Lack of Food Security: Focussed Literature Review and Research Framework - August 2001

1. Brief Overview Based on the Literature Review

The responsibility for food, nutrition, health consequences and security of food supply rests with Health Canada and Agriculture Canada. At Human Resources Development Canada, the Applied Research Branch (ARB) conducts research on other forms of insecurity. The Branch has researched, for example, job and income insecurity. This research on food insecurity is part of that work on different types of insecurity.

Currently, some questions on the National Population Health Survey (NPHS) and on the National Longitudinal Survey of Children and Youth provide information on families and children who experience difficulties due to the lack of food. The ARB planned a supplement to the NPHS data in order to broaden the picture of the experience of food insecurity.

The purpose of this literature review is to identify definitions and conceptual models that focus on the insecurity aspects of the anxiety related to the lack of food. The intention was to review existing questions for use in the NPHS supplement. Based on the literature review, a research framework was constructed, which is discussed in Chapter 3.

There is a large body of research on hunger. The lines between hunger and food insecurity are blurred, and these terms are often used as synonyms. Nutrition or health professionals have conducted most of the research on hunger, among them many notable Canadian researchers. The research has focussed on identifying prevalence of hunger, conditions related to its occurrence and consequences following episodes of prolonged hunger.

To grade the severity of the problem, researchers have used categories such as "moderate" and "severe" hunger. Some studies have focussed on the impact on households; others have studied the impact on individuals, particularly children. Radimer et al (1992) identified two levels of hunger: The first individual level with four components — insufficient intake, nutritional inadequacy, psychological aspects (deprivation, lack of control) and social aspects (not meeting the social norm of three meals a day; and the second household level with four components — depletion of food resources, unsuitable food options, food anxiety and acquisition of food in socially unacceptable ways. Though the impact of insecurity was noted, it did not receive the same attention. The broader consequences were mentioned by several researchers. Food insecurity in developed nations encompasses not only the physical experience of hunger, but also coping mechanisms, nutritional concerns, social and psychological aspects (Kramer-LeBlanc and McMurry, 1998). It has also been related to social exclusion (Radimer et al, 1992), low productivity (Daponte, 1996) low human and social capital (Starkey, et al, 1998).

The association with poverty has been well documented and many researchers have noted that households relying on government transfers are not protected from the experience of food insecurity. Key among the factors was the depth of poverty, since hunger is an extreme form of disadvantage. Economic security has been recognized as complex and factors such as adequacy, stability, and reliable flow have been noted (Kramer-LeBlanc and McMurry, 1998). When lack of food is due to irregularity and insecurity of income, the resulting coping strategies are for the periods of food shortage rather than a stable strategy, generally relying on an ad hoc system (Tarasuk and Davis, 1996). Researchers have also noted the mutual dependence between health and the ability to earn adequate income.

The justifiable focus on poverty has eclipsed other associated or independent factors related to food insecurity. Other potential reasons such as physical disability and poor health were often not measured (Blumberg et al, 1999). Food insecurity among the elderly is more complex than simply one of lack of access, because of the inability to prepare and eat food available due to functional impairments (Frongillo, 2001). Riches (1996) has identified the importance of "non-food" factors and warns against the use of indirect measures (such use of food banks) alone to determine food insecurity. The importance of contextual factors such as economic context, income management, food acquisition, food management at home, and coping strategies were also noted (Olson, 1992).

Food insecurity is an experience and a process, comprising of a sequence of events, where the household manages the nature and extent of compromise at each event in the sequence. Quality was traded-off for quantity, for instance. This managed aspect of food insecurity means that each household will experience different components of food insecurity at different time and different degrees (Tarasuk, 2001). The experience of food insecurity may be episodic arising from loss of income due to termination of benefits or a job or due to unplanned and unexpected expenditures such as illness. Monthly fluctuation with reduced intake at the end of the month was noted by Wilde and Ranney (1998). Wolfe et al (1998), describe a pathway of progressive severity rather than a dichotomy between being food secure or insecure. A United States study has categorized households as being food insecure and being food insecure with hunger (Andrews 2000). Therefore, the pathways to the episodes of financial crisis and the temporal patterns are important to understand the nature of insecurity experienced by households.

In order to avoid the long and difficult task of instrument design and testing, it was hoped to use questions that had already been used in large surveys. The Cornell/Radimer scale and CCHIP (Community Childhood Hunger Identification Project) questions were considered. In the end, it was decided to use a series of questions for the purpose at hand, which were developed with Statistics Canada, based on successful questions that had been previously used. Principles identified in the development of food insecurity instruments such as the fact that adults and children experience food insecurity differently and both quantity and quality of food are important factors (Kendall et al, 1995) were incorporated in the design.

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