Kimberly Reid RD Prince Edward Family Health Team April 12, 2012

“Social injustice is killing people on a grand scale”

Closing the gap in a generation, World Health Organization, 2008

  Our Family Health Team is a group of skilled health professionals working together to provide better access to high quality, co ordinated health care and health services, as close as possible to where you live Our team includes; 25 family physicians, 5 nurse practitioners and a supporting team of nurses, dietitians, social workers, pharmacists, respiratory therapists, psychiatrists, visiting specialists (internist, pediatrician, etc.) and a full administrative team

 ◦ Our community has chronic illness Hastings and Prince Edward County      Obese or overweight Diabetes Asthma High blood pressure 56.5% (88 140) 8.0% (12 480) 6.1% ( 9 520) 19.4% (30 260) State Health Status very good or excellent 53.5% (83 460) South East sub-LHIN mapping March 2009

 ◦ ◦ ◦ ◦ ◦ Residents are living on a low income Belleville Prince Edward Central Hastings North Hastings Quinte West 15.1% (7850) 9.2% (2410) 12.7% (2860) 11.3% (1350) 11.1% (6220) South East sub-LHIN mapping March 2009

 More that 1.1 million households or 9.2% were food insecure at some point in the previous year (2004)  2.7 million Canadians or 8.8% lived in food insecure households in 2004 Canadian Community Health Survey Cycle 2.2, Nutrition, 2004

 High stress increases levels of a hormone called cortisol in the body  Cortisol can increase blood pressure, insulin resistance and cholesterol

  ◦ ◦ ◦ ◦ Household food insecurity is associated with the consumption of poorer quality diets Nutrient inadequacies were noted for: Protein (found in all cells and is required for growth and development) Vitamin A (required for retinal development and cell growth, particularly epithelial) Thiamin (required for cell processes such as breakdown of sugars and amino acids) Riboflavin (required for processes of energy metabolism) Kirkpatrick SI. et al, Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents , 2008

◦ ◦ ◦ ◦ ◦ Vitamin B6 (required for metabolism of amino acids and release of sugars in the body) Vitamin B12 (required for metabolism and DNA synthesis) Magnesium (required for nerve processes and blood vessel regulation) Phosphorus (required for development of cell membranes and is a component of DNA) Zinc (requiring in many bodily processes and deficiency can lead to growth retardation, delayed sexual maturation, infection susceptibility, and diarrhea) Kirkpatrick SI. et al, Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents , 2008

 An analysis of the American National Health and Nutrition Examination Study was completed to determine the association between food security and risk for overweight or obesity  Overweight is BMI ≥85%ile and obese is BMI ≥95%ile. Casey PH. et al . The association of child and household food insecurity with childhood overweight status , 2006

 ◦ ◦ ◦ Children in food insecure households were more likely to demonstrate significant associations with being at risk in the following groups; 12-17 year old Girls White Casey PH. et al . The association of child and household food insecurity with childhood overweight status , 2006

   ◦ ◦ Food insecure children have also been shown to have lower cognitive and academic performance Lower arithmetic scores More likely to have repeated a grade Living in low income households increases risk throughout adulthood If living in food secure households as an adult risk decreases but is still higher than those who have never experienced food insecurity Position of the American Dietetic Association: Food insecurity and hunger in the United States, 2006

   In an analysis of the1997 National Population Health Survey individuals in food-insufficient households were more likely to report heart disease, diabetes, high blood pressure and food allergies All of these disease are in some part controlled or prevented by dietary modifications Quantity vs. Quality!

Vozoris NT. et al 2003 . Household food insufficiency is associated with poorer health ,

  Our food choices play a significant role in the prevention and management of chronic diseases. To maintain calories on a low income foods that are chosen often are low cost, energy dense and nutritionally poor foods (refined carbohydrates with added sugars, fats and sodium) Seilgman HK. et al. 2010 Hunger and socioeconomic disparities in chronic disease ,

 ◦ ◦ ◦ ◦ Between 1985 and 2000 prices have increased disproportionately Soft drinks 20% Fats and oils 35% Sweets 46% Fresh fruits and vegetables 118% Seilgman HK. et al. 2010 Hunger and socioeconomic disparities in chronic disease ,

   Women living on a low income are 40-50% more likely to develop diabetes Adults with diabetes are 40% more likely to achieve poor glycemic control due to cyclic eating and poor food choices Adults with diabetes who experience food insecurity have 5 more physician encounters per year than their counterparts ($$) Seilgman HK. et al. 2010 Hunger and socioeconomic disparities in chronic disease ,

 ◦ An analysis of the National Population Health Survey and the Canadian Community Health Survey examined the following trends from 1994-2005: Heart disease     27% increase in lowest income category 37% increase in lower middle income category 12% increase in upper middle income category 6% increase in highest income category Lee DS. et al. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors , 2009

◦ ◦     Diabetes    56% increase in lowest income category 93% increase in lower middle income category 59% increase in upper middle income category  0% increase in highest income category Hypertension 85% increase in lowest income category 80% increase in lower middle income category 80% increase in upper middle income category 117% increase in highest income category Lee DS. et al. Trends in risk factors for cardiovascular disease in Canada: temporal, socio-demographic and geographic factors , 2009

 ◦ ◦ ◦ ◦ ◦ Food insecurity has been connected with mental health conditions Depression, particularly maternal depression Suspension from school Difficulty getting along with others in school and the workplace Need of counselling by a psychologist/psychiatrist Increased risk of suicide Position of the American Dietetic Association: Food insecurity and hunger in the United States, 2006

 ◦ ◦ When meeting with/counselling people with a chronic disease we need to address these issues 72% of people with diabetes on social assistance state that they lack the resources to eat the way the have been taught at their diabetes education centre Encourage the Special diet allowance, Special necessities supplement, Monitoring for health, Trillium drug benefits, etc.

 ◦ Encourage low-cost preventative health care Active lifestyles, regular visits with PCP, community services (community kitchens, education groups, etc)