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“It’s not a food issue; it’s an income issue”: using Nutritious Food Basket costing for health equity advocacy

  • Elaine PowerEmail author
  • Susan Belyea
  • Patricia Collins
Special Section on Why Public Health Matters Today: Qualitative Research

Abstract

Objectives

Ontario’s public health units (PHUs) face considerable challenges in addressing the social determinants of health, even though “reducing health inequities” is a primary population health outcome in the Ontario Public Health Standards (OPHS). Since 1998, the OPHS mandated PHUs to use the Nutritious Food Basket (NFB) protocol to document food costs, a requirement that was removed in 2018. This study examined how the NFB advanced health equity advocacy by Ontario PHUs, and why some have used this tool more strategically than others.

Methods

Semi-structured qualitative phone interviews were conducted with 18 public health dietitians (PHDs) and three key informants between May and October 2017. Interviews were audio-recorded, transcribed, inductively coded, and analyzed.

Results

The PHDs agreed that the NFB tool provides essential localized evidence of inadequate incomes for people living in poverty, and supports the health equity mandate of PHUs in Ontario. Factors that support NFB research and advocacy work include strong PHU leadership regarding health equity, participation in community coalitions, and engagement with Ontario Dietitians in Public Health (ODPH). Interviewees identified lack of support at the PHU level and lack of coordination of food insecurity work at the Ministry of Health as significant barriers to PHUs’ use of the NFB to advance health equity mandates.

Conclusion

This study offers compelling evidence for reinstating NFB costing in the Ontario Public Health Standards as a mandatory requirement of PHUs. Without this requirement, the already-limited capacity of PHUs to advance health equity in Ontario will be further compromised.

Keywords

Poverty Public health Dietitians Health equity Ontario Standards 

Résumé

Objectifs

Les bureaux de santé publique (BSP) de l’Ontario ont des obstacles importants à surmonter pour aborder les déterminants sociaux de la santé, même si la « réduction des iniquités en santé » est l’un des trois grands résultats relatifs à la santé de la population inscrits dans les Normes de santé publique de l’Ontario (NSPO). Depuis 1998, les NSPO demandaient aux BSP d’utiliser le Protocole concernant le panier à provisions nutritif (PPN) pour établir le coût des aliments, une exigence qui a été levée en 2018. Nous avons cherché à déterminer si le PPN a favorisé le rôle actif des BSP de l’Ontario en faveur de l’équité en santé et pourquoi certains bureaux en ont fait une utilisation plus stratégique que d’autres.

Méthode

Des entretiens qualitatifs semi-structurés ont été menés par téléphone auprès de 18 diététistes en santé publique et de trois autres informateurs entre mai et octobre 2017. Les entretiens ont été auto-enregistrés, transcrits, codés par induction et analysés.

Résultats

Les diététistes ont convenu que le PPN est un outil essentiel, car il offre des données localisées sur l’insuffisance des revenus des personnes sous le seuil de la pauvreté et appuie le mandat de promotion de l’équité en santé par les BSP en Ontario. Les facteurs propices au travail de recherche et de promotion sur le PPN sont la force du leadership assuré par les BSP en matière d’équité en santé, la participation aux coalitions associatives et l’adhésion aux Diététistes en santé publique de l’Ontario (ODPH). Les personnes interrogées ont cité le manque de soutien aux BSP et le manque de coordination du travail sur l’insécurité alimentaire au ministère de la Santé comme étant d’importants obstacles à l’utilisation du PPN pour favoriser le rôle actif des BSP dans le dossier de l’équité en santé.

Conclusion

Notre étude présente des preuves convaincantes de la nécessité de redonner un caractère obligatoire, dans les Normes de santé publique de l’Ontario, au calcul des coûts du PPN par les bureaux de santé publique. Sans cette exigence, la capacité déjà limitée des BSP de favoriser l’équité en santé en Ontario ne peut que se détériorer.

Mots-clés

Pauvreté Santé publique Nutritionnistes Équité en santé Ontario Normes 

Notes

Acknowledgements

The authors are deeply grateful to the public health dietitians and key informants who participated in this research. We would especially like to thank Tracy Woloshyn, RD, and Mary Ellen Prange, RD, from Ontario Dietitians in Public Health for their advice and guidance.

Funding information

This research was supported by the Social Sciences and Humanities Research Council of Canada.

References

  1. Brassolotto, J., & Raphael, D. (2014). Epistemological barriers to addressing the social determinants of health among public health professionals in Ontario, Canada: a qualitative inquiry. Critical Public Health, 24(3), 321–336.CrossRefGoogle Scholar
  2. Bryant, T., Raphael, D., Schrecker, T., & Labonte, R. (2011). Canada: a land of missed opportunity for addressing the social determinants of health. Health Policy, 101(1), 44–58.  https://doi.org/10.1016/j.healthpol.2010.08.022.CrossRefGoogle Scholar
  3. Cohen, B. E., & Marshall, S. G. (2017). Does public health advocacy seek to redress health inequities? A scoping review. Health & Social Care in the Community, 25(2), 309–328.  https://doi.org/10.1111/hsc.12320.CrossRefGoogle Scholar
  4. Collins, P. A., & Hayes, M. V. (2007). Twenty years since Ottawa and Epp: researchers’ reflections on challenges, gains and future prospects for reducing health inequities in Canada. Health Promotion International, 22(4), 337.CrossRefGoogle Scholar
  5. Collins, P. A., Resendes, S., & Dunn, J. R. (2014). Exploring community health centres’ initiatives to address upstream health determinants at the neighbourhood level in Ontario. Health Policy, 10(1), 14–29.Google Scholar
  6. Dietitians of Canada. (2008). Monitoring the cost of a nutritous food basket: a snapshot of activity across Canada. Vancouver: Dietitians of Canada, BC Region.Google Scholar
  7. Dunning, J. (2015). Simcoe Muskoka health unit first in Ontario to call for basic-income guarantee. Retreived from: www.simcoe.com/news-story/5675030-simcoe-muskoka-health-unit-first-in-ontario-to-call-for-basic-income-guarantee/. Accessed 11 Nov 2018.
  8. Guyon, A., Hancock, T., Kirk, M., MacDonald, M., Neudorf, C., Sutcliffe, P., Talbot, J., Watson-Creed, G. (2017). The weakening of public health: a threat to population health and health care system sustainability [editorial]. Canadian Journal of Public Health, 108(1), E1-E6.Google Scholar
  9. Hancock, T. (2015). Advocacy: it’s not a dirty word, it’s a duty. Canadian Journal of Public Health, 106(3), E86–E88.CrossRefGoogle Scholar
  10. Johnson, C., Williams, P. L., & Gillis, D. (2015). The capacity building experience of women engaged in determining the cost and affordability of healthy food in Nova Scotia, Canada. Journal of Hunger & Environmental Nutrition, 10(3), 356–378.CrossRefGoogle Scholar
  11. KFL&A Public Health (2017). Cost of healthy eating. Kingston, ON: Author. Retrieved from https://www.kflaph.ca/en/healthy-living/Cost-of-Healthy-Eating.aspx. Accessed 18 June 2018.
  12. Macdonald, J. (2009). The impact of “The Cost of Eating in BC” report. Vancouver, BC: Dietitians of Canada. Retrieved from https://phabc.org/wp-content/uploads/2015/07/045_Janice_MacDonald_Impact_Cost_of_Eating.pdf.
  13. McPherson, C., Ndumbe-Eyoh, S., Betker, C., Oickle, D., & Peroff-Johnston, N. (2016). Swimming against the tide: a Canadian qualitative study examining the implementation of a province-wide public health initiative to address health equity. International Journal for Equity in Health, 15(1), 129.  https://doi.org/10.1186/s12939-016-0419-4.CrossRefGoogle Scholar
  14. Ministry of Health and Long-Term Care. (2017). Summary of themes raised at the regional consultation meetings on the modernized Ontario standards for public health program and services. Toronto: Author.Google Scholar
  15. Mosby, I. (2014). Food will win the war: the politics, culture and science of food on Canada’s home front. Vancouver: UBC Press.Google Scholar
  16. Nathoo, T., & Shoveller, J. (2003). Do healthy food baskets assess food security? Chronic Diseases in Canada, 24(2), 65–69.Google Scholar
  17. National Collaborating Centre for Determinants of Health [NCCDH]. (2015). Let’s talk advocacy and health equity. Antigonish, NS: Author. Retrieved from: http://nccdh.ca/resources/entry/lets-talk-advocacy-and-health-equity. Accessed 15 May 2018.
  18. Ontario Dietitians in Public Health. (2018). No money for food is...Cent$less. Retrieved from https://www.odph.ca/centsless. Last accessed on 4 January 2019.
  19. Ontario Ministry of Health Promotion. (2010). Nutritious food basket guidance document. Toronto, ON: Queen's Printer for Ontario. Retrieved from: www.ontla.on.ca/library/repository/mon/24006/302017.pdf.
  20. Ontario Society of Nutrition Professionals in Public Health Food Security Workgroup. (2015). Income-related policy recommendations to address food insecurity. Toronto, ON: Ontario Society of Nutrition Professionals in Public Health Retrieved from www.odph.ca/upload/membership/document/recommendations-document-final.pdf. Accessed 18 June 2018
  21. Potvin, L. (2014). Canadian public health under siege [editorial]. Canadian Journal of Public Health, 105(6), e401–e403.CrossRefGoogle Scholar
  22. Power, E. (2017). Hunger and Poverty. In P. Tortell, M. Young, & P. Nemetz (Eds.), Reflections of Canada: illuminating our opportunities and challenges at 150+ years (pp. 176–181). Vancouver: Peter Wall Institute for Advanced Studies.Google Scholar
  23. Raphael, D. (2003). Barriers to addressing the determinants of health: public health units and poverty in Ontario, Canada. Health Promotion International, 18, 415–423.CrossRefGoogle Scholar
  24. Raphael, D., Brassolotto, J., & Baldeo, N. (2015). Ideological and organizational components of differing public health strategies for addressing the social determinants of health. Health Promotion International, 30(4), 855–867.  https://doi.org/10.1093/heapro/dau022.CrossRefGoogle Scholar
  25. Ritchie, J., Lewis, J., McNaughton Nicholls, C., & Ormston, R. (2014). Qualitative research practice: a guide for social science students and researchers (2nd ed.). London: SAGE Publications.Google Scholar
  26. Schrecker, T. (2013). Beyond ‘run, knit and relax’: can health promotion in Canada advance the social determinants of health agenda? Health Policy, 9(SP), 48–58.Google Scholar
  27. Simcoe Muskoka District Health Unit. (2017). Basic income pilot critical for reducing food insecurity [Press release], http://www.simcoemuskokahealth.org/docs/default-source/jfy-media/media-kit%2D%2D-food-security/drsimonbiography_finalaf0ada5f97be6bc38c2dff0000a8dfd8.pdf?sfvrsn=2. Accessed 15 May 2018.
  28. Sunderland, N., Harris, P., Johnstone, K., Del Fabbro, L., & Kendall, E. (2014). Exploring health promotion practitioners’ experiences of moral distress in Canada and Australia. Global Health Promotion, 22(1), 32–45.  https://doi.org/10.1177/1757975914532505.CrossRefGoogle Scholar
  29. Syal, R. (2017). Public health experts blame Ontario government for gap in food insecurity data. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/life/health-and-fitness/health/food-insecurity-ontario/article35510687/). Accessed 11 Nov 2018.
  30. Tracy, S. J. (2010). Qualitative quality: eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16(10), 837–851.CrossRefGoogle Scholar
  31. Williams, P. L. (2014). “I would have never…?”: a critical examination of Women’s Agency for Food Security through participatory action research. In J. Page-Reeves (Ed.), Off the edge of the table: Women redefining the limits of the food system and the experience of food insecurity (pp. 275–313). London: Lexington Books.Google Scholar
  32. Williams, P. L., Watt, C. G., Amero, M., Anderson, B. J., Blum, I., Green-LaPierre, R. J., et al. (2012). Affordability of a nutritious diet for income assistance recipients in Nova Scotia (2002-2010). Canadian Journal of Public Health, 103(3), 183–188.Google Scholar

Copyright information

© The Canadian Public Health Association 2019

Authors and Affiliations

  1. 1.School of Kinesiology & Health StudiesQueen’s UniversityKingstonCanada
  2. 2.Department of Geography and PlanningQueen’s UniversityKingstonCanada

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