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Food Insecurity: Consequences for the Household and Broader Social Implications

Département des sciences des aliments et de nutrition, Université Laval, Québec, Canada G1K 7P4 and ^a Division of Nutritional Sciences, Cornell University, Ithaca, NY 14850

	ABSTRACT

TOP ABSTRACT INTRODUCTION METHODS RESULTS AND DISCUSSION CONCLUSION REFERENCES

 
A conceptual framework showing the household and social implications of food insecurity was elicited from a qualitative and quantitative study of 98 households from a heterogeneous low income population of Québec city and rural surroundings; the study was designed to increase understanding of the experience of food insecurity in order to contribute to its prevention. According to the respondents' description, the experience of food insecurity is characterized by two categories of manifestations, i.e., the core characteristics of the phenomenon and a related set of actions and reactions by the household. This second category of manifestations is considered here as a first level of consequences of food insecurity. These consequences at the household level often interact with the larger environment to which the household belongs. On a chronic basis, the resulting interactions have certain implications that are tentatively labeled "social implications" in this paper. Their examination suggests that important aspects of human development depend on food security. It also raises questions concerning the nature of socially acceptable practices of food acquisition and food management, and how such acceptability can be assessed. Guidelines to that effect are proposed. Findings underline the relevance and urgency of working toward the realization of the right to food.

KEY WORDS: • food insecurity • food pantries • right to food • Québec

	INTRODUCTION

TOP ABSTRACT INTRODUCTION METHODS RESULTS AND DISCUSSION CONCLUSION REFERENCES

 
Someof the earlier studies on food insecurity in North America allude to the consequences of food insecurity (e.g., Campbell 1991 , Radimer et al. 1990 and 1992 , Sigman-Grant and Suter 1994 ) or address more specific issues such as behavioral and emotional problems in children (Kleinman et al. 1998 ) or the emerging two-tiered food distribution system (Campbell 1990 , Davis and Tarasuk 1994 ). Several others look at potential consequences such as the food and/or nutrient intake of those using food pantries. Concerned about the wider significance of food insecurity in our society, we studied its social implications in a heterogeneous low income population from Québec City and rural surroundings. This is part of a wider qualitative and quantitative research project designed to gather data on the nature of the experience of household food insecurity in order to contribute to its prevention.

One characteristic of this work is that it was done in a culture different from previous North-American studies. Although influenced by the American and English-Canadian environment, the population of the Province of Québec is largely a French-speaking, Latin culture, influenced by Catholicism; it is known to give particular importance to lifestyle, including the pleasure of eating and sharing food (Dumont, 1995 , Harris et al. 1987 and 1990 ). Yet Quebecers who participated in our study used household management strategies to face food insecurity similar to those described earlier by Radimer and her collaborators (1990 and 1992), in Upstate New York. This paper tries to identify the household and social implications of food insecurity and to address questions they raise regarding the social acceptability of the practices of food acquisition and management employed under conditions of food insecurity.

	METHODS

TOP ABSTRACT INTRODUCTION METHODS RESULTS AND DISCUSSION CONCLUSION REFERENCES

 
Details of the methods are described elsewhere (Hamelin et al. 1998 ). Essentially, a purposive and progressive sampling using predefined criteria was implemented in this research, oriented toward understanding the experience of food insecurity. The population under study included French-speaking single- and two-parent households from urban and rural areas in and around Québec City. Other than basic income 130% of low income cut-offs as established by Statistics Canada (1996 data; 1992 base), selection criteria included households having dependent children, showing a diversity of economic, health and social precariousness among the pool of selected households, as well as participating or not in food aid programs. Households were recruited by means of a triple system as follows: 1) referrals by a variety of community groups that assist the general population as well as low income people, some of which targeted people in need of food; 2) referrals by ordinary people in each milieu; and 3) announcements in the media. Sample size was determined by theoretical saturation. Selection was carried out throughout the interviews according to ongoing preliminary analysis.

Data were collected by group interviews (focus groups) and individual semistructured interviews in the Fall of 1996. Twenty-three focus groups (3–6 respondents in each), including the pretest, were carried out alternatively with 12 individual interviews to reach a total of 98 households (each respondent was the person most involved with food acquisition and preparation in the household). The interview guide comprised 12 open-ended questions divided into three sections: manifestations, strategies and risk factors. A new idea emerging from one type of interview was tested in the following days in another type of interview, either to confirm conceptual representativeness of concepts (focus groups), or to specify (individual interviews) the conditions under which the phenomenon exists, the interactions that pertain to them and the associated strategies and consequences (Strauss and Corbin 1990 ). Although it was not central to the interview guide, information about consequences came out naturally in the course of conversation. For example, someone would say "some days I feel so weak that I have no strength left to go to work." Each respondent participated once, and at the end of the interview was asked to respond to two questionnaires, one on sociodemographic characteristics and a French version of the Radimer/Cornell hunger and food insecurity measures (Olson et al. 1994 ).

The interviews lasted on average 2–2.5 h; they were audiotaped, transcribed and analyzed according to the principles of theme analysis described by Strauss (1987) and Strauss and Corbin (1990) . Text analysis and interpretation were greatly facilitated by the software Atlas/ti. It allowed us to maximize iterations between the text, the codes and the classification of codes into code families. Thus, >700 units of meaning were drawn from a body of 1125 pages of statements from respondents; they were classified under 15 themes encompassing 74 families of codes. This process led to an in-depth description of the experience of food insecurity (particularly its manifestations) including an incursion into its consequences.

The status of food insecurity of each household was assessed by the first author on the basis of the above evaluation of the household food situation and according to the work of Frongillo and collaborators (1997) toward the development of a definitive criterion measure of food insecurity, i.e., "would a reasonable person conclude that the household was insecure, considering the generally accepted definition of food insecurity (certainty, acceptability, quality and quantity of food)?" Elements of vulnerability did not enter into the classification scheme. Whenever there was a doubt about classification, any household who had to resort to practices considered to be unsustainable from the point of view of food security was confirmed food insecure. All other households were judged to be food secure. Assessment was made without knowledge of the results of the Radimer/Cornell hunger and food-insecurity measures. The two measures were highly correlated ( = 0.88).

	RESULTS AND DISCUSSION

TOP ABSTRACT INTRODUCTION METHODS RESULTS AND DISCUSSION CONCLUSION REFERENCES

 
Ninety-eight (98) respondents (83 women, 15 men) participated and contributed information about their household food security situation; 77 households were found to be food insecure according to the criterion measure. For 93 of the 98 respondents, the assessment of food security was straightforward. The five remaining were classified as food insecure because the practices they used to maintain apparent food security were judged to be unsustainable (cutting on quantity and/or quality of food, buying food on credit).

According to the respondents' description, the experience of household food insecurity is characterized by two categories of manifestations: 1) the core characteristics of the phenomenon which are reflected by not having enough food in the present, by worrying about having enough in the future and by expressing a feeling of alienation; and 2) a related set of actions and reactions by the household to these core manifestations. This second category of manifestations is considered here to be a first level of consequences of food insecurity. These consequences at the household level often interact with the larger environment to which the household belongs. On a chronic basis, the resulting interactions have certain implications, which we tentatively labeled "social implications."

Household consequences of food insecurity.

After the content analysis of respondents' statements, three potential areas of consequences of food insecurity at the household level were apparent, namely, physical, psychological and sociofamilial; each also has a corollary at the "social" level. Table 1 shows a summary of the areas of consequences at the household level. Thirty respondents reported an experience of hunger pangs either among adults and/or children; ~40 respondents cited episodes of fatigue (depletion) and/or illness related to insufficient food. These physical manifestations could translate into a lack of concentration at school and low work capacity either at home or at work. Psychological manifestations related to a lack of access to food were leading to a clear feeling of being constrained to go against held norms and values, as well as creating enormous stress in the home. Stress was illustrated by a range of reactions from decreased interest in food and nourishment (e.g., no more pleasure, no more desire to do the cooking) to the fear expressed by a few respondents of losing custody of their child. A third area of consequences was a variety of sociofamilial perturbations that cover the modification of eating patterns and related ritual, disrupted household dynamics as well as distorted means of food acquisition and management. More than 50 households had to modify their eating patterns and satisfy themselves with meals that were not complete and/or balanced from their perspective (e.g., skimpy meals). With regard to the ritual of meals, 16 complained of not being able to invite friends to dinner and a few deplored the fact that meals were no longer a happy gathering opportunity for the family. Around 20 respondents even revealed disrupted dynamics within the household, particularly in the parent-child relation (e.g., irritability; anger; parents less available because of increased time required to procure food, conversation gap with children because parents are not able to face their incapacity to feed them adequately). Disrupted household dynamics also included deviant behavior, such as overcompensation (e.g., save up food because one is afraid that it will not be there any more). In addition, all food-insecure households had to resort to some extent to food acquisition and management strategies that included unsustainable practices such as "pernicious practices" creating unexpected dependency (e.g., relying on others or relying on credit to eat), the "regular use of food pantries", and "obliged means" (e.g., borrowed money for food, selling personal belongings; parents depriving themselves to feed their children, going to usurers, poaching animals, stealing). It is noteworthy that ~20 respondents identified that disrupted household dynamics and distorted means of food acquisition and/or management further compromised the quality of diets, i.e., on the one hand, home climate was not propitious for preparing meals; on the other hand, quality of food obtained at a food pantry, for example, was not satisfying. The compromised suitability of diets might be expected to have long-term detrimental effects.

Broader implications with an effect beyond the household level were also identified from the respondents' perceptions (Table 2 ).They are referred to as "social implications" because they likely affect the potential for development of a society. They also correspond to the three areas just described. Many respondents mentioned that physical impairment because of a lack of food ("good" food for some) contributed to reduced learning in children and adults as well as a loss of productivity (e.g., absenteeism at work); ~20 households reported increased need for health care (e.g., sacrificed medication to food, depression).³Psychological suffering related to food intensified the feeling of exclusion and powerlessness (including pessimism as well as a difficulty to overcome obstacles and get back to a normal situation) that was already present in ~40 deprived households. The many expressions of sociofamilial perturbations also had broad repercussions. A few of the respondents felt strongly that disorganized eating patterns and jeopardized ritual eroded the transfer of knowledge and practices; several others suggested it also hindered conviviality. Many mentioned that disrupted household dynamics decreased participation in social life. Some even suggested that the use of food pantries reinforced the development of a two-tiered food distribution system. Even though the majority of food-insecure respondents made regular use of food pantries, the social implications did not appear alleviated. Not to be ignored are the feelings of revolt expressed by four respondents such as the very violent antigovernment remarks by one respondent as a result of her insufficient access to food for herself and her four children. Such repercussions of food insecurity were reported to be an important threat to harmonious life in a community; if this exists on a large enough scale, it could intensify conflicts in society. Similarly, increased social inequities associated with reduced learning, with increased illnesses and with feelings of exclusion and powerlessness are certainly not conducive to social or economic development.

Social acceptability of practices.

In addition to the aforementioned implications of household food insecurity, a shift in what is acceptable to respondents was observed. Although many food-insecure respondents were reluctant to resort to food pantries at the first signs of a problem or to benefit from some sort of food aid, they appeared to adapt over time. Moreover, they seemed to develop some efficiency in using various services; for example, many ate lunch a few days a week at a community restaurant that served meals to low income people. In addition, on Wednesday, they would get free bread at one place and on Thursday, expect to get free fruits and vegetables at another place. Some of these, particularly low wage workers, mentioned that they had to overcome their own prejudice if their families were to be fed. One father acknowledged resorting to illegal means, saying "when hunger nibbles at my consciousness, I don't have any more consciousness." It appears from these different statements that, eventually, the search for food takes precedence over previously held values. This tendency to adapt in the long run to "unusual" means of food acquisition does not preclude the fact that most respondents of food-insecure households found it abnormal not to be able to feed their family adequately with current income.

The normative constructs that are central to the experience of food insecurity are delicate to evaluate. This difficulty, further illustrated below, may indicate the need for some guidelines to assess the social acceptability of practices that are used and/or fostered to assure the food security of the majority. In this study, two respondents relied heavily on parental help for eating and one relied on her credit card; the three of them felt perfectly at ease doing this. Another respondent, who is a seasonal worker, admitted loading her credit card up to 8,000 CAN$ a year, for eating only; in theory, this respondent is able to reimburse this sum at the end of each year. Although the respondent felt very insecure during the first years of that system, by the time of the interview, she indicated that she was now used to it and declared her household as food secure. These examples raise a fundamental question: Who judges the social acceptability of related practices? Until such a time as consensus is reached on this emerging debate, at least two general avenues can be explored, i.e., either the household or civil society as a whole. From the foregoing, it seems that with time, food insecure households adapt according to their evolving situation and modify their own assessment of what might be acceptable. If so, their judgment would then differ from their own original one and probably from that of the broader society. However, many factions of the broader society also now consider "normal" the organization, for example, of an ever more extended network of food banks and food pantries (Tarasuk and Davis 1996 ). Is it "desirable" for society that such systems become common and accepted practice? What is the threshold we consciously want to accept in society ? Who in society participates in such a decision? Should those most affected by the problem not be part of such decisions? The debate must be launched urgently before some situations become too difficult to reverse. However, until such a time as a consensus can be reached, how can those involved more directly with the resolution of the problem assess the social acceptability of current practices used by food insecure households?

The Life Sciences Research Office definition of food insecurity (Anderson 1990 ) suggests that " ... to acquire acceptable foods in socially acceptable ways" refers to acquisition "... without resorting to emergency food supplies, scavenging, stealing and other coping strategies." One can ask what are the boundaries of "other coping strategies"? Is relying on parental support at an advanced age or eating on credit considered acceptable? Is acquiring supplemental food through the Montréal Diet Dispensary or related programs in Québec or WIC vouchers or food stamps in the U.S. acceptable? If yes, what strategies are they part of? Are current efforts and resources in society adequately balanced among short-term strategies to alleviate food insecurity and those that are more clearly directed at its specific prevention? What are the generally accepted social norms related to food access, as we embark on the 21st century? Does the fact that an increasing number of households resort regularly to food pantries indicate the dawn of a new norm?

Because it might be illusory to think that related criteria would have universal application, we may need guidelines that could be adapted to different times and places. On the basis of an initial interpretation of the results that emerged from this study, including results on factors of vulnerability (Hamelin et al. 1998 ), the following elements are advanced to guide the assessment of the social acceptability of practices related to food security: the means of food acquisition and of food management available to households should 1) contribute to sustainable household food security; 2) not be at the expense of one member in the household, nor at the expense of another household's food security, such as "their parents"; 3) conform to laws and regulations; and 4) not represent an eventual threat to harmonious life in a community. Although such elements may require testing and further refinement, they are proposed as an initial step to help advance the debate and the practice on this question.

	CONCLUSION

TOP ABSTRACT INTRODUCTION METHODS RESULTS AND DISCUSSION CONCLUSION REFERENCES

 
By moving beyond immediate management of hunger and food insecurity, this paper has shown that the consequences of food insecurity at the household level have repercussions at the social level. Important social implications have been identified for each of the physical, psychological and sociofamilial manifestations of food insecurity. They suggest that key aspects of human development depend on food security. They also generally indicate the need for further reflection on what are socially acceptable practices for a household to ensure its food security. On the basis of these findings, some preliminary guidelines are proposed to help assess the social acceptability of such practices; however, these need to be further refined and tested. Results underline the relevance of working toward achieving food security for all and of realizing the right to food.

	FOOTNOTES

 
¹ To whom correspondence should be addressed.

¹ Presented at the symposium "Advances in Measuring Food Insecurity and Hunger in the U.S." as part of Experimental Biology 98, April 18–22, 1998, San Francisco, CA. The symposium was sponsored by the American Society for Nutritional Sciences. Published as a supplement to The Journal of Nutrition. Guest editor for the symposium publication was Christine M. Olson, Cornell University, Ithaca, NY.

² Depression was sometimes a consequence of food insecurity, sometimes part of its cause.

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