A Glimpse of Child Hunger in Canada

5. Discussion

This study reports on a very small sample of the NLSCY—1.2%. Respondents who reported their child ever experiencing hunger because there was no food in the house or money to buy food nonetheless represent a rich data set. This sub-sample exceeds 200 nationally-dispersed families that would otherwise be difficult to identify. In that way, the NLSCY provides a unique and valuable way of 'glimpsing' the health and economic situation of Canadian families that report actual hunger.

Is a self-report of hunger valid? Does it truly reflect a diminished intake of nutrients? The answers appear to be "yes". Rose and Oliveria (1997) recently reported that in the United States, at least for adults, self-reported hunger measures are valid surrogate measures for low intakes of required nutrients. Their study adds further credibility to national surveys using self-report measures of hunger in the United States such as the Community Childhood Hunger Identification Project and the Food Security/Hunger Module of the 1995 Current Population Survey, whose questions are similar to the NLSCY (Sidel, 1997).

5.1 Hungry Families Have Many Similarities to Other Families

Because of the very large comparison sample, it is easy for small differences between hungry and non-hungry families to be statistically significant. In actual fact, the families of Canada's hungry children look very similar to other Canadian families with a few clinically meaningful differences. These include single parent status, very low household income, and poorer reported health status of both PMKs and their children. The interplay between health and family food insecurity is distressing and it is unclear which comes first—ill health of the PMK or disadvantage increasing risk for ill-health. For children, the relationship is likely clearer as they are probably born into conditions of disadvantage that subsequently affect their health and well-being (Shah et al, 1987).

While hunger was reported from families from all sizes of communities, a preponderance of hungry families live in Canada's largest urban centres. This might indicate isolation and lack of social support in these areas. In terms of equity, it is reassuring to note that immigrants and racially visible persons are not over-represented in hungry families. In fact, almost half of the hungry are those who call themselves Canadians or claim to be of British descent.

The glaring exception in the demographics of hungry families is the overrepresentation of the aboriginal population who suffers from extremes of poverty in Canada (Royal Commission on Aboriginal Peoples, 1996). The NLSCY excluded on-reserve populations. Supports in urban centres for First Nations people may not be reaching the neediest.

It is reassuring that even among the hungry, only a third are frequently hungry, however, differences between the frequently and occasionally hungry signify the real marginalization of single mothers on social assistance who are also likely to suffer from chronic ill-health. It is interesting to note that no lone father-led household reported frequent hunger.

Over two-thirds of mothers reporting hunger had completed high school and over 50% had some post-secondary education. Education is clearly insufficient to ward off hunger or extreme poverty in women with children. In fact, few women are immune to poverty. Many are just a job loss, a male partner loss, or an illness or disability away from poverty and the possible experience of hunger (Canadian Public Health Association, 1997).

5.2 Income Thresholds

Very low income, particularly earnings mainly from social assistance or welfare, is a main indicator of reported hunger. Many families (57%), however, also report wages and salaries as a source of income or as a main source of income (39%) annually indicating some labour force participation. The significantly lower participation in self-employment may reveal a lack of personal resources to engage in such activities or may be due to heavy responsibilities borne by lone parents with children. Similarly, the lack of difference between hungry and non-hungry families as recipients of employment insurance may point to lower eligibility rates for employment insurance accrued in hungry families, or to a comparable turnover rate in employment once a job is secured.

The critical income gap in families reporting hunger is not in personal income of the PMK which is about 25% lower than other PMKs, but in total household income which is 44% lower than other families. The difference between occasional and frequent hunger is also a matter of household income and a modest $4800 or 21% increase over current social assistance rates might reduce the more frequent occurrence of hunger in the most disadvantaged families. The National Council of Welfare's analysis of 1996 welfare income as percent of poverty line revealed that the poverty gap ranged from -$10,976 in Alberta to -$6134 in Newfoundland for a single parent with one child; half of this amount would go a long way to providing these families with at least a modicum of food security (National Council of Welfare, 1997).

5.3 Ill-Health is Pervasive

The purpose of this paper is not to identify the outcomes of hunger in Canadian families, but rather to describe the characteristics of families reporting hunger and to report on their coping strategies. Ill-health repeatedly emerges as a predictor of hunger in both the PMK and the child and for purposes of this analysis remains a determinant. Future research will be able to track health status and outcomes in such families.

The concurrence of health problems and reported hunger is disturbing but perhaps not unexpected. Others have identified an association between household food insecurity and poor parental health. Cristofar and Basiotis (1992) found that women most likely to report food insufficiency did not own their own homes, perceived themselves to be in poor health, or were smokers.

Women's income levels are directly related to their health, including effects on nutrition, risk behaviors such as smoking, stress, mental health, and health-seeking behaviours for preventive and treatment services (Canadian Public Health Association, 1997). PMKs reporting ever experiencing hunger are not well as a group—more than half suffer from a chronic health condition, and the conditions they report— back problems and migraines — are associated with chronic pain and discomfort. Back problems might be impediments to employment that requires manual labour that might otherwise be an option for those with low levels of educational attainment. Higher levels of activity limitation reported by hungry PMKs at home is an indication of the severity of the chronic conditions and how their quality of life is affected by their chronic ill-health.

Poverty is strongly associated with lower health status in children (Canadian Institute of Child Health, 1994). The prevalence of poorer health status in children in this study, while expected, is nonetheless a disturbing finding and the higher occurrence of asthma, affecting almost one-quarter of children is also worrying, particularly given the second hand smoke exposure these children likely encounter (Chen, Rennie & Dosman, 1996). It is comforting that the rate of inhalant use parallels the reported rate of asthma indicating similar asthma severity in hungry children compared with other children as well as equitable access to health care. One could also surmise, however, that the indirect costs associated with having a child with a chronic illness such as transportation to health appointments or indirect expenses associated with hospitalization, could deplete family resources necessary to purchase food.

5.4 Smoking

Poor women are 1.6 times more likely to smoke than do women of higher income groups (Jensen, 1994). Tobacco use was very high among those who reported ever experiencing hunger and higher still among those reporting frequent hunger. One of the primary effects of smoking is stress reduction and studies have shown that the fear of the family running out of food is very stressful in low income families (Campbell & Desjardins, 1989; Tarasuk & MacLean, 1990). Stress must be even higher in families that actually encounter hunger. Cigarette use in disadvantaged women is known to reduce their stress (Stewart, et al, 1996) and nicotine acts as an appetite suppressant which is helpful in a situation of food insecurity.

The health effects of tobacco use are clearly known and smoking is the leading cause of death in Canada in women. The health effects of household tobacco use are already being seen in this study with higher asthma rates in children of household's ever experiencing hunger. Johnson and colleagues analyzed the diet quality of low-income children living with smoking and non-smoking parents. Their study found that parents who smoked spent less money on food and as a result had children with lower intakes of several nutrients than those with non-smoking parents (Johnson, Wang, Smith, & Connolly, 1996).

Tobacco control policies have increased the price of cigarettes in Canada almost two-fold between 1985-1995 (Mummery & Hagen, 1996). While higher prices reduce consumption at a population level (Mummery & Hagen, 1996), tobacco pricing could be viewed as a regressive though voluntary tax on these disadvantaged families. High smoking rates are clearly a complex issue among families reporting hunger but one that requires urgent attention.

5.5 Predicting Hunger

This study found that the independent predictors of hunger versus no hunger were very low income, single parent status, earnings from social assistance or welfare, poorer health in PMK and child, aboriginal status, and parent looking for work. These predictors are not surprising although they do indicate the independent effects of poor PMK and child health status on hunger occurrence as well as the unique disadvantage encountered by First Nations people. The finding that a parent looking for work is an independent predictor may be because families experiencing new economic disruption are unprepared to cope with accumulated debt or higher than sustainable living expenses thus leaving no money to buy food.

5.6 Responding to and Coping with Hunger

Badun and colleagues identified coping strategies of women who reported anxiety about not having the money to purchase food as required (Badun et al., 1995). Women in their study reported relying on family and friends, social assistance benefits, meal programs, and food banks in order to postpone the experience of hunger in their families. They also stated that they could delay hunger by skipping or having smaller meals, and eliminating snacking. These coping strategies have been similarly noted in other studies (e.g., Smith and Hoerr, 1992; Wehler et al., 1992).

If food continues to be scarce, despite reliance on outside sources for help, Radimer asserts that mothers' nutritional intakes (in terms of both quantity and quality) will then decline, followed by a deterioration of their children's nutritional status and eating habits in only the most severe cases (Radimer et al, 1992). Kendall and colleagues' (1996) analysis of a random sample of women in New York indicated their food insecurity was 2.6 times higher than their children's. Childhood hunger, then, appears to be the most severe and least common form of food insecurity, and declines in mothers' nutritional status may, therefore, be used as risk indicators for childhood food insecurity (Campbell & Desjardins, 1989).

The response to hunger in the NLSCY indicates that parents are seven times more likely to go hungry when there is no food in the house or money to buy food than are their children. Public attention to poverty and child hunger must recognize that food deprivation in children is rare even in hungry households. A family encountering food insecurity is likely to reveal a hungry mother of a barely fed child. In fact, a recent United States study found that maternal self-deprivation was very common in extremely poor households while child nutritional consumption data for the pre-school children of these households was not significantly different from other children (Rose and Oliveira, 1997).

According to regression analyses, both chronically ill and working parents are most likely to skip a meal when there is no food in the house. One could imagine a scenario of self-sacrifice in such a situation.

The two most common coping strategies in the face of hunger are seeking help from the food bank and seeking help from relatives. Very different types of families seem to use these two strategies. Food bank users are single parents (mothers probably), Ontario residents, and parents free of activity limitation. Travel to a food bank could be the reason parents with activity limitations do not use them. It may also be that they have other support networks that address their activity limitation that they can also draw upon when food supplies are exhausted.

Critics have suggested that Ontario has institutionalized food banks as a normative strategy for food procurement among the poor (Tarasuk & MacLean, 1990a). The problem with the institutionalization of charitable food services (ie., food banks, food bags, soup kitchens) is that they are a poor solution to the hunger crisis. Food supplies are often limited, and inconsistent as they rely on donations from community members and local businesses. Food quality may be low (Emmon, 1987; Starkey, 1994). When resources are low, food banks often have to limit the amount of food distributed and may even have to turn away people who are dependent on their services (Riches, 1989). It is often difficult to obtain the required numbers of personnel to run these agencies (Lipsky & Thibodeau, 1988). In addition, the process can be degrading and disempowering as it removes the individual's choice regarding when and what they eat (Tarasuk & MacLean, 1990).

A recent study of food bank users in Montreal found that food bank users over-represented single persons living alone in the city but that fewer recipients lived in single parent households with children less than 18 years of age than were found in the general population. The principal source of income of food bank attendees was social assistance (83.5%). The authors speculated that some single parent families may be seeking assistance from programs other than food banks such as collective kitchens (Starkey, Kuhnlein, Gray-Donald, 1998).

In contrast to food bank users, those who seek help from relatives include those with two biological parents, fewer children, absence of a chronic condition in the PMK, and a higher income. Interpretation of these data are clearly speculative but it may that members of an intact nuclear family have a broader family base to draw upon and are less burdensome if they have fewer children. Higher income reported in such families may suggest that a lack of food would not be a regular occurrence. A healthier PMK seeking assistance from relatives again might imply that hunger is an infrequent state.

Fewer families sought help from friends but those that did reported a low, but not very low, income. Mother's unemployment indicates as well that the mother may appear 'down on her luck' rather than likely to be in a chronically needy state and this might induce friends to provide some temporary relief.

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