Social Determinants of Health and Food Poverty

Health Promotion and Caring for Self

The social determinants of health are a mixture of external conditions that mold and establish the health of individuals, communities, and higher authorities as a whole. These determinants include the conditions a person works, grows, lives, and ages in that further influences the extent a person is able to thrive, achieve, and cope in their environment (Raphael, 2004, p.1). Although there are many barriers present to individuals, Huffingtonpost believes the cost of poverty is detrimental to the economy. Therefore, granting the proposal of basic income would supply individuals with a sufficient amount of money to mask the face of this issue (Appendix). Nonetheless, the purpose of this paper is to acknowledge the principal determinants of health that effect those victimized by food poverty; Income, stress, and social exclusion. Furthermore, the objective is to also recognize the advantages of basic income and how it can decrease current injustices present in society. As well as understanding the cause and effect of these determinants, while conceptualizing implications, such as, promoting justice, equity, and advocacy, from a nurse perspective to effectively minimize inequities and maximize the health of Canadians.

Applications of Three Social Determinants of Health

Income is stated to be the most influential determinant of health because it controls the quality of other determinates, influences an individual’s accessibility to basic needs, regulates physiological responses, and manages health-related outcomes, such as, diet, exercise, and substance abuse (Mikkonen & Raphael, 2010). In fact, the cost of poverty has left low income individuals more susceptible to diseases and shorter life expectancy (Krisberg, K., 2016). As a matter of fact, Mikkonen & Raphael (2010) have established the importance of income by proclaiming that, “More equal income distribution has proven to be one of the best predictors of better overall health of a society” (p. 12). In regard to food poverty, Elaine Power stated in 2005, “Household food insecurity is a product of poverty”, therefore, it is evident that lack of sustainable income can deprive individuals and families of the essential nutrients and fluids needed to maintain proper health. With a natural human instinct to survive, an insufficient amount of income will leave families no other option but to purchase affordable products, despite the unhealthy lifestyle that comes along with it. For instance, students orientating from low- income neighbourhoods are 95% more likely to consume fast food options daily. In fact, research reveals that food- insecure families prioritize affordable, substantial meals regardless of the poor dietary nutrition that follows (Velazquez, Black, Billette, Ahmadi, & Chapman, 2015). Notably, in 2017, the inability to provide healthy alternatives resulted in depressive symptoms among female university students in Markham, Ontario (Quehl, Haines, Lewis, & Buchholz). Similarly, the constant ingestion of unhealthy meals has proven to lead to drastic health complications. For example, diabetes, psychological distress, and increased physical inactivity is remarkably higher in Canadians living in food-insecure households (Gucciardi, Vogt, DeMelo, & Stewart, 2009). Considering the circumstances, the addition of basic income would allow communities to live an appropriate standard of living by providing the opportunity for access to simple needs such as rent, food, and services. Nonetheless, the long-term vision towards a hunger-free society would be attainable, providing individuals the chance to obtain a healthy well-being status (Ontario Association of Food Banks, 2016).

Despite the powerful impact that income has on the health of those living in food poverty, stress is more so often an additional determinant that carries equal importance in exhibiting the living conditions of vulnerable populations. For years, the effects of stress on the body were misunderstood. Although, research has been able to determine that constant stress has the ability to weaken resistance to diseases and disrupt metabolic and hormonal systems. In addition, stressful situations directly correlate with extreme tiredness, shame, insecurities and increased anxiety that can lead to the adoption of unhealthy coping patterns, such as, substance abuse, smoking, and excessive eating (Mikkonen & Raphael, 2010). When it comes to food poverty, stress can directly affect the overall function of a family. For instance, Conger et al. believes that parents struggling to effectively provide for the family, increases stress that can drastically alter the emotions and attitudes that govern parental skills. Furthermore, this can lead to negative cognitive and psychological complications in the child’s future (as cited in McCurdy, Gorman, & Metallinos-Katsaras, 2010). Not only does stress impact families on the grand scale but it has also been noted to personally terrorize individuals as well. In 2012, 19% of Americans have reported to dramatically stressing over the ability to afford nutritious meals each year (Pan, Sherry, Njai, & Blanck). Additionally, the dangers of stress became prevalent amongst a single mother from southern Ontario, who admitted that stress experienced from food insecurity was a main factor to depression, and self-threatening behaviour that resulted in hospitalization (Buck-McFadyen, 2015). Despite methods trying to address the needs of marginalized communities, the desired outcome is not always positive. In particular, documented emotions of high stress and shame has been associated with users who access food banks. In fact, perhaps the stigma surrounding the use of charity, can explain why only less than one-quarter of those living in food poverty, utilize food banks in Canada (Loopstra, 2018). According to the Ontario Association of Food Banks, low-income individuals who face high amounts of stress have a greater chance of being frequent users of the health care system. With these factors in mind, the introduction of basic income could potentially minimize hospitalization rates, annihilate the use of food banks, and decrease mental health issues nationally (2016).

With the implications that stress has on well-being, it is essential to recognize social support systems that entitle and alleviate communities to widen the potential of individuals. However, the presence of social exclusion turns away from the power of unity and has become an uprising issue that fabricates a perception of hopelessness, uselessness, and incapability. Likewise, this act of social denial is directly associated with educational underachievement, low-income, unemployment, chronic diseases, and crime. Furthermore, social exclusion rejects specific groups from the freedom of participating in Canadian life by restricting access to economic, social and cultural resources (Mikkonen & Raphael, 2010). With regards to food poverty, a significant number of individuals coming from food insecure households, reported on having poor health and an insufficient amount of social support (Vozoris & Tarasuk 2003). Consequently, only being able to afford low nutritional meals can negatively affect cognitive function. In 2017, an analysis verified that constant low dietary options cause an unfavourable effect on academic achievement and school performance (Faught, Gleddie, Storey, Davison, & Veugelers 2017). As a result, inadequate education levels would drastically inhibit students to obtain a secure job, thus effecting future income distribution (Keller 2010). Nonetheless, the chain of poverty would continue to strengthen and be persistent with its reputation as being the root cause of hunger (Huffingtonpost 2016). Regardless of food poverty being a notably widespread matter in North America, the denial of affordable, nutritious food is twice as much in northern areas of Canada then it is in southern. Provided that transportation and fuel costs are higher, an increased risk of damage due to extended periods of transportation, and a limited selection of nourishing produce, indicates that First Nation communities have an unreliable availability of food due to unpredictable circumstances. As a matter of fact, First Nations have been noted to travel unrealistic distances to obtain food, necessary products, and simple services due to the fact that there is an absence of grocery stores in the area. In fact, some northern communities have gone more than two months without fresh meat at local grocery stores, a product rich in protein and other essential nutrients. Despite purchasable quality food being a simple human right, many citizens are excluded from the opportunity to live a healthy life (Food Secure Canada, 2016). With the consideration of these inequities, the deprivations of fundamental human needs could potentially be appeased with the establishment of a basic income. After all, poverty is difficult to escape, therefore, a basic income would be a flexible solution to provide individuals access to simple resources and guarantee that the needs of those below the social safety net are properly addressed (Huffingtonpost, 2016).

Implications for Nursing Practice

As nurses, there is an ethical commitment to portray an expected behaviour and empathetic understanding towards patients and health care members. In addition, the role of a nurse includes knowing personal responsibilities and advocating for safe, quality care (The Canadian Nurse, 2002). In addition, according to the Ottawa Charter for Health Promotion of 1986, health is noted as a positive resource of everyday life. Furthermore, it is the role of health care physicians to enable others to increase and empower control of mental, physical, and social well-being in order improve health (The Ottawa Charter for Health Promotion, 2016). With basic income yet to be initiated, it is in the hands of nurses to implement effective solutions to minimize the suffering of those in food insecure settings. For instance, Hampton believes that nurses must take the responsibility to inform patients how to select nutrient-dense meals in a way that is cost productive. As well as conducting informative seminars in high poverty populations in order to increase awareness and reduce stress (as cited in Kregg-Byers & Schlenk, 2010). In addition, it is evident that nurses must team with other health professionals, health services, and food producers to productively increase transportation to isolated communities, create adequate food storages, and raise consciousness towards proposals of prevention of food shortages (Kregg-Byers & Schlenk, 2010). Especially, since the importance of nutrition is essential to maintain health and proper quality of life, it is mandatory to advocate towards healthy food access. Regardless of the social support that food banks provide, multiple products are presented outdated and in an unsatisfactory condition. Therefore, to truly address the issue of food poverty, all perspectives must be thoroughly assessed in order to form an effective approach. For instance, gathering church communities to exhibit monthly cycles to donate fresh vegetables, fruits, eggs, and dairy products has been proven to be an achievable method towards proving nourishing meals to food insecure populations (Gracias, 2013).

Conclusion

To summarize, Huffingtonpost believes that the cost of poverty to society is damaging (2016). Along with elements such as income, stress, and social exclusion, that are evident factors to be detrimental to the health of those facing food poverty. Explicitly, the destruction of these determinants is noticeable throughout the negative health implications, harmful phycological matters, denial of educational and cognitive opportunities, and deprivation of essential human needs. Although, the commencement of basic income could drastically reduce these hardships by giving individuals a set amount to potentially meet recipient’s simplest needs, decrease hospitalization rates, and empowering communities through increased social support (Huffingtonpost, 2016). With the installation of basic income yet to be announced, it is the responsibility of nurses to provide as many implications to reduce food poverty and promote supportiveness, righteousness, and impartiality. Throughout the paper, it is evident that nurses may accomplish these desires by informing citizens how to purchase low-costing nutritious meals, advocating for unchallenging food access in isolated populations, and using the power of unity to bring communities together to help one another.

References

• Buck-McFadyen, E. (2015). Rural food insecurity: When cooking skills, homegrown food, and perseverance aren’t enough to feed a family. Canadian Journal of Public Health, 106(3), E140-E146. Retrieved from https://www-lib-uwo-ca.proxy1.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com.proxy1.lib.uwo.ca/docview/1695740490?accountid=15115
• Code of ethics for registered nurses. (2002). The Canadian Nurse, 98(9), Insert 1-28. Retrieved from https://www-lib-uwo-ca.proxy1.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com.proxy1.lib.uwo.ca/docview/232087774?accountid=15115
• Faught, E. L., Gleddie, D., Storey, K. E., Davison, C. M., & Veugelers, P. J. (2017). Healthy lifestyle behaviours are positively and independently associated with academic achievement: An analysis of self-reported data from a nationally representative sample of Canadian early adolescents. PLoS One, 12(7) doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1371/journal.pone.0181938
• Food Secure Canada. (2016) Paying for Nutrition: A Report on Food Costing in the North. Retrieved from https://foodsecurecanada.org/sites/foodsecurecanada.org/files/201609_paying_for_nutrition_fsc_report_final_wt_erratum.pdf
• Gracias, J., (2013). A Nursing Intervention to Improve Nutrition for Health Promotion for a Vulnerable Urban Adult Group. Retrieved November 9, 2018 from https://scholarworks.gvsu.edu/cgi/viewcontent.cgi?article=1010&context=dissertatios
• Gucciardi, E., Vogt, A., DeMelo, M., & Stewart, E. (2009). Exploration of the relationship between household food insecurity and diabetes in Canada. Diabetes Care, 32(12), 2218-24. Retrieved from https://www-lib-uwo-ca.proxy1.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com.proxy1.lib.uwo.ca/docview/223035878?accountid=15115
• Keller, K. R. (2010). How Can Education Policy Improve Income Distribution?: An Empirical Analysis of Education Stages and Measures on Income Inequality. The Journal of Developing Areas 43(2), 51-77. Tennessee State University College of Business. Retrieved November 8, 2018, from Project MUSE database
• Kregg-Byers, C., & Schlenk, E. A. (2010). Implications of food insecurity on global health policy and nursing practice. Journal of Nursing Scholarship: An Official Publication of Sigma Theta Tau International Honor Society of Nursing, 42(3), 278-285. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1111/j.1547-5069.2010.01351.x
• Krisberg, K. (2016). Social determinants of health: Income inequality: When wealth determines health. American Journal of Public Health, 106(12), 2088. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.2105/AJPH.2016303495
• Loopstra, R. (2018). Interventions to address household food insecurity in high-income countries. The Proceedings of the Nutrition Society, 77(3), 270-281. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1017/S002966511800006X
• McCurdy, K., Gorman, S., & Metallinos-Katsaras, E. (2010). From poverty to food insecurity and child overweight: A family stress approach. Child Development Perspectives, 4(2), 144-151. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1111/j.1750-8606.2010.00133.x
• Mikkonen, J., & Raphael, D. (2010). Stress, Bodies, and Illness. Social Determinants of Health: The Canadian Facts, 10-11
• Mikkonen, J., & Raphael, D. (2010). Income and Income Distribution. Social Determinants of Health: The Canadian Facts, 12-14.
• Mikkonen, J., & Raphael, D. (2010). Social Exclusion. Social Determinants of Health: The Canadian Facts, 32-34.
• Ontario Association of Food Banks. (2016). A Basic Income Could Lift Canadians Out Of Food Poverty. Retrieved November 7, 2018 from https://www.huffingtonpost.ca/ontario-association-of-food-banks/basic-income_b_12107622.html
• Pan, L., Sherry, B., Njai, R., & Blanck, H. M. (2012). Food insecurity is associated with obesity among US adults in 12 states. Journal of the Academy of Nutrition and Dietetics, 112(9), 1403-1409. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1016/j.jand.2012.06.011
• Power, E. (2005). Individual and household food insecurity in Canada: Position of dietitians of Canada. Canadian Journal of Dietetic Practice and Research, 66(1), 43-6. Retrieved from https://www-lib-uwo-ca.proxy1.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com.proxy1.lib.uwo.ca/docview/220784578?accountid=15115
• Quehl, R., Haines, J., Lewis, S. P., & Buchholz, C. (2017). Food and mood: Diet quality is inversely associated with depressive symptoms in female university students. Canadian Journal of Dietetic Practice and Research, 78(3), 124-128. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.3148/cjdpr-2017-007
• The Ottawa Charter for Health Promotion. (2016). Retrieved from http://www.who.int/healthpromotion/conferences/previous/ottawa/en/
• Velazquez, F., Black, L., Billette, J., Ahmadi, N., & Chapman, E. (2015). A comparison of dietary practices at or en route to school between elementary and secondary school students in Vancouver, Canada. Journal of the Academy of Nutrition and Dietetics, 115(8), 1308. Retrieved from https://www-lib-uwo-ca.proxy1.lib.uwo.ca/cgi-bin/ezpauthn.cgi?url=http://search.proquest.com.proxy1.lib.uwo.ca/docview/1706498383?accountid=15115
• Vozoris, N. T., & Tarasuk, V. S. (2003). Household food insufficiency is associated with poorer health. The Journal of Nutrition, 133(1), 120-6. doi:http://dx.doi.org.proxy1.lib.uwo.ca/10.1093/jn/133.1.120

Appendix

• https://www.huffingtonpost.ca/ontario-association-of-food-banks/basic-income_b_12107622.html