Cost of the Nutritious Food Basket - PDF document

Cost of the Nutritious Food Basket – Toronto 2014 1 STAFF REPORT ACTION REQUIRED Cost of Nutritious Food Basket – Toronto 2014 Date: October 31, 2014 To: Board of Health From: Medical Officer of Health Wards: All Reference Number: SUMMARY The pu r pose of this r e po r t is to p r ovide in f o r m a tion on the c ost of the Nut r i tious F ood B a sk e t in To r onto f o r 2 0 14. The Nut r itious F ood B a sk e t is a f ood c osting t ool us e d to m ea su r e the c ost of a b a sic l e v e l of h e a lt h y ea ti n g in eac h of the B o ar d of H ea lth ( B OH) ju r isdi c tions within Ont a r io. The su r v e y p r oto c ol p r ovid e s op e r a tion a l di r e c tion to the B OH in monito r ing f ood aff o r d a bili t y , a s it re l a t e s to pov er t y , h ea lth out c o m e s a nd h ea lth in e quiti e s. I n 2014, t h e e stim a t e d a v er a g e w ee k l y c ost of the Nut r itious F ood B a s k e t f or a r e fe r e n c e fa mi l y of f our in To r onto is $193.05 ( $835.91 p e r month ) . This re p re s e nts a 5.4% in crea s e in the c ost of f o od fr om the 2013 p r i c i n g su r v e y . I t is impo r t a nt to note th a t the Nut r itious F ood B a s k e t in c lud e s 67 f oods, w hi c h is s e t b y the Minist r y of H ea lth a n d L o n g - T er m C a r e . The f oods list e d ar e b a s e d on the a ssumption th a t a ll m ea ls ar e a lmost e x c lusiv e l y m a de fr om s c ra t c h; a nd do not in c lude sn ac ks or c ultu r a l l y - a pp r op r i a te f oods. The a nnu a l list a lso do e s not in c lude in fa nt f o r mula a nd b a b y f ood a nd fr o z e n or p ac k a g e d/p r e p are d f oods th a t a r e o f t e n pu rc h a s e d b y low e r in c ome f a mili e s a s th e se f ood it e ms a r e o f t e n c h e a p e r a nd e a si e r to p re p a r e . As To r onto is a l a r g e a nd h e t er og e n e ous u r b a n c e nt r e , the a nnu a l su r v e y lik e l y und ere stim a t e s the hous e hold c ost of f ood. R e vising the su r v e y c ould r e sult in a mo r e acc u r a te r ef l e c tion of the t r ue c ost of f ood wh i c h in c lud e s e thno - c ultu r a l l y a pp r op r i a t e , p re - p a c k a g e d/ fr o z e n a nd sn ac k f oods. Cost of the Nutritious Food Basket – Toronto 2014 2 RECOMMENDATIONS The Medical Officer of Health recommends that: 1. The Minist r y of H ea lth a n d L o n g - T er m C a r e upd a t e the Nut r itious F ood B a sk e t tool to mo r e acc u r a t e l y r ef l ec t the t r u e c ost of e a ting p e r hous e hold, in c lud i ng f ood it e ms th a t ar e e thn o - c ultu ra l l y a pp r o p r i a t e , p re - p a c k a g e d/ fr o z e n a nd s n ack f oods. 2. The Board of Health f o r w a r d this re po r t to: the G e n e ra l M a n a g er s of E mpl o y m e nt a nd S o c i a l S er vi ce s; S h e lt er , S uppo r t a nd Ho u sing Administ ra tion; C hi l d re n ’ s S er vi c e s; A ff o r d a ble Housing O f f i ce ; E c onomic D e v e lopm e nt a nd C ul t u re ; S o c i a l D e v e lopm e nt, F in a n c e a nd Administ ra t i on; U r b a n HEA R T; Ont a r io Minist e r of H ea lth a n d L o n g - T er m C a r e ; C ommuni t y a nd S o c i a l S er vi c e s; C hild re n & Youth S e r vi ce s, a nd the C a bin e t C ommit t e e on P ov er t y R e du c tion a nd S o c i a l I n c lusion; Ont ar io ' s C hi e f M e di ca l O f f i c e r of H ea lth; P ublic H ea lth O n t ar io; the Asso c i a tion of L o c a l P ublic H ea lth Ag e n c i e s; the Ont ar io P ublic H ea l t h Asso c i a tion; the Asso c i a tion of Ont ar io H ea lth C e nt r e s; the Ont ar io S o c i e t y of N u t r ition P r o fe ssion a ls in P ublic H ea lth; Di e titi a ns of C a n a d a ; a nd the f i v e L o ca l H ea lth I nt e g r a tion N e two r ks ( L H I Ns) in the G r e a t e r T o r onto ar e a . Financial Impact This re po r t will h a ve no di rec t f in a n c i a l impli ca tions. DECISION HISTORY S in c e 1999, To r onto P ublic H ea lth h a s r e po r t e d a nnu a l l y to the B OH on t h e Nut r itious F ood B a sk e t su r v e y f indin g s. I n 2008, the N utritious Food Bas ke t Proto c o l w a s upd a t e d a nd a ll Ont ar io B o ar ds of H ea lth m a nd a t e d to mo n itor f ood aff o r d a bili t y in acc o r d a n c e with the n e w N utritious Food Bas ke t Proto c ol , 2 008 a nd the Population H e alth Ass e ssm e nt and Sur ve ill a n c e Proto c ol , 2008, a s s t a t e d in the Ont ar io P ublic H ea lth S t a nd ar ds 2008. E ac h y e ar , re sults fr om the Nut r itious F ood B a s k e t su r v e y ar e submitt e d to the Minist r y o f H e a lth a nd L o n g - T e r m C ar e b y J u l y 1. The 2013 Nut r itious F o o d B a sk e t su r v e y r e sults w er e p r e s e nt e d to the B OH a t its m ee ting on S e pt e m b e r 3 0, 2013: http:// a pp.to r onto. ca /t m mis/vi e wA g e n d a I t e mHi s to r y .do ? it e m = 2013. H L 2 4 .4 ISSUE BACKGROUND P re vious re po r ts on the a ff o r d a bili t y o f the Nut r it i ous F ood B a sk e t h i g hlight e d the c o rre l a tion b e tw ee n f ood ins ec u r i t y a nd in a d e q u a t e in c om e . F ood s ec u r i t y i s e ss e nti a l f or h ea lt h y ea ti n g – without ac c e ss to su ff i c i e nt nut r i t ious f ood, h ea lt h y ea ti n g ca nnot be ac hi e v e d, i n cr e a sing t h e r isk of poor h ea lth. Cost of the Nutritious Food Basket – Toronto 2014 3 COMMENTS Th e N u tr i t io u s F ood B as k e t S u r v e y The Nut r itious F ood B a s k e t is a su r v e y tool th a t is a m ea su r e of the c ost of h ea lt h y ea tin g . A f i x e d b a sk e t of 67 f oods in sp ec i f i e d pu r c h a se units a r e p r i c e d a t t w e lve g r o ce r y sto r e s. The Nu t r itious F ood B a s k e t is us e d to monitor both aff o r d a b ili t y a nd ac c e ssibili t y o f f oods b y re l a ting t h e c ost of the f o od b a sk e t to individu a l a nd hous e hold in c om e s. The su r v e y ref l ec ts a n e a ting p a tt er n th a t m ee ts the r e c omm e nd a tions fr om Eating W e ll w ith C anada ' s Food Guide a nd acc o u nts f or ea ti n g b e h a vio u r s a nd f ood pu rc h a si n g p a tt er ns h i g h l i g ht e d in the C a n a d i a n C ommuni t y H ea lt h y S u r v e y 2.2 r e sults. I n 2014, t h e a v e r a g e w e e k l y c ost f o r a f a mi l y of f our to pu rc h a s e the Nut r i tious F ood B a sk e t in To r onto in 20 1 4 is $193.05 or $835.91/month. This re p re s e nts a n in crea s e of 5.4% in the c ost of f ood f r om the su r v e y c ond u c t e d in 2013. The m a in c ont r ibuto r s to the r ise in c osts w e r e :  Me at a n d Al ter n a t i v e s: po r k 28 % ; l e ntils 24 % ; b ee f 15 % ; f ish 1 4 % ; c hi c k en 13 % ; p ea nuts 11 % ;  V e g et a b l e s a n d F r u i t : p e pp e r 27 % ; b r o cc oli 25 % ; o ra ng e s 24 % ; i ce b e r g l e ttu c e 23 % ; sw e e t pot a to 18 % ; g r ee n p ea s, c a bb a g e a nd pot a to 17 % ; sn a p b ea ns 13 % ; p e a r 11 % ; g r a p e s 10 % . F ood I n s ec u r i t y a n d H e al t h F ood ins ec u r i t y is r e c o g n i z e d a s a s er ious public h ea lth issue in hi g h - in c ome c ount r i e s. F ood ins e c u r i t y is d ef i n e d a s the in a bil it y to ac qui r e or c onsume a n a d e q u a te di e t qu a li t y or su f f i c i e nt qu a nti t y of f ood in so c i a l l y a cce p t a ble w a y s, o r the un cer t a in t y th a t one will be a ble to d o so, due to f in a n c i a l c o n st ra ints ( 1 ) . Most re c e nt e stim a t e s in C a n a da fr om 2012 re v e a l th a t 12.6% of hous e hol d s e x p er i e n ce d some d e g r e e of f ood ins ec u r i t y d u r ing t h e p r e vious tw e lve months. F ood ins ec u r i t y h a s b ee n link e d with hi g h e r ra t e s o f c h r onic h ea lth c onditions, g r ea t e r r isk of vuln era ble h ea lth a mong c hild re n a nd po o r nut r ition a l st a tus a mong a dults. R e s earc h indi c a t e s th a t h ea lth r isks ar e h e i g ht e n e d with the s e v er i t y of f ood s ec u r i t y , as w e ll a s, du ra tion of the e x p er i e n c e ( 2 ) . F ood ins ec u r i t y imp ac ts on nut r ition a l int a ke a nd ca n c ont r ibute to a num b e r of di e t - re l a t e d dis e a s e s. C a n a di a n re s e a rc h h a s sh o wn th a t a dults a nd t ee ns ( but n o t c hild re n) in f ood ins ec u r e hous e holds h a ve low e r int a k e s of v e g e t a bl e s a nd f r uit a nd milk p r odu c ts a nd ar e a t hi g h e r r isk of i n a d e qu a te int a k e s of s e v era l k e y nut r i e nts, in c luding p r ot e in, vit a min A, f ol a te a nd ot h e r B vit a mins, m a g n e si u m, phospho r us a nd z inc ( 3 ) . C o rre sponding nu t r i e nt d ef i c i e n c i e s m a y l ea d to t h e d e v e lopm e nt of c h r onic dis ea s es su c h a s c a r diov a s c ul a r dis ea s e , di a b e t e s or d e p re s s ion ( 4 - 9 ) , a nd l a c k of ac ce ss to a d e qu a te h ea lt h y f ood m a k e s it di ff i c ult to m a n a ge c h r onic dis e a se a nd nu t r ition - re l a t ed illn e ss. A C los e r Look at t h e N u t r i t io u s F ood B as k e t S u r v e y T ool The Nut r itious F ood B a s k e t su r v e y in its c u rre nt f o r m m a k e s a numb e r o f a ssumptions, in c ludin g : Cost of the Nutritious Food Basket – Toronto 2014 4  I ndividu a ls a l w a y s pu rc h a se a c c o r di n g to the low e st p r i c e a nd not n e ce ss ar il y acc o r di n g to n e e d, p r ef e r e n c e or a v a il a bili t y ;  I ndividu a ls h a v e the tim e , skills a nd e quipm e nt to p re p a r e m ea ls;  I ndividu a ls h a v e a cce ss t o qu a li t y g r o c e r y sto r e s a nd lit era c y a nd l a n g u a g e skills to shop f or the low e st p r i ce ;  G r o c e r y shopping is a r e g ul a r ac tivi t y (e v e r y one to two w ee ks ) . T h e f r e q u e n c y of shopping imp ac ts p a c k a ge si z e s th a t ar e pu r c h a s e d ;  S in c e the f ood b a sk e t is b a s e d on a v e r a ge hous e h old pu rc h a si n g p a tt er ns, t he sp ec i f ic f ood p u rc h a si n g p a tt er ns of a n y e thno - c u l tu ra l or a g e g r oup is not re p re s e nt e d. R e vi e w i n g t h e N u tr i t io u s F ood B as k e t S u r v e y D e v e lopi n g a r ea listic b a sk e t of f oods involv e s b a l a n c ing s e v e r a l impo r t a nt fac to r s. Ad a pt a tions to the tool should ref l ec t c u r r e nt di e t a r y r e c omm e nd a tions, c u ltu ra l ly a pp r op r i a te f oods a nd v a r i a tions in shopping p r a c ti ce s, ac tu a l c onsumption p a tt er ns, di ffere nt hou s e hold si z e a nd in c ome l e v e ls within the stu d y a rea s. A cc o r di n g to the sto r e s e l ec tion cr it er i a , a s r e fe r e n ce d in the N utritious Food Bas ke t Proto c ol, 2008 ( or a s c ur re nt) ( 10 ) , f ood c osti n g is c ondu c t e d e ac h y e a r in M a y within a two w ee k p e r iod. F oods ar e p r i ce d in a minimum of six g r o ce r y sto r e s or m a x imum of tw e lve within the h ea lth unit ca t c hm e nt a r ea . F or To r onto, tw e lve sto re s a r e c hos e n f o r the su r v e y . The s e l ec t e d sto re s a li g n with To r onto P ublic H ea lth ' s pl a nni n g area s c ustom ar i l y us e d f or s e r v i c e d e liv e r y . A s y st e m a tic s e l ec tion of sto r e s e ns u re s th a t the f in a l s e t of sto re s c h ar a c t er i z e s: eac h of t h e m a jor c h a ins; both p re mium a n d dis c ount sto re s fr om a n y of t h e m a jor c h a ins; a nd ind e p e n d e nt g r o c e r y sto re s. Ho w e v er , a re - e x a min a tion of the Nut r itious F ood B a s k e t su r v e y is w arra nt e d - one th a t m a k es a llow a n ce s f or e thno - c ultu ra l f ood p r a c ti ce s, p r e - p ac k a g e d/ fr o z e n f oods a n d sn ac k f oods. The in c lusion of th e se it e ms in the su r v e y would mo r e a c c u ra t e l y ref l e c t the t r ue c ost of h ea lt h y ea ti n g in To r ont o . Th e se a dditions would a lso ac hi e ve re p r e s e nt a t i on of To r ont o ' s l ar ge a nd h e t er o g e n e ous popul a tion a nd so c io - d e mo g ra ph i c c h a r a c t er isti c s. I m p li c a t io n s of F i nd i n gs f or Ci t y P r og r a m s R ising f ood c osts ca n h a ve both sho r t - t er m imp a c ts a nd lon g - t e r m c ons e q u e n ce s on out c om e s of c i t y p r o g r a ms a nd s er vi ce s wh i c h h a ve f ood a s a c ompon e nt. S tud e nt Nut r ition P r o g r a ms, whi c h p r ovide h ea lt h y m e a ls a nd sn ac ks to 1 5 5,484 c hild re n a nd y outh in 681 p r o g r a ms acr oss the c i t y , will f a c e a ddition a l bu d g e t p r e s su re s this n e w s c hool y e a r a s a r e sult of hi g h e r f ood c osts. The f u ll muni c ip a l g ra nt f o r stud e nt nut r ition p r og ra ms is d e di ca t e d to the c ost of pu rc h a sing n u t r itious f ood ( $7,071,839 in 2014) a nd acc ounts f or a 14% c ont r ibution ra te b y the C i t y o f To r onto tow ar ds the to t a l c ost the p r og ra m. A 5.4% i n cr e a s e in f ood c osts t ra nsl a t e s into a n e t in crea s e of $3 8 1,879 on the e x isting muni c ip a l l y f u n d e d p r o g ra ms. A c ost of l iving a djustm e nt is re qu i re d to pu rc h a se nut r itious f ood a nd m a int a in the c u r r e nt nut r ition a l st a nd ar ds f or t h e se p r o g r a ms. In Au g ust 2014, a re po r t o u tlining a 2015 Op e r a ting B u d g e t in c r ea se f or the S tud e nt Nut r ition P r o g ra m w a s s ubmitt e d to the B o ar d of H ea lth f or c onsid era tion re qu e sti n g a $381,879 n e t in crea s e to c ov e r in c rea s e d f ood c os t s. Cost of the Nutritious Food Basket – Toronto 2014 5 The H ea lthi e st B a bi e s P o ssible a nd P ee r Nut r ition p r og ra ms s er v e “a t - r isk ” , c ultu ra l l y div er se To r onto f a mili e s. Th e se p r o g r a ms p r ovide f ood vou c h er s to p ar ti c i p a nts, su c h as p r e g n a nt wom e n a nd p a r e nts with c hild re n up to six y e ar s old. F ood vo u c h er s a r e int e nd e d to h e lp c li e nts pu rc h a se h ea lt h y f oods, s u c h a s v e g e t a bl e s a nd f r uit a nd milk a nd a lt er n a tiv e s to m ee t k e y nut r i e nts n ee d e d f o r h e a lt h y p r e g n a n c i e s a nd f o r a d e qu a te g r owth a nd d e v e lopm e nt in the e ar l y y ea r s. I n c r ea s e d f o o d costs reduces the p u rc h a sing po w e r f o r th e se m u c h n ee d e d nut r itious f oods. The TPH 2015 Operating Budget for these programs can accommodate current food costs. A review of the use of food vouchers in TPH programs is underway and will include approaches to managing increasing food costs in the future. The r ise in f ood c osts wi l l a lso h a ve a n imp ac t on a ll C i t y p r o g ra ms a nd s e r vi ce s th a t p r ovide f ood, in c ludi n g c hild car e c e nt re s, hom e s f or the a g e d a nd sh e lt e r s f or hom e l e ss p e opl e . I n 2013, S h e lt er , S uppo r t a nd Housing A d minist ra tion und e r its E m e r g e n c y S h e lt e r a nd R e l a t e d S up p o r t ac tiviti e s p r ovid e d 8 6 2,401 m ea ls a nd sn ac ks t ot a lling $5.5 M; a nd 153,375 f ood a llow a n ce s p r ovid e d t o t a l e d $0.614 M. A 5.4% i n crea s e in f ood c osts will pl ac e f u r t h e r bu d g e t p r e ssu re s on f ood - b a s e d p r o g ra ms a nd s er vi ce s f o r To r onto ' s most vuln e r a ble popul a tions. F ood s ec ur it y i s a pro f ou n d ma r k e r of h ea l t h i n e qu it y i n T oron t o. T h e N u t r iti o us F ood B a s k e t d at a ca n a ss i s t i n i d e n ti f y i ng c o mm un i t y i s s u e s a nd n ee ds. Am e ndm e nts to t h e c u r r e nt list of 67 f oods s e t b y the M i nist r y of H ea lth a nd L o n g - T er m – to in c lude f oo d s th a t ar e e thno - c ultu ra l l y a pp r o p r i a t e , p r e - p ac k a g e d/ f r o z e n, a s w e ll a s, sn a c k f oods - would mo r e acc u r a t e l y r ef l ec t the t r u e c ost of h ea lt h y e a ting in To r onto. This in f o r m a tion c ould in f o r m d ec ision m a king on k e y ar e a s f or in v e stm e nt to imp r ove the h ea lth of c ommuniti e s, with a p ar ti c ul a r f o c us on vuln era b l e popul a tions. CONTACT C ar ol Timmin g s Anne Birks Di rec t o r, M a n a g e r, C h r onic Dis ea se & I nju r y P re v e ntion C h r onic Dis ea se & I nju r y P re v e ntion To r onto P ublic H ea lth To r onto P ublic H ea lth Tel.: 416 - 338 - 8402 Tel.: 416 - 338 - 7550 Em a il: c timmin g @to r onto. c a Email: abirks@toronto.ca SIGNATURE _______________________________ Dr. David McKeown Medical Officer of Health ATTACHMENTS Attachment 1: Weekly Cost of the Nutritious Food Basket in Toronto, May 2014 Attachment 2: May 2014 Nutritious Food Basket Scenarios Cost of the Nutritious Food Basket – Toronto 2014 6 REFER E NCES 1. D a vis B ., a nd T a r a suk V. Hung e r in C a n a d a . Agric Hum Valu e s . 1994; 11 : 50 - 57. 2. L oopst r a R ac h e l, T ara s u k V a l er i e . 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