In this interview with CARRFS eNews, Dr. Lynn McIntyre describes how hunger and severe food insecurity in children has life-long consequences.
How would you define child hunger?
The actual term that we use in Canada and the United State is Food Insecurity - which is simply defined as lack of access to food due to financial constraint. There is a gradation of food insecurity—from marginal to moderate to severe: A marginally food insecure household is one worrying about running out of food; a moderate would have some diet quality issues associated with the food that they are able to acquire; and a severely food insecure household is really the one that has to do with deprivation.
What we think about as child hunger is a child that lives in a household with severe food insecurity. It means that the child is food deprived—maybe skipping meals, maybe not eating for the whole day, and certainly having to compromise in both the quantity and quality of food. When I use the term child hunger in my research I refer explicitly to the parents that actually answer yes to a specific question: “Has your child ever experienced being hungry because the family has run out of food or money to buy food?” This question is from the National Longitudinal Survey of Children and Youth (NLSCY) and is thus very specific to that particular “state”. Otherwise the preferred term is child-level severe food insecurity.
How do you actually measure it?
Canada, the United States and many other countries have adopted the same measurement tool, namely the Household Food Security Survey Module. For households with children, it contains 18 questions that are answered in a phased approach ending with deprivation. The NLSCY with its single question on child hunger predates this instrument.
How does food insecurity manifest itself in bad health?
Food insecurity for children and adults is very much related to health—and particularly poor health and poor mental health. The results of nutritional intake studies in Canada show little difference between children living in food secure and food insecure households. For children, the health harm does not seem to be through nutritional deficiencies but rather the experience of food insecurity is a psycho-social stress associated with anxiety, worrying and tension.
It is important to make a distinction between “first world” and “third world” hunger. We have been able to show that in Canada, instances of actual nutrient deficiencies are few. “Stunting” for example, is pervasive in lower income countries where it is very much nutrition and infection associated. In higher income counties, child poverty has different results. It appears to be the stress that comes from an impoverished environment that is the main factor that causes harm.
Stress manifests itself physiologically. Chronic stress seems to influence the neural circuitry of the child and can create long term epigenetic changes. We have been exploring that hypothesis with our NLSCY data and can show why depression, but not self-esteem and other kinds of capabilities, is higher in children that have experienced hunger. In other words, severe food insecurity is created sociologically, but has physiological effects. We need to recognize how dangerous it is to have children experience severe food insecurity in their households and we need to understand that giving them a little bit of extra food cannot undo that. Child poverty to the point of child hunger has to be addressed as it is totally unnecessary. In fact it does not require a lot of money to keep a family out of severe child food insecurity.
Isn’t the Food Bank network a good compensation or substitute for food insecure families?
Absolutely not and never! One must be absolutely clear that food is not what is required in a household that is food insecure. Income is what is required. The discretionary income is used to buy food and it is the only flexible part of the budget which is why it is compromised in households that can barely meet their needs for shelter, transportation, heating and other necessities. We know that one-third of food insecure households never seek help from a Food Bank for a variety of well documented reasons ranging from lack of access to stigma to pride. Coming back from the Food Bank with a couple of bags does not change the social stress. Food Banks provide very few meals in relation to what is required throughout a month. It is a place of last resort—and people who use the Food Bank really need it. But the Food Bank has absolutely no curative effect on whether the children are being harmed by food insecurity. And the health effect from food insecurity is not going to be mitigated or reduced by Food Banks.
Which groups in Canada experience most child hunger?
If we take the north into account the most disadvantaged in Canada are of course the aboriginal children. If we talk about the majority of the society–the advanced ticket to child hunger is to live in a mother-led lone-parent household. Living on the income from the social assistance or welfare system is today a virtual guarantee that you will be a food insecure household. It is very difficult or even impossible for a mother with children who is reliant on social welfare to live without food insecurity. And there are certainly low income households—a parent working full time on minimum wage, for example—that are equally guaranteed to be food insecure. This is really an income issue.
How can we reduce the rate of child hunger in Canada?
I have walked away from minimum wage or increased social assistance rates because they are too narrow as solutions. A guaranteed annual income is really the universal solution. It has worked beautifully for seniors’ poverty reduction and it is what we need for households and for all individuals. It is a universal solution for access to basic needs and in fact it will more than pay for itself. It avoids stigmatization–one is not means- tested, one is not judged. It is not about being on welfare. It is a universal entitlement and gives one the ability to meet basic needs. The health gains alone will easily pay for such a solution.
When you measure food insecurity - how do you make sure that the answers you get are valid–that the respondent due to pride or other reasons will not admit that their children go hungry therefor will not answer those questions “truthfully”?
A huge amount of work has gone into the process ensuring both the validity and reliability of household food insecurity measurement. The Household Food Insecurity Survey Module comes with a built-in progression of questions—for instance, if you answer yes to the question “do you worry about running out of food?” we will then go to the next question, and it does have a screener. It is done either through face-to-face or over the telephone. It is not self-administered. These surveys are done in trusting and safe conditions with confidentiality and they have been reproduced in millions of households where they have been answered by the person with the best knowledge of the household.
In one of the studies that we published, we realized that some females in married households reported more food insecurity than the husbands in a very similar household—the difference in food insecurity it revealed is not likely a result of true versus false reporting, but what we would call imperfect information. It may be that some women may hide their circumstances from their husbands who are doing their very best to provide for the family. Similarly in our longitudinal national study of children and youth we asked the parents about child hunger when the child was little and later we asked the child about the same thing and got higher response rates from youth. This raises the question as to whether the youth are exaggerating? Not necessarily. In fact, youth health problems were more correlated with youth self-report of child hunger than parental report. Maybe the mother didn’t even know or realize that her children were going hungry because they cleverly hid their hunger. I have found in studies that children ‘trick’ their mother into eating when she looks like she is sparing food for the children. But this is more about family dynamics rather than being untruthful. These are the kinds of stresses that are taking a huge toll on individuals, but don’t affect the prevalence rates of food insecurity in Canada.
What are the next steps?
In 1994 we started out with a representative cohort of children from all the provinces in Canada and we have followed them every two years until 2008-2009. They were one to 11 years old when we started and 14-25 years old when we finished. Every two years we have learnt about their health, school, family, mom and dad, and about their hunger. I have studied these 768 children over the course of 16 years.
We have been able to look at what happens to their health over time, their educational outcomes, early fertility, mental health, depression, suicidal thinking and so on. Today, we know that hunger is not another example of poverty–but something unique. We have been able to show that child hunger has a lasting effect on a person’s general health–that early on it is related to generally poorer health and as children grow to adolescence, they have more chronic conditions, particularly asthma.
We also know that child hunger in youth and young adulthood is independently related to depression and suicidal ideation even taking into account biological factors such as mother’s depression etc.
We can also show—independent of many other “bad” things that happens in a child’s life—that if you experience hunger as a child you are less likely to graduate from high school than other poor kids.
I hope to publish more papers on these 768 children in order to understand more about the unique stress they encountered and how this had damaging long term effects. I am also working on how a guaranteed annual income actually could be very cost effective for society in solving this very difficult situation for many families across Canada. <>
By Jostein Algroy