Report to/Rapport au :

 

Ottawa Board of Health

Conseil de santé d’Ottawa

 

Monday 21, November, 2011/le lundi 21 november 2011

 

Submitted by/Soumis par:

Dr./Dr Isra Levy,

Medical Officer of Health/Médecin chef en santé publique

 

Contact Person/Personne-ressource :

Sherry Nigro, Manager/Gestionnaire

Health Promotion and Disease Prevention/Promotion de la santé et prévention des maladies

Ottawa Public Health/Santé publique Ottawa

613-580-2424, ext./poste 28971, sherry.nigro@ottawa.ca

 

City Wide / À l’échelle de la ville

ACS2011-OPH-HPDP-0004

 

 

SUBJECT:

 

 ACCESS TO HEALTHY FOODS

 

OBJET :

 

Accès à des aliments sains

 

REPORT RECOMMENDATIONS

That the Board of Health for the City of Ottawa Health Unit:

1.      Receive for information the Worksheet: The Cost of a Nutritious Food Basket Ottawa, 2011 and The Price of Eating Well in Ottawa, 2011, included in Document 1 and 2 of this report;

2.      Direct staff to implement the future programming for food security, as outlined in this report; and

3.      Approve that the letter, attached as Document 4, be sent to the Minister of Health and Long-Term Care, on behalf of the Ottawa Board of Health, advocating improved access to healthy foods for everyone.

 

RecommandationS du rapport

Que le Conseil de santé de la circonscription sanitaire de la ville d’Ottawa :

  1. prenne connaissance des documents intitulés Feuille de Travail: Ce qu’il en coûte pour manger sainement à Ottawa en 2011 et Ce qu’il en coûte pour manger; sainement à Ottawa en 2011, présentés comme documents 1 et 2 du présent rapport;
  2. demande au personnel de mettre en œuvre la programmation future de la sécurité alimentaire, telle que décrite dans le présent rapport; et
  3. approuve l’envoi de la lettre, jointe comme document 4, à la ministre de la Santé et des Soins de longue durée, au nom du Conseil de santé de la Ville d’Ottawa, afin de revendiquer un meilleur accès à des aliments sains pour toute la population.

 

Executive Summary

Since 1999, Ottawa Public Health (OPH) has been conducting an annual Nutritious Food Basket (NFB) survey that monitors the cost of 67 basic food items. This survey allows OPH to gauge the affordability and accessibility of healthy foods for individuals and families of all income levels.

 

It costs $175.39/week to feed a family of four in Ottawa, according to the 2011 NFB survey.

 

This represents a 4.9% increase from 2010. For those with low incomes, this often means there is not enough money to afford healthy food after paying for other essentials such as housing, transportation and childcare. Poor nutrition leads to an increased risk of infectious and chronic disease, difficulties managing these diseases, as well as health problems such as low birth weight. OPH is aiming to improve access to nutritious food by enhancing and expanding food skills education, increasing breastfeeding rates, improving the availability of healthy foods and supporting community action related to food security.

 

Background

 

Food security is an important public health issue and is recognized as a determinant of health (1, 2, 3). Poor birth outcomes, reduced learning and productivity, chronic diseases and lack of nutrients are examples of how poverty, manifested as lack of food security, affects health (1, 4, 5, 6). Food Security exists when all people at all times, have physical and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life (7).  Specific to food security the Ontario Public Health Standards require health units to monitor food affordability, provide opportunities for food skill development, mobilize and promote access to community resources, share best practices and evidence for the prevention of chronic diseases and develop healthy public policies that support healthy eating and breastfeeding.

 

In 2009/2010, 6.8% of residents in Ottawa worried about not having enough to eat, compromised the quality or variety of food eaten, or did not have enough to eat because of a lack of money (8). This is similar to the rest of Ontario, where 7.6% of the population report some level of food insecurity (8).

 

Being food secure means more than just getting enough food; it is also having access to nutritious and safe food in a socially acceptable way.  An increasing number of Ottawa residents are relying on emergency food assistance from food banks to meet their basic needs.   In 2011, 8,107 households were served by the Ottawa Food Bank. The number of people using food banks in Ottawa has steadily been climbing over the past 3 years showing an annual increase of nearly 4% per year (9).  Data from the Ottawa Neighbourhood Study shows that fewer full service grocery stores are located in low-income communities relative to other neighbourhoods (10).  The stores that remain are convenience stores or more expensive specialty shops.  This further undermines low income residents’ ability to access healthier options such as vegetables, fruit and whole grains. It also encourages consumption of more readily available, energy rich, nutrient poor foods.

 

The high cost of living, low supply of affordable housing and a highly competitive job market are three factors which impact Ottawa residents’ ability to be financially secure and therefore, food secure (11). Seven per cent of Ottawa residents receive social assistance. With the decline in the economy and the impact on the job market, this number continues to increase (11).  The purchasing power of social assistance benefits (Ontario Works and Ontario Disability Support Program) has not kept up with the cost of living. For people on social assistance the rates fall far short of what is needed to purchase healthy food after they have paid for market rate shelter.  Low income individuals and families in Ottawa often live in rental housing.  In 2011, the average monthly cost of a three bedroom apartment is $1227.00.  For a family of four on Ontario Works, this represents 61% of their monthly income.  For a family of four with one full-time minimum wage earner, this represents 47% of their monthly income.  These scenarios illustrate that households on fixed incomes and minimum wage earners have little if any money left over to cover basic monthly expenses like heat and hydro, telephone and transportation.  In reality, people choose to pay rent and other fixed expenses, before buying food.   Food becomes a “discretionary” expense, resulting in a diet of poor nutritional quality.  Poor nutrition leads to an increased risk of infectious and chronic disease and difficulties managing these, as well as health problems such as low birth weight. 

 

Monitoring the Cost of Healthy Eating in Ottawa

Since 1999, OPH’s Nutrition Team has monitored the cost of healthy eating in Ottawa by conducting an annual Nutritious Food Basket (NFB) survey each May. The NFB survey tool monitors the cost of 67 basic food items representing current nutrition recommendations and average eating patterns of Canadians. 

 

OPH uses the data from the NFB to estimate the average cost of healthy eating for 22 age and gender groups and a reference family of four (Document 1).  The data is also used to monitor both affordability and accessibility of foods by relating the cost of the food basket to individual and family incomes (Document 2). 

 

According to the 2011 NFB survey, it costs $759 per month ($175.39/week) to feed a family of four in Ottawa.  Compared to 2010 this is a 4.9% increase or $8.23 more per week (10) (Figure 1).   Analysis of the cost of the NFB in relation to individual and family incomes show that households with a low income have inadequate funds to afford healthy eating after paying for other essentials, such as housing, transportation and childcare.  

 

Figure 1: Cost of Nutritious Food Basket in Ottawa and Ontario from 2009 to 2011
 

Source: Nutritious Food Basket data, Ottawa Public Health, Ontario Ministry of Health Promotion and Sport

Data Note: Due to the change in protocol, NFB data from after 2008 cannot be compared to data from earlier years
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 






Household income is related to food security status.  The proportion of food secure households increases with increasing household income.  In 2009/2010, 41% of Ottawa residents in the lowest income category and 29% of residents in the lower middle income category indicated some level of food insecurity (Figure 2). The lowest income and lower middle income category capture residents living below the Low Income Cut-Off (Document 3).

 


Figure 2: Food Secure Households by Household Income Category City of Ottawa 2009/2010
 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 






Dissemination of Nutritious Food Basket Data

OPH reports the NFB findings to the Ministry of Health and Long Term Care. In addition, OPH shares the data with a wide range of community partners to inform program planning, service delivery and policy development.  These community partners include:  Just Food, Ottawa Food Bank, Ottawa Network for Education (formerly School Breakfast Program), Good Food Box, Ottawa Poverty Reduction Network, Wabano Centre for Aboriginal Health, Community Health Centres, Ottawa Community Immigrant Services Organization, United Way and the City of Ottawa, Community and Social Services Department.  

 

Limitations of the Nutritious Food Basket

The tool excludes take out and restaurant foods, processed convenience foods, snack foods and household non-food items such as toilet paper, toothpaste or detergent that would normally be purchased at the grocery store.  As a result the cost of the NFB is lower than actual grocery expenditures for the average resident.

 

The NFB is a useful tool for assessing food affordability; however, it is important to note that it is based on a series of assumptions.  It assumes that individuals have the food skills, time and ability to prepare foods from scratch; the literacy, knowledge and interest to shop for the lowest price; and can regularly access grocery stores.  Consequently, the NFB tool may underestimate the true affordability and accessibility of foods for more vulnerable residents. 

 

As demonstrated by the NFB data, the rise in food prices and the cost of living means people on lower incomes face increasing difficulty affording healthy food.  At a macro level our food system is becoming increasingly more unstable creating a need to look at supporting more sustainable means of procuring food.  At a micro level many people living in low-income and under-serviced communities in Ottawa have difficulty accessing affordable, healthy food and many Ottawa residents lack the food skills to purchase and prepare healthy food at the lowest price.

 

DISCUSSION

 

Ottawa Public Health Programming Related to Food Security

The ability to budget, shop and prepare food are examples of food skills that can help people access nutritious food.  OPH provides food skills programming to priority populations through a variety of channels. The I Love to Cook and Play project teaches basic food skills to low income children in after school sessions at community houses.  Community Food Advisors (CFAs), a group of trained OPH volunteers, provide food skills training to priority populations.  This year OPH has expanded its food skills programming with the Ottawa Food Bank to include CFA food skills education and demonstrations at five emergency food program sites.   

 

Food security also means access to food across the lifecycle.  Supporting breastfeeding promotes food security for families with young children.  Breastfeeding not only has numerous health advantages for both the mother and baby; it is cost effective.  For over 15 years, OPH has promoted breastfeeding through supporting breastfeeding friendly hospitals and Community Health Centres, implementing workplace policies and increasing acceptance of breastfeeding in public.  As well, OPH works directly with women and their support systems to promote breastfeeding through prenatal classes, home visiting, tele-nursing, and well baby drop-ins.  OPH’s Breastfeeding Buddies program, which pairs a breastfeeding mom with a volunteer, and the new weekend breastfeeding support drop-in are recent initiatives that have demonstrated considerable uptake.  These activities serve to advance OPH in its efforts to achieve Baby Friendly TM designation, which is a reporting requirement from the Ministry of Health and Long Term Care, as part of the Public Health Accountability Agreement.   At the other end of the lifecycle, OPH works to address nutrition concerns of low income seniors through programs like the Aging in Place Program by providing regular presentations on healthy aging including eating for one, reducing sodium and eating on a budget.  

 

In addition, a recent Put Food in the Budget campaign requested the provincial government recognize the financial challenges recipients of social assistance face to purchase healthy food by implementing a Healthy Food Supplement of $100 per month for social assistance recipients.  Social Assistance in Ontario is currently under review.  As part of this review, in July OPH worked alongside 12 local organizations to host a community consultation for the Social Assistance Review Commissioners in Ottawa. This event provided an opportunity for approximately 280 people affected by social assistance, service providers and community organizations to meet with the Commissioners and provide input on how social assistance in Ontario should be changed.  As part of the event, OPH shared the NFB data with the Commissioners and participants. 

 

In addition to sharing information from the NFB, OPH works closely with community agencies to increase access to nutritious food.  OPH Registered Dietitians provide nutrition consultation services and training to agencies such as the Ottawa Food Bank and the Ottawa Network for Education.  OPH has been on the advisory committee for the Food for All project since 2009.  This community-based project led by Just Food and the University of Ottawa is developing a Food Action Plan for Ottawa and creating a Community Food Assessment Tool. Examples of other projects OPH is working on with Just Food include surveying community agencies’ food skill needs and procurement practices, and enhancing an electronic community directory called Food Link, that connects residents with community food programs and services.   

 

City of Ottawa Community Food Security Initiatives

An increasing number of City of Ottawa departments are working on initiatives related to community food security.  OPH contributes to a number of these initiatives at various levels.  These initiatives include: Choosing our Future, development of Ottawa’s Sustainability and Resilience Plan (Sustainability Department); Savour Ottawa (City of Ottawa Markets Management & Rural Affairs); working with By-law and Regulatory Service regarding Food Carts; and funding of community food programs (Community and Social Services Department- Community Funding Branch). OPH also participates on the recently established Internal Food Systems meetings that provide an opportunity for cross-departmental dialogue about food and community food security, including discussions about the Food for All Food Action Plan.  

 

Future Directions for Food Security Programming 

To further address food insecurity in Ottawa, OPH is planning the following programming:

 

Improving access to nutritious food

·         Enhance food skill programming for new immigrants, seniors and low income residents.   

·         Expand the reach of the CFA Program to promote access to existing community resources and increase food skills in priority populations. 

·         Support expansion of local initiatives that increase the availability and accessibility of healthy food such as school nutrition programs and the Good Food Box.

·         Identify opportunities to increase access to healthy, affordable foods in municipally owned facilities and low income neighbourhoods.

·         Promote access to available food supplements; for example allowances for medical conditions and pregnancy/ breastfeeding through Ontario Works program.

 

Increasing breastfeeding rates  

·         Work towards the achievement of Baby Friendly TM designation and continue to work with partners to promote breastfeeding friendly hospitals and Community Health Centers, implement workplace policies, and increase acceptance of breastfeeding in public.

 

Supporting community action related to food security such as:

·         The upcoming Food For All Food Action Plan that addresses the accessibility and availability of food and promotes a sustainable food system. 

·         With partners, advocate for social assistance rates and minimum wage to reflect the real cost of living.

 

Continuing to monitor and report on affordability

·         Continue to monitor both affordability and accessibility of healthy foods by relating the cost of the Nutritious Food Basket to individual and family incomes.

·         Raise community and political awareness about food insecurity and its connection to income and housing to influence local and provincial policy development.

 

CONSULTATION

There are many partners that work collaboratively with OPH to improve the food security status of Ottawa residents.  As part of this work, OPH has shared the NFB data with Just Food, Ottawa Food Bank, Ottawa Network for Education, Good Food Box, and City of Ottawa departments such as the Community and Social Services Department.

 

LEGAL IMPLICATIONS

There are no legal impediments to receiving the information described in recommendation no. 1 of this report. There are no legal impediments to the implementation of report recommendations no. 2 and no. 3.

 

FINANCIAL IMPLICATIONS

There are no financial implications associated with the recommendation of this report.

 

Technology Implications

There are no technical implications associated with this report.

 

SUPPORTING DOCUMENTATION

Document 1: Worksheet: The Cost of a Nutritious Food Basket Ottawa, 2011

Document 2: The Price of Eating Well in Ottawa, 2011

Document 3: Food Security Status –Epidemiology data

Document 4: Letter to Honourable Deb Matthews, Minister of Health and Long Term Care, advocating improved access to healthy foods for everyone

 

DOCUMENTS À L’APPUI

Document 1: Feuille de Travail: Ce qu’il en coûte pour manger sainement à Ottawa en 2011

Document 2 : Ce qu’il en coûte pour manger sainement à Ottawa en 2011
Document 3 : Situation de la sécurité alimentaire – Données épidémiologiques

 

DISPOSITION

Ottawa Public Health will use the Cost of a Nutritious Food Basket and the Price of Eating Well in Ottawa to further engage community partners, policy-makers and Ottawa residents to improve access to nutritious food, increase breastfeeding rates and support community action related to food security.

 

References

1.      Power E. Individual and household food insecurity in Canada: Position of Dietitians of Canada. Can J Diet Pract Res. 2005 Spring;66(1):43-6.

2.      McIntyre L. Food security: More than a determinant of health. Policy Options. 2003 Mar:46-51.

3.      Rideout K, Seed B, Ostry A. Putting food on the public health table: Making food security relevant to regional health authorities. Can J Public Health. 2006 May-Jun;97(3):233-6.

4.      Ontario Healthy Communities Coalition. Healthy food, healthy community: A community action guide (2nd ed.). Toronto (ON): Ontario Healthy Communities Coalition; 2006.

5.      Cancer Care Ontario. Healthy eating, physical activity and healthy weights guidelines for public health in Ontario. Toronto (ON): Cancer Care Ontario; 2010.

6.      Hawkes C, Rule M. The links between agriculture and health: An intersectoral opportunity to improve the health and livelihoods of the poor. Bull World Health Organ. 2006 Dec;84(12):984-990.

7.      Food and Agriculture Organization of the United Nations. Rome declaration on world food security and world food summit plan of action [Internet]. 1998 [cited 2009 Jan 9]. Available from: http://www.fao.org/docrep/003/w3613e/w3613e00.htm 

8.      Statistics Canada. Share File. Knowledge Management and Reporting Branch. MOHLTC. Canadian Community Health Survey 2009/2010.

9.      Ottawa Food Bank. Annual hunger count- data for Ottawa [online]. Email to Jamie Hurst (Jamie.hurst@ottawa.ca) 2011 Nov 07 [cited 2011 Nov 07].

10.  Kristjansson E.  Spatial inequalities and health inequalities: Neighbourhood socio-economic status, resources for health, and health outcomes in Ottawa, Canada [unpublished presentation notes]. Why Place Matters: Discussing Ottawa’s Neighbourhoods’; presentation given 2009 Feb 20.

11.  City of Ottawa Social Services Department. Housing and poverty reduction investment plan: Report to community and protective services planning committee. 2011 Apr.