Affordability of a nutritious diet for income assistance recipients in Nova Scotia (2002-2010)

Capacity building and personal empowerment: participatory food costing in Nova Scotia, Canada

Food insecurity impacts millions of people globally. It has been recognized as a priority and a human right by the United Nations where empowerment of women is identified as a significant goal in addressing food insecurity. In the Maritime Province of Nova Scotia (NS), Canada, more than one in five children live in food insecure households. Since 2002, participatory action research (PAR) has been an integral component of food costing in NS with an aim to support capacity building for food security. Building on earlier research that examined short-term outcomes, and recognizing a lack of research examining outcomes of PAR processes, this study aimed to explore the medium-term individual capacity building processes and outcomes of women involved in Participatory Food Costing (PFC). Findings revealed that capacities were built with respect to interrelated themes of 'awareness, participation, personal development, readiness to change, political impact, influence on others, self-esteem, project growth and project continuity'. In addition, the involvement of these women in PFC resulted in both personal empowerment and food security-related policy change. Involving vulnerable populations through PAR is valuable in influencing health-related policy.

The development of the gluten free healthy food basket in Cyprus. Is it affordable among low-income adults diagnosed with celiac disease?

BACKGROUND

Gluten free (GF) diets are not only restrictive but also costly. The main aim of this study was to evaluate the acceptability, cost and affordability of a Gluten Free Healthy Food Basket (GFHFB) and further examine whether low-income Cypriots diagnosed with celiac disease (CD) experience food stress.

METHODS

GFΗFBs were constructed for adult women and adult men (±40 years) diagnosed with CD. Feasibility and acceptability was tested through three focus groups. Affordability was defined as the cost of the GFΗFB as a percentage of the Guaranteed Minimum Income (GMI).

RESULTS

The GFΗFB was 33.6 and 47 euros/month more expensive compared to the HB (Healthy Basket) for women and men, respectively. The total budget for GF-manufactured products were 27.81 and 28.5% of the total food budget, for women and men, respectively. For low-income people receiving the GMI, the proportion of income that would need to be spent on the GFHFB ranges from around 42 to 60%.

CONCLUSIONS

The GFΗFB is costly and not affordable among low-income Cypriots diagnosed with CD; thus, they are likely to suffer from food stress. As such, the risk of reducing their adherence to a GF diet is high and thus compromises their long-term health.

The cost and affordability of growing and feeding a baby in Nova Scotia

OBJECTIVE

This paper examines the affordability of a basic nutritious diet for low-income families in Nova Scotia over three developmental periods (pregnancy, perinatal, early infancy) using economic simulations that include food costing and secondary data.

METHODS

The cost of a nutritious food basket was determined from a random sample of grocery stores in Nova Scotia (n = 21), along with the cost of infant formula (n = 29) and prenatal vitamins and vitamin D drops (n = 15), from randomly selected pharmacies. The monthly funds remaining to purchase a basic nutritious diet were calculated for several household scenarios, after deducting essential living expenses from net incomes. Each scenario included either a pregnant woman or a breastfed or formula-fed infant at 3 months, and either Income Assistance, Federal Maternity Benefits based on minimum wage employment, or a $15/h wage.

RESULTS

Income Assistance and Federal Maternity Benefits, based on minimum wage, were inadequate to purchase a basic nutritious diet during pregnancy or in early infancy whether breastfeeding or formula feeding. All household scenarios faced significant potential monthly deficits if they were to purchase a basic nutritious diet.

CONCLUSION

Minimum wage and income security programs are inadequate for the purchase of a basic nutritious diet throughout the prenatal, perinatal, and early infancy periods in Nova Scotia, emphasizing risk of food insecurity as a critical issue for young families facing income constraints. Adequate maternity protection is required to support access to food and nutrition essential for maternal and infant health.

"It's not a food issue; it's an income issue": using Nutritious Food Basket costing for health equity advocacy

OBJECTIVES

Ontario's public health units (PHUs) face considerable challenges in addressing the social determinants of health, even though "reducing health inequities" is a primary population health outcome in the Ontario Public Health Standards (OPHS). Since 1998, the OPHS mandated PHUs to use the Nutritious Food Basket (NFB) protocol to document food costs, a requirement that was removed in 2018. This study examined how the NFB advanced health equity advocacy by Ontario PHUs, and why some have used this tool more strategically than others.

METHODS

Semi-structured qualitative phone interviews were conducted with 18 public health dietitians (PHDs) and three key informants between May and October 2017. Interviews were audio-recorded, transcribed, inductively coded, and analyzed.

RESULTS

The PHDs agreed that the NFB tool provides essential localized evidence of inadequate incomes for people living in poverty, and supports the health equity mandate of PHUs in Ontario. Factors that support NFB research and advocacy work include strong PHU leadership regarding health equity, participation in community coalitions, and engagement with Ontario Dietitians in Public Health (ODPH). Interviewees identified lack of support at the PHU level and lack of coordination of food insecurity work at the Ministry of Health as significant barriers to PHUs' use of the NFB to advance health equity mandates.

CONCLUSION

This study offers compelling evidence for reinstating NFB costing in the Ontario Public Health Standards as a mandatory requirement of PHUs. Without this requirement, the already-limited capacity of PHUs to advance health equity in Ontario will be further compromised.

Interventions to address household food insecurity in high-income countries

Household food insecurity is a serious public health concern in high-income countries. Canada and the USA regularly monitor household food insecurity, while in other countries, such as the UK, it has been the rapid rise of food bank usage that has drawn increased attention to this longstanding, but largely overlooked, problem. This review evaluates evidence on interventions intended to reduce household food insecurity in high-income countries. Research on social protection interventions suggests both cash transfers and food subsidies (e.g. the US Supplement Nutrition and Assistance Programme) reduce household food insecurity. In contrast, research on community-level interventions, such as food banks and other food programmes, suggests limited impacts. Although food banks have become a common intervention for food insecurity in high-income countries, evidence suggests their reliance on donations of volunteer time and food make them inevitably limited in the assistance they are able to provide. The stigma people feel using food banks may also make them untenable. Alternatives to, or enhanced, food banks such as community shops or community kitchens, have become common, but evidence also suggests they may be limited in effectiveness if they do not reach people experiencing food insecurity. This review highlights the difficulty of trying to address household food insecurity with community-based food interventions when solutions likely lie upstream in social protection policies.

Reproducing or Reducing Inequity? Considerations for School Food Programs

It is important to consider health inequities when exploring the extent to which school food programs may contribute to the stigmatization and social exclusion of families experiencing food insecurity. As part of a broader school-based project, this paper considers evidence derived from a secondary analysis of research in Nova Scotia (NS). In the original research, interviews were conducted with key stakeholders involved in supporting health promotion activities across NS elementary schools. For this article, data were re-examined using tenets of critical discourse analysis to evaluate if school practices were addressing the root social issues by identifying patterns in language and institutional norms. Our findings suggested that further illumination of programs may be needed to ensure that they do not contribute to the stigmatization and social exclusion of families experiencing food insecurity. Nutrition professionals are in a position to engage families experiencing food insecurity in policy action that will shift from a focus on individual determinants towards the social-structural conditions that underlie the complex issue of food insecurity.

Do low-income Cypriots experience food stress? The cost of a healthy food basket relative to guaranteed minimum income in Nicosia, Cyprus

AIM

The aim of the present study was to assess the cost, acceptability and affordability of the healthy food basket (HFB) among low-income families in Cyprus.

METHODS

HFBs were constructed based on the National Guidelines for Nutrition and Exercise for six different types of households. Acceptability was tested through focus groups. Affordability was defined as the cost of the HFB as a percentage of the guaranteed minimum income (GMI). The value of the GMI is set to be equal to €480 for a single individual and increases with the size of the recipient unit in accordance with the Organization for Economic Co-operation and Development equivalence scales. The Ministry of Labour estimates that, on average, nearly 50% of the GMI is required for food.

RESULTS

The total monthly budget for HFB is 0.80, 1.11, 1.27, 1.28, 1.44 and 1.48 times higher than the GMI budget for food among different types of households in Cyprus (a single woman, a single man, a couple, a single woman with two children, a single man with two children and a couple with two children, respectively). In particular, a family with two children on GMI would need to spend a large proportion of their income on the HFB (71.68%).

CONCLUSIONS

The GMI scheme appears not to consider the cost of healthy food, and thus, families on welfare payments in Cyprus are at a high risk of experiencing food stress. Therefore, additional research is required to measure the cost of the six HFBs in various settings.

Is the minimum enough? Affordability of a nutritious diet for minimum wage earners in Nova Scotia (2002-2012)

OBJECTIVE

This paper aims to assess the affordability of a nutritious diet for households earning minimum wage in Nova Scotia (NS) from 2002 to 2012 using an economic simulation that includes food costing and secondary data.

METHODS

The cost of the National Nutritious Food Basket (NNFB) was assessed with a stratified, random sample of grocery stores in NS during six time periods: 2002, 2004/2005, 2007, 2008, 2010 and 2012. The NNFB's cost was factored into affordability scenarios for three different household types relying on minimum wage earnings: a household of four; a lone mother with three children; and a lone man. Essential monthly living expenses were deducted from monthly net incomes using methods that were standardized from 2002 to 2012 to determine whether adequate funds remained to purchase a basic nutritious diet across the six time periods.

RESULTS

A 79% increase to the minimum wage in NS has resulted in a decrease in the potential deficit faced by each household scenario in the period examined. However, the household of four and the lone mother with three children would still face monthly deficits ($44.89 and $496.77, respectively, in 2012) if they were to purchase a nutritiously sufficient diet.

CONCLUSION

As a social determinant of health, risk of food insecurity is a critical public health issue for low wage earners. While it is essential to increase the minimum wage in the short term, adequately addressing income adequacy in NS and elsewhere requires a shift in thinking from a focus on minimum wage towards more comprehensive policies ensuring an adequate livable income for everyone.

Beyond 'run, knit and relax': can health promotion in Canada advance the social determinants of health agenda?

Can health promotion in Canada effectively respond to the challenge of reducing health inequities presented by the WHO Commission on Social Determinants of Health? Against a background of failure to take seriously issues of social structure, I focus in particular on treatments of stress and its effects on health, and on the destructive congruence of Canadian health promotion initiatives with the neoliberal "individualization" of responsibility for (ill) health. I suggest that the necessary reinvention of the health promotion enterprise is possible, but implausible.