Food Security and Health

1. Food Security and Health Kimberly Reid RD Prince Edward Family Health Team April 12, 2012

2. “Social injustice is killing people on a grand scale” Closing the gap in a generation, World Health Organization, 2008

3. The Prince Edward Family Health Team • Our Family Health Team is a group of skilled health professionals working together to provide better access to high quality, co-ordinated health care and health services, as close as possible to where you live • Our team includes; 25 family physicians, 5 nurse practitioners and a supporting team of nurses, dietitians, social workers, pharmacists, respiratory therapists, psychiatrists, visiting specialists (internist, pediatrician, etc.) and a full administrative team

4. Why do we need to look at this connection? • Our community has chronic illness • Hastings and Prince Edward County • Obese or overweight 56.5% (88 140) • Diabetes 8.0% (12 480) • Asthma 6.1% ( 9 520) • High blood pressure 19.4% (30 260) • State Health Status very good or excellent 53.5% (83 460) South East sub-LHIN mapping March 2009

5. Why do we need to look at this connection? • Residents are living on a low income • Belleville 15.1% (7850) • Prince Edward 9.2% (2410) • Central Hastings 12.7% (2860) • North Hastings 11.3% (1350) • Quinte West 11.1% (6220) South East sub-LHIN mapping March 2009

6. Why do we need to look at this connection? • More that 1.1 million households or 9.2% were food insecure at some point in the previous year (2004) • 2.7 million Canadians or 8.8% lived in food insecure households in 2004 Canadian Community Health Survey Cycle 2.2, Nutrition, 2004

7. Stress • High stress increases levels of a hormone called cortisol in the body • Cortisol can increase blood pressure, insulin resistance and cholesterol

8. Let’s look at the evidence • Household food insecurity is associated with the consumption of poorer quality diets • Nutrient inadequacies were noted for: • Protein (found in all cells and is required for growth and development) • Vitamin A (required for retinal development and cell growth, particularly epithelial) • Thiamin (required for cell processes such as breakdown of sugars and amino acids) • Riboflavin (required for processes of energy metabolism) Kirkpatrick SI. et al, Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents, 2008

9. Let’s look at the evidence • Vitamin B6 (required for metabolism of amino acids and release of sugars in the body) • Vitamin B12 (required for metabolism and DNA synthesis) • Magnesium (required for nerve processes and blood vessel regulation) • Phosphorus (required for development of cell membranes and is a component of DNA) • Zinc (requiring in many bodily processes and deficiency can lead to growth retardation, delayed sexual maturation, infection susceptibility, and diarrhea) Kirkpatrick SI. et al, Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents, 2008

10. Let’s look at the evidence • An analysis of the American National Health and Nutrition Examination Study was completed to determine the association between food security and risk for overweight or obesity • Overweight is BMI ≥85%ile and obese is BMI ≥95%ile. Casey PH. et al. The association of child and household food insecurity with childhood overweight status, 2006

11. Let’s look at the evidence • Children in food insecure households were more likely to demonstrate significant associations with being at risk in the following groups; • 12-17 year old • Girls • White Casey PH. et al. The association of child and household food insecurity with childhood overweight status, 2006

12. Let’s look at the evidence • Food insecure children have also been shown to have lower cognitive and academic performance • Lower arithmetic scores • More likely to have repeated a grade • Living in low income households increases risk throughout adulthood • If living in food secure households as an adult risk decreases but is still higher than those who have never experienced food insecurity Position of the American Dietetic Association: Food insecurity and hunger in the United States, 2006

13. Let’s look at the evidence • In an analysis of the1997 National Population Health Survey individuals in food-insufficient households were more likely to report heart disease, diabetes, high blood pressure and food allergies • All of these disease are in some part controlled or prevented by dietary modifications • Quantity vs. Quality! Vozoris NT. et al. Household food insufficiency is associated with poorer health, 2003

14. Let’s look at the evidence • Our food choices play a significant role in the prevention and management of chronic diseases. • To maintain calories on a low income foods that are chosen often are low cost, energy dense and nutritionally poor foods (refined carbohydrates with added sugars, fats and sodium) Seilgman HK. et al. Hunger and socioeconomic disparities in chronic disease, 2010

15. Let’s look at the evidence • Between 1985 and 2000 prices have increased disproportionately • Soft drinks 20% • Fats and oils 35% • Sweets 46% • Fresh fruits and vegetables 118% Seilgman HK. et al. Hunger and socioeconomic disparities in chronic disease, 2010

16. Let’s look at the evidence • Women living on a low income are 40-50% more likely to develop diabetes • Adults with diabetes are 40% more likely to achieve poor glycemic control due to cyclic eating and poor food choices • Adults with diabetes who experience food insecurity have 5 more physician encounters per year than their counterparts ($$) Seilgman HK. et al. Hunger and socioeconomic disparities in chronic disease, 2010

17. Let’s look at the evidence • An analysis of the National Population Health Survey and the Canadian Community Health Survey examined the following trends from 1994-2005: • Heart disease • 27% increase in lowest income category • 37% increase in lower middle income category • 12% increase in upper middle income category • 6% increase in highest income category Lee DS. et al. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors, 2009

18. Let’s look at the evidence • Diabetes • 56% increase in lowest income category • 93% increase in lower middle income category • 59% increase in upper middle income category • 0% increase in highest income category • Hypertension • 85% increase in lowest income category • 80% increase in lower middle income category • 80% increase in upper middle income category • 117% increase in highest income category Lee DS. et al. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors, 2009

19. Let’s look at the evidence • Food insecurity has been connected with mental health conditions • Depression, particularly maternal depression • Suspension from school • Difficulty getting along with others in school and the workplace • Need of counselling by a psychologist/psychiatrist • Increased risk of suicide Position of the American Dietetic Association: Food insecurity and hunger in the United States, 2006

20. What can we do? • When meeting with/counselling people with a chronic disease we need to address these issues • 72% of people with diabetes on social assistance state that they lack the resources to eat the way the have been taught at their diabetes education centre • Encourage the Special diet allowance, Special necessities supplement, Monitoring for health, Trillium drug benefits, etc. • Encourage low-cost preventative health care • Active lifestyles, regular visits with PCP, community services (community kitchens, education groups, etc)