Research supports the idea that food insecurity takes a toll on societies in a variety of ways. Its costs include the direct costs of increased educational needs for food insecure children and the indirect costs of lost productivity in the workforce. They also include the costs of food insecurity-related health problems, but understanding these costs—the effect of food insecurity on health care spending—remains a challenge.
In 2015, a team of researchers seeking to study the association between household food insecurity and annual health care costs in Canada presented its results. Their research found that “individual-level health care costs rose systematically with increasing severity of household food insecurity,” even when controlling for other common factors known to contribute to health like neighborhood income level and education level.
Based on their findings and existing studies, the researchers suggest that food security programs and policy interventions could “offset considerable public expenditures in health care and improve overall health.”
Food Tank had the opportunity to speak with Naomi Dachner, co-author on the study, about the relationship between food insecurity and health care costs, the potential implications for policy interventions on food insecurity, and the team’s new research on food security and health care in Canada.
The researchers used a standard measure of food insecurity, as Dachner explains below. Health care services in the cost calculation included inpatient care, same-day surgery, visits to the emergency department, physician services, home care, drug benefits claims, rehab, long-term care, and complex continuing care.
Food Tank (FT): What do you find to be the most notable result from this study?
Naomi Dachner (ND): The magnitude of the effect of severe food insecurity on health care costs is quite remarkable, with adults in severely food insecure households costing the healthcare system nearly 2.5 times the amount as their food secure counterparts. Further, elevated costs were associated even with marginal food insecurity. The strong gradient in health care costs associated with increasing severity makes a strong case for causality.
FT: Briefly explain the ways that food security is linked to health care costs.
ND: There is a plethora of research that demonstrates that food insecurity is associated with a range of physical and mental health problems, and in this research, that is born out in elevated health care costs. Moreover, we know that food insecure individuals are not only more likely to suffer from chronic conditions and face multiple conditions, but they are less able to manage them. This also must be contributing to the increased health care costs associated with food insecurity.
FT: Your study differentiates between four levels of food security: food secure, marginally food insecure, moderately food insecure, and severely food insecure. What tool did you use to classify households into these categories?
ND: Household food insecurity was assessed using the 18-item Household Food Security Survey Module (HFSSM). The coding and terminology we applied to classify severity of food insecurity are based on Health Canada’s approach to interpreting data from the HFSSM and convention among Canadian researchers, which differs from that employed by USDA. Overall food insecurity was defined as any affirmative response, in keeping with research indicating heightened vulnerability among households with even a single affirmative response (i.e., ‘marginally food insecure’ households). The thresholds we used are defined in Appendix 2 of the paper, and a comparison of these definitions to those used in the U.S., can be found in our 2016 paper on changes in social policies on food insecurity in British Columbia.
FT: Your report mentions that, because publicly-funded food insecurity alleviation programs do not exist in Canada, a “more upstream approach is required.” What might this approach look like?
ND: In Canada, income-based policies (e.g. seniors’ benefits, provincial actions to reduce poverty) that improve the material circumstances of food insecure households have been shown to reduce food insecurity. Improvements to the adequacy of social assistance (i.e. welfare) as well as policies targeting households reliant on employment income (i.e. employment insurance, employment benefits and workplace policies to reduce precarious work, working tax benefits and credits) could be designed to address food insecurity. We also advocate for a basic income policy which would prevent low-income households from falling below a certain income threshold, and thus dramatically reduce the risk of food insecurity for all low-income households regardless of income source.
FT: How can this study’s results speak to the relationship between food security and health care expenditure in other countries or areas outside of Canada, if at all?
ND: Health care costs and who bears them depend on a country’s health care system. However, the results of this study speak to the very real health implications of household food insecurity—because Canada provides universal coverage, the potential for selection bias related to health insurance access was removed in this study. The findings in the study are also consistent with US research that has raised concerns about food insecurity as a key contributor to poor health and higher costs.
FT: What motivated you to conduct research in food security and its relationship to health care and health care costs?
ND: Although food insecurity is a significant public health problem in Canada, there are no policies designed to address it. With a universal health care system and the linked data available to us, this study was an opportunity to better understand the economic implications of food insecurity to the health care system. While the cost of food insecurity is much greater than health care expenditures, and the full economic and social burden of the problem has yet to be described, this study presents a fiscal and public health imperative for action in Canada.
FT: What further research would you like to see on the relationship between household food insecurity and health care costs?
ND: We are continuing to expand the understanding of the impact of food insecurity at various life stages on different dimensions of health, through ongoing research using linked health administrative data. Our recent research examines the relationship between food insecurity and mortality and mental health, and most recently we have undertaken a study of the implications of household food insecurity for maternal and infant health.
FT: Have you seen any promising policy changes or new policy interventions proposed to reduce household food insecurity since publication of your paper?
ND: Since the publication of this paper, the Government of Ontario, Canada’s largest province, has announced a Basic Income Pilot that is slated to roll out in 3 areas of the province beginning this spring. A reduction in food insecurity has been named a key outcome to be measured in the pilot.
FT: What topics in food security are you currently working on?
ND: In addition to our research on the impact of household food insecurity on health and health care, we continue to study the effects of various policy interventions on food insecurity. In Canada, we don’t have federally funded food programs like SNAP; instead, we have a social safety net which is meant to prevent people from falling into poverty. In this context, our research teases apart the collection of programs that comprise the social safety net to better understand which programs and features of the net mitigate against household food insecurity. We are also working to inform the development of a National Food Policy in Canada so that the policy considers household food insecurity.