Food insecurity

There are four dimensions or driving factors of food security; food availability, access, use and stability:

– Availability of appropriate quality, nutritious food within food stores.
– Physical and economic access to purchase and transport food.
– Having the knowledge, skills, and facilities to use food to create adequate and safe meals, and how to allocate it within a household.
– Food stability and sustainability through having consistent supply of food and the capability to account for risks such as natural disasters, price flux and conflict.

Food insecurity isn’t regularly measured in Australia. The prevalence in the general population is estimated to be between 4 per cent and 13 per cent. Among specific population groups, the prevalence has been found to range from 2 per cent in older Australians and up to 90 per cent in asylum seekers.

Groups at greater risk of food insecurity in Australia include:
– Aboriginal and Torres Strait Islander people.
– Individuals experiencing financial hardship (welfare recipients/unemployed/low-income earners).
– People living in remote areas or who are geographically isolated.
– Older people.
– People experiencing homelessness.
– Single parent households.
– Migrants from culturally and linguistically diverse communities, particularly tertiary students and people in rented accommodation.
– Asylum seekers and refugees. 
– Individuals experiencing substance use disorders, particularly those with co-existing mental health concerns

(Rosier, 2011)
(Beardmore et al., 2023)

Food insecurity negatively impacts the physical, mental, and social health of adults and children.

People experiencing food insecurity are more likely to:
– Consume inadequate nutrients and have poorer quality diets.
– Develop chronic conditions, including diabetes, heart disease, hypertension, and poor mental health, and may experience difficulties managing existing chronic health conditions.

Children who live in households experiencing food insecurity are:
– Almost three times more likely to have iron deficiency anaemia.
– Twice as likely to have asthma.
– More likely to have a greater consumption of energy-dense foods or additional carbohydrates to compensate for overall lack of food.
– More likely to have poorer academic outcomes and emotional and behavioural problems.

(Bowden, 2020)

An awareness of what to consider before screening for and discussing food insecurity with patients:

Stigma:
– There can be stigma associated with experiencing food insecurity, therefore it is important to have good rapport with your patients before raising the topic and ensure you do so in a sensitive and supportive manner.
– Food insecurity is a sensitive topic and can evoke an emotional response. Therefore, be prepared for this and know how you will manage this if it occurs.

Screening:
Food insecurity is not often disclosed due to feelings of embarrassment or shame, and therefore is underreported and often untreated. Increased screening for food insecurity is an important step towards addressing this issue in primary care.   

The next two questions are about your food situation. We know that going without food happens to lots of Australian families now and again. These questions will let us know about your food situation and help us understand what support you might need to get through these times.
 
For each question, can you tell me whether this is often true, sometimes true, or never true for your household in the last 12 months:

1. Have you ever worried that food would run out before you are able to buy more?
2. Have you run out of food and not had enough money to buy more?

(Bowden, 2020)

There are various degrees of food insecurity (see the food security continuum).

Some support options may be more suitable than others, depending on the extent of food insecurity that your patient is experiencing:

– Budgeting information may not be useful to people experiencing severe food insecurity, as they are likely already very competent with this. Instead, they may be more likely to benefit from financial assistance or emergency food relief.
– People with mild food insecurity may likely benefit from food literacy education including cooking on a budget and simple food preparation and recipe ideas etc.

Depending on the extent of food insecurity experienced – mild, moderate or severe, there are different support options you can provide your patients:

Mild food insecurity
– Increasing food and nutrition literacy (including budgeting skills) through education
– Foodbank programs: Fremantle Healthy Eating Hub and nom! Children
– HEAL Program – run by City of Cockburn
– No Money No Time Website – how to eat for $60 per week

Moderate to severe
Emergency food relief or food assistance:
Utilise these websites to support your patients to access food assistance close to them.
– askizzy.org.au
– WA Connect

Please note these are general suggestions on how to support patients experiencing differing extents of food insecurity. Always take a person-centred approach and work together in partnership with the patient to determine what support is required rather than simply assuming what they need.
 
For more information and guidance on how to support your patients, review the CFCA Practice guide for identifying and responding to food insecurity in Australia.