P R E S E N T E R T O O L – R E V I S E D S U M M E R 2 0 1 3

FOOD SECURITY

FOOD SECURITY (PREZI)

OUTLINEObjectivesTed TalkDefinitions of Food SecurityGlobal Context of Food SecurityLocal Context of Food SecurityFood Security and Primary CareDiscussion / ActivityAdditional Resources

OBJECTIVES

• Be able to define food security

• Be familiar with the Millennium Development Goals that relate to food security

• Be able to name 3 manifestations of food insecurity in Canada

• Be able to explain to a colleague why an understanding of food security is relevant to primary care

JAMIE OLIVER'S TED PRIZE WISH: TEACH EVERY CHILD ABOUT FOOD

• Sharing powerful stories from his anti-obesity project in Huntington, W. Va., TED Prize winner Jamie Oliver makes the case for an all-out assault on our ignorance of food. Jamie Oliver is transforming the way we feed ourselves, and our children

JAMIE OLIVER'S TED PRIZE WISH: TEACH EVERY CHILD ABOUT FOOD

During this TED talk, pay special attention to:

• The evidence Jamie Oliver presents of unhealthy food choices as a major threat to health

• The arguments for educating our children about food choices

• Why this talk is relevant to you as a primary care practitioner

TED TALKS

http://www.ted.com/talks/lang/en/jamie_oliver.html

FOOD SECURITY

• What is food security?

FOOD SECURITY

“When all people at all times have access to sufficient, safe, nutritious food to maintain a healthy and active life”

1996 World Food Summit

FOOD AND HEALTH

• What evidence does Jamie Oliver present of Food Insecurity as a major threat to health?

(4 Americans will die in 20 minutes due to the food they eat, shortened life span due to food we eat, diet related disease as the biggest killers, 10% of healthcare costs)

FOOD SECURITY (EXTRA)

• Food is a basic human need

• Providing global food security is one of the principle challenges for humanity in current times

"I have the audacity to believe that people everywhere can have three meals a day for their bodies, education and culture for the minds and dignity, equality and freedom for their spirits.“

~ Martin Luther King, Jr., taken from his remarks upon acceptance of the Nobel Prize

FOOD AND AGRICULTURE ORGANIZATION (FAO) – UNITED NATIONS

• Specialized organization of the UN that leads international efforts to defeat hunger

• Established October 16 1945

• World Food Day is therefore celebrated every October 16th

• Focuses on achieving food security for all

"What the people of the world want most and have always wanted...are bread and peace.  World Food Day gives voice to that yearning.“Patricia Young, National Coordinator WFD USA in remarks to the UN General Assembly

FOOD AND AGRICULTURE ORGANIZATION (FAO) – UNITED NATIONS

FAO’s Mandate:

• To ensure people have regular access to enough high-quality food to lead active, healthy lives

• To raise levels of nutrition, improve agricultural productivity, better the lives of rural populations and contribute to the growth of the world economy

WORLD FOOD SUMMIT -1996

• The FAO called for the 1996 World Food Summit in response to growing concern around undernutrition and the ability to meet future food needs

• Goals of the 1996 Summit were to develop and implement plans of action to achieve food security domestically and internationally

FOOD SECURITY IN CANADA

• Based on the action plan developed at the 1996 World Food Summit

FOOD SECURITY IN CANADA

• “Food security requires that adequate amounts of safe, healthy, nutritious, culturally acceptable food be accessible to all in a dignified manner; that food producers earn a fair return on their labour, and that food production, harvesting and distribution methods sustain the environment”

Food Secure Canada

FOOD SECURITY (PREZI)

FIVE A’S OF FOOD SECURITYAvailability - sufficient food for all people at all times

Accessibility - physical and economic access to food for all at all times

Adequacy - access to food that is nutritious and safe, and produced in environmentally sustainable ways

Acceptability - access to culturally acceptable food, which is produced and obtained in ways that do not compromise people's dignity, self-respect or human rights

Agency - the policies and processes that enable the achievement of food security

Ryerson University

3 PILLARS OF FOOD SECURITY

• Food availability: sufficient quantities of food available on a consistent basis

• Food access: having sufficient resources to obtain appropriate foods for a nutritious diet

• Food use: appropriate use based on knowledge of basic nutrition and care, as well as adequate water and sanitation

Food Secure Canada

AVAILABILITY

http://farmscapegardens.com/blog/subsidizing-fresh-fruits-and-vegetables-part-iihttp://www.susandopart.com/blog/tag/farmers-markets

ACCESS

http://balanceoffood.typepad.com/balance_of_food/2012/06/think-food-prices-are-high-try-the-northern-territories-of-canada.html

USE

http://www.odditycentral.com/pics/the-tasty-cooked-mice-of-malawi.htmlhttp://www.ivcm.edu.mt/courseJamieO.html

http://myplus.org/proper-hand-washing-procedures-7-important-things-you-should-know.html

FOOD SECURITY AS A DETERMINANT OF HEALTH

QUESTIONS TO CONSIDER

• How does an awareness of your patient’s income and their ability to access nutritious foods impact upon your ability to care for them?

FOOD SECURITY ON A GLOBAL SCALE

MILLENNIUM DEVELOPMENT GOALS

• Eight Goals developed by the United Nations

• In 2000, all 193 UN member countries signed on to an agreement to reach these 8 goals by the year 2015

• Goal 1: Eradicate extreme poverty and hunger

• The MDG on hunger requires that the proportion of people suffering from hunger be halved between 1990 and 2015

http://www.jm.undp.org/files/u80/jpeg%20FILES%20MDG/MDG1.JPG

FOOD SECURITY

• What are some manifestations of food insecurity on a global scale?

"Hunger is not an issue of charity.  It is an issue of justice."

Jacques Diouf, FAO Director-general

FOOD INSECURITY- MALNUTRITION

• Malnutrition has been growing since the mid-1990s

• Over 1 billion people suffer from hunger

• One sixth of all humanity currently goes hungry every day

• In 2008 malnutrition was affecting approximately 915 million people

• These trends are expected to worsen given high food prices the global economy

GLOBAL CONTEXT – LOW INCOME COUNTRIES

• Food Security depends on supply of food (and the composition of supply), reliability of supply, and access

• Food is often produced in rural areas however food security in many countries is higher in urban areas where power to access is higher

• Have to also consider food utilization- whether micronutrient intake is sufficient in quantity and balance to allow adequate absorption of available macronutrients

• Many factors can influence food security: distribution, corruption, commodity prices, climate change, natural disasters, gender, power differentials

"Hunger denies, wastes, and degrades the gift of life."

Edouard Saouma, former FAO director-general

FOOD INSECURITY- OBESITY

• Obesity has also been on the rise in the last decades

• The rates of obesity world-wide have more than doubled since 1980

• In 2008 1.5 billion adults aged 20 and over were overweight

• Obesity is not always due to food insecurity but can be a manifestation of an inability to access nutritious food

FOOD SECURITY ON A LOCAL SCALE

• Can you name some manifestations of food insecurity in Canada?

MANIFESTATIONS OF FOOD INSECURITY IN CANADA

• Use of food banks

• Malnourished children and adults

• Widespread obesity in children and adults

• Diabetes in First Nations populations

• Financial problems amongst farmers and fishermen (and women)

MANIFESTATIONS OF FOOD INSECURITY IN CANADA

http://www.news1130.com/news/local/article/130183--food-bank-use-is-up-across-canada

http://www.nccah-ccnsa.ca/103/First_Nations__Inuit_and_Metis_Public_Health.nccahhttp://www.drsharma.ca/people-with-obesity-have-heads-too.html

OBESITY

“It is a bitter irony that as developing countries continue their efforts to reduce hunger, some are also facing the opposing problem of obesity. Obesity carries a higher incidence of chronic illness including diabetes, heart disease and cancer. And while some of the poor are becoming plumper, they are not necessarily better fed. Obesity often masks underlying deficiencies in vitamins and minerals”FAO

http://www.fao.org/FOCUS/E/obesity/obes1.htm

FOOD SECURITY AND PRIMARY CARE

• How does Food Security relate to your role as a family doctor?

FOOD SECURITY• As family doctors we are in the business of preventative

care and trying to create good health outcomes for patients

• It is therefore crucial for us to have a good understanding of the determinants of health

• Without understanding the factors influencing our patients’ health, it is difficult to have an impact upon their health

• Food security or insecurity will greatly affect our patients’ health and is therefore important for family doctors to address

PRIMARY CARE

“I wish for your help to create a strong, sustainable movement to educate every child about food, inspire families to cook again and empower people everywhere to fight obesity.”

• As family doctors, how can we work towards making Jamie’s wish a reality?

DISCUSSION & CASES

• These are two of your patients, what do they have in common, what more do you need to know in order to care for them? How are you going to help them?

FOOD INSECURITY – CASE 1

When working in Malawi I saw an 8 month old child who weighed 4 kg (half the weight of an average Canadian child). She was in clinic with her grandmother. Looking at her growth chart, she had not gained any weight for several months. Lab work revealed severe anemia with a hgb of 40. What more would you want to know?

CASE 1 CONTINUED….

On review of history she was breastfed until 4 months when her mother became pregnant again. At this point her mother’s milk supply dried up. Since she was 4 months of age the family has struggled to feed her. When they could afford it they have bought her cow’s milk. The father recently abandoned the family and they now have almost no means of getting foodWhat aspects of food security are important to consider here?

CASE 2

• Rachel is a patient in my practice in Markham-Stouffville. She is a 42 yr old with 2 kids. She is obese with a BMI of 40 and has uncontrolled diabetes.

• What information do you need to know in order to help Rachel achieve better health?

ACTION PLAN

Group Discussion:

• After today’s workshop, make a list of tangible action plans to implement in your respective practices.

FOOD SECURITY (EXTRA)Divide up into groups. How does Food Security relate to your role as a family doctor?

Gatekeeper – health care costs related to food insecurity

Educational/Teaching role – how important is it to encourage patients to teach their kids to cook, to cook their own meals, to make healthy choices, encourage healthy choices (portion size, fresh foods, less processed), presentations at schools, cooking classes

Advocate – access to food that is safe, nutritious

Health promotion – live longer if eat healthy, do better in school

FOOD SECURITY AND DFCM CORE COMPETENCIES

Here are some DFCM core competencies that relate to food security:

• “Elicit information regarding the social situation of the patient”(history taking) – ask about income and access to food

• “Assess the impact of social conditions on the presenting symptoms” (patient-centered approach) – determine how inadequate access to healthy food is affecting their health and their family

• “Link patient’s symptom to their social situation and to a lifestyle behaviour and in doing so, employ the principles of disease prevention and health promotion and advocacy” (treatment plan)

• “Mobilize services within the health care and community institutions on behalf of the patient” (engages resources)

"For now I ask no more than the justice of eating“

Pablo Neruda, Chilean Poet, Noble Prize Winner