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“Nothing is going to change three months from now”: A mixed methods characterization of food bank use in Greater Vancouver
Abstract
North American food bank use has risen dramatically since the 1980s, and over 850,000 Canadians were estimated to have visited a food bank monthly in 2015. Food banks serve multiple roles in communities, ranging from 'emergency responses' to individualized and short-term experiences of hunger, to 'chronic' supports as part of long-term subsistence strategies. This study used a mixed-methods design to examine the spectrum of food bank user experiences in a large urban context, as part of a community-based project aiming to envision a redesign of the food bank to contribute to broader community food security outcomes. Survey (n = 77) and focus group (n = 27) results suggested that participants widely viewed food banks as a long-term food-access strategy. Inadequate financial resources, steep increases in housing and food costs, and long-term health challenges emerged as the most prominent factors influencing food bank use. Participants commonly reported unmet food needs despite food bank use, limited agency over factors influencing access to sufficient food, and anticipated requiring food bank services in future. These findings contest global constructions of food banks as "emergency" food providers and support growing evidence that food banks are an insufficient response to chronic poverty, lack of affordable housing and insufficient social assistance rates underlying experiences of food insecurity. Participants envisioned changes to the food bank system to increase community food security including improved food quality and quantity (short-term), changes to service delivery and increased connections with health services (capacity building), and a greater role in poverty reduction advocacy (system redesign).
... 4 These figures are unsurprising as food banks are not the only intervention for food insecurity; in addition, referrals are often not received and stigma discourages use. 4,29,30 Corresponding with rising food insecurity, food bank use has been increasing. 2,31 In the UK, USA, and Canada, this is driven by recession, austerity and welfare reforms, particularly benefit sanctions and delays. ...
... 2,31 In the UK, USA, and Canada, this is driven by recession, austerity and welfare reforms, particularly benefit sanctions and delays. 2,12,14,30 saw an exacerbated demand for food banks, including an increase of 33% in the UK from 2020 to 2021, resulting in 2 537 198 parcels being distributed. 32 This is significantly greater than typical annual rises, with 37% of use attributed to COVID-19. 2 Europe, Canada, the USA, and Australia also report unforeseen demand from consequences related to the COVID-19 pandemic. ...
... 16,48 In addition, quantitative studies investigating whether food banks reduce food insecurity have conflicting results. 30,47,69 Considering dietary intake, improvements in energy and nutrient intake are seen following food bank use, yet overall dietary quality may remain poor. 59,70 There is recognised need for further research investigating the efficacy of food banks, including a synthesis of these studies. ...
Background:
Research indicates that food parcels provided by foodbanks are nutritionally-poor. Food insecurity and foodbank use are rising, with detrimental effects on the dietary intake and health of users. This mixed-method systematic review aims to investigate the current nutritional adequacy of pre-packaged food parcels and whether using foodbanks reduces the food insecurity and improves the dietary intake of their users.
Methodology:
A mixed-method systematic literature review, restricted to articles published from 2015, was conducted using 8 electronic databases, 4 grey literature databases and 8 relevant websites. Quantitative findings, investigating the nutritional quality of food parcels and/or their impact on dietary intake or food insecurity, were presented narratively. Qualitative findings, reporting views of foodbank users regarding foodbank food, underwent thematic synthesis. These independent syntheses were integrated using configurative analysis and presented narratively.
Results:
Of 2,189 articles, 11 quantitative and 10 qualitative were included. Food parcels were inconsistent at meeting nutritional requirements and often failed to meet individual needs, including cultural and health preferences. Using foodbanks improved food security and dietary quality of users, allowing otherwise unachievable access to food. However, food insecurity remained, explained by limited food variety, quality and choice. The mixed-method findings support interventions to ensure consistent, adequate nutrition at foodbanks, including catering for individual needs.
Conclusions:
Foodbanks are a lifeline when severely food insecure. However alone, foodbanks struggle to eliminate the heightened food insecurity of their users. Efforts to improve the nutritional quality of food parcels could improve the experiences and diet-related outcomes of those requiring foodbanks. This article is protected by copyright. All rights reserved.
... 10 Previous research has affirmed the relationship between socioeconomic problems such as poverty, ill health, dietary quality, education level, and food insecurity. [11][12][13][14][15][16][17] Qualitative studies have also identified feelings of stigma and shame, [18][19][20] dealing with persistent and long-term need, [21][22][23][24] and the challenges of dealing with poor health or chronic conditions while food is insecure. [25][26][27] Some studies have explored the broader social factors impacting food pantry clients, and these include employment challenges, 22,25 financial challenges, 11,22,25,28,29 a history of food insecurity, 29 and the need for basic foods. ...
... [11][12][13][14][15][16][17] Qualitative studies have also identified feelings of stigma and shame, [18][19][20] dealing with persistent and long-term need, [21][22][23][24] and the challenges of dealing with poor health or chronic conditions while food is insecure. [25][26][27] Some studies have explored the broader social factors impacting food pantry clients, and these include employment challenges, 22,25 financial challenges, 11,22,25,28,29 a history of food insecurity, 29 and the need for basic foods. 28 Additionally, food pantry users may face challenges associated with mental health and trauma 11 and providing for family members and children. ...
... 10,11,27,29 Food pantry users often express both gratitude for services and reluctance to use services. 19,20 There are also findings that show food pantry users value choice-based environments 32 that are inclusive of culturally specific foods, 32 responsive to food allergies or restrictions, 22 and can provide access to healthy food, 31,33,34 including to help manage health conditions. 10,25,29 Despite these findings, existing qualitative research on food pantry use has focused on nutrition and diet quality among clients, and has primarily been gathered through small focus groups and one-on-one interviews, 1,[35][36][37][38][39][40] and the need to increase the focus on the voices of those experiencing food insecurity remains. ...
Objectives:
In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients.
Methods:
Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed.
Results:
Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use.
Conclusion:
The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.
... Bestaand onderzoek naar de sociaal-economische profielen van personen die voedselhulp ontvangen, toont aan dat het merendeel niet aan het werk is maar leeft van een (ontoereikende) uitkering waarbij vooral leefloontrekkers, personen die een leefloon of bijstandsuitkering ontvangen, oververtegenwoordigd zijn (Holmes et al., 2018;Onthaal Sint-Antonius, 2018;Tarasuk et al., 2014). Het is dan ook niet verwonderlijk dat voedselhulpgebruikers het tekort aan financiële middelen als belangrijkste reden naar voren schuiven waarom ze gebruikmaken van voedselhulp (Ghys en Diercks, 2013). ...
... Zo zou volgens Ghys en Dierckx (2013) voedselhulp mensen afhankelijk maken, met een negatief effect op het zelfbeeld als gevolg. Ander onderzoek geeft aan dat mensen voedselhulp als een langetermijnhulpbron kunnen beschouwen (Holmes et al., 2018). ...
... De grootste groep is echter te vinden in de sociale bijstand: 42% van de klanten ontvangt een leefloon. Ook internationaal onderzoek bevestigt dat mensen met een leefloon de grootste groep uitmaken van klanten bij de voedselbank (Holmes et al., 2018;McPherson, 2006;Tarasuk et al., 2014). ...
In dit artikel schatten we de monetaire waarde van voedselpakketten voor een lokale voedselbank in Antwerpen en vergelijken we dit met de hoogte van het leefloon in België. Op deze manier trachten we een eerste zicht krijgen op de financiële impact van voedselhulp voor gezinnen met een beperkt huishoudbudget en in welke mate deze hulp kan compenseren voor ontoereikende minimum inkomensbescherming.
... Moreover, the drive to 'keep up appearances' and pretence to appear 'normal' and 'respectable' is universally experienced in cultures of widely varying economic circumstances throughout the world [55]. There is certainly a growing body of experiential studies, investigating food bank users' perspectives, that has revealed that their use is the action of last resort, and is commonly accompanied by feelings of great shame and powerlessness [56][57][58][59][60][61]. This apparently human instinct, to hide individual household food insecurity from public and professional scrutiny, has significant implications for the design and delivery of policies intended to address it. ...
... Almost all the community food programmes we engaged with had been operating without a food bank for over a decade but reported very similar experiences in relation being compelled to add this facility to their service offerings in response to locally expressed need in recent times. Nevertheless, there were mixed views amongst study participants about the extent to which they thought their food banks were effectively addressing their clients' needs, a finding which concurs with the lived experiences of food bank users reported elsewhere [56][57][58][59][60]. There was also some concern expressed in this study in relation to food banks not being able to meet the needs of people with a long term health condition or conditions. ...
... The experience of living with food insecurity is known to adversely affect individuals' ability to manage their health condition and achieve optimal health outcomes [68][69][70]. Furthermore, there is also an emerging trend in the UK to suggest that more people are relying on food bank parcels on a regular basis, as opposed to this being a one off, rarely-used food crisis support [56,71]. Therefore, there is a need to undertake research with people in Scotland and the rest of the UK, who are living with a long term condition or conditions and who are affected by chronic or periodic food insecurity, to develop a better understanding of these experiences and their impacts. ...
This qualitative study explored frontline service providers’ perceptions of the nature of food insecurity in Scotland in 2015 to inform national policy and the provision of locally-based support for ‘at risk’ groups. A country-wide in-depth interview study was undertaken with informants from 25 health, social care, and third sector organisations.
The study investigated informants’ perspectives associated with how food insecurity was manifesting itself locally, and what was happening at the local level in response to the existence of food insecurity. Data analysis revealed three key themes. First, the multiple faces and factors of food insecurity involving not only increased concern for previously recognised ‘at risk of food insecurity’ groups, but also similar concern held about newly food insecure groups including working families, young people and women. Secondly, respondents witnessed stoicism and struggle, but also resistance amongst some food insecure individuals to external offers of help. The final theme identified community participation yet pessimism associated with addressing current and future needs of food insecure groups. These findings have important implications for the design and delivery of health and social policy in Scotland and other countries facing similar challenges.
... This condition has been associated with reductions in nutritional outcomes (Bhattacharya et al., 2004;Kirkpatrick and Tarasuk, 2008;Olson, 1999) and negative physical and mental health impacts in children and adults (Elgar et al., 2021;Jones, 2017;Ramsey et al., 2011;Seligman et al., 2010;Stuff et al., 2004). Over at least the past four decades food banks and related services have become an essential line of defense against food insecurity in Canadian communities (Black and Seto, 2020;Holmes et al., 2018;Riches, 2002;Tarasuk et al., 2020). In this respect, Canada is not unlike numerous other wealthy countries where a systematic dismantling of the welfare state took place in the intervening period (Tarasuk et al., 2014). ...
... The study of place-based geographic accessibility is concerned with capturing the potential to reach destinations of value using the transportation network (Páez et al., 2012). Indeed, the Government of Canada's recent Food Policy (Agriculture and Agriculture Canada, 2019) has made "access" to healthy food a priority for Canadian communities and previous research suggests that such accessibility plays a key role in user satisfaction with food bank service delivery (Holmes et al., 2018). However, as with research into the prevalence of food deserts, accessibility to food banks is unlikely to be evenly distributed, and variation throughout a city can be expected due to transportation network characteristics and the spatial distribution of service locations and the population they are meant to serve. ...
In this paper we analyze the changes in accessibility to emergency and community food services before and during the COVID-19 pandemic in the City of Hamilton, Ontario. Many of these food services are the last line of support for households facing food insecurity; as such, their relevance cannot be ignored in the midst of the economic upheaval caused by the pandemic. Our analysis is based on the application of balanced floating catchment areas and concentrates on households with lower incomes (<CAD40,000, approximately the Low Income Cutoff Value for a city of Hamilton's size). We find that accessibility was low to begin with in suburban and exurban parts of the city; furthermore, about 14% of locations originally available in Hamilton closed during the pandemic, further reducing accessibility. The impact of closures on the level of service of the remaining facilities, and on accessibility, was disproportionate, with system-wide losses exceeding 39%. Those losses were geographically and demographically uneven. While every part of the city faced a reduction in accessibility, inner suburbs fared worse in terms of loss of accessibility. As well, children (age ≤18) appear to have been impacted the most.
... Our qualitative findings of reasons for FAP use and nonuse were consistent with the literature. Other qualitative and mixed-methods studies in Argentina, the US, Canada, and the UK support our findings that financial need is a principal reason for FAP use [13,[37][38][39]. Research in Argentina, Brazil, and the US supports our findings of ineligibility, lack of access, and other system hassles as primary barriers to FAP participation [13,37,40]. ...
... Research in Argentina, Brazil, and the US supports our findings of ineligibility, lack of access, and other system hassles as primary barriers to FAP participation [13,37,40]. Additionally, research in Canada and of Latinos living in the US found that not having access to preferred foods limited participants' abilities to use food banks as many participants desired foods of better nutritional quality [38,41]. This is comparable to our findings that concerns about food preference and nutritional quality were primary reasons for not using FAPs. ...
The goal of this study was to measure food insecurity among families with children in a low-income district of Lima, Peru and to identify the formal and informal food resources available to them that may affect their food security status. In June-July 2019, we collected data from 329 randomly selected households in Villa El Salvador (Lima, Peru). Following a mixed methods approach, we found that the percentage of households using food assistance programs (FAPs) increased with increasing levels of food insecurity, but two FAPs were heavily used by households regardless of food (in)security. The main reasons for using FAPs included financial need, already being signed up in the program, and believing that the food was of nutritional value; the main reasons for non-use were finding the program unnecessary, dislike or poor perceived quality of the food, and not being able to sign up for the program. Similarly, informal food resources, such as buying food on credit or receiving food from someone outside the household, were incrementally used with increased levels of food insecurity. Our study clarifies the relationship between level of household food insecurity and FAP use – FAPs more commonly used by food insecure households were used because of financial need, whereas the FAPs most commonly used by food secure households were those with automatic enrollment. At a programmatic level, our research highlights the need for making nutritious and preferred foods available in FAPs and standardizing the application of enrollment criteria.
... This also includes Belgium, Finland, Hungary and Spain, although, as we will see below, benefit levels differ greatly across these countries. Third, at least partly driven by the substantial inadequacy of social assistance benefits, social assistance recipients are overrepresented among food aid beneficiaries (Holmes et al., 2018;Tarasuk et al., 2014). ...
Many European welfare states are confronted with a growing demand for charitable food aid among households that struggle to make ends meet. This issue is particularly pressing today as a consequence of the COVID-19 crisis, the Russian invasion of Ukraine and the following soaring inflation. In this exploratory case study research, we estimate the financial importance of charitable food aid packages for vulnerable recipient families by using cross-country comparable food basket data. Concretely, we collected data about the content of food packages and conducted interviews in twelve food distribution points in Antwerp, Barcelona, Budapest and Helsinki. Furthermore, we evaluate the content of food aid packages by comparing them with food basket and Household Budget Survey data. Based on the data in our twelve case study organisations, we find that the monetary value of food aid packages differs greatly between and within cities. While average food aid packages in Antwerp and Barcelona exceed 100 euros a month (adjusted for Purchasing Power Parities), this value is lower in Helsinki but especially in Budapest. This variation seems to be partially driven by differences in administrative and volunteer capacity, the (financial) support by municipalities and the position within the broader food aid network. Nevertheless, food aid packages as a top-up to inadequate minimum incomes are never able to close the at-risk-of-poverty-gap for social assistance recipients in the studied organisations in the four countries. Furthermore, our results show that the food aid packages do not fully represent a healthy and varied diet and do not correspond to people's average consumption choices. Hence, it is very likely that food aid recipients will attach a lower recipient value to the food aid packages than the estimated market values, because the packages do not entirely reflect specific household preferences and needs.
... Food banks focus on the provision of foods versus addressing the root cause of food insecurity-income, and evidence suggests that use of food banks is one of the least common strategies used by severely food-insecure households when met with financial challenges [14]. Food banks have been criticized for a limited ability to meet individuals' food needs and not providing access to foods in a dignified, socially acceptable manner [15,16]. Income and housing policies are critical to promote food security, but in the absence of systems level changes, alternative food initiatives (AFIs) such as community gardens, cooking skill development programs, community kitchens, farmers markets, food waste 'rescue' programs, lowcost food markets and food budgeting among others are potential means to empower individuals and lessen the burden of food insecurity [17]. ...
An estimated 20 to 50% of post-secondary students experience food insecurity. Students who are food insecure are more likely to have poor health and lower academic performance relative to food secure peers. Food hubs are physical or digital spaces that provide access to food initiatives and wraparound programs such as employment placement or income support are increasingly of interest as a means to respond to food insecurity. We conducted a scoping review to identify best practices and effective approaches to food hubs that promote food security in post-secondary institutions in North America. The Medline, Embase, CAB Direct and Web of Science databases were searched. A total of 4637 articles were identified and screened by two reviewers. Four articles were included. They encompassed a mix of interventions: a campus pantry and garden, a food rescue program, food literacy-based curriculum and a toolkit to support implementation of interventions on campus. The heterogeneity of studies precluded identification of best practices, but positive impacts of all interventions were noted on metrics such as self-efficacy and greater awareness of food insecurity. The gap in evidence on effective approaches that promote campus food security is a critical barrier to development and implementation of interventions, and should be addressed in future studies.
... 21), a problem which was corroborated in our original 6-month study where participants described having to live on a monthly cycle [20]. A mixed-methods study conducted in Vancouver using surveys and focus groups [37] also found that financial constraints related to insufficient income, when receiving social assistance benefits as the primary source of income, combined with rising housing costs and chronic health issues, reinforced the participants' perception of food banks as a resource they would need to rely on over the long term. ...
Background
Despite the widespread proliferation of food banks in high-income countries over the past several decades, there is a paucity of data regarding the long-term experiences of the people who rely on food banks. We were unable to find any other studies with follow-up interviews later than 6 months after baseline.
Objective
This study examined the changes in the lived experiences of people who accessed food banks over a period of 18 months.
Methods
Semi-structured interviews were conducted with 11 people who accessed food banks in Ottawa, Canada and who had participated in a 6-month study that ended one full year before this follow-up study was done. Transcripts of the interviews were analyzed through a general inductive approach involving repeated readings and coding of relevant segments of text with NVivo software according to themes that emerged iteratively. Code reports were then used to discuss and reach consensus on a final set of themes.
Results
Three main themes emerged: (1) chronic physical and mental health issues intersecting with food bank access; (2) psychosocial impact of relying on food banks; and (3) living on a low income and dealing with poverty. Chronic physical and mental health conditions were prevalent among the participants. As well, 10 of the 11 participants in this 18-month follow-up continued to rely on food banks as a regular resource – not as an emergency relief measure – to supplement their nutritional needs. While most of the participants reported that food banks helped them in some way, many shortcomings were also noted regarding food amounts, quality and choice. Overall, there was little change reported since the 6-month follow-up.
Conclusions
The shortcomings reported by participants can mostly be attributed to the dependence of food banks on charitable donations; thus, despite the commendable work of food bank staff and volunteers, participants described the food assistance as inadequate. Additionally, long-term food bank usage was a common denominator in the lived experiences of all our participants; therefore, our findings reinforce the need for assistance programs that target long-term food insecurity and its underlying causes, to replace or supplement charity-based food bank programs.
... There is a long history of charitable food relief in North America . Research from Canada and the United States shows that food poverty is increasing, and so is the entrenchment of charity as a poverty management strategy (Holmes et al. 2018;Tarasuk et al. 2014;Wakefield et al. 2013). In the United States, Janet illustrated how the number of people who rely on charity and of charitable initiatives for the poor increased exponentially in the last few decades of the twentieth century. ...
... Food banks emerged in Canada in the early 1980's as a short-term measure to ameliorate a surge in food insecurity due to job losses after a downturn in the oil industry and the subsequent economic recession [17]. The number of visits to Canadian food banks has been climbing since then, with 1,084,386 visits reported across the Canadian Food Bank Network in March 2019 [18,19]. In the absence of comprehensive government policies, food banks have continued to propagate, and these agencies are now the first line of response to the issue of hunger and food insecurity in Canada [20]. ...
Background
Food insecurity is strongly associated with poor mental and physical health, especially with chronic diseases. Food banks have become the primary long-term solution to addressing food insecurity. Traditionally, food banks provide assistance in the form of pre-packed hampers based on the food supplies on hand, such that the food items often do not meet the recipients’ cultural, religious or medical requirements. Recently, new approaches have been implemented by food banks, including choice models of food selection, additional onsite programming, and integrating food banks within Community Resource Centres.
Methods
This study examined changes in food security and physical and mental health, at four time points over 18 months at eleven food banks in Ottawa, Ontario, Canada. The participants – people who accessed these food banks – were surveyed using the Household Food Security Survey Module (HFSSM) and the Short-Form Health Survey Version 2 (SF-12). Statistical analyses included: pairwise paired t-tests between the mean perceived physical and mental health scores across the four waves of data collection, and longitudinal mixed effects regression models to understand how food security changed over time.
Results
The majority of people who were food insecure at baseline remained food insecure at the 18-month follow-up, although there was a small downward trend in the proportion of people in the severely food insecure category. Conversely, there was a small but significant increase in the mean perceived mental health score at the 18-month follow-up compared to baseline. We found significant reductions in food insecurity for people who accessed food banks that offered a Choice model of food distribution and food banks that were integrated within Community Resource Centres.
Conclusions
Food banks offer some relief of food insecurity but they don’t eliminate the problem. In this study, reductions in food insecurity were associated with food banks that offered a Choice model and those that were integrated within a Community Resource Centre. There was a slight improvement in perceived mental health at the 18-month time point; however, moderately and severely food insecure participants still had much lower perceived mental health than the general population.
... Moreover, there is no indication that the receipt of food charity takes households out of a state of food insecurity. Persistent unmet food needs and significant levels of food deprivation are commonly reported among food bank users despite the receipt of assistance (Loopstra and Tarasuk 2012, Holmes et al. 2018, Williams, McIntyre, and Glanville 2010, Williams et al. 2012). These findings are consistent with reports from food bank operators that demands for their help typically outstrip available supplies (Food Banks Canada 2013, Matern and Iman 2016, Tarasuk et al. 2014. ...
To mitigate the effects of the COVID-19 pandemic, the federal government has implemented several financial assistance programs including unprecedented funding to food charities. Using the Canadian Perspectives Survey Series 2, we examine the demographic, employment, and behavioural characteristics associated with food insecurity in April-May, 2020. We find that one-quarter of job-insecure individuals experienced food insecurity, which is strongly associated with pandemic-related disruptions to employment incomes, major financial hardship, and use of food charity. Yet the vast majority of food insecure households did not report receiving any charitable food assistance. Increased financial support for low-income households would reduce food insecurity and mitigate negative repercussions of the pandemic.
... There is emerging evidence within UK that some health and social care professionals are also referring some patients to a food bank for help with food provisioning [34]. However, the notion that foodbanks, as charitable emergency response-based entities, are in a position to offer a food supply that can sustainably meet wider community demand, and provide sufficient quantities and nutritional quality of the food needed to meet individual patient's needs, is problematic [35][36][37][38][39][40]. argue that involuntary, constrained food access not only undermines people's ability to cope with their condition, but the ongoing uncertainty and stress associated with living with food insecurity can lead to (mal) adaptive coping strategies and practices which can lead to poor condition management [41]. ...
Background:
As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual's health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them.
Methods:
Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.
Results:
Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants' economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.
Conclusions:
This study, the first of its kind in the UK, indicated that participants' health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
... There is emerging evidence within UK that some health and social care professionals are also referring some patients to a food bank for help with food provisioning [34]. However, the notion that foodbanks, as charitable emergency response-based entities, are in a position to offer a food supply that can sustainably meet wider community demand, and provide su cient quantities and nutritional quality of the food needed to meet individual patient's needs, is problematic [35][36][37][38][39][40]. argue that involuntary, constrained food access not only undermines people's ability to cope with their condition, but the ongoing uncertainty and stress associated with living with food insecurity can lead to (mal)adaptive coping strategies and practices which can lead to poor condition management [41]. ...
Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them.
Methods : Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.
Results : Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.
Conclusions : This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
... For many commentators, the growth and expansion of food hub style operations internationally is symptomatic of inadequate social policy, the devolution of government responsibilities to the non-government sector, the failure of governments to recognize and adequately address the underlying structural causes of food insecurity, and the shrinking (or for some the expansion) of the welfare state (Booth and Whelan 2014;De Schutter 2012;Dickinson 2016;Ferguson and Gupta 2002;Fox-Piven 1993;McIntyre et al. 2016). Others demonstrate consistently that food charities are wholly inadequate responses to food insecurity (Pollard et al. 2018;Riches 2002;Tarasuk et al. 2014;van der Horst et al. 2014) that may be contributing to the problem, rather than solving it (Holmes et al. 2018;Salonen 2014;Silvasti 2015). International studies also suggest that despite receiving food assistance, users of food hub style operations are still going hungry (Tarasuk et al. 2014), because these services are often used as a last resort (De Marco et al. 2009;Douglas et al. 2015;Loopstra and Tarasuk 2012) and people fear being judged for using them (De Marco et al. 2009;Douglas et al. 2015;Garthwaite et al. 2015;Hamelin et al. 2002;Loopstra and Tarasuk 2012;Mares 2013;Tarasuk and Beaton 1999;van der Horst et al. 2014). ...
Food insecurity is a significant problem in many countries, including Australia. Consequently, food hubs, through which food is distributed using a supermarket style layout, have become an important new source of charity food provision. However, little is known about users’ experiences. We draw on ethnographic research to understand the everyday experiences of people using South Australian food hubs. We suggest that attempts to produce a more dignified experience by creating a normalizing experience of shopping is not being achieved, because of the shame and stigma surrounding poverty, confusing operational processes, poor food quality, staff attitudes, and the disciplinary capacity of food hubs.
... There is emerging evidence within UK that some health and social care professionals are also referring some patients to a food bank for help with food provisioning [33]. However, the notion that foodbanks, as charitable emergency response-based entities, are in a position to offer a food supply that can sustainably meet wider community demand, and provide su cient quantities and nutritional quality of the food needed to meet individual patient's needs, is problematic [34][35][36][37][38][39]. argue that involuntary, constrained food access not only undermines people's ability to cope with their condition, but the ongoing uncertainty and stress associated with living with food insecurity can lead to (mal)adaptive coping strategies and practices which can lead to poor condition management [40]. ...
Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them.
Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.
Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.
Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
... More than half of households who use food assistance programs do so on a regular basis (Weinfield et al., 2014), with many relying on emergency food programs as a long-term strategy for procuring food (Holmes et al., 2018). Without undermining the critical need to promote food security through structural and policy level interventions, the current reality presents repeated engagement opportunities with individual smokers to conduct tobacco cessation outreach. ...
Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.
L’accès à une saine alimentation pour tous dans la dignité est indissociable des enjeux d’équité et de sécurité alimentaires durables. Pour travailler efficacement sur les enjeux de l’alimentation durable, dans une approche systémique basée sur la coopération et sur la mutualisation dans toutes les communautés du Saguenay‒ Lac-Saint-Jean, le Comité régional de réflexion et d’action en sécurité alimentaire (CRRASA) et son sous-comité Cuisinons et cultivons du Lac au Fjord (CCLF) participent au développement d’un projet d’espaces collaboratifs de transformation alimentaire. Ce projet permettra entre autres une offre universelle et équitable de produits conditionnés locaux et sains pouvant être transformés pour diverses clientèles, dans une approche structurante, afin de consolider le système alimentaire et le rendre plus durable. Le projet s’inscrit dans le Plan stratégique visant l’augmentation de l’autonomie alimentaire régionale, porté par la démarche Borée. Cet article vise à présenter cette illustration d’une approche systémique et de l’apport de lieux de concertation intersectorielle pour répondre aux enjeux d’insécurité alimentaire.
Objective:
To assess changes in food pantries' consumer nutrition environment (CNE) after the provision of technical assistance.
Design:
Pre-post study with 2 phases.
Setting:
Staff completed observational assessments using the Nutrition Environment Food Pantry Assessment Tool (NEFPAT) at food pantries in an initial pilot phase. Then, staff conducted NEFPAT observations at pantries in Illinois statewide.
Participants:
In the pilot phase, 6 staff assessed 28 pantries. In the statewide phase, 35 staff assessed 119 pantries.
Intervention:
After completing an initial NEFPAT at each pantry, technical assistance was provided by staff to support changes in the pantries' CNE before another NEFPAT observation was completed.
Main outcome measure:
Changes in the CNE, as assessed with the NEFPAT, when comparing preassessment and postassessment.
Analysis:
Score differences were evaluated with paired t tests.
Results:
In the pilot phase, among 23 pantries with preassessment and postassessment data, 2 objectives on the NEFPAT observation increased significantly. In the statewide phase, among 66 pantries with preassessment and postassessment data, most NEFPAT objectives and the overall NEFPAT score (22.12 ± 8.16 vs 28.20 ± 7.14, P < 0.001) significantly increased.
Conclusions and implications:
Technical assistance provided by Supplemental Nutrition Assistance Program Education implementing staff were related to improvements in the CNE of food pantries in Illinois. Future work should evaluate the association of these CNE changes with changes in behavior among pantry patrons.
Background:
Food bank users suffer high food insecurity. Food insecurity increases risk for chronic health conditions. However, chronic pain and its relation to food insecurity among food bank users is unknown. Knowledge about populations with chronic pain is important to direct appropriate public health nutritional strategies.
Methods:
Participants completed a survey including sleep, pain, depressive symptoms and food insecurity measures. Descriptive statistics characterized the burden of chronic pain among the sample, and a series of chi-square and t-tests assessed for demographic differences between food bank users who reported pain compared to those who did not. Logistic regression tested for variables predicting food insecurity.
Results:
Within the sample (N = 207), 53% reported a chronic pain diagnosis. Adults with pain were more likely to receive food stamps and to have a mental health condition than those without pain. Regression analyses revealed that depressive symptoms and chronic pain significantly predicted food insecurity when controlling for age and gender.
Conclusions:
Exploring the link between depression, pain and nutritional resources may enhance understanding of causal relationships driving food insecurity. Public health officials should address nutritional needs of adults including those with chronic pain who use food bank services.
High costs of living and low wage growth in Australia have resulted in an increase in the number of people experiencing food insecurity, and a corresponding increase in the number of people accessing food aid. This research employs qualitative methods alongside standard methods to explore food security to investigate these issues in food aid settings in Victoria, Australia. The two aims of this study were, 1) to explore the profile of people who access food aid and 2) to explore the experiences of people accessing food aid. A convenience sample of people was recruited from organisations that distribute food aid from across the state. People in need of food aid typically self‐refer to charities, who then apply varied and localised criteria to manage access to the charitable service. Interviews were conducted with 78 participants between June 2018 and January 2019. Participants had been accessing food aid for 4 years on average (SD 5.7, range 1 month—40 years), most participants were female (n = 57, 73.1%), with an average age of 52.6 years (SD 15.9), and over half were born in Australia (n = 44, 56.4%). Most participants were in receipt of a government welfare payment (n = 75, 96.2%), and over 40% were living in private rental accommodation. Around two thirds of participants reported low or very low food security (n = 54, 67.5%). Participants reported a range of both positive and negative experiences accessing food aid. This study adds to the body of literature exploring food insecurity in high‐income settings and its persistence despite significant national economic prosperity. Current economic and political conditions in Australia mean that the reliance on food aid by welfare recipients is unlikely to decrease.
Food banks are one of the most common responses to food insecurity in Canada, but there has been little research to examine experiences of longer-term food insecurity and food bank access This study aims to examine experiences associated with accessing food banks over two consecutive time points. Semi-structured interviews were conducted at baseline (n = 29) and six months later (n = 20) with people who have accessed a food bank in Ottawa, Canada. The findings illustrate the variation in social and emotional experiences and a common theme of long-term and regular access to food banks among people with an income insufficient to meet their basic household needs.
Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. However, while international evidence outside of the UK indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this high-income country context.
Methods :A qualitative investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Interview audio recordings were fully transcribed and thematically analysed.
Results : Twenty individuals living with a wide range of self-reported health conditions, and being supported by a local poverty alleviation social enterprise took part. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.
Conclusions :This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.
Evidence suggests that management of food insecurity in primary care may enhance preventive care delivery. This study assessed the impact of a food pantry in a pediatric primary care center over 22 months. Quantitative outcome assessments (number of children affected, number of referrals, and completion of preventative services) compared the child receiving food from the pantry to age-matched controls. Commonalities from interviews with pantry-using families were identified using thematic analysis. A total of 504 index patients received food from the pantry during an office visit. There were 546 in-clinic and community referrals. There was no significant relationship between accessing the pantry and preventative service completion by 27 months of age. Themes that emerged during interviews included the need for an emergency food source, facilitation of referrals, and increased trust in the clinic. An in-clinic food pantry is a feasible and family-welcomed approach to address food insecurity in pediatric primary care.
Food security governance is broadening and diversifying, resulting in organizations coming together in novel collaborative actions, despite little history of working together. Alternative food initiatives coexist alongside traditional charitable, emergency-based approaches. Tensions can arise between approaches and collaborating organizations due to differences in philosophy, priorities, constraints and practices. There is limited knowledge on how converging interests are interacting with one another within shifting landscapes of collaborative intervention, or the experiences of governance stakeholders involved. Through in-depth interviews this case-study examines the experiences of diverse stakeholders involved in a novel food security coalition and their perceived benefits, challenges, tensions and lessons learned. Benefits included greater communication, information sharing, understanding of diverse needs, more frequent and customized referrals, and the development of a community food centre that has increased access to affordable fresh produce in inclusive manners. Simultaneously changes in governance have produced turf wars and competition over resources. We reveal the importance of sensitivity when advocating for food system reforms to avoid ‘villainizing’ organizations that have been supporting those in need through charitable means, or further marginalizing populations who may perceive less access barriers when using food banks. Our findings suggest perceptions on what it means to provide ‘dignified’ food access vary according to unique needs and lived experiences, and one delivery model is likely inappropriate. Food banks and alternative food initiatives serve unique roles and efforts should be made to ensure they can co-exist and that those with lived experience play an influential role in changing food governance systems.
In industrialisierten Ländern folgt die Verteilung der Mortalität und Morbidität einem sozialen Gradienten. Damit einhergehend weisen Personen mit einem niedrigen sozioökonomischen Status (SES) eine ungesündere Ernährung auf und konsumieren weniger Obst und Gemüse (OG) als Personen mit einem höheren SES. Eine besonders gefährdete Personengruppe sind sozial benachteiligte Menschen wie zum Beispiel Tafelkunden (TK). Unter diesen ist Ernährungsarmut (EA) stark verbreitet. Tafeln existieren weltweit und verteilen Lebensmittel, die u.a. von Lebensmittelhändlern gespendet werden, an sozial benachteiligte Menschen. Allein in Deutschland werden etwa 1.5 Millionen Menschen von über 900 Tafeln mit überwiegend frischem OG versorgt. In Deutschland ist aber sehr wenig über die Ernährung von TK bekannt. Damit ergaben sich für diese Arbeit folgende Fragestellungen: 1. Unterscheiden sich TK aus verschiedenen Städten in ihrem Gesundheitszustand und Ernährungsverhalten untereinander und von der deutschen Bevölkerung mit einem niedrigen SES (2. Kapitel, erste Publikation)? 2. Wie verbreitet ist EA unter TK und welche soziodemographischen, gesundheitlichen und tafelassoziierten Variablen korrelieren mit EA (3. Kapitel, zweite Publikation)? 3. Unterscheiden sich männliche TK von tafelnutzungsberechtigten männlichen nicht-TK in ihrem OG-Konsum und kann der OG Konsum von sozial schwachen Männern durch eine wöchentliche kostenlose Bereitstellung (14 Portionen/ pro Woche) von selbstgewählten OG über einen Zeitraum von vier Wochen erhöht werden (4. Kapitel, dritte Publikation)? Für die Publikationen dieser Arbeit wurden Daten zur Soziodemographie, zum Gesundheits- und Ernährungsverhalten sowie zu EA in verschiedenen Städten erhoben. Die Fragen für die dabei verwendeten Fragebögen stammen aus den Erhebungsinstrumenten der nationalen Befragungen DEGS (Studie zur Gesundheit Erwachsener in Deutschland) und GEDA (Gesundheit in Deutschland aktuell) und der FIES (Food Insecurity and Experience Scale), wurden aber an die Zielgruppe adaptiert. Allen Publikationen liegt ein Querschnittstudiendesign zugrunde. In der dritten Publikation wurde außerdem für den zweiten Teil der Fragestellung eine Interventionsstudie im Längsschnittstudiendesign durchgeführt. Die erste Publikation zeigt, dass es sich bei TK an den drei untersuchten Standorten (Berlin n=94, Ludwigsburg n=64, Fulda n=114) um keine homogene Gruppe handelt. TK schätzen TK ihre Gesundheit vermehrt schlechter ein (Anteil subjektive Einschätzung der Gesundheit als moderat, schlecht oder sehr schlecht: Männer 67.4% vs. 43.5%, Frauen 68.8% vs. 36.7%) im Vergleich zu der deutschen Bevölkerung mit einem niedrigen SES. Außerdem konsumieren weniger TK täglich Obst (Anteil täglicher Obstkonsum: Männer 39.8% vs. 43.5%, Frauen 56.2% vs. 62.4%). Die zweite Publikation offenbart mit 70.2% die weite Verbreitung von EA unter TK (Stuttgart n=510, Karlsruhe n=186, Berlin n=337). Insbesondere die Variablen Alter (r Ï = -0.224, p
Food banks have grown substantially in Canada since the 1980s but little is known about patterns or predictors of engagement including frequency or duration of service use. This study examined food bank program data from a large food bank organization in Vancouver, Canada, finding that between January 1992 and June 2017, at least 116,963 individuals made over 2 million food bank visits. The majority of members were engaged for a short time and came for relatively few visits, but 9% of members engaged in longer-term episodic or ongoing usage over several years, accounting for 65% of all visits. Results from cluster and regression analyses found that documented health and mobility challenges, larger household size, primary income source, and older age were predictors of higher frequency and duration of service usage. Findings add to growing critical examinations of the “emergency food system” highlighting the need for better understanding of the broader social policies influencing food bank use.
Food banks play a major role in the food aid sector by distributing donated and purchased groceries directly to food insecure families. The public health implications of food insecurity are significant, particularly as food insecurity has a higher prevalence among certain population groups. This review consolidates current knowledge about the function and efficacy of food banks to address food insecurity. A systematic review was conducted. Thirty-five publications were reviewed, of which 14 examined food security status, 13 analysed nutritional quality of food provided, and 24 considered clients' needs in relation to food bank use. This review found that while food banks have an important role to play in providing immediate solutions to severe food deprivation, they are limited in their capacity to improve overall food security outcomes due to the limited provision of nutrient-dense foods in insufficient amounts, especially from dairy, vegetables and fruits. Food banks have the potential to improve food security outcomes when operational resources are adequate, provisions of perishable food groups are available, and client needs are identified and addressed.
The persistence, and international expansion, of food banks as a non-governmental response to households experiencing food insecurity has been decried as an indicator of unacceptable levels of poverty in the countries in which they operate. In 1998, Poppendieck published a book, Sweet charity: emergency food and the end of entitlement, which has endured as an influential critique of food banks. Sweet charity‘s food bank critique is succinctly synthesized as encompassing seven deadly “ins” (1) inaccessibility, (2) inadequacy, (3) inappropriateness, (4) indignity, (5) inefficiency, (6) insufficiency, and (7) instability. The purpose of this paper is to examine if and how the contemporary food bank critique differs from Sweet charity’s “ins” as a strategy for the formulation of synthesizing arguments for policy advocacy. We used critical interpretive synthesis methodology to identify relationships within and/or between existing critiques in the peer-reviewed literature as a means to create “‘synthetic constructs’ (new constructs generated through synthesis)” of circulating critiques. We analyzed 33 articles on food banks published since Sweet charity, with the “ins” as a starting point for coding. We found that the list of original “ins” related primarily to food bank operations has been consolidated over time. We found additional “ins” that extend the food bank critique beyond operations (ineffectiveness, inequality, institutionalization, invalidation of entitlements, invisibility). No synthetic construct emerged linking the critique of operational challenges facing food banks with one that suggests that food banks may be perpetuating inequity, posing a challenge for mutually supportive policy advocacy.
Household food insecurity, a measure of income-related problems of food access, is growing in Canada and is tightly linked to poorer health status. We examined the association between household food insecurity status and annual health care costs.
We obtained data for 67 033 people aged 18-64 years in Ontario who participated in the Canadian Community Health Survey in 2005, 2007/08 or 2009/10 to assess their household food insecurity status in the 12 months before the survey interview. We linked these data with administrative health care data to determine individuals' direct health care costs during the same 12-month period.
Total health care costs and mean costs for inpatient hospital care, emergency department visits, physician services, same-day surgeries, home care services and prescription drugs covered by the Ontario Drug Benefit Program rose systematically with increasing severity of household food insecurity. Compared with total annual health care costs in food-secure households, adjusted annual costs were 16% ($235) higher in households with marginal food insecurity (95% confidence interval [CI] 10%-23% [$141-$334]), 32% ($455) higher in households with moderate food insecurity (95% CI 25%-39% [$361-$553]) and 76%($1092) higher in households with severe food insecurity (95% CI 65%-88% [$934-$1260]). When costs of prescription drugs covered by the Ontario Drug Benefit Program were included, the adjusted annual costs were 23% higher in households with marginal food insecurity (95% CI 16%-31%), 49% higher in those with moderate food insecurity (95% CI 41%-57%) and 121% higher in those with severe food insecurity (95% CI 107%-136%).
Household food insecurity was a robust predictor of health care utilization and costs incurred by working-age adults,independent of other social determinants of health. Policy interventions at the provincial or federal level designed to reduce household food insecurity could offset considerable public expenditures in health care.
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Background
Food banks have emerged in response to growing food insecurity among low-income groups in many affluent nations, but their ability to manage this problem is questionable. In Canada, in the absence of public programs and policy interventions, food banks are the only source of immediate assistance for households struggling to meet food needs, but there are many indications that this response is insufficient. The purpose of this study was to examine the factors that facilitate and limit food bank operations in five Canadian cities and appraise the potential of these initiatives to meet food needs.
Methods
An inventory of charitable food provisioning in Halifax, Quebec City, Toronto, Edmonton, and Victoria, Canada was conducted in 2010. Of the 517 agencies that participated in a telephone survey of their operations, 340 were running grocery programs. Multivariate regression analyses were conducted to determine the association between program characteristics, volume of service, and indicators of strain in food banks’ abilities to consistently achieve the standards of assistance they had established.
Results
Extensive, well-established food bank activities were charted in each city, with the numbers of people assisted ranging from 7,111 in Halifax to 90,141 in Toronto per month. Seventy-two percent of agencies indicated that clients needed more food than they provided. The number of people served by any one agency in the course of a month was positively associated with the proportion of food distributed that came from donations (beta 0.0143, SE 0.0024, p 0.0041) and the number of volunteers working in the agency (beta 0.0630, SE 0.0159, p 0.0167). Food banks only achieved equilibrium between supply and demand when they contained demand through restrictions on client access. When access to assistance was less restricted, the odds of food banks running out of food and invoking measures to ration remaining supplies and restrict access rose significantly.
Conclusions
Despite their extensive history, food banks in Canada remain dependent on donations and volunteers, with available resources quickly exhausted in the face of agencies’ efforts to more fully meet clients’ needs. Food banks have limited capacity to respond to the needs of those who seek assistance.
Purpose
– The purpose of this paper is to address how food, social status as well as the interactions at the food bank induce emotions in receivers, such as shame, gratitude and anger. Since early 2000s a steadily growing number of low-income and/or over-indebted households in the Netherlands alleviate their situation with food donations from local food banks. Such food banks collect from companies edible food that would otherwise have gone to waste. The growing demand for food assistance indicates it is a welcome contribution to the groceries in many households. However, receiving food assistance as well as eating the products forces the receivers to set aside embodied dispositions towards food and norms about how to obtain food. Furthermore, it places them in interactions of charitable giving that may be harmful to the self-esteem of receivers.
Design/methodology/approach
– The paper is based on a qualitative study at a food bank in the Netherlands, consisting among others of in-depth interviews with 17 receivers of food assistance, observations and several interviews with volunteers.
Findings
– Of all emotions that were expressed during the interviews, shame appeared as the most prominent. Particularly issues of shame emerged in relation to all three food-bank-related experiences: the content of the crate, the interaction with volunteers and lastly the understanding of one's positioning in a social hierarchy. While shame can be a very private emotion – even talking about being ashamed can be shameful – it is also an utterly social emotion.
Originality/value
– This research is among the few ones explicitly addressing emotional emotions related to receivers in food bank.
Background:
The concept of health promotion rests on aspirations aiming at enabling people to increase control over and improve their health. Health promotion action is facilitated in settings such as schools, homes and work places. As a contribution to the promotion of healthy lifestyles, we have further developed the setting approach in an effort to harmonise it with contemporary realities (and complexities) of health promotion and public health action. The paper introduces a modified concept, the supersetting approach, which builds on the optimised use of diverse and valuable resources embedded in local community settings and on the strengths of social interaction and local ownership as drivers of change processes. Interventions based on a supersetting approach are first and foremost characterised by being integrated, but also participatory, empowering, context-sensitive and knowledge-based. Based on a presentation of "Health and Local Community", a supersetting initiative addressing the prevention of lifestyle diseases in a Danish municipality, the paper discusses the potentials and challenges of supporting local community interventions using the supersetting approach.
Discussion:
The supersetting approach is a further development of the setting approach in which the significance of integrated and coordinated actions together with a participatory approach are emphasised and important principles are specified, all of which contribute to the attainment of synergistic effects and sustainable impact of supersetting initiatives. The supersetting approach is an ecological approach, which places the individual in a social, environmental and cultural context, and calls for a holistic perspective to change potentials and developmental processes with a starting point in the circumstances of people's everyday life. The supersetting approach argues for optimised effectiveness of health promotion action through integrated efforts and long-lasting partnerships involving a diverse range of actors in public institutions, private enterprises, non-governmental organisations and civil society.
Summary:
The supersetting approach is a relevant and useful conceptual framework for developing intervention-based initiatives for sustainable impact in community health promotion. It strives to attain synergistic effects from activities that are carried out in multiple settings in a coordinated manner. The supersetting approach is based on ecological and whole-systems thinking, and stipulates important principles and values of integration, participation, empowerment, context and knowledge-based development.
The University of Ottawa Bon Appétit! food bank was established to protect students against food insecurity and hunger. The current study seeks to determine program outcomes through a review of services, initiatives, and activities offered to students. Surveys and semistructured interviews were used to collect information from the 3 levels of involvement: service recipients, program volunteers, and program coordinators. Results revealed adequate program satisfaction at all levels. However, insufficient communication of policy-related issues, poor dissemination of roles and responsibilities, and minimal documentation of best practices were also among the results found. Structural issues are discussed and recommendations are provided.
Background:
Despite public and private food assistance programs, food insecurity and hunger are persistent public health problems. Freshplace is an innovative food pantry collaborative whose goal is to build long-term food security and self-sufficiency among residents of the North End of Hartford, Connecticut. Freshplace was founded by Foodshare (FS), the Chrysalis Center (CC), Inc., and the Junior League of Hartford (JLH), Inc., who then partnered with the University of Connecticut to design and evaluate the program.
Objectives: This article describes the community-based participatory research process involved with developing and evaluating Freshplace.
Methods: We are conducting a randomized, controlled study to compare 100 Freshplace members with 100 people who receive food from traditional food pantries. Main outcome measures include food security, self-sufficiency, and diet quality. Change scores are compared from baseline to 3 months using independent t tests.
Results: Freshplace opened in July 2010. We have recruited 233 people to participate in the study. Over 3 months, Freshplace members had larger change scores than the comparison group in food security scores (1.6 vs. 0.7 points; p < .01), and fruit and vegetable intake (1.9 vs. –1.4 points; p < .01).
Conclusions: Freshplace is a successful, community– university partnership bringing together three community agencies and a state university. This is the first food pantry intervention to be evaluated, and preliminary results are promising.
The Canadian welfare state has changed significantly in the last decade with the federal devolution of policy responsibilities creating opportunities for some provinces to adopt American social policy ideas. Given the expectations of resilience and non-convergence, in the welfare state literature, this article addresses the issues of policy change by demonstrating that the movement of British Columbia’s
labour and social policy towards international neoliberal norms, including policy examples set in many US jurisdictions, have produced
limited convergence. We suggest that this indicates that more change
has occurred and is occurring in the Canadian welfare state than the
resilience model or comparative public policy literature would indicate.
This study was conducted to understand why some low-income people use pantries and others do not.Telephone and face-to-face interviews were conducted with 400 adults living in households with an income below 185% of the poverty level. Households were selected from a preliminary screening of 25,000 households in Allegheny County, Pennsylvania and included 174 current pantry users and 226 nonusers. Consistent with prior research, most households using food pantries report difficulty adequately feeding their families, and pantry use appears to be evolving into a chronic issue rather than one of short-term emergency. New pantry users are likely to remain pantry users for roughly 2 years. Pantry use is highest among African-American households, single-headed households with children, and households with low levels of education. Regression analysis indicates, however, that pantry use is higher among these groups only because these households are generally the poorest. When variables for income and assets are entered into the regression equation, the only variable significantly related to the probability of using a pantry is whether or not the household owns a car.This latter finding underscores the importance of neighborhood-based pantries and localized food-distribution systems.
Temporal trends in risk factors for cardiovascular disease and the impact of socio-economic status on these risk factors remain unclear.
Using data from the National Population Health Survey and the Canadian Community Health Survey, we examined national trends in heart disease, hypertension, diabetes mellitus, obesity and smoking prevalence from 1994 to 2005, adjusting for age and sex. We stratified data by income adequacy category, body mass index and region of residence.
An estimated 1.29 million Canadians reported having heart disease in 2005, representing increases of 19% for men and 2% for women, relative to 1994. Heart disease increased significantly in the lowest income category (by 27%), in the lower middle income category (by 37%) and in the upper middle income category (by 12%); however, it increased by only 6% in the highest income group. Diabetes increased in all but the highest income group: by 56% in the lowest income group, by 93% in the lower middle income group and by 59% in the upper middle income group. Hypertension increased in all income groups: by 85% in the lowest income group, by 80% in the lower middle income group, by 91% in the upper middle income group and by 117% in the highest income group. Obesity also increased in all income groups: by 20% in the lowest income group, by 25% in the lower middle income group, by 33% in the upper middle income group and by 37% in the highest income group. In addition to socio-economic status, obesity and overweight also modified the trends in risk factors. Diabetes increased to a greater extent among obese participants (61% increase) and overweight participants (25% increase), as did hypertension, which increased by 80% among obese individuals and by 74% among overweight individuals. Trends in diabetes, hypertension and obesity were consistent for all provinces.
During the study period, heart disease, hypertension, diabetes and obesity increased for all or most income groups in Canada. Further interventions supporting modification of lifestyle and risk factors are needed to prevent future cardiovascular disease.
Concerns about adequate food supply is a mounting problem in Canada, making food bank visits a necessity for over 820,000 Canadians. Given this reliance, the purpose of this study was to compare contents of food hampers with Canadian guidelines, at a large urban food bank in Southwestern Ontario that intends to provide 3 days worth of food per person.
Thirty hampers of each available size (for 1-6 people) were sampled (N = 180). Food items were recorded and analyzed for caloric value, food group, and macro- and micro-nutrient values. Results were compared to Dietary Reference Intakes (DRI) and Canada's Food Guide to Healthy Eating.
99% of hampers did not provide 3 days worth of nutrients. Grains and cereals met the lower range of Canada's Food Guide recommendations, and fruits and vegetables, meats and alternatives, and dairy products were below recommended levels, as were numerous vitamins and minerals, including vitamins A, D, B12, C, riboflavin, niacin, calcium, magnesium and zinc. Carbohydrates were slightly above recommended DRI, and energy from fat and protein scarcely met the minimums recommended. Hampers contained 1.6 days worth of energy per person.
The energy available per person was below recommendations for most Canadians. Nutrients missing from the hampers can come from fresh fruits, vegetables, dairy products, and meats and alternatives. However, many low-income families have limited finances to purchase these foods which are relatively more expensive than processed foods. Encouraging more perishable food donations and storage facilities to maximize the nutritional intake for clients is imperative.
First World Hunger examines hunger and the politics of food security, and welfare reform (1980-95) in five 'liberal' welfare states (Australia, Canada, New Zealand, the UK and the USA). Through national case-studies it explores the depoliticization of hunger as a human rights issue and the failure of New Right policies and charitable emergency relief to guarantee household food security. The need for alternative integrated policies and the necessity of public action are considered essential if hunger is to be eliminated.
Purpose:
Food banks have become the main response to food insecurity in many high-income countries, but it has been argued that they lack the capacity to respond consistently and fully to the food needs of the people who use them. This literature review set out to answer the question 'how do food bank recipients experience food relief services and how does this impact their lives and wellbeing?'
Results:
A comprehensive search of electronic databases yielded twenty qualitative studies, conducted in developed countries, exploring user perspectives of food banks. From the studies reviewed, there emerged three main categories that represented the different aspects of the food bank process from the food bank user's perspective: the user's perceptions about the idea of being fed from food banks, the user's perceptions about food bank offerings and operations, and the socio-psychological impact of receiving food from food banks. While participants of these studies spoke positively of the volunteers and were thankful for the service, they also consistently report limited food choice, poor quality, shame, stigma and embarrassment associated with food bank use.
Conclusions:
The food bank industry continues to expand despite there being little evidence that food banks are an appropriate response for those facing food insecurity. This is worrying as the results of this review indicate that although participants value the service provided by the food bank, the experience can be largely negative. These findings raise questions about the food bank model as a long-term strategy.
In May 2012, Olivier De Schutter, the UN Special Rapporteur on the Right to Food, undertook an official visit to Canada, the first to an OECD country. His report, informed by national statistics, indicated widespread and increasing food insecurity; a deplorable incidence of hunger and poverty amongst First Nations communities and Aboriginal peoples living in Northern Canada; and the lack of a national food policy. He drew attention to the nearly 900,000 people per month dependent on charity-based food aid, noting this ‘reliance on food banks was symptomatic of a broken social protection system’ which served as ‘a moral safety valve for the State’. Observing that Canada had escaped the worst of the 2007–2008 global financial crisis, De Schutter questioned the Government’s lack of compliance with its obligations under international law (ICESCR, 1976) to implement the human right to adequate food (OHCHR, 2012; HRC, 2013a).
The objective of this study was to bring to light legislators’ construction of household food insecurity using a dataset of debate texts from the Hansard records of four Canadian jurisdictions over approximately the last two decades. We found that legislators’ fundamental problematization of food insecurity was one of insufficient income but that certain groups were of greater policy concern than others. Proposals to address food insecurity linked to legislators’ differing perceptions of underlying cause. Consensual agreement on structural mitigation strategies for household food insecurity is likely to require a shift in symbolism of who is deserving of attention.
In the last two decades, emergency food provision (e.g., food banks, meal programmes) has become an increasingly institutionalized form of hunger relief. Critiques of the emergency food system, as articulated by Poppendieck's 1998 book Sweet Charity?, suggest that such programmes are unable to cope with growing hunger in a meaningful, stable, efficient, or culturally appropriate way, and that they may facilitate government retrenchment. Meanwhile, popular attention has increasingly focused on the environmental and social costs of our globalized industrial food system, and efforts to challenge it (e.g., urban fruit gleaning, chicken rearing) are becoming widespread. These efforts have drawn new kinds of organizations into the world of food (in)security. Drawing on organizational documents and key informant interviews, this paper examines how emergency food provision is changing because of the rise of community food security' discourse and practice in the period since Sweet Charity? Findings suggest that emergency food providers have responded to critiques in partial and incongruent ways. Organizations face structural constraints that curtail their ability to reorganize, while new kinds of organizations are engaging in community food security projects, both challenging and reinforcing the charity food model in ways that have relevance for progressive (food) organizing more generally.
Emergency foodbanks have become an increasingly prominent and controversial feature of austerity in Europe and the USA. In the UK, foodbanks have been called a 'public health emergency'. Despite this, there has been no UK research examining the health of foodbank users. Through an ethnographic study, this paper is the first to explore the health and health perceptions of foodbank users via a case study of Stockton-on-Tees in the North East of England, UK during a period of welfare reform and austerity. Participant observation, field notes and interviews with foodbank users and volunteers were conducted over a seventeen month period (November 2013 to March 2015) inside a Trussell Trust foodbank. Foodbank users were almost exclusively of working age, both men and women, with and without dependent children. All were on very low incomes - from welfare benefits or insecure, poorly paid employment. Many had pre-existing health problems which were exacerbated by their poverty and food insecurity. The latter meant although foodbank users were well aware of the importance and constitution of a healthy diet, they were usually unable to achieve this for financial reasons - constantly having to negotiate their food insecurity. More typically they had to access poor quality, readily available, filling, processed foods. Foodbank users are facing the everyday reality of health inequalities at a time of ongoing austerity in the UK.
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Using a structured dialogue method, 56 women from Nova Scotia, Canada, affiliated with 2 federally funded programs housed in family resource centers (FRCs) shared their experiences of living with food insecurity. Their stories revealed an overall lack of supportive environments for them and their children, characterized by (1) the struggle to obtain nutritious food; (2) lack of supports within systems; (3) feeling judged; and (4) stress and its impacts. Through telling their stories and engaging in reflection and critical analysis of their experiences, these women have enriched a research process that is working toward policy change to build food security.
A national online survey of 137 US food banks was conducted along with in-depth interviews with staff at 6 California food banks to assess the characteristics of their organizational culture, including the extent to which they focused on nutritional quality of emergency food. The majority of US food banks reported a substantial level of commitment to nutrition. Only a minority has written formal nutrition policies, but several California food bankers were in the process of developing policies. US food banks most often reported seeking to increase fresh produce; fewer reported deliberate efforts to increase low-fat dairy, lean meats, or whole grains or to reduce unhealthful foods. California food banks revealed that they have significantly expanded their capacity to respond to increased produce donations, yet there are still substantial limitations to be addressed in procuring, handling, and monitoring the quantity of more nutritious foods. Organizational practices commensurate with a nutrition policy are not widely evident although there is variation. Study results highlight a number of issues for attention in assisting food banks to align their culture, capacity, and practices more closely with their stated commitment to nutrition quality.
Household food insecurity (HFI) is a persistent public health problem affecting 3.8 million Canadians. While the causes of HFI are rooted in income insecurity, solutions to HFI have been primarily food-based, with the bulk of activity occurring at the municipal level across Canada. We conceptualize these municipal-level actions as falling within three models: "charitable", "household improvements and supports" and "community food systems". Many initiatives, especially non-charitable ones, generate widespread support, as they aim to increase participants' food security using an empowering and dignified approach. While these initiatives may offer some benefits to their participants, preliminary research suggests that any food-based solution to an income-based problem will have limited reach to food-insecure households and limited impact on participants' experience of HFI. We suspect that widespread support for the local-level food-based approach to HFI has impeded critical judgement of the true potential of these activities to reduce HFI. As these initiatives grow in number across Canada, we are in urgent need of comprehensive and comparative research to evaluate their impact on HFI and to ensure that municipal-level action on HFI is evidence-based.
Étant donné l’absence de politiques publiques précises face au problème de l’insécurité alimentaire des ménages au Canada, les banques alimentaires restent la solution la plus courante, malgré les questions qui se posent au sujet de leur efficacité. En effet, parmi 371 familles à faible revenu de Toronto que nous avons interviewées dans le cadre de cette étude, 75 % avaient vécu de l’insécurité alimentaire, mais seulement 23 % avaient eu recours à une banque alimentaire ; et, pour la plupart des utilisateurs de banque alimentaire, l’insécurité alimentaire était un problème chronique grave. Parmi les raisons qui font que les familles vivant de l’insécurité alimentaire n’ont pas recours à une banque alimentaire, notons une certaine réticence à demander la charité, mais aussi un accès difficile à ces banques pour diverses raisons. Ces résultats remettent en question le rôle que les gouvernements fédéral, provinciaux et territoriaux semblent donner aux organismes caritatifs comme moyens de réduire l’insécurité alimentaire, et soulignent la nécessité de politiques publiques claires en cette matière.
In the absence of targeted public policy to address household food insecurity in Canada, food banks remain the dominant response, despite questions about their effectiveness. Interviews with 371 low-income Toronto families revealed that 75 percent had experienced some food insecurity, but only 23 percent had used a food bank; for most food bank users, food insecurity was a severe and chronic problem. Food-insecure families’ reasons for not using food banks indicated resistance and, in some instances, access barriers. These results draw into question the apparent reliance of federal and provincial/territorial governments on food charity to alleviate food insecurity and highlight the need for a public policy response.
Food insecure households in the United States seek assistance from both public assistance and private community programs. This research examines the needs of those accessing services from a county network of food pantries in Michigan. Interviews with a stratified sample of 104 pantry users identified two distinct groups accessing food: those who began visiting food pantries within the last 24 months (over half of whom were also recently unemployed); and long-term users who are more likely to also use government programs like food stamps and WIC. Findings suggest food pantries are serving more than emergency food needs, and are responding to the food needs of two separate types of households.
Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household socio-demographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household socio-demographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.
Nutrition educators research, teach, and conduct outreach within the field of community food security (CFS), yet no clear consensus exists concerning what the field encompasses. Nutrition education needs to be integrated into the CFS movement for the fundamental reason that optimal health, well-being, and sustainability are at the core of both nutrition education and CFS. Establishing commonalities at the intersection of academic research, public policy development, and distinctive nongovernmental organizations expands opportunities for professional participation. Entry points for nutrition educators' participation are provided, including efforts dedicated to education, research, policy, programs and projects, and human rights.
Foodshelves provide a vital service of distributing food to food insecure families, but the resources foodshelves have to source and distribute healthy food and the extent to which this emergency food is healthy have not been evaluated. All member foodshelves of the Emergency Foodshelf Network (n = 58), a food bank in Minnesota, were sent a survey that assessed resources and barriers related to organizational policies, infrastructure, and access to healthy food that foodshelves face. Results from 35 responding agencies suggest that foodshelves with healthy food sourcing and distribution policies tended to serve larger caseloads, be managed by paid staff, and purchase more food than received as donations. Lack of healthy food in the hunger relief system was a barrier to foodshelves implementing policies.
This text offers a comprehensive resource on the theory and application of community based participatory research for health. The authors provide information on a variety of topics including planning and conducting research, working with communities, promoting social change, and core research methods. This book also contains an appendix of tools, guides, checklists, and sample protocols. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The development of political strategies in Canada to support the transition from conventional to sustainable agriculture has been limited by the absence of a comprehensive conceptual framework for identifying the most critical policies, programs, and regulations. In this paper, we propose a framework that uses an efficiency/substitution/redesign spectrum to categorize both sustainable fanning systems and government activities. The framework is then used to identify a diverse range of short, medium, and longterm strategies to be pursued by governments in Canada to support the transition. Strategies discussed include research, diffusion, and training; market development; and safety net programs and tax provisions. Finally, the implications and implementation of the redesign concept for food production, processing, and distribution are outlined.
Food insecurity refers to the inability to afford enough food for an active, healthy life. Numerous studies have shown associations between food insecurity and adverse health outcomes among children. Studies of the health effects of food insecurity among adults are more limited and generally focus on the association between food insecurity and self-reported disease. We therefore examined the association between food insecurity and clinical evidence of diet-sensitive chronic disease, including hypertension, hyperlipidemia, and diabetes. Our population-based sample included 5094 poor adults aged 18-65 y participating in the NHANES (1999-2004 waves). We estimated the association between food insecurity (assessed by the Food Security Survey Module) and self-reported or laboratory/examination evidence of diet-sensitive chronic disease using Poisson regression. We adjusted the models to account for differences in age, gender, race, educational attainment, and income. Food insecurity was associated with self-reported hypertension [adjusted relative risk (ARR) 1.20; 95% CI, 1.04-1.38] and hyperlipidemia (ARR 1.30; 95% CI, 1.09-1.55), but not diabetes (ARR 1.19; 95% CI, 0.89-1.58). Food insecurity was associated with laboratory or examination evidence of hypertension (ARR 1.21; 95% CI, 1.04-1.41) and diabetes (ARR 1.48; 95% CI, 0.94-2.32). The association with laboratory evidence of diabetes did not reach significance in the fully adjusted model unless we used a stricter definition of food insecurity (ARR 2.42; 95% CI, 1.44-4.08). These data show that food insecurity is associated with cardiovascular risk factors. Health policy discussions should focus increased attention on ability to afford high-quality foods for adults with or at risk for chronic disease.
Responses to food insecurity in Canada have been dominated by community-based food initiatives, while little attention has been paid to potential policy directions to alleviate this problem. The purpose of this paper is to examine food security circumstances, participation in community food programs, and strategies employed in response to food shortages among a sample of low-income families residing in high-poverty Toronto neighbourhoods.
Data from surveys conducted with 484 families and neighbourhood mapping were analyzed.
Two thirds of families were food insecure over the past 12 months and over one quarter were severely food insecure, indicative of food deprivation. Only one in five families used food banks in the past 12 months and the odds of use were higher among food-insecure families. One third of families participated in children's food programs but participation was not associated with household food security. One in 20 families used a community kitchen, and participation in community gardens was even lower. It was relatively common for families to delay payments of bills or rent and terminate services as a way to free up money for food and these behaviours were positively associated with food insecurity.
While documenting high rates of food insecurity, this research challenges the presumption that current community-based food initiatives are reaching those in need. Public health practitioners have a responsibility to critically examine the programs that they deliver to assess their relevance to food-insecure households and to advocate for policy reforms to ensure that low-income households have adequate resources for food.
Over the past two decades, the demand for charitable food assistance has steadily grown, and a massive ad hoc system of food banks has become established in Canada. To assess the food insecurity and nutritional vulnerability of one subgroup of food bank users, interviews were conducted with a sample of 153 women in families using emergency food relief programs in Metropolitan Toronto. Ninety percent reported household incomes which were less than two thirds of the 'poverty line', and 94% reported some degree of food insecurity over the previous 12 months. Seventy percent reported some level of absolute food deprivation, despite using food banks. The findings highlight the limited capacity of ad hoc, charitable food assistance programs to respond to problems of household food insecurity which arise in the context of severe and chronic poverty.
Community-based charitable food assistance programs have recently been established in several affluent nations to distribute public and corporate food donations to 'the needy'. In Canada, food banks comprise the primary response to hunger and food insecurity, but problems of unmet food need persist. We conducted an ethnographic study of food bank work in southern Ontario to examine the functioning of these extra-governmental, charitable food assistance programs in relation to problems of unmet need. Our results suggest that the limited, variable and largely uncontrollable supply of food donations shaped the ways in which food assistance was defined and the practices that governed its distribution. Workers framed the food assistance as a supplement or form of acute hunger relief, but generally acknowledged that the food given was insufficient to fully meet the needs of those who sought assistance. In response to supply limitations, workers restricted both the frequency with which individual clients could receive assistance and the amount and selection of food that they received on any one occasion. Food giving was essentially a symbolic gesture, with the distribution of food assistance dissociated from clients' needs and unmet needs rendered invisible. We conclude that, structurally, food banks lack the capacity to respond to the food needs of those who seek assistance. Moreover, the invisibility of unmet need in food banks provides little impetus for either community groups or government to seek solutions to this problem.
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