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

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3. A Research Framework for the Lack of Food Security

3.1 Introduction

This research framework examines the issue of lack of food security from the perspective of Human Resources Development Canada. While larger contextual issues such as the national and local food security, rights to food, commodification of food, market failure in the provision of nutrition, community and institutional food infrastructure, changes in culinary culture are not specifically considered, they are recognized as contextual factors.

This study is about insecurity — regarding food insecurity as an extreme manifestation of personal and household insecurity. Applied Research Branch has also studied other types of insecurity, such as job insecurity and income insecurity.

This framework provides a structure for studying the lack of food security and the relationship between variables. Based on the framework, potential questions drawn from other surveys are suggested for a supplement to the National Population Health Survey. The Applied Research Branch worked with Statistics Canada to finalize the questions for the supplement.

3.1.1 Old problems in new contexts

The distinguishing characteristic of first world countries is growing prosperity widely shared among its population, as evidenced by good housing, health, education and prospects for individuals. In the post-war years, these countries strove to guarantee a basic standard of food, shelter, and income through economic and social welfare policies; and, by the sixties and seventies, much headway had been made in eliminating poverty. However, the affluent industrialized countries are currently undergoing transformation due to major shifts to globalized economies based on information. Governments, including Canada, have undertaken major social policy reform. In recent years, significant social issues such as homelessness and lack of food have re-appeared. These problems are particularly vexing for countries such as Canada, which have sufficient food and housing stocks and which have retained safety net policies.

Issues of food revolve around both availability and access (See definition by Anderson below). . Food availability is linked with the production and distribution of food resulting in food that is present to be acquired. While there may be problems in local and national food supply in Canada, they are not the focus of this study. Food access, on the other hand, is related to the process of consumption by individuals and households. It involves having sufficient financial resources to acquire food at market prices, being able to travel to places where food is sold and being able to store food until use. The intention of focusing solely on access does not imply that solutions for such problems lie with individuals but to examine the problem from the perspective of individuals for policy purposes.

What causes households to be not food secure in the new context? Old assumptions regarding the reasons for lack food security continue to persist. The problem of lack of food tends to be oversimplified as exclusively poor income management, either in terms of acquiring income or in budgeting resources, and are, therefore, generally addressed by income security programs, with mixed success. There are indications that households experiencing food insecurity had arrived at this situation through different paths. They would therefore rely on different coping strategies. If this was the case, then the policy response has to be more diverse also. The lack of food security is a symptom of unsuccessful responses to changes in context which results in a combination of disadvantage in terms of income, health, employability and expectations which characterize extreme manifestations of poverty rather than just the lack of income. It is essential to develop a realistic understanding of the lack of food security, and the potential of levers available for government and non-government action.

This research framework provides a backdrop for discussion regarding data collection, linkages and research and policy development. The intention is to develop indicators of the problem, recognizing the interaction between people and their context, but focusing on consumption. This discussion paper and the framework was revised after an extensive public review. The components of the framework are discussed in greater detail below. For each section policy and research issues are identified. From a review of questions used in previous studies, the suggested question or series of questions used for discussions with Statistics Canada, is also given.

A module on food insecurity was added to the National Population Health Survey in 1998. It is not an ideal vehicle and not all data requirements can be met, however, it has many advantages.

3.1.2 Consequences of not being food secure in "food rich" countries

A key reason for examining the various experiences of those not food secure, is to identify those vulnerable and at-risk populations for the development of adequate preventive and supportive policy measures. Therefore, it is important to include those who are food insecure as well as those who actually experience lack of food.

Food insecurity is a managed process (Tarasuk, 2001) where individuals make choices in a sequence of events. These pathways to food insecurity can therefore, vary in terms of duration, coping strategies and consequences. Food insecurity can be episodic and temporal in nature.

A sense of security is experienced when people have a wide range of options, most of which are desirable, at their potential disposal and when they have confidence that they can exercise them. Insecurity is accompanied by a narrowing of the range of options, most of which are undesirable, and the uncertainty that they can exercise them. It has been pointed out, that food economies are exercised by people of all incomes, however, the poor have less choice in the duration, the type, the content and the responses to the need for food economies. Whether one is secure or insecure results in various behavioural consequences. If secure, people are able to focus their efforts on desired goals other than survival, to take risks when seizing opportunities, to create an orientation towards the future and to develop economic, social and human capital (Starkey, et al, 1998). Insecure people cannot. Anxieties may be heightened by knowing the consequences of the lack of food, and previous experiences of it (See Table 2).

It is wise to begin by specifying what food security is so that it possible to identify those that have failed to achieve it. Food security implies the certainty or confidence that there will be sufficient food in the foreseeable future. The elements involved in food security appear to include: the means and the ability to acquire food, the consumption of good quality food in sufficient quantity and the achievement of nutrition goals. While these elements are common to developing countries as well, the differentiating point is to accomplish these elements in the current Canadian context in a manner that meets community standards for respectability (without resorting to emergency or charitable food sources or scavenging) and fairness (without eliminating other options important for welfare, such as medical care, transportation, etc., necessary to function in modern societies).

Table 2 - Consequences of Food Insecurity for Individuals and Households

Food Secure	Food Insecure
Focus efforts on desired goals	Focus efforts on survival, could be time poor
Seize opportunities, take risks	Lack of resilience, no fall back
Future orientation	Live from moment to moment
Develop social and human capital	Have difficulty investing in themselves
Ability to develop support system	Poorer social network
Adequate earned income	Working poor, unemployment
Generally good health	Disability, chronic conditions

Food security has been defined as "Access by all people at all times to enough food for an active and healthy life. Food security includes at a minimum a) the ready availability of nutritionally adequate and safe foods b) an assured ability to acquire acceptable foods in socially acceptable ways" (Anderson, 1990). A Canadian definition is similar. "People have food security when they can get enough to eat that is safe, that they like to eat and that helps them to be healthy. They must be able to get this food in ways that make them feel good about themselves and their families."(Ontario Public Health Association, 1995).

Those that lack food security, as expected, are defined as failing to achieve this goal. This is demonstrated in the following two American definitions. Lack of food security is: "The inability to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways or the uncertainty that one will be able to do so" (Radimer, et.al., 1992) and "Food insecurity exists whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain."(Anderson, 1990). A Canadian definition reflects the same issues: Food insecurity is the "inability to obtain sufficient, nutritious, personally acceptable food through normal food channels or the uncertainty that one will be able to do so." (Davis and Tarasuk, 1994).

In this framework a distinction is made between those lacking food security and food insecurity, in the spirit of the last definition above. For this study, those who are not food secure (1) experience uncertainty that they will be able to acquire and consume adequate quality and quantity of food in mainstream ways (2) consume nutritionally inadequate food (3) consume reduced quantity and quality of food (4) acquire and consume food in non-mainstream (socially unacceptable) ways or by incurring further disadvantage (deplete assets, not spending on necessary medications, etc.). It recognizes that there can be a progression of severity in the process of food insecurity (Wolfe, et al, 1998) and that the conditions can be cumulative.

3.1.3 The emerging context

In Canada, as elsewhere, work and family, not the state were considered the principal foundations for social welfare. The range of government programs that are available were designed with this assumption and therefore are residual and safety net in nature. There are indications that during this era of transition, both the family and labour market have changed radically due to exogenous forces such as the global nature of trade and capital, the churning of labour markets, the demographic changes such as a population that is aging and increasingly diverse. Families, too, have changed in structure, composition and function due to increasing divorce and separation, lower fertility, and inability to build assets and security through the labour force participation. Some families incur a debt burden, when unable to manage unforeseen circumstances because they have insufficient disposable income to manage them. These changes have resulted in the re-emergence of problems that were once considered solved, or at least receiving attention.

Social policy reform and changes in government programs have also had their impact. Canada, along with other industrialized countries, is seeking to make adequate changes to policy to respond to the emerging context. While not abandoning government's residual role, there has been a tendency to rely more on markets on the one hand, and to shift responsibility back to family and community, on the other.

Lack of food security may be affected by social, legal, institutional or infrastructure factors and these are included in the context. However, economic factors are given prominence. For instance, low, irregular, or failed streams of income may result from interrupted employment, non-standard jobs, or no job at all. In addition, income may be reduced or lost due to loss of an earning member of the family due to death or divorce. Persistent low income is associated with poor health and higher rates of disability which may affect access to food. There are also some indications that the system, or infrastructure, disadvantages those below a certain level of income. For example, persons with low income may unable to shop around for low food prices if they do not operate a car, or if they cannot pay transportation costs. Researchers have noted that community characteristics are important intervening variables in the experience of food insecurity (Olson, C.M., et al., 1996). Others have noted a change in the practice of food consumption with a preference for prepared or processed foods has resulted in people being inexperienced in preparing food, though "raw" food is cheaper.

Research and policy issues

Basic demographic information is necessary to understand the characteristics of the persons who are not food secure. It would be valuable to also have some basic information about their employment and health status.

The larger policy question is the degree to which transfers allow individuals and families to maintain a socially acceptable standard of living, while still having to rely on consumption in the market. Since only a minimum is guaranteed, the margin of manoeuvre offered is a key issue. Furthermore, while countries like the United States have food aid, such as food stamps, Canada, at least at the Federal level, does not offer food assistance. The value of food assistance for children in terms of breakfast programs and school lunches has been discussed by several provinces. Are income security programs sufficient to prevent the problem and to support those who lack food?

3.2 Income and Expenditure

Since socially accepted sources of food are provided in the market, income is a critical variable. Indeed, some researchers argue that all barriers to food sufficiency can be reduced to income. The sources of income and their reliability for a steady flow and reliable amounts are important to individuals and households. Households have worked to maintain a level of income necessary to raise families with a good quality of life. As real average income has been in decline, in the nineties, for the first time, census data is picking up households that have two earners with more than two jobs as families seek to increase their income. The process of budgeting and planning is a key process for managing income in times of economic turbulence and labour market churning. For those with low income or irregular income, the planning horizon is short and money for contingencies may cut deeply into disposable income.

Though disposable income is the key, the flexibility afforded after fixed expenditures is important at low incomes. The lack of food security may be periodic, such as during periods of unemployment, or during the winter. For instance, those with fixed incomes such as the elderly have noted that their income is insufficient in the winter months when they have higher heating costs. For those with low incomes or high fixed costs, it may be experienced at the end of the month (Wilde and Ranney, 1998). Since much of the fixed expenditures such as rent are paid at the beginning of the month, they are faced with a phenomenon that is called "too much month at the end of the money."

Research and policy issues

Information on work history, income, sources of income, and disposable income will be necessary to inform policy. However, at low incomes, it is not only the relation between the income and expenditure, but also the pattern of inflows and outflows within the month or year. Information on those living under the low income cut-off or under conditions of deep poverty (50% of the low income cut-off) and the duration of such poverty may also be linked to the lack of food security.

3.3 Characteristics of Those Who Lack Food Security

The first step is to separate those who are food secure from those who are not. A series of questions would then try to illuminate the conditions faced by those who are not food secure. The literature describes three negative food states experienced by people who are not food secure which are included in the framework. Food insecurity is the anxiety arising from the limited or uncertain ability to obtain and consume sufficient quantity of nutritionally adequate food through normal food channels. When food insecure households begin to reduce their intake or to reduce the quality of their diet, they are nutrition insecure. However, it should be noted that food security is a necessary but insufficient condition for nutrition security. Nutrition security may be adversely affected by food choices that are made, due to factors other (lack of information, poor food habits, dieting, etc.) than income. Food poverty is the inability to obtain and consume sufficient quantity of nutritionally adequate food. These levels are not discrete and they tend to be cumulative. In other words, the food-poor also experience the anxiety of food insecurity. There can be movement between the three states. Those who are food insecure, may begin coping strategies for fear of running out of food. For instance, a family may experience all three levels in a month, worrying about a shortage of food and money, compromising quantity and quality of food to delay a crisis and, if money and food run out, absolute deprivation at the end of the month, until the cycle begins again.

The severity of the problem is a function of both the level to which food intake (quantitative and qualitative) is compromised and the duration of the deprivation. The distinctions are useful for developing a package of policies that target all three levels. While all three food states are problematic, the seriousness of the impacts vary with the severity and duration of the time spent in each state. Up to one fifth of food bank users are first time users, so for many this may be a new experience. They may not have developed ways to cope with the situation. Weight loss, on the other hand, would result only if persons experience food poverty for period of time. Income security programs may not be serving this group adequately.

The consequences of the lack of food security results also in behavioural decisions referred to above with long term results. Households that are food-insecure tend to spend more time and effort to obtain food for their members, in contrast to the current trend for households to reduce effort through intake of purchased prepared foods or restaurant meals. So the shortfall is not only of disposable income but also of disposable time. The nutrition-insecure are households that compromise their diet and begin to experience problems of low energy, deficiencies, anxiety and even hunger if meals are skipped over a long period. The impacts of chronic and repeated food poverty range from affected development for children, difficulty in learning for students, and low productivity for adults.

Within poor families, transfers can be of access to food. For instance, in many households of traditional culture, males may be fed first and followed by females but there may not be enough food for all. Mothers may feed children by reducing their own intake. This type of sharing has negative consequences of varying degrees for the members of the family, particularly for earning members.

3.3.1 Research and policy issues

To understand a predisposition to experience the lack of food security, it is important to know the characteristics of those who state they are food insecure. Perhaps, comparisons between those experiencing various conditions of lacking food will illuminate where existing policies are weak.

3.3.2 Suggested questions

Screening questions

Which of the following, best describes the food situation in your household in the past year:

1. You were satisfied with the food you ate.
2. You worried that you may not have enough to eat because you did not have enough money for food.
3. You sometimes did not eat the kind, quality or variety of food that you wanted to eat because you were running out of money.
4. You sometimes did not have enough food to eat because you ran out of money for food.

Source: Based on the National Population Health Survey Questionnaire with some modifications

A screening question separates those who are food secure from those who are not during a defined period (last year). Links to other questions in the survey will indicate their employment, age and health status. Screening for the last year allows the respondent to answer more detailed questions for that year.

The screened-in respondents are then asked a series of questions that provides insights into those who are not food secure. Questions have also been developed in prior surveys to measure food insecurity among adults and children, as well as households. For example, The Cornell Radimer questionnaire is a validated instrument (See appendix). However, experts pointed out that the concept of food insecurity measured by that instrument was not the same as described in this framework.

Positive responses to any of the questions other than the first allow us to examine the experience of those who are not food secure. Responses to the following questions provide more detail on their experience. The severity of the problem can be surmised from those who experience food poverty on a regular basis. For effective policy impact, responses would need to vary with periodicity of food insecurity. Therefore, questions on the periodicity of food insecurity are required. These will distinguish those who are food insecure for the first time, those who are periodically food insecure, those that are food insecure at the end of the month and those who are regularly food insecure.

Follow-up questions to those screened in

In the past year:

Did you worry whether food will run out in your household before there was money to buy more? (Never, at the end of the month, sometimes, often, always)

Rationale: Persons at risk or food insecure

Did you or anyone in your household eat cheaper foods or the same foods several days in a row because you did not have money to buy more food? (Never, at the end of the month, sometimes, often, always)

Rationale: Persons compromizing food quality (nutritionally at risk)

Did you or anyone in your household skip meals or eat less than you should because you lacked the money to buy food? (Never, at the end of the month, sometimes, often, always)

Rationale: Persons eating insufficient food (nutritionally at risk)

Have you or anyone in your household been hungry because you cannot afford to buy food? (Never, at the end of the month, sometimes, often, always)

Rationale: Persons experiencing food poverty

There continue to be concerns that responses to these questions may not provide a complete picture.

The concerns are:

• Under-reporting due to the social stigma attached to hunger in food-rich countries.
• Since normal sampling may not result in sufficient responses from the poor and the near poor, the numbers may be too low to draw inferences.
• If there is one respondent per household, differences due to age and to family roles may not be captured.
• If the screening question relies on the respondent having actually experienced food insecurity in the past year, potential households at risk may not be captured. However, there is a preference to screening on the basis of actual experience, than a determinant such as low income.
• Questions should work over the life path and provide information on the vulnerable such as children and the elderly.
• Length of the reference period could affect prevalence rates. Questions should capture first time, repeat or episodic cases.
• Questions have been largely used on samples drawn from the low income population and users of food bank and may not work for the general population.
• Comparisons should be possible across settings and sub-populations.

3.4 Differences Between Those Who Are Food Secure and Those Who Are Not

As shown in the framework, those that are food secure have many options and most of these options are mainstream and desirable. Those who are not food secure, on the other hand, have fewer options and most of them are less desirable and not mainstream. These options can be grouped under food-related behaviour categories of income management, food acquisition and food management in the home. The focus of the questions deal with the use of options that are less desirable.

3.4.1 Income management

Income management involves ensuring the flow of income and expenditures in a manner that ensures the well-being of the household. The process is harder for low income households that have less disposable income and hard choices between necessary expenditures. They may have difficulties even with foreseen expenditures and unexpected expenditures can upset the budget over long periods.

First time food insecure households may have options that are not available to those with a persistent problem of food security. They may borrow hoping that the crisis will pass, or they may start to deplete assets, ranging from borrowing from mainstream credit institutions against the security of house or car, or other institutions such as pawnshops which accept other durables as security. Even informal borrowing may be difficult because most poor people, tend to know people like themselves who do not have much income. But credit is not a viable option for those in constant food insecurity since they have depleted their assets and have little ability to pay back loans. It makes it impossible for them to make ends meet in the months when the debt is repaid. Some are able to manage small shortfall by either the use of coupons or returning bottles and cans to increase food dollars or by substituting regular expenditures, such as avoiding transportation or drug expenditures in favour of food.

Research and policy issues

It is possible that below a certain level of income, middle class solutions no longer hold, however, these often characterize the recommendations that are made. For example, gardening to reduce costs for fresh produce, is not attractive to households who may live in rooms or apartments without land, and are not sure that they can pay the rent long enough to reap the fruits of their labour. Options, therefore, may fall into categories that are not socially acceptable.

Under income management, the key issues for research and policy are the barriers faced by households with respect to, the inability to increase income, inability to deal with unexpected expenditures resulting in forced substitution, inability to deal with expected variations (rents at the beginning of month, heating costs in winter), very high fixed expenditures (including rent, mortgage). Employment and income information will provide some background but the picture would be one sided because of the lack of expenditure data. Substitution was an issue addressed by questions in the U.S. (See appendix). Some of the other issues may be handled by examining other sources, such as tax files, or information on expenditures, though links are not possible with the National Population Health Survey. If recipients of social assistance are using money allocated to food for housing or other needs, the calculations for social assistance payments may require revisiting. It may also be worthwhile providing a larger margin to allow households some economic flexibility, in exchange for reduced public expenditures in the long run. Information on the percentage of monthly expenditures dedicated for shelter would provide an indication if housing costs are squeezing other necessary expenditures.

Suggested questions

1)What proportion of your income do you spend on Housing (Rent or mortgage+taxes __in)?

2)People do different things to stretch their food money when they cannot afford food. In the past year, has anyone in your household: (Never, sometimes, often)

1. Borrowed money for food?
2. Sold or pawned possessions for food money?
3. Used coupons or returned bottles at the end of the month when short of food money?
4. Delayed paying bills to keep money for food?
5. Did without heat or telephone to keep money for food?
6. Bought food on credit?
7. Grew some of your food?
8. Hunted or fished for food?
9. Joined a food buying club?

Rationale: Information on income management

3.4.2 Food acquisition

Food acquisition activities can make a difference to food security. Food staples may be bought in large quantities. Other food products can be bought in bulk to reduce costs while shopping more frequently for fresh foods with short storage times. With good stock management additional flexibility is gained for composing meals for both quality and variety.

When income is irregular or low, households may have fewer options. They may shop daily to eke out money for food or they may be forced to rely on options that are less desirable such as using a food bank. Programs such as home care for elderly and disabled people may assist them with the purchase of food if they are unable to do so themselves.

The key barriers to food acquisition are poor health, disabilities, transportation costs, limited choice of shopping possibilities without transportation, inability to stock up or buy in bulk or store food. Some variables interact, too. The lack of transportation limits the geographic shopping range and bulk buying, particularly when food must be carried back. Elderly and disabled persons encounter difficulties shopping, particularly in winter. These factors, in addition to a shortage of money, may require frequent shopping trips with small packages; which, may be more expensive then large ones.

Research and policy issues

The tested survey questions appear to be limited to those addressing poor health and disabilities or the use of food banks. Some questions have been included in other Canadian surveys such as the Health and Activity Limitation Survey and the General Social Survey (See appendix). The question suggested is based on this experience.

Have you or others in your household had problems shopping for food? No,

• Yes, stores too far away.
• Yes, no transportation.
• Yes, no money for transportation.
• Yes, ill (health).
• Yes, disability.
• Yes, other problems.

Rationale: Difficulties accessing food

3.4.3 Food management

Food management at home requires the proper storage of food, judicious meal planning and monitoring for nutritious content. Lack of adequate food storage can result in spoilage, and waste as well as working with the short term life of foods. Where time is an issue, the quality of foods may be sacrificed.

Positive options include meal planning to ensure the use of inexpensive foods, using ingredients on hand and foods in season. Negative options include stretching food components by reducing quality and eating the same thing over and over again. It is also possible to also rely on programs such as meals on wheels and school meals. Food may be prepared for some elderly and disabled persons by home care workers.

Policy and research issues

For most people, it appears that when quantity is an issue, nutrition and variety are not a consideration. For some, however, there are some critical requirements due to health conditions. For instance, those on insulin treatment require food intake at fixed times. Disability or disease may require special diets or soft foods. Those allergic to certain food may require special foods that tend to be more expensive. While a generic food allocation may be part of the social allowance, it is an issue whether a special allocation is required for certain conditions or whether a greater margin allows sufficient flexibility.

Most surveys in the past have not used questions on this type of detail. There have been some questions on surveys that include participation on programs such as home care, meals on wheels and school meals. Diary type of information on food expenditure and consumption are rarely collected because they are labour intensive. Nutritious food basket calculations appear to be more common, however, it is not clear how closely these resemble the actual food consumption of those of low income.

Suggested questions

Have you or any one in your household used the following programs:

• Meals on wheels?
• School meals?
• Home care for shopping or and food preparation?

Rationale: Use of food services. The National Population Health Survey has a question on the use of home care services in the past month. It does not capture school meals.

3.5 Child Food Insecurity

The government has made the reduction of child poverty a major policy objective. Lack of food or poor food has pernicious and long term effects on the development of children. This will be a good opportunity to gain data and to link it to other population health data.

Suggested questions on child food insecurity

In the past year: (Never, at the end of the month, sometimes, often, always)

1. Have you worried that you cannot afford to feed your child?
2. Were you unable to provide your child with a variety of foods to make up a balanced diet because you could not afford it?
3. Did you reduce the size of your child's meals because there was not enough money for food?
4. Has your child been hungry because there was not enough food and not enough money to buymore?
5. Has you child lost weight due to skipped meals because you could not afford food?

Rationale: To identify children at risk, eating food of compromised quality, insufficient food, food poverty and at-risk from hunger

3.6 Limitations and Federal Priorities

3.6.1 Limitations

A major limitation will be the inability to develop the long term consequences of food insecurity from a single supplement to the NPHS. Some socio-demographic information may be available from the main survey.

3.6.2 Federal priorities

The exercise of personal responsibility and civic participation requires fairness as well as equality. Research on food insecurity is the negative extreme of inequality and would contribute to this priority. Lack of food security affects adults and their capacity to be productive and to cope with the future. Furthermore, another goal is to invest in children. Food insecurity affects the development of children, and has physical, social and psychological consequences for their future. Child poverty is a major target of policy attention.

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