Addressing Food Insecurity and Food Access Issues in St. Thomas and Elgin County Elgin St. Thomas Public Health February 2017

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1 Addressing Food Insecurity and Food Access Issues in St. Thomas and Elgin County Elgin St. Thomas Public Health February 2017 SUMMARY Community food security exists when all individuals have the physical and financial means to access safe, sufficient, and nutritious food to meet their food preferences and dietary needs. Household food insecurity is the inadequate or insecure access to food due to financial constraints. Inadequate social assistance rates, low wages, and precarious employment are barriers to accessing a healthy diet. Household food insecurity is a serious public health problem, affecting individuals physical, mental, and social well-being. In , 9.5% of households in Elgin St. Thomas were food insecure. The Nutritious Food Basket is a survey that measures the affordability of healthy foods for individuals and families. In 2016, the cost of a healthy diet in Elgin St. Thomas for a family of four was $199/week or $865/month. Improvements have been made to minimum wage and the Canada Child Benefit in order to reduce poverty and food insecurity. However, additional solutions are required to ensure that vulnerable populations are able to access a healthy diet. Current evidence indicates the need for targeted and sustainable approaches to reduce food insecurity. Income solutions and community food access programming is warranted. SUGGESTED ACTIONS The following suggested actions are recommended to address food insecurity and food access issues: 1. Support the provincial government in the establishment of the Basic Income Guarantee pilot to reduce poverty and income insecurity. 2. Advocate for municipal, provincial, and federal action in the development of a Living Wage policy. 3. Encourage the provincial and federal government to increase social assistance rates to reflect the actual cost of nutritious food and adequate housing as informed by the Ministry of Health and Long-Term Care s Nutritious Food Basket survey and the Canada Mortgage and Housing 1

2 Corporation Rental Market report, respectively. 4. Encourage the provincial government to provide all Ontarians living in low income with access to health benefits, regardless of their source of income. 5. Encourage the Ministry of Health and Long-Term Care to update the Nutritious Food Basket survey to more accurately reflect the cost of eating by including items that represent a wellbalanced diet and are culturally appropriate. 6. Support community food access programs that promote the availability and affordability of healthy food, such as community gardens and edible gardens, fruit and vegetable gleaning programs, and the Good Food Box program, through the Healthy Kids Community Challenge. 7. Work with community partners to support the establishment of new community food access programs in different regions throughout Elgin St. Thomas, specifically targeting areas with poor access to healthy food. HISTORY As a result of the establishment of the Elgin St. Thomas Community Leaders Cabinet and the initiation of the Healthy Kids Community Challenge a review of existing community reports was conducted. This review identified common themes or issues in our community. The top issues identified were: Poverty Food Insecurity and Food Access Safe and Affordable Housing Transportation Awareness of Community Services Education and Workforce Development Mental Health Community Safety and Violence Prevention Access to Health Services Access to Affordable Recreation Based on this research and discussions at the Community Leaders Cabinet, staff at Elgin St. Thomas Public Health began systematically understanding transportation, food insecurity and food access issues, safe and affordable housing, and access to recreation using a process called System Mapping. System Mapping is an approach to identify and present components of a system in a structured way. The purpose of System Mapping is to gather a better understanding of what is happening in the community, who is doing what, and identify what models other communities are using. These System Mapping Reports will provide an opportunity for community partners and the Community Leaders Cabinet to systematically and collectively develop a plan to address these community wide issues and improve the quality of life in Elgin St. Thomas. 2

3 The analysis of the food system involved assessing the availability of food retail resources as well as food access interventions for at-risk populations. To complete this analysis, components of the Elgin St. Thomas food system were incorporated into a geographic information system (GIS). GIS mapping involves integrating components of the food system with demographic variables to produce maps in order to analyze the community. Locations of various food retailers were mapped in order to determine which areas are considered food deserts and/or food swamps. Information about the classification of retailers can be found in the glossary section of this report. Geographic maps were developed during The introduction of new retailers and closure of existing retailers may cause changes to the maps over time. OVERVIEW Household Food Insecurity Food security exists when all individuals have the physical and economic access to safe, sufficient, nutritious, and culturally acceptable food to meet their food preferences and dietary needs (1-2). In Canada, food insecurity is monitored at the household level. Household food insecurity is the inadequate or insecure access to an adequate food supply due to financial constraints (1). The term hunger is often used in place of food insecurity; however, they are not the same. Hunger refers to the physical discomfort, pain, or weakness experienced by an individual who has not eaten for an extended period of time (2). Hunger may be a result of an individual experiencing food insecurity. Individuals and households experiencing food insecurity may worry about being unable to afford a nutritious diet. They may run out of food before they are able to afford to buy more and resort to skipping meals, eating a less healthy diet, or in extreme cases, going a full day without eating. Since 2005, food insecurity in Canada has been measured through the Household Food Security Survey Module (HFSSM) of the Canadian Community Health Survey (CCHS), administered by Statistics Canada. The CCHS is administered to a sample of approximately 60,000 Canadians, which are considered representative of the 10 provinces and 3 territories (1). The HFSSM is an 18-item questionnaire that asks respondents whether he/she or other household members experience various conditions relating to food insecurity. Conditions may include: anxiety that their food supply will run out before they can afford to buy more food; skipping or cutting meals; eating less than they felt they should; or not eating for an entire day. Based on the number of positive responses to the 18 questions, the households are classified as food secure 1, marginally food insecure 2, moderately food insecure 3, or severely food insecure 4 (1). Statistics Canada and Health Canada report household food insecurity using only three categories: food secure (food secure + marginally food insecure), moderately food insecure, and severely food insecure (2). Therefore, statistics presented in their reports may underestimate the true prevalence of household food insecurity in Canada. In Ontario, Canada s most populous 1 No indication that there are any income-related challenges associated with food access 2 Some concern with food access over the past 12 months 3 Compromised quality and/or quality of food consumed over the past 12 months 4 Reduced food intake among adults and/or children due to lack of money 3

4 province, 11.9% of households were food insecure in (1). Food Insecurity: A Serious Public Health Problem A growing body of research shows that household food insecurity is closely linked to individuals health and well-being. Adults and children from food insecure households have poorer physical and mental health compared to adults and children from food secure households (2). Children and adolescents in food insecure households are more likely to experience poor overall health; birth defects; asthma; chronic health conditions; developmental and behavioural problems; mental health problems, including depression, social anxiety, suicidal ideation, and suicide attempts compared to children and adolescents from food secure households (1-4). In adults, food insecurity is associated with self-reported poorer physical, mental, and oral health; mental health problems, such as depression, anxiety, and suicidal ideation; and chronic conditions such as diabetes, hypertension, and heart disease (2, 5-10). Food insecurity can also impact an individual s ability to manage their chronic health problems, creating a significant burden on the healthcare system. A study published in the Canadian Medical Association Journal looked at the relationship between food insecurity and healthcare costs. The researchers found that healthcare costs were 23% higher for adults in marginally food insecure households; 49% higher for adults in moderately food insecure households; and 121% higher for adults in severely food-insecure households; compared with adults in food-secure households (11). Food Insecurity by Household Characteristics Certain characteristics place a household at greater risk of food insecurity. Since food insecurity is impacted by a household s finances, income is the strongest predictor of food insecurity. Figure 1 (Food insecurity by household income) shows that individuals and households in lower income brackets have a dramatically higher probability of being food insecure (1). In addition to total income, the source of income can be a strong predictor of food insecurity. The vulnerability of individuals and families that live in low-income to food insecurity has been documented extensively. CCHS data from 2014 has shown that 60.9% of individuals and households in Canada whose main source of income was from social assistance experienced some level of food insecurity. In Ontario, this number is Figure 1. Food insecurity by household income 4

5 higher at 64% (1). Among all food insecure households in Canada, 62.2% of the households main source of income was from wages, salaries, or self-employment (1). These figures suggest that wages, salaries, and social assistance levels are inadequate for Canadians to meet the basic cost of living. Other household characteristics that are associated with a greater prevalence of food insecurity include (1): Households with children under 18 years of age (15.6% food insecure Canadians) Households with children under 18 years of age, headed by female lone-parents (33.5% food insecure Canadians) Individuals without children under 18 years of age that are unattached, and living alone or with others (15.7% food insecure Canadians) Individuals or households spending more than 30% of a household s income on shelter costs can make it difficult to afford basic needs: 24.5% of households that rent their shelter experience food insecurity, in comparison to 6.2% of homeowners (Canada data). In , 9.5% 5 of all households in Elgin St. Thomas experienced food insecurity (12). This value does not include households that are marginally food insecure, and therefore, may be an underrepresentation of the true prevalence of households that are food insecure in Elgin St. Thomas. Every May, all health units across Ontario are mandated by the Ministry of Health and Long-Term Care to survey the price of food items using a tool called the Nutritious Food Basket (NFB). The cost is determined by pricing 67 food items from grocery stores in the catchment area and calculating the average lowest retail price. The NFB measures the cost of a healthy diet that meets recommendations from Canada s Food Guide. Prepared convenience foods, personal and household non-food items such as toothpaste and cleaning supplies are not included in the NFB. The monthly cost of feeding a reference family of four 6 in Elgin St. Thomas was $801 in 2013, $833 in 2014, $838 in 2015, and $865 in After paying housing expenses and food costs, individuals and households still have to pay for other necessities, such as: heat and hydro; child care; transportation, car maintenance, gas; clothing; home maintenance; school supplies; household cleaning supplies; personal hygiene products; insurance; eye and dental care; and other necessities. Figure 2 (Nutritious Food Basket 2016 scenarios) depicts real life situations for individuals and households living in Elgin St. Thomas in 2016 (13). An individual or family of four on social assistance may struggle to afford rent, food, and the cost of all other remaining expenses. They will often cut their food budget to afford other basic expenses. 5 95% CI: 7.0%, 12.8% 6 A reference family of four is composed of a male years old, a female years old, a male years old, and a female 4-8 years old. 5

6 Figure 2. Nutritious Food Basket 2016 scenarios Current Responses to Food Insecurity Downstream-level approaches Downstream-level approaches to food insecurity focus on removing barriers to programs and services that promote healthy eating and access to food. In other words, these approaches focus on reducing the acute effects of hunger, rather than addressing the underlying causes of food inaccessibility, which is poverty. Food banks and emergency food services are among the most well-known charitable responses to food insecurity. Food banks originated as a temporary food relief solution during the 1980s recession; however, as the economy improved, the demand for food banks didn t decrease. Today, food banks have grown into an extensive food charity system serving low income individuals and households. The stigma associated with reliance on food banks may explain why less than 25% of individuals experiencing food insecurity access food banks and other food charities (2). For this reason, food bank usage statistics should not be used as an accurate measure of food insecurity in a community. Other downstream-level approaches in Elgin St. Thomas include community meals, low cost meals, and student nutrition programs in schools. Midstream-level approaches Midstream-level approaches to food insecurity aim to reduce barriers to food access at an individual and community level and develop food skills and knowledge. These approaches 6

7 increase access to affordable, nutritious food, which can ease the strain on food insecure individuals and households. However, they still do not increase an individual or household s income to assist with purchasing these foods. Midstream-level solutions in Elgin St. Thomas include cooking programs, community gardens and edible gardens, and Good Food Box programs. Elgin St. Thomas has opportunities for community gardening as a number of supportive policies have already been developed. Central Elgin and the City of St. Thomas have recognized community gardens as a valuable community resource that promotes health and well-being, positive social interaction, a sense of community, and local food security (14). Central Elgin s official plans allow for all municipal land use designations, with the exception of natural heritage lands, to be used as regulated community gardens. Currently, two additional public edible garden sites are being planned within St. Thomas. Upstream-level approaches Upstream-level approaches to food insecurity aim to redesign the food system through the implementation of food policies, policy councils, and social advocacy activities in order to improve the sustainability of the food system. Coordinated government policies such as social assistance, subsidized housing, child benefits, old age security, and employment insurance can assist individuals and households that are food insecure; however, these policies have not been designed to alleviate food insecurity. In support of the Ontario government s poverty reduction strategy, the Basic Income Guarantee (BIG) pilot is a strategy that is being developed in order to assist individuals living in low income. The cost of implementing a basic income program would be a significant public expenditure. However, even conservative estimates of the indirect costs of poverty (e.g., health care, remedial education, crime, and social assistance programs) are far higher than the costs of implementing an income approach to food insecurity. Other upstream-level approaches include food strategies, food charters, and food security social advocacy groups. The Food for All committee is a food security group in Elgin St. Thomas that provides a mechanism for members to collaborate on the implementation and delivery of food-related programs and initiatives. Currently, Food for All is developing the Elgin St. Thomas Food & Nutrition Strategy, a plan for healthy food and healthy food systems in Elgin County and St. Thomas. The strategy is based on principles from Food for All s Food Charter, which describes our community s vision of a healthy food system. The strategy includes three key strategic directions: 1. Healthy Food Access: Residents of Elgin St. Thomas have access to safe, affordable, healthy, and culturally acceptable foods. 2. Food Skills and Literacy: Residents of Elgin St. Thomas have the knowledge, skills, confidence, and environment to support healthy eating choices where they live, learn, work, and play. 3. Healthy and Sustainable Food Systems: Elgin St. Thomas has a healthy and resilient food system that promotes health and contributes to a prosperous economy. Suggested midstream and upstream level actions will be developed for each strategic direction. 7

8 GLOSSARY Food Desert A food desert is a term used to describe an area where residents may not have access to a healthy food retailer such as a grocery store. For the current analysis this is defined as living more than 1km from a healthy food retailer in an urban environment or living more than 16km away from a healthy food retailer in a rural environment. During this analysis it was recognized that the borders of Elgin County, while used for administrative and municipal purposes, likely do not influence the retail/commercial behaviour of the residents of Elgin St. Thomas. Therefore, food retailers from surrounding counties (Oxford, Middlesex, Chatham-Kent) were included if they were less than 16km from Elgin s border and thus may have had an effect on food deserts within Elgin St. Thomas. Food Swamps A food swamp is a term used to describe an area with an overabundance of less-healthy food retailers and poor access to healthy food outlets (i.e. there are more Less-Healthy Food Retailers compared to Healthy Food Retailers in a 1km buffer zone). Food swamps may be a better indicator of eating behaviours than food deserts. The query used in this report calculates the food swamp index using a derived calculation. Food swamp index results can be between -100 to 100. All values under 0 represent areas that are not considered food swamps, all values above 0 were considered a food swamp. Using the calculation, food swamps were categorized into one of three groups, including mild, moderate, or severe food swamps. Urban area: An area with a population of at least 1000 residents and a density of 400 or more residents/km 2. Statistics Canada data was used to determine areas within Elgin St. Thomas that are considered urban areas. Rural area: All areas that falls outside of the definition of an urban area. Statistics Canada data was used to determine areas within Elgin St. Thomas that are considered rural areas. Healthy Food Retailers To be classified as a Healthy Food Retailer, the retailer must have met all of the following criteria: Open to the public (does not restrict access to certain populations or require a membership) Sells fresh fruit and vegetables Sells food from at least 1 other food group (grains, dairy & alternatives, and/or meat & alternatives) Healthy Food Retailers in Elgin St. Thomas include grocery stores and farmers markets. Healthy Single Food Group Retailers To be classified as a Healthy Single Food Group Retailer, the retailer must have met all of the following criteria: Open to the public (does not restrict access to certain populations or require a membership) 8

9 Must primarily sell healthy fresh food from one food group from Canada s Food Guide (vegetables & fruits, grains, dairy & alternatives, or meat & alternatives) Healthy Single Food Group Retailers in Elgin St. Thomas include bakeries, butchers, fish markets, produce markets, and community supported agriculture. Less-Healthy Food Retailers To be classified as a Less-Healthy Food Retailer, the retailer must have met all of the following criteria: Open to the public (access is not restricted to certain populations or require a membership) Does not sell fresh fruits or vegetables and at least one other food group Primarily sells processed and pre-packaged food and beverage items Less-Healthy Food Retailers in Elgin St. Thomas include fast food restaurants, cafes, food trucks/concession stands, and convenience stores/gas stations. Exclusions from the System Map In an effort to best identify and classify key features of the food environment it was necessary to make a number of exclusions from the map. Restaurants with table service were omitted from the project as they do not sell readily available food and these establishments likely have a variety of healthy and less healthy options rendering them unclassifiable. Because the goal of the project was to assess the food system as it relates to members of the general population, several retailers that are not intended to serve the public were removed. These included the following: Production facilities (production bakeries, food processing plants) Bed and Breakfasts Cafeterias and institutional serveries targeted to specific populations only (hospitals, schools, childcare centres, group homes) Caterers Food warehouses Private clubs (private golf clubs, sports clubs, legions etc.) Furthermore, because the goal of the project was to identify resources in the food system relative to the day to day lives of local residents, food services that were intended to only provide food on an intermittent or inconsistent basis were excluded from the map. These include: Banquet halls and church kitchens Special events (food services for summer festivals etc.) Food Access Relief Interventions and Capacity Building Programs Food Access Relief Interventions and Capacity Building Programs in Elgin St. Thomas include food banks and emergency food services, community meals, low cost meal programs, Good Food Box program, cooking programs, and community gardens. A complete list of the retailers and food access relief interventions included in this report are available upon request. 9

10 SYSTEM MAPPING OF THE FOOD ENVIRONMENT Figure 3. Food Deserts in Elgin St. Thomas (Year-Round Only), Excludes Healthy Single Food Retailers, 2016 Urban food deserts Areas of St. Thomas, Aylmer, and Port Stanley are considered food deserts. For those with a vehicle, being located in a food desert isn t as great of a barrier to food access. Individuals without access to a vehicle may have to depend on other means to access a healthy food retailer, such as walk to the retailer, depend on someone else for a ride, or pay for public transportation (where available). This may impact how frequently they go to a grocery store for food. They may access healthy food retailers less frequently and purchase larger quantities of food at a time, they may have to depend on convenience stores, and/or stock up on less perishable food items. This map was created in 2016 when there was no longer a grocery store in Rodney. At that time, Rodney was considered a food desert. It was especially difficult for many individuals in West Elgin to access food as they would have to travel to West Lorne for a grocery store. Rural food deserts Defining rural food deserts as areas that are greater than 16km away from healthy food retailers, there are very few rural food deserts in Elgin County. However, for those with limited mobility or no access to a vehicle it may be difficult to access healthy food. For these individuals, healthy food retailers that are less than 16km away may still be difficult to access. Areas that may have difficulty accessing healthy food retailers lay around the perimeter of the county lines. 10

11 Figure 4. Food Deserts (Excludes Healthy Single Food Retailers) in Elgin St. Thomas by Average Total Household Income (Year-Round Only), 2011 The average household income for Elgin St. Thomas is $69,000. The two darkest blue areas represent households with household income levels well below the average income for the community. The 7 areas with the highest concentration of low income residents are all located within St. Thomas. Northwest St. Thomas, an urban food desert, is comprised of average household incomes less than $40,000. At the time this map was created, Rodney was located in an urban food desert with an average household income between $40,000-$59,999. Rural food deserts that are comprised of average household incomes between $40,000-$59,999 include the southwest area of West Elgin, northern and southern Malahide, and southern Bayham. Individuals living in low income and within a food desert may be especially vulnerable to food insecurity. 11

12 Figure 5. Percentage of Households Spending 30% or more of their Income on Shelter Costs in Relation to Food Deserts (Excludes Healthy Single Food Retailers) in Elgin St. Thomas (Year-Round Only), 2011 Households that spend more than 30% of their total income on shelter costs may have difficulty affording other basic needs, such as food. Across Elgin St. Thomas 24.2% of households spend more than 30% of their income on shelter costs. This figure needs to be considered within the household income and family context. For example, higher income areas may have adequate residual income even if paying 40% on housing; however, lower income households paying 20% of their income on shelter costs may still be struggling. The number of dependents also needs to be considered: a household with 6 children that spends 30% of their income on shelter may struggle more financially compared to a household without children spending 30% of their income on shelter. There is overlap between the areas where households are more likely to spend 30% or more of their income on shelter costs and the areas that have poor access to grocery stores/healthy food retailers. This can be seen in seen in various locations, including parts of West Elgin, Dutton- Dunwich, Southwold, St. Thomas, Central Elgin, Malahide, and Bayham. 12

13 Figure 6. Food Access Relief Interventions and Capacity Building Programs in Relation to Food Deserts (Excludes Healthy Single Food Retailers) in Elgin St. Thomas (Year-Round Only), 2016 Food access relief interventions and capacity building programs are all located within the urban areas of Rodney, West Elgin, Dutton, St. Thomas, Aylmer, and Port Stanley. The locations of the food access relief interventions in urban areas tend to be located in more central areas that are not considered food deserts. In addition, there are no food access relief interventions located in rural areas, which tend to be where food access is more difficult. Individuals that already struggle to access healthy food would also need to travel to access these services. 13

14 Figure 7. Food Swamps in Elgin St. Thomas (Seasonal & Year-Round), 2016 Mild, moderate, and severe food swamps can be found in locations throughout Elgin St. Thomas. While mild and moderate food swamps are more commonly found in rural areas, severe food swamps are located primarily within urban areas. Mild and moderate food swamps are located in West Lorne, Dutton, St. Thomas, Port Stanley, Aylmer, Bayham, and southern Malahide. Severe food swamps can be found within Rodney, West Lorne, St. Thomas, and Aylmer. 14

15 Figure 8. Food Swamps in Elgin St. Thomas by Average Total Household Income (Seasonal and Year-Round), 2011 The average household income for Elgin St. Thomas is $69,000. The two darkest blue areas represent households with household income levels well below the average income for the community. The 7 areas with the highest concentration of low income residents are all located within St. Thomas. Many of these areas are also located within severe food swamps. Northwest St. Thomas has an average total household income of less than $40,000 and is located within a severe food swamp. Food swamps that are located in areas with average household incomes between $40,000-$59,999 can be found in West Lorne, Dutton, Port Stanley, St. Thomas, Aylmer, Straffordville, and Port Burwell. At the time this map was created, Rodney was located in a severe food swamp with an average household income between $40,000-$59,

16 CONCLUSIONS Food insecurity is a serious public health problem impacting health and quality of life. Upstream level approaches are required to effectively address the root cause of food insecurity, which is poverty. Efforts that focus on a coordinated action which address food security, housing, transportation, access to community services, and income security are warranted. In addition, midstream level approaches are needed to increase the availability and affordability of healthy food. In Elgin St. Thomas, community-based food programs should target areas of poor food access. Community-based food programs should be targeted and sustainable. 16

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