Via CMAJ: Food insecurity in Nunavut following the introduction of Nutrition North Canada. The abstract:
BACKGROUND: Household food insecurity, a measure of income-related problems of food access, is a pressing public health problem in Canada’s North, especially in Nunavut. We aimed to assess the impact of Nutrition North Canada, a food retail subsidy intended to improve food access and affordability in isolated communities, on household food insecurity in Nunavut.
METHODS: Using data from 3250 Nunavut households sampled in the annual components of the Canadian Community Health Survey (2007 to 2016), we conducted interrupted time series regression analyses to determine whether the introduction of Nutrition North Canada was associated with changes in the rates of self-reported food insecurity, according to a validated instrument. We used propensity score weighting to control for several sociodemographic characteristics associated with food insecurity.
RESULTS: Food insecurity affected 33.1% of households in 2010 (the year before the launch of Nutrition North Canada), 39.4% of households in 2011 (the year of the launch) and 46.6% of households in 2014 (the year after full implementation). After controlling for several covariates, we found the rate of food insecurity increased by 13.2 percentage points (95% confidence interval [CI] 1.7 to 24.7) after the full implementation of the subsidy program, and the increase in food insecurity first occurred in 2011 (9.6 percentage points, 95% CI 2.7 to 16.4), the year Nutrition North Canada was launched.
INTERPRETATION: Food insecurity was a pervasive problem in Nunavut before Nutrition North Canada, but it has become even more prevalent since the program was implemented. Given the important health consequences of food insecurity, more effective initiatives to address food insecurity in Canada’s North are urgently needed.
Household food insecurity, defined as insecure or inadequate access to food because of financial constraints, is increasingly recognized as a serious public health problem in many affluent nations. The latest national estimate for Canada indicates that 12.6% of households experienced food insecurity in 2012, but important geographic variations exist within the country, with heightened vulnerability in the North. Since national monitoring began, Nunavut has consistently had the highest rates of food insecurity, with the rate reaching 46.8% in 2014.
Food insecurity is strongly associated with poor nutrition and adverse mental and physical health outcomes across the life cycle. Recent research also indicates that food insecurity is a robust and independent predictor of increased health care use and expenditures. Food insecurity represents an experience of material deprivation strongly influenced by the economic resources of households, but high food prices are also considered an important driver of food insecurity in Canada’s North. In April 2011, the Government of Canada replaced the long-standing Food Mail Program with Nutrition North Canada, a market-driven food retail subsidy intended to make perishable, nutritious foods more affordable and accessible in northern communities that do not have year-round rail, road or marine access.
Similar to the Food Mail Program, Nutrition North Canada serves communities that are predominantly inhabited by Indigenous Peoples and have high rates of food insecurity, low educational attainment, low income, underemployment and unemployment.
Whereas the Food Mail Program consisted of an air freight transportation subsidy transferred to Canada Post for the delivery of numerous perishable foods, nonperishable foods and essential nonfood items, Nutrition North Canada is a retail subsidy focused primarily on perishable, nutritious foods and transferred directly to southern suppliers and northern retailers, who are expected to pass on the full subsidy to consumers at the point of purchase (a summary of the programs is provided in Appendix 1, Supplemental Table A1, available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.181617/-/DC1).
Nutrition North Canada follows a market-driven approach predicated on the assumption that giving full control to retailers and suppliers over the supply chain and relying on market competition can reduce the prices of subsidized foods more effectively. The program’s focus on perishable, nutritious foods and its market-driven approach were strategies adopted to help contain program costs. Nutrition North Canada also includes a small nutrition-education component, and it is assumed that reductions in the prices of perishable, nutritious foods coupled with nutrition education will improve northerners’ food access.
Although Nutrition North Canada does not explicitly aim to reduce food insecurity, the pervasiveness of food insecurity in the North is embedded in the rationale for the program.
Our objective was to assess the impact of the introduction of Nutrition North Canada on household food insecurity in Nunavut communities.
