Food insecurity and hunger: A review of the effects on children’s health and behaviour

Abstract

In 2012, an estimated four million Canadians, including 1.15 million children, lived in households that experienced some degree of food insecurity (1). Food insecurity refers to the lack of nutritious foods in sufficient quantities to maintain good health. The measurement and monitoring of food insecurity in Canada focuses on a household’s experience of food insecurity, or the inadequate or insecure access to adequate food due to financial constraints (2). While children living in households classified as food insecure are not necessarily going hungry, 25% of students in grade 6 surveyed by the Public Health Agency of Canada reported that they sometimes went to bed hungry because there was not enough food in the house (3). Therefore, it is surprising that the effects of hunger on children are not well documented, and this remains an important area for further research.

The purpose of the present article is to review the immediate and long-term effects of hunger on children’s physical development, mental health and behaviour. We will also examine the indirect effects of maternal hunger on child development. A limitation of the present review is that food insecurity is inextricably linked to other social and environmental problems such as poverty and stress. Therefore, it is challenging to isolate the effects of food insecurity and hunger on children and mothers. Furthermore, much of the current research has been performed in the United States, and experiences of food insecurity may be different in Canada. In addition, there is a lack of research examining vulnerable groups, such as First Nations populations, who have unique food security considerations related to traditional food practices (4).

EFFECTS ON CHILDREN

EFFECTS ON MOTHERS

With high housing expenses in Canada, many low-income families are forced to choose between expenditures, such as rent, and putting food on the table (19). Not only are children going hungry, but parents themselves are also going hungry. Medical trainees participating in a new social paediatrics elective have reported both parent and youth hunger (20,21).

Depression is common among mothers with young children. Studies have suggested that ID may be a risk factor for maternal depressive disorders. In one study, low maternal hemoglobin status was associated with postpartum depression in a sample of American mothers (22). Symptoms include fatigue, low energy and difficulty concentrating on daily tasks. As a result, maternal depression is associated with lower child health status, which may result from unresponsive caregiving practices (3,23). In addition, maternal depression has shown to have negative effects on early childhood growth, particularly stunting, which results from chronic nutritional deficiencies and is also associated with unresponsive care-giving. The effects of unresponsive caregiving have also been extended to delays in children’s cognitive development (3).

Furthermore, Weinreb et al (24) showed that mothers of severely hungry school-age children were more likely to have a lifetime diagnosis of post-traumatic stress disorder or substance abuse, which can also negatively affect a mother’s ability to respond to children’s physical and emotional needs.

RECOMMENDATIONS TO DECREASE FOOD INSECURITY

While food banks are an attempt to address unmet food needs, they are not a solution because the food provided is low in nutrients. There is no fresh milk or produce available in food banks and their existing food supply is limited (25). In addition, a study conducted in Toronto (Ontario) indicates that participation rates are extremely low among low-income families and that food banks are only considered at times of desperation as opposed to a routine service for food acquisition (26). Based on these findings, food banks should not be considered in any way an adequate component of our social safety net. In contrast, subsidized food may be a solution that could help improve the quality of people’s diets and significantly reduce hunger. As for housing, there is a potential for subsidized food with foods such as apples, cheese, soy nuts, carrots and broccoli to be provided at all food stores at a fixed low price.

Canada is the only G8 country that does not have a national feeding program in schools. A national food supplementation program could strengthen household food security by providing breakfast, lunch and/or snacks either at no cost or at a reduced price in schools. This would free up household resources that could be used to feed other family members and provide other necessities. The program would also reduce substantial stress for children who do not know when they will have their next meal in addition to meeting a portion of their food needs (27). Roustit et al (28) found that the association between household food insecurity and scholastic difficulties in adolescents was no longer present among those who benefitted from school food supplementation programs.

However, these immediate solutions to urgent and compelling needs will not solve the issue of hungry infants and toddlers who are below school-age, nor after-school, weekend, holiday and parent nutrition needs. Therefore, we also need to target the issue of poverty. One way of doing this would be by advocating for an increase in minimum wage and also ensuring that fresh groceries are affordable. In addition, we need to educate society about making healthy food choices for their children and how they can ensure their children are getting sufficient nutrients. Health professionals are an important point of contact at which education should occur, and it is important for food security to be addressed during routine checkups. Children and adolescents who are experiencing recurrent hunger can be identified efficiently by a brief verbal assessment. This provides health professionals with the opportunity to link families to the appropriate social services. For example, doctors should ask their patients whether they have eaten today and yesterday, and provide resource brochures to target the immediate problem of food insecurity while higher-level policy changes are being implemented.

CONCLUSION

Household food insecurity is a significant problem in Canada that affects an estimated one in every six children (1). It is shocking that food insecurity continues here, especially given the plethora of wide-ranging effects – reduced learning and productivity, mental health, chronic diseases and effects on mothers (Table 1). School food supplementation programs and subsidized food are an essential immediate need and we need to advocate for these at a national level. However, these solutions are not sufficient on their own. Health professionals are an important point of contact to educate parents about making healthy food choices for their family and to link patients who are experiencing recurrent hunger to the appropriate services. It is clear from our review that there are gaps in the literature regarding the effects of food insecurity and hunger on children, and limitations to existing studies. Therefore, we should continue to improve our understanding of hunger through future research in Canada, but we also must act now.