The most recent national estimate showed that 1 in 8 Canadian households is food insecure.1 In other words, over 4 million Canadians struggle to put food on the table. Dr. Valerie Tarasuk, a Professor in the Department of Nutritional Sciences at the University of Toronto and the Principal Investigator of PROOF, has been leading research studies to investigate household food insecurity in Canada. We interviewed Dr. Tarasuk to learn more about the relationship between household food insecurity and mental health in Canada.
What is food insecurity? How do you study it?
In a nutshell, we measure the struggle to afford food due to financial constraints. Since 2004, we have been using a complicated 18 item questionnaire that was originally developed by the United States to assess one’s ability to afford food for their household, and then we scale the severity. Every question has a clause attached to it to establish that food insecurity is about money. The severity of food insecurity ranges from ‘people worrying about running out of food before they get money to buy more’ to ‘compromises to quality and/or quantity of food.’ We assess severity because research shows, depending on how severe it is, that it has different implications for people’s health, different causes, and different solutions.
Using Canadian population health data, you have shown clear correlations between food insecurity and mental health. What do you think are the root causes of this relationship?
At this stage, much of the research suggests this relationship is bi-directional. Since food insecurity is such a stressful and extremely demanding condition to manage, it predisposes people to experience depression. On the flip side, people who are struggling with mental illness are perhaps more vulnerable to food insecurity. They may be less able to manage in the workforce and maintain circumstances that would support food security at a household level.
There is one piece of work with prospective data that is worth talking about. In the mid-90’s, Canada launched the National Longitudinal Survey of Children in Youth and Family, where they recruited a cohort of young children and their parents and followed them over time. Back then, we didn’t know a lot about food insecurity measurement. We asked basic food insecurity questions like, “Has your child ever gone hungry in the last year because you didn’t have food or money for food?” That’s a very extreme manifestation of household food insecurity. Interviews with low-income parents show that parents would do anything they can to prevent their kids from going hungry. When kids go hungry, it’s a signal that there’s a significant level of deprivation in that household. Ten to twelve years later, children exposed to such extreme levels of deprivation were more likely to exhibit suicidal thoughts and to have been diagnosed with depression.2,3 The exposure to severe food insecurity in children appears to increase the development of mental health problems, but we are still a long way from saying that there’s a causal pathway.
The co-occurrence of mental health problems and food insecurity is common. One of our studies showed that almost half of women in severely food insecure situations have been diagnosed with mood or anxiety disorders.4 There is no other health condition that we or anyone else has looked at that shows this level of overlap. We also saw a very strong relationship in household food insecurity and the use of mental health services in Ontario. The more severe the food insecurity in a household, the greater the likelihood of an adult receiving treatment for a mental health problem by a physician, an emergency department doctor, or through being hospitalized.5 The chances of hospitalizations due to mental health problems isn’t high—that’s fairly an extreme event. But people who are food insecure, particularly people who are severely food insecure, were much more likely to be hospitalized for mental health reasons than other groups.
The relationship between food insecurity and mental health may not be as apparent as the relationship between food insecurity and physical health. What do you think contributes to the way we perceive these two public health issues?
Our instinct is to think of food insecurity as a food problem, so the manifestation should be related to poor nutrition. For sure, there’s a negative relationship between food insecurity and dietary intake, but what’s become clear over the years is that the stress of food insecurity and the social isolation that characterizes this condition is very damaging to mental health. Day in and day out, individuals in food insecure households are living in this beaten down way where they are isolated by their deprivation. If they have children in their household, the pressure on them to try to make ends meet is phenomenal.
One of the things that we have come to appreciate is when someone is food insecure, we are identifying fairly significant levels of deprivation in the context of financial constraints. If they are struggling to put food on the table because they cannot afford to, they are also struggling to pay their rent, transit, or shoes for their kids. Someone who has a mental health problem may not be able to manage it as well as those who are food secure; they are not able to afford a therapist, pay for transit to access treatment that is publicly funded, or even afford the costs of the medication to manage their conditions. Once you start realizing food insecurity is actually economic, it makes sense that mental health will suffer in that context.
You talk about a need for policy interventions to address underlying causes of food insecurity. What could that look like?
I think a starting point is prevention. If we think about preventing food insecurity from happening, a big part of that is making sure that people have good incomes. Research shows that when people hit 65 years of age, their likelihood of food insecurity drops dramatically,6 and self-reported mental health improves.7 The reason is that people are entitled to old age security and guaranteed income supplement when they turn 65. For people who are currently on welfare, for example, the seniors’ benefits will more than double their income. They’ll also get Pharmacare, which somebody who is trying to make ends meet through precarious work probably doesn’t have. When we have publicly funded programs, like old age pensions, that look after people and provide an income floor, it makes a difference.
In terms of prevention strategies, we need to look at people under the age of 65 and ask, “What are the conditions that predispose them to food insecurity?” and “What can we put in place to make sure nobody falls so far down?” There are many policies at the provincial and federal level that determine income. If we are serious about getting to the root causes of food insecurity, we need to see how we can insulate people from extreme levels of income inadequacy.
1. Tarasuk V, Mitchell A, Dachner N. Household food insecurity in Canada, 2012. Toronto ON: Research to Identify Policy Options to Reduce Food Insecurity (PROOF); 2014. Available from: https://proof.utoronto.ca/.
2. McIntyre L, Williams JV, Lavorato DH, Patten S. Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger. Journal of Affective Disorders. 2013;150(1):123-9.
3. McIntyre L, Wu X, Kwok C, Patten SB. The pervasive effect of youth self-report of hunger on depression over 6 years of follow up. Social Psychiatry and Psychiatric Epidemiology. 2017;52(5):537-47.
4. Tarasuk V, Mitchell A, McLaren L, McIntyre L. Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. The Journal of Nutrition. 2013;143(11):1785-93.
5. Tarasuk V, Cheng J, Gundersen C, de Oliveira C, Kurdyak P. The relation between food insecurity and mental health care service utilization in Ontario. The Canadian Journal of Psychiatry. 2018;63(8):557-69.
6. McIntyre L, Dutton DJ, Kwok C, Emery JH. Reduction of food insecurity among low-income Canadian seniors as a likely impact of a guaranteed annual income. Canadian Public Policy. 2016;42(3):274-86.
7. McIntyre L, Kwok C, Emery JH, Dutton DJ. Impact of a guaranteed annual income program on Canadian seniors’ physical, mental and functional health. Canadian Journal of Public Health. 2016;107(2):e176-82.
Edited by Natasha Cheong & Jeffrey Lynham
Article featured in Elemental Issue 5: Nutrition & Eating Disorders