insecurity is very strongly associated with serious negative health outcomes, this reduction is significant.

A more recent study found the families with children under age six receiving higher CCB (up to $1068 more annually) had a lower risk of food insecurity. The study authors conclude that, “increasing benefits for economically disadvantaged households, characterized by low incomes, single parenthood, and renting (versus owning), may improve the program’s efficiency and equity in supporting families’ food security.” Additionally, the findings also support equalizing the CCB for families with children over age six in recognition of the high rates of food insecurity among those families. The current design of the CCB overlooks the needs of families with older children.

Conclusion

The findings of recent Canadian research on the CCB demonstrate how modest income supplements can reduce food insecurity, with the largest effect being for lowest-income families most at risk for food insecurity and particularly severe food insecurity. This research also reinforces the need to design policies with the explicit outcome of reducing food insecurity to maximize their potential.

The cost of inaction is too high. Living in a household struggling to afford food is toxic to children’s health and well-being. Not only does household food insecurity compromise children’s nutritional health; they are at much higher risk for serious mental health problems.

This document provides supporting information for the 2023 Resolution on Monitoring Food Affordability in Ontario and Inadequacy of Social Assistance Rates from alPHa (Association of local Public Health Agencies)

SPONSOR: Ontario Dietitians in Public Health

Food insecurity, inadequate or insecure access to food due to household financial constraints, continues to be a serious and pervasive public health problem. Physical and mental health are tightly linked to individuals’ household food security status.1 The health consequences of food insecurity are a large burden on our healthcare system and are costly for public health care budgets.1 The most current data indicate approximately one in six households in Ontario experience some level of food insecurity.2

Social assistance recipients, including those reliant on Ontario Works (OW) and the Ontario Disability Support Program (ODSP), are at extremely high risk of food insecurity. In 2021, approximately 67% of households in Ontario receiving social assistance experienced food insecurity.2 The situation has undoubtedly worsened since then with extraordinary food inflation over the past year. The price of food purchased from stores from February 2022 to February 2023 increased by 10.6%, rising at a rate not seen since the early 1980s.3

Food affordability monitoring conducted by local Public Health Units (PHUs) in May/June 2022 substantiates that individuals receiving social assistance experience extremely dire financial situations, particularly single adults without children. Table 1 illustrates that for a sample of PHUs across all Ontario regions, monthly OW rates in addition to all potential tax credits (assuming individuals file income tax returns) fall short of covering only the cost of a bachelor apartment and food by a range of -$132 in Chatham-Kent to -$752 in Toronto. Other basic costs of living (e.g., clothing, personal care, transportation, phone, etc.) are not included. These data clearly indicate the extreme inadequacy of OW rates which have been frozen since 2018.4

Table 1: Single Adult receiving ONTARIO WORKS (OW)

Table 2 shows the monthly funds remaining or shortfall of ODSP and available tax credits after rent for a one-bedroom apartment and cost of food are deducted. Again, other basic costs of living are not included. The monthly funds remaining for ODSP recipients range from $121 in Chatham-Kent to a shortfall of -$525 in Toronto. Despite an increase of 5% to ODSP in September 2022, an increase from $200 per month to $1000 per month on employment earning cap, and an adjustment for inflation beginning in July 2023,4,5,6, ODSP falls well below the actual costs of living.

Table 2: Single Adult receiving ONTARIO DISABILITY SUPPORT PROGRAM (ODSP)

Ontario’s poverty reduction plan, Building a Strong Foundation for Success: Reducing Poverty in Ontario (2020-2025) includes various indicators (e.g., poverty rate, employment rate, graduation rate); however, it does not include an indicator or provincial targets for the reduction of household food insecurity (HFI). HFI is a highly sensitive measure of material deprivation that is strongly associated with health outcomes and health care utilization. Food insecurity data collected in the Canadian Community Health Survey and the Canadian Income Survey should be utilized to implement and evaluate effective policy interventions for alleviating food insecurity.7

References

PROOF (Food Insecurity Policy Research). What are the implications of food insecurity for health and health care? [webpage online]. Accessed April 18, 2023 from: https://proof.utoronto.ca/food-insecurity/what-are-the-implications-of-food- insecurity-for-health-and-health-care/.
Tarasuk V, Li T, Fafard St-Germain AA. Household food insecurity in Canada, 2021. Toronto: Research to identify policy options to reduce food insecurity (PROOF). 2022. Accessed April 18, 2023 from: https://proof.utoronto.ca/.
Statistics Canada. Consumer Price Index, February 2023. Retrieved 13 April 2023 from https://www150.statcan.gc.ca/n1/daily-quotidien/230321/dq230321a-eng.pdf.
Income Security Advocacy Centre. OW and ODSP rates and the OCB as of September 2022. 2022. Accessed April 18, 2023 from: https://incomesecurity.org/ow- and-odsp-rates-and-the-ocb-as-of-september-2022/.
Government of Ontario. News release: Ontario’s plan to build supporting stronger province and economy. 2022. Accessed April 18, 2023 from: https://news.ontario.ca/en/release/1002233/ontarios-plan-to-build-supporting-stronger- province-and-economy.
Community Living Ontario News Updates. Key Changes Announced in the 2022 Ontario Fall Economic Update. 2022. Accessed April 18, 2023 from: https://communitylivingontario.ca/key-changes-announced-in-the-2022-ontario-fall- economic-update/.
Food Insecurity Policy Research (PROOF). Provincial Policy Levers to Reduce Household Food Insecurity [webpage online]. Accessed April 18, 2023 from: https://proof.utoronto.ca/resource/provincial-policy-levers-to-reduce-household-food-insecurity/.

Situation

In 2021, 2.34 million Ontarians experienced household food insecurity.¹ The situation has undoubtedly worsened since then with extraordinary food inflation over the past year. The price of food purchased from stores in 2022 increased by 9.8%, rising at a rate not seen since the early 1980s.²

Background

Ontario Dietitians in Public Health (ODPH) is the independent and official voice of Registered Dietitians (RDs) working in Ontario’s public health system. ODPH urges all levels of government to support policies that enhance incomes as the most effective responses to the pervasive and prevalent problem of household food insecurity.⁴

Social assistance recipients in Ontario have an extremely high risk for food insecurity. Almost 7 in 10 of Ontario households receiving social assistance were food insecure in 2021.¹

Assessment

The table below illustrates results of monitoring of food affordability by ODPH members, specifically among single adults receiving Ontario Works (OW), from six selected PHUs in May/June 2022. The data clearly indicate the deep inadequacy of current OW rates, with the shortfall ranging from $192 in North Western to $752 in Toronto.

Recipients of OW across the province do not have enough money to afford the two most basic living expenses: housing and food. The inadequacy of OW for single adults as exemplified by these results requires urgent policy action to increase benefit rates.

OW recipients experience a state of poverty which has become progressively exacerbated by rates that have been frozen since 2018⁶ coupled with extraordinary inflation. The effects of deep poverty have made it difficult for OW recipients to focus on anything but basic day-to-day survival that necessarily takes time and energy away from job searching. Prolonged periods receiving OW, with its dangerously inadequate benefits levels, often result in a severe decline in mental and physical health. Unaddressed, declining health can lead to serious disability, making gainful employment unlikely or impossible.⁷

Recommendation

As a priority for the 2023 Ontario budget, ODPH strongly urges the Ontario Government to increase OW to reflect basic costs of living and index the rate to inflation, as will be done for the Ontario Disability Support Program beginning in July 2023.

References:

Tarasuk V, Li T, Fafard St-Germain AA. (2022). Household food insecurity in Canada, 2021. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved 06 February 2023 from https://proof.utoronto.ca/.
Statistics Canada. Consumer Price Index, Annual Review. Retrieved 06 February 2023 from https://www150.statcan.gc.ca/n1/daily-quotidien/230117/dq230117b-eng.htm.
Tarasuk, V., Cheng, J., De Oliveira, C., Dachner, N., Gundersen, C., & Kurdyak, P. (2015). Association between household food insecurity and annual health care costs. Canadian Medical Association Journal, October 06, 2015 187 (14) E429-E436; Retrieved 06 February 2023 from https://doi.org/10.1503/cmaj.150234.
Ontario Dietitians in Public Health. (2020). Position Statement and Recommendations on Responses to Food Insecurity. Retrieved 06 February 2023 from https://www.odph.ca/upload/membership/document/2021- 04/ps-eng-corrected-07april21_3.pdf.
Ministry of Health and Long-Term Care. (2018) Population Health Assessment and Surveillance Protocol. Retrieved 06 February 2023 from https://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/protocols_guidelines/Popul ation_Health_Assessment_Surveillance_2018_en.pdf.
Income Security Advocacy Centre. (2022). OW and ODSP Rates and the OCB as of September 2022. Retrieved 06 February 2023 from https://incomesecurity.org/ow-and-odsp-rates-and-the-ocb-as-of- september-2022/.
Hamilton Community Foundation. (2015). Vital Signs 2015. Retrieved 06 February 2023 from https://www.hamiltoncommunityfoundation.ca/vital-signs-2015/barriers-to-employment- 2015/#:~:text=Prolonged%20periods%20on%20OW%2C%20with,gainful%20employment%20unlikely%20or %20impossible.

October 27, 2022

Hon. Doug Ford, Premier of Ontario via email: doug.fordco@pc.ola.org

Hon. Sylvia Jones, Deputy Premier and Minister of Health via email: sylvia.jones@pc.ola.org

Hon. Merrilee Fullerton, Minister of Children, Community and Social Services via email: Merrilee.Fullertonco@pc.ola.org

Dear Premier Ford, Deputy Premier and Minister Jones, and Minister Fullerton:

Ontario Dietitians in Public Health (ODPH) is the independent and official voice of Registered Dietitians working in Ontario’s public health system. We are writing to you, as newly re-elected leaders of the Province of Ontario, to express serious concern about the 2.34 million Ontarians who experienced household food insecurity in 2021.¹ The situation has undoubtedly worsened in 2022 with an extraordinary rate of food inflation. In Ontario, the price of food purchased from stores in September 2022 was 11.5% higher than in September 2021², rising at a rate not seen since the early 1980s.

Household food insecurity (HFI) is inadequate or insecure access to food due to household financial constraints. HFI is an urgent public health, human rights, and social justice problem that, if not addressed, will continue to have serious consequences to Ontario’s economic progress as well as the health and well-being of citizens. We strongly urge the Ontario government to adopt policies, as outlined in Provincial Policy Levers to Reduce Household Food Insecurity³, proven to effectively reduce HFI:

Higher minimum wage rates
Increasing social assistance rates
Reducing income tax rates for the lowest income households.

The health consequences of food insecurity are a large burden on our province’s healthcare system. Not being able to afford food has serious adverse effects on people’s physical and mental health and the ability to lead productive lives. Ontarians living with food insecurity are at greater risk for numerous chronic conditions including mental health disorders, non-communicable diseases (e.g., diabetes, hypertension and cardiovascular disease), and infections.¹ People who have chronic conditions and are food insecure are more likely to have negative disease outcomes, be hospitalized, or die prematurely.¹ Policies that effectively reduce food insecurity could offset considerable public expenditures on healthcare in Ontario.

Ontarians receiving social assistance have an extremely high risk for food insecurity. In 2021, 67.2% of Ontario households reliant on social assistance were food insecure.¹ Benefits are inadequate to meet recipients’ basic needs. When people are not able to meet their basic needs, they cannot achieve the physical, mental and social well-being needed to sustain long-term employment. In a province as wealthy as Ontario, it is unacceptable and unjust that Ontario Works (OW) rates are not based on the actual costs of living, are not indexed to inflation, and do not protect vulnerable citizens from living in dire situations without the money they need to buy food. While Ontario Disability Support Program (ODSP) rates have increased by 5% and are now indexed to inflation, this is no where near enough to protect ODSP recipients from food insecurity.

Having a job is not necessarily protective against food insecurity. In 2021, 48.2% of food insecure households in Ontario reported wages, salaries, or self-employment as their household’s main source of income.¹ The high prevalence of food insecurity among those in the workforce reflects precarious and low-paying jobs and multi-person households with a single income-earner.⁴

Food charity is NOT a solution to the problem of HFI. Food banks may provide temporary food relief but do not address the persistent problem of inadequate income.⁵ Only about one-quarter of households experiencing food insecurity go to food banks and for those who do use them, food insecurity does not go away.⁶

Individuals and families struggling to put food on the table also struggle to afford other basic needs. HFI is a sign of deprivation, rooted in inadequate and unstable incomes that have not kept pace with the costs of living. ODPH strongly encourages the Government of Ontario to adopt income-based policy solutions that effectively reduce food insecurity. You have the power to make our province a better place for all Ontarians to lead healthier and happier lives.

Sincerely,

Elizabeth Smith
Co-Chair ODPH Executive

Erin Reyce, RD
Co-Chair, Food Insecurity Workgroup

cc.

Peter Tabuns, MPP Toronto−Danforth, Leader, Official Opposition and Leader, New Democratic Party of Ontario via email tabunsp-qp@ndp.on.ca

France Gélinas, MPP Nickel Belt, Health Critic via email: gelinas-qp@ndp.on.ca

Chandra Pasma, MPP Ottawa-West Nepean, Poverty and Homelessness Reduction Critic via email: CPasma- CO@ndp.on.ca

Laura Mae Lindo, MPP Kitchener-Centre, Anti-Racism and Equity Critic via email: LLindo-QP@ndp.on.ca

Monique Taylor, MPP Hamilton Mountain, Children, Community and Social Services Critic via email: MTaylor- QP@ndp.on.ca

John Fraser, MPP Ottawa South, Interim Leader of the Ontario Liberal Party via email: jfraser.mpp.co@liberal.ola.org

Mike Schreiner, MPP Guelph, Leader of the Green Party of Ontario via email: mschreiner@ola.org

Loretta Ryan, Executive Director, Association of Local Public Health Agencies via email: loretta@alphaweb.org John Atkinson, Executive Director, Ontario Public Health Association via email: jatkinson@opha.on.ca

www.odph.ca

info@odph.ca @RDsPubHealthON

References:

Tarasuk V, Li T, Fafard St-Germain AA. (2022). Household food insecurity in Canada, 2021. Toronto: Research to identify policy options to reduce food insecurity (PROOF). Retrieved 20Sept2022 from https://proof.utoronto.ca/.
Statistics Canada. Table 18-10-0004-03 Consumer Price Index, monthly, percentage change, not seasonally adjusted, Canada, provinces, Whitehorse and Yellowknife — Food DOI: https://doi.org/10.25318/1810000401-eng.
Food Insecurity Policy Research (PROOF). Provincial Policy Levers to Reduce Household Food Insecurity [webpage online]. Retrieved 20Sept2022 from: https://proof.utoronto.ca/resource/provincial-policy-levers-to- reduce-household-food-insecurity/.
Tarasuk V. Implications of a basic income guarantee for household food insecurity. Northern Policy Institute – Research Paper No. 24. Retrieved 20Sept2022 from: https://proof.utoronto.ca/wp- content/uploads/2017/06/Paper-Tarasuk-BIG-EN-17.06.13-1712.pdf.
Ontario Dietitians in Public Health. (2020). Position Statement and Recommendations on Responses to Food Insecurity. Retrieved 20Sept2022 from https://www.odph.ca/upload/membership/document/2021- 04/ps-eng-corrected-07april21_3.pdf.
Food Insecurity Policy Research (PROOF). What can be done to reduce food insecurity in Canada? [webpage online]. Retrieved 20Sept2022 from: https://proof.utoronto.ca/food-insecurity/what-can-be-done- to-reduce-food-insecurity-in-canada/.