The COVID-19 pandemic has impacted most facets of daily life, including what we eat. Long grocery store lineups, the anxious masked faces of essential staff at checkouts, the elderly carrying heavy bags to avoid public transit and empty non-perishable aisles have become common sights. To some, these changes were an inconvenience. To others, it has meant no food on the table.
On March 11, the World Health Organization declared a global COVID-19 pandemic. In Toronto and elsewhere, the virus has disproportionately impacted individuals and groups based on income, housing status, race and other socioeconomic factors.
More than 4.4 million Canadians experience food insecurity, a long-standing issue that refers to a lack of physical and economic access to nutritious and culturally safe food. The reasons are complex but in urban settings include geographic food deserts, inadequate access to transportation, health concerns that limit mobility or dictate more expensive diets and, most commonly, economic constraints.
In rural regions, higher food costs and supply chain disruptions are barriers. For Indigenous communities, the loss of land and disruption of culture plays a role. In fact, Indigenous and racialized households experience food insecurity at much higher rates than the national average and this is intricately tied to systemic racism and colonization. FoodShare Executive Director Paul Taylor described the painful connection between food security and race in his recent interview with Toronto Life, outlining a collaboration between FoodShare and the University of Toronto’s PROOF research team that found Black people are 3.56 times more likely to be food insecure than white people.
Statistics Canada’s recent survey on food security during COVID-19 confirmed what we already suspected. One in seven, or 14.6 per cent of Canadians, reported experiencing food insecurity during the pandemic, a significant increase compared to 10.5 per cent in 2017-2018. Individuals who lost their jobs during the pandemic are more likely to experience food insecurity than those still employed. Food bank usage has surged, meaning many organizations have had to close their doors or change their way of operating. The Daily Bread Food Bank reports that 76 per cent of new food bank clients began accessing food banks because of COVID-19, primarily because of job loss or fewer working hours. Respondents also reported higher levels of anxiety and stress regarding access to food. In addition, consumer patterns of “panic buying” early in the pandemic decreased the availability of food to vulnerable populations such as the elderly.
From a healthcare perspective, food insecurity and COVID-19 is a double whammy, with the same high-risk groups affected by food insecurity also being most vulnerable to COVID-19. We know that those with underlying medical conditions are both at higher risk of adverse health outcomes secondary to COVID-19 and have higher rates of food insecurity. Racialized households are more likely to be food insecure and neighbourhoods most affected by COVID-19 have disproportionately higher percentages of Black, Latin American, South Asian and Southeast Asian residents. Migrant workers in Ontario, who play an important role in Canada’s food system, have been targets for outbreaks. Yet, they have been left largely unprotected with crowded living conditions, lack of labour protections and barriers to health insurance.
Food insecurity is about more than just food. It is a marker of healthcare, economic, political and environmental consequences. As with any issue pertaining to the social determinants of health, it is important to tackle it upstream and from multiple angles.
On a systemic level, efforts to tackle its root determinants must include increasing social assistance rates to adequate liveable incomes, ensuring that employment legislation protects all workers, improving access to multidisciplinary health teams and urgently addressing systemic racism. The introduction of the Canada Emergency Response Benefit and temporary halting of evictions were essential protective measures to keep individuals safe and housed during the height of the pandemic but require long-term plans to ensure everyone has access to supports as we move beyond the pandemic. Healthcare providers can do their part by speaking out and supporting organizations such as FoodShare and Daily Bread that are leading this work.
On an individual patient level, our interdisciplinary team within the St. Michael’s Hospital Academic Family Health Team has connected patients with registered dietitians, social workers and income security health promoters; provided patients with information on local food banks and grocery delivery services; and in some cases mailed out grocery store gift cards obtained through fundraising.
When it comes to nutritional counselling by healthcare providers, we need to ensure solutions are realistic and individualized to patients. A resource developed by our multidisciplinary team at St. Michael’s aims to help patients incorporate more home-cooked and healthier meals into their diet while keeping costs low. Research shows that cooking and food preparation interventions improve fruit, vegetable and energy intake as well as nutrition knowledge. A Canadian survey also demonstrated that 23.4 per cent of food insecure individuals self-reported low to moderate cooking skills, with only 62 per cent stating that they adjusted recipes to make them healthier.
This new tool includes a weekly shopping list and menu plan, complete with practical cooking tips and simple recipes. The menu keeps cost in mind as it focuses on affordable sources of macronutrients and minimizes the number of ingredients needed throughout the week. While this does not replace the need to enact policy changes to address food insecurity, it can serve as a practical resource for patients and practitioners.