Photo by: Evgeni Tcherkasski
The socio-ecological model (SEM) is a theoretical multilevel model that was initially employed to understand and appreciate early childhood development within multiple spheres including the child’s environments and circumstances (Kilanowski, 2017). The SEM was first introduced by psychologist Urie Bronfenbrenner in 1977, to infer that the interactions an individual has with others in their environments, ultimately has a profound impact on shaping who they are and who they become as an adult (Golden & Earp, 2012). These happenstance outcomes serve as an interface between the differing spheres within the model to empirically quantify interactions (Galea, 2015).
The fluidity of the SEM reveals that it can be easily adapted to learn more about health outcomes of individuals from a multilevel approach. For this week’s activity, we were asked to apply a multilevel model of health to an area of interest in our respective fields of practice, thus I have chosen to delve into the realm of a public health crisis and population health concern: Canadians who are experiencing food insecurity due to Covid-19. This niche is important to me, from both a personal and professional lens, and is magnified due to my experience in working in mental health and additions as a registered nurse.
To apply the SEM to food insecurity in Canada in the context of Covid-19, we must: firstly define what food insecurity is; determine how it impacts and influences the health of the individual on multiple spheres; reveal how it affects Canadians’ mental health and wellbeing; and lastly, outline what’s needed to address this public health crisis and population health concern from a systemic point of view.
What is food insecurity?
Food insecurity occurs “whenever the availability of nutritionally adequate and safe foods, or the ability to acquire acceptable foods in a socially acceptable way, is limited or uncertain” (Peng, Dernin, & Barry, 2018). Food security is a basic, fundamental right, and one that “Canada has a legal obligation to respect, protect, and fulfill” (Food Secure Canada, 2020). Living with food insecurity must be devastatingly challenging and exceedingly stressful, particularly in the context of Covid-19.
Figure A: Depicts food insecurity rates across Canada, sourced from the Community Food Centres Canada’s report, Beyond Hunger: The hidden impacts of food insecurity
How does food insecurity impact health?
Food insecurity affects vulnerable and marginalized individuals, particularly those who are on the lower end of the socioeconomic spectrum. “Black Canadians, Indigenous Peoples, and Persons of Colour (BIPOC)” (Canadian Human Rights Commission, CHRC, n.d.), along with individuals who are unemployed/underemployed, homeless/precariously housed (Ikura & Tepper, 2020), displaced persons, individuals with special needs/disability, aged individuals, single parent/caregivers, immigrants, and individuals with mental health challenges all disproportionately experience food insecurity (Peng, Dernini, & Barry, 2018).
Food insecurity has also been “associated with other demographic factors like younger age, ethnicity, immigration status, and the presence of a chronic condition (mental or physical)” (Schwartz, Tarasuk, Buliung, & Wilson, (2019). However, "these socio-demographic characteristics provide only a partial explanation for the vulnerability of individual households to encounter and endure food insecurity, suggesting that other factors must be at play. One such factor may be adults' health status” (Tarasuk, Mitchell, McLaren, & Macintyre, 2013).
The SEM, as it relates to food insecurity and the impact of health on Canadians, can be conceptualized as nesting Matryoshka dolls, each sphere interdependent upon the others; the building blocks of what makes up a whole person. There are 6 distinct components to the SEM model: (1) Individual (Intrapersonal); (2) Microsystem (Interpersonal); (3) Mesosystem; (4) Exosystem; (5) Macrosystem; and (6) Chronosystem.
To illustrate the deep-seated constellation of factors contributing to food insecurity and the pervasive impact it has on individuals and communities alike, please view Figure B: The Socio-Ecological Model (SEM) of health: Examining the impact on health due to food insecurity during Covid-19.
Prior to Covid-19, an alarming 4.5 million Canadians were negatively affected by food insecurity. In only 2 months following the pronouncement of the pandemic, that statistic grew by 39%, thereby touching the lives of every 1 in every 7 Canadians (Polsky & Gilmour, 2020). In March 2020, our nation experienced the pervasive devastation and upheaval which has persisted 1 year later, indisputably negatively impacting the lives of many Canadians. There were job losses and reduced hours, there were interruptions to school, work, and childcare (Polsky & Gilmour, 2020). In Toronto, some food bank locations were mandated to close, and this subsequently, cut off the supply of food for many Torontonians who relied upon this support (CHRC, n.d.). Within the context of Toronto and other larger urban areas, the influence of food insecurity hit some individuals and families the hardest, negating their right to right to availability and accessibility to adequate food. However, for individuals, families, and communities settled in more rural, remote, and northern locations of Canada, the cost of food is already exorbitant even without the undue hardship of a pandemic.
How does food insecurity affect mental health and wellbeing?
Not surprisingly, food insecurity poses a deleterious threat to the health and wellbeing of an individual, thus influencing all spheres of individual and population health and wellness. Consequently, the “impact of COVID-19 pandemic on food security and poor health outcomes is complex, multilevel and bidirectional” (Leddy et. al., 2020). In Canada, “household food insecurity is associated with heightened nutritional vulnerability, increased risk of numerous physical and mental health problems, higher mortality rates, and higher health care costs, independent of income, education, and other social determinants of health” (Tarasuk, St-Germain, & Mitchell, 2019). Additionally, depression is “related to many risk factors such as socioeconomic status, physical activity, overweight and obesity, comorbidites, inflammation, stress, and genetic factors. – also found to be associated with mental health status” (Shafiee, Vatanparast, Janzen, Serahati, Keshavarz, Jandaghi, & Pahwa, 2021).
There is consistent evidence to support that there are increased risks of poorer health outcomes and an increased risk of chronic diseases including diabetes, and cardiovascular disease (Polsky & Gilmour, 2020). Additionally, there is a strong relationship between food insecurity and mental health distress and concerns (Jenkins, McAuliffe, Hirani, Richardson, Thomas, McGuinness, Morris, Kousoulis, & Gadermann, 2020), including depression, anxiety, and poor self-perceived mental health (Polsky & Gilmour, 2020) in the context of the COVID-19 pandemic. Due to the stress of food insecurity, many Canadians report feeling “stress, frustration, feelings of powerlessness and alienation – shame associated with experiencing greater challenges in accessing food – which may trigger new or amplify pre-existing physiological stresses” (Polsky & Gilmour, 2020). Perhaps we won’t know the totality of the consequences to individuals’ physical and mental health until much later, and perhaps in years to come.
To further elucidate the impact of food insecurity on Canadians’ mental health, please view, Figure C, the statistics from the Community Food Centres Canada’s report, Beyond Hunger: The hidden impacts of food insecurity, where 561 Canadian participants were asked how food insecurity impacts their day to day lives.
Figure C: 561 participants nationwide shared their lived experiences that reach beyond hunger. Below are disheartening responses, shedding some light on the hidden impacts of food insecurity.
What are the solutions to reducing food security for Canadians?
From a population health lens and public health stance, there is a call for necessary reforms in current government policy at the municipal, provincial/territorial, and federal levels to address this pervasive and systemic health issue. The following solutions to improving policies are: to invest in income supports for low income families by way of tax benefits; making an honest commitment to making life affordable through ensuring there is affordable and adequate housing; to increase the federal budget for childcare and early learning centres in neighbourhood; to expand the Health Care Act to include universal pharmacare; to set targets by which to reduce food insecurity, particularly in rural and northern communities; and to ensure that this is done impartially and with the application of a racial equity lens by which to view food insecurity policies (Canadian Food Centres Canada (CFCC), 2020).
Mikkonen and Raphael (2010) outline the following as necessary changes: an increase in minimum wages and offer social assistance to a point where adequate food that is both nutritious and affordable, and is also accessible too; housing must be affordable and must be suitable for an individual and their family to live in; ensuring that mothers’ employment through job supports, making available and affordable child-care, and providing employment training to reduce food in security”; and set in place, a better way in which monitoring systems are able to keep abreast of up to date food insecurity in Canada (Mikkonen & Raphael, 2010).
These recommendations for measures to reduce food insecurity for Canadians are not at all unreasonable. They do, however, require policy makers to take a stern and honest look at the way in which systemic racism and prejudice keep marginalized citizens underfoot, and thus perpetuating disproportionate experiences of poorer health outcomes, food insecurity, substandard housing, and precarious employment, to name only a few of many disparities. Our society is only as good as we treat our most vulnerable members, and we're failing. Reform can happen. The table is large enough to equitably share food and resources for all Canadians.
References
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