In 2022, a staggering 1.8 million Canadian children found themselves living in food-insecure households, a sobering statistic for a wealthy country like Canada (Proof, 2023). This statistic doesn't merely highlight a struggle to put food on the table; it reflects the broader battle to meet the most fundamental of life’s expenses.
Food insecurity exposes the interconnected nature of the social determinants of health, reminding us that health outcomes are shaped by a multitude of factors well beyond individual choices. Frieden's Health Impact Pyramid (2010) provides a framework to guide a review of the broader social determinants of health on childhood food insecurity.
At the base of the Pyramid, we encounter socio-economic factors, where interventions often involve public policies. Within Canada, the authority to create, enforce, and adapt legislation rests with the public sector, which wields the power to mitigate household food insecurity. However, given the current crisis of food insecurity, policies aimed at tackling the root causes, including inadequate household income, employment instability, housing challenges, and educational disparities, demand amplified public support to ignite the political will essential for addressing this urgent issue (McIntyre, L., et al., 2016).
At the next level, we encounter the importance of changing the context to make healthy decisions the default. This level of intervention includes supporting communities to have accessible and affordable nutritious foods. Interventions at this level may involve the implementation of restrictions on aggressive food marketing aimed at children or restricting vending machine content to health-conscious choices in machines frequently accessed by children.
Next is long-lasting protective interventions that benefits a broad cross-section of the population. Programs like school meal initiatives and weekend food assistance packages provide enduring safeguards against health issues. A study conducted by Bruce, J., et al., (2019) on childhood food insecurity found that school-based programs foster a sense of community, encouraging social interactions. However, these programs require distinct interventions to ensure access to meals for children when schools are not in session.
The next level brings us to direct clinical interventions, which focuses on preventing ill health. This level is critical for safeguarding the health of those at risk. Clinical interventions are focused on the individual, targeting those at risk or already experiencing health problems, often through screenings tools and/or medical referral patterns (Men, F., et al., 2022).
At the top of the pyramid is counselling and education about health. Although this is labour-intensive, counselling and education empower individuals with the knowledge and tools to make healthier choices. Knowledge profoundly shapes a family's ability to make informed decisions regarding food choices and resources.
Frieden's Pyramid, when examined from the bottom-up, directs our attention toward individual efforts, emphasizing the importance of personal choices and actions. In contrast, as we move downward, it underscores the substantial potential for creating broad, population-wide impacts through collective interventions.
This model aligns with the analysis of childhood food insecurity because it's not about choosing between 'either/or' options; instead, it encourages a 'both/and' approach, encompassing large-scale public initiatives and individual efforts to achieve a healthier, food-secure future for Canadian children.
References
Bruce, J., La Cruz, M., Lundberg, K., Vesom, N., Aguagyo, J., Merrell, S. (2019). Combating Child Summer Food Insecurity: Examination of a Community-Based Mobile Meal Program. Journal of Community Health, 44, 1009-1018. https://www.zotero.org/dlaforce1d/items/ZMLKLJZX/attachment/U3AXEW6K/reader
Frieden, T. (2010). A Framework for Public Health Action: The Health Impact Pyramid. American Journal of Public Health, 100(4), 590-595. https://www.zotero.org/dlaforce1d/items/RN4EFF6U/attachment/3NPABVZI/reader
Frieden, T. (2015). The Future of Public Health. New England Journal of Medicine, 373(18), 1748-1754. https://www.zotero.org/dlaforce1d/items/UHLVAXM9/attachment/5T45P3TI/reader
McIntyre, L., Lukic, R., Patterson, P., Anderson, L., Mah, C. (2016). Legislation Debate as Responses to Household Food Insecurity in Canada, 1995-2012. Journal of Hunger and Environmental Nutrition,11(4), 441-455. https://www.zotero.org/dlaforce1d/items/SRKZ38FD/attachment/G42QE5HC/reader
Men, F., Urquia, M., Tarasuk, V. (2022). Pain-driven emergency department visits and food insecurity: a cross-sectional study linking Canadian survey and health administrative data. CMAJ OPEN, 10(1), 8-18. https://www.zotero.org/dlaforce1d/items/FVJWTTMW/attachment/VKFIVZNR/reader
Proof. (2023). New data on household food insecurity 2022.https://proof.utoronto.ca/2023/new-data-on-household-food-insecurity-in-2022/
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