Measuring household food insecurity: - PowerPoint Presentation

1. Measuring household food insecurity: what, why, methods, limitations, progressRachel Loopstrarachel.loopstra@kcl.ac.ukDivision of Diabetes and Nutritional Sciences, King’s College Londonhttp://nutritionalsciences.lamp.utoronto.ca/

2.

3.

4. Early 1980s, lines for food banks in North America

5. Sound familiar?“There are no hard data available to estimate the extent of hunger directly. Those who argue that hunger is widespread and growing rely on indirect measures…. We regret our inability to document the degree of hunger… for such lack of definitive, quantitative proof contributes to a climate in which policy discussions become unhelpfully heated and unsubstantiated assertions are then substituted for hard information.”(The President’s Task Force on Food Assistance in United States, 1984)

6. Narratives of hunger: Anxiety of uncertain access to food“When I see my cupboard becoming empty, I wonder how am I going to fill it again and I get panicky.”“You always have a solution for yourself: to do without, but if you don’t have enough for the kids, what do you do? This is where stress starts to build and then you struggle to find a solution to be able to eat until the end of the month”

7. Narratives of hunger: Shortage of food, restricting intake“From the second week of each month, there is so little food left in the fridge and in the cupboard that it is hard to make up a dish”“For sure we are not starving to death, but we cannot eat so we can fill up” “I have to watch and tell my children “you ate enough, save some for tomorrow…”

8. Narratives of hunger: Unsuitability of food and monotony of diet“We are limited to items on sale (or to what we are given)”.“I am not able to offer enough fresh fruit, vegetables, cheese, quality foods for my kids”“The same stuff always… noodles with soya sauce, shepherd's pie, pancakes…”“I don’t eat what I want to eat: I don’t have enough to make a meal so I eat junk food…”

9. Narratives of hunger: Going without enough food“In the hardest times, I cut the number of meals…”“My stomach often hurts when I go to bed at night, I endure the situation because I want my daughter to grow normally.”

10. Core components of household food insecurity identified in qualitative in-depth interviews with low income families.QuantityQualityPsychologicalSocialHousehold LevelFood DepletionUnsuitable foodFood AnxietyUnacceptable means of food acquisitionIndividual LevelInsufficient intakeInadequate dietFeeling deprived, lack of choiceDisrupted eatingRadimer et al. 1992; Hamelin et al. 2002. Range in severity Multi-dimensional  Not equally experienced

11. Definitions of household food insecurity (synonymous with food poverty?)“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., J of Nutrition, 1992)“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, J of Nutrition. 1990)

12. Development of USDA Household Food Security Survey ModuleUSDA testing in Current Population Survey – over 40 items in original scaleSeries of 18 questions describing increasingly severe household food circumstances Questions specify financial resource constraint, specify time period of past 12 months, and differentiate experiences of adults and childrenOperational definition: inadequate or insecure access to adequate food due to financial constraint.

13. These next questions are about the food eaten in your household in the last 12 months, since (current month) of last year and whether you were able to afford the food you need.In the last 12 months, can you tell me if these statements were true for you?1 “We worried whether our food would run out before we got money to buy more.” Often true Sometimes trueNever true2“The food that we bought just didn’t last, and we didn’t have money to get more.” Often true Sometimes trueNever true3“We couldn’t afford to eat balanced meals.” Often true Sometimes trueNever trueAdult: Stage 1If at least one question affirmed, on to Stage 2.

14. Adult: Stage 2In the last 12 months… 4aDid (you/you or other adults in your household) ever cut the size of your meals or skip meals because there wasn't enough money for food?YesNo4bIf yes: How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?Almost every monthSome months but not every monthOnly 1 or 2 months5Did you ever eat less than you felt you should because there wasn't enough money for food?YesNo6Were you every hungry but didn't eat because there wasn't enough money for food?YesNo7Did you lose weight because there wasn't enough money for food?YesNoIf at least one question affirmed, on to Stage 3.

15. Adult: Stage 3In the last 12 months…8aDid (you/you or other adults in your household) ever not eat for a whole day because there wasn't enough money for food?YesNo8bIf yes: How often did this happen—almost every month, some months but not every month, or in only 1 or 2 months?Almost every monthSome months but not every monthOnly 1 or 2 months 

16. Child: Stage 1Now I'm going to read you several statements that people have made about the food situation of their children. In the last 12 months, were these statements…1“We relied on only a few kinds of low-cost food to feed our children because we were running out of money to buy food.”Often trueSometimes trueNever true2“We couldn’t feed our children a balanced meal, because we couldn’t afford that.”Often trueSometimes trueNever true3“The children were not eating enough because we just couldn't afford enough food."Often trueSometimes trueNever trueIf at least one question affirmed, on to Stage 2.

17. Child: Stage 2In the past 12 months…4Did you ever cut the size of any of the children’s meals because there wasn't enough money for food?YesNo5aDid any of the children ever skip meals because there wasn't enough money for food?YesNo5bHow often did this happen?Almost every monthSome months but not every monthOnly 1 or 2 monthsIf at least one question affirmed, on to Stage 3.

18. Child: Stage 3In the past 12 months…6aWere the children ever hungry but you just couldn't afford more food?YesNo6bDid any of the children ever not eat for a whole day because there wasn't enough money for food?YesNo

19. Prevalence of food insecurity in selected provinces across Canada

20. Outputs from monitoring household food insecurity in Canada

21.

22. Now I would like to ask you some questions about food. During the last 12 MONTHS, was there a time when... :1... you were worried you would not have enough food to eat because of a lack of money or other resources?2... you were unable to eat healthy and nutritious food because of a lack of money or other resources?3... you ate only a few kinds of foods because of a lack of money or other resources?4... you had to skip a meal because there was not enough money or other resources to get food?5... you ate less than you thought you should because of a lack of money or other re- sources?6... your household ran out of food because of a lack of money or other resources?7... you were hungry but did not eat because there was not enough money or other resources for food?8... you went without eating for a whole day because of a lack of money or other re- sources?FAO Food Insecurity Experience Scale

23. Rates of food insecurity based on FAO Food Insecurity Experience Scale in Gallup World Poll (2014)

24. USDA Household Food Security MonitorFood Insecurity Experience ScaleAble to compare with numerous other studies (over 259 used this scale over 1999 to 2014)New, but expect take-up across countries; recommendation by ONS for monitoring of SDG.Chronicity contributes to rank of severityLess complicated response patternMore detailed, less risk of underestimating food insecuritySimple, easy to useNumber of questions: as few as 3 Number of questions: 8Includes child scale option– important indicator of severity; motivates action – yet likely underestimates child hunger.No questions ask specifically about child circumstances

25. Ashby et al. Measurement of the dimensions of food insecurity in developed countries: a systematic literature review. Public Health Nutrition. Nov 2016.

26. Domains of food securityEconomic and physical ACCESS to foodFocus of household food insecurity measurement scales.Physical AVAILABILITY of food Food availability addresses the “supply side” of food security. Food UTILIZATIONFeeding practices, food preparation, diversity and adequacy of the diet and intra-household distribution of food. STABILITY of the other three dimensions over timeEven if your food intake is adequate today, you are still considered to be food insecure if you have inadequate access to food on a periodic basis.Source: FAO.Ashby et al. Measurement of the dimensions of food insecurity in developed countries: a systematic literature review. Public Health Nutrition. Nov 2016.

27. What do household food insecurity scales NOT measure?Availability of foodDietary intake, dietary quality, nutritional status, malnutritionSocial exclusion from social ways of eating, cultural food practicesAcceptability: sources of food & feelings about sources of food; ability to follow preferred diet.“Household food insecurity is not the flipside of food security.”

28. Why measure & monitor household food insecurity using an available measure?No one should worry about not having enough to eat, let alone go without eating.To understand magnitude & vulnerability in population (move beyond reliance on food bank usage data).Food insecurity is a unique dimension of poverty.Food insecurity has distinct consequences for health and well-being.Tools validated, well-accepted measures of problem of insecure food access.To understand consequences.To understand policy-drivers and tailor interventions.

29. Estimated magnitude of “hidden hunger” in UK* Food insecurity estimate from Gallup World Poll sample in UK. Validated measure of food insecurity.

30. Why measure & monitor household food insecurity using an available measure?No one should worry about not having enough to eat, let alone go without eating.To understand magnitude & vulnerability in population (move beyond reliance on food bank usage data).Food insecurity is a unique dimension of poverty.Food insecurity has distinct consequences for health and well-being.Tools validated, well-accepted measures of problem of insecure food access.To understand consequences.To understand policy-drivers and tailor interventions.

31. Toward work on national household food insecurity measurementEducationWorkshops on measurementPolicy briefsLobbyingMeetings with government ministers, civil servantsParliamentary questionsParliamentary debateCampaigning and raising awarenessEnd Hunger NowMedia

32. Response from Westminster so far…

33. Too complex a construct.“We do not intend to measure household food insecurity because there is no single definition of food insecurity…. There are multiple indicators such as quality, variety and desirability of diet as well as total intake, not all of which are measured consistently. It is therefore very difficult and potentially misleading to develop a single classification of food insecurity.”(Response to Parliamentary Question, February 2016)

34. We’re doing that already.“The long-standing measure of household food security that we have is the annual living costs and food survey. We look in particular at the percentage of household income spent on food by the poorest 20% of families. The reality of that consistent measure of household food security and affordability, which we have had for many years, is that it has been remarkably stable in the past decade at about 16% to 16.5%.”-George Eustice, DEFRA Minister, Weestminster Hall Debate, 6 December 2016

35. Reasons to be hopeful…Scotland taking a lead?DFID committing funds to measurement of household food insecurity using FIES scale on Gallup World Poll – leverage for UK measurement?ONS Consultation on progress toward Sustainable Development Goals (though delayed)Ongoing interest/engagement from civil servants in Public Health England, Department of Health, DEFRAInterest from local authorities; garnering funds for local measurement

36. Thank you

37. Extra Slides

38. What insight could household food insecurity measure

39. Household Food Insecurity in Canada, 201239(Tarasuk, Mitchell & Dachner, Household Food Insecurity in Canada, 2012. 2014.)

40. Who experiences food insecurity?

41. What are the consequences of food insecurity?Child health and development outcomesChronic disease, disease managementCosts to the healthcare system, welfare system, child protection system, etc.

42. Poverty and Social Exclusion Survey

43. What drives people to use food banks?No other options left; a last resort.When they don’t have enough money to cover all basic needs.When hunger drives them to.

44. Consensus definitions of poverty feature foodFor adults:Two meals a dayFresh fruit and vegetables every dayMeat, fish, vegetarian equivalent at least once a dayFor children:Three meals a dayFruit and vegetables every dayMeat, fish, vegetarian equivalent at least once a dayDeclining consensus for social aspects of eating:<50%, for adults, have friends and family for a meal or drink once a month<50%, for children, having friends to visit for a tea or snack once a fortnight