Today, I had the privilege to be a part of the Town Hall meeting at Vancouver City Hall. We had a great turn out from the public, and an amazing panel of activists from the community and at the stakeholder level. Councillor Andrea Reimer, the President of the BC Federation of Labour Irene Lanzinger, and MLA of Vancouver West End, Spencer Chandra Herbert was there alongside members of the Raise the Rates and Carnegie Community Action Project who live this challenge day after day. It was both heart-wrenching and inspiring. Heart-wrenching to hear the personal stories, and inspiring to see action spring from such difficult situations. It was also incredibly moving to see talk about implementing a poverty reduction plan, to bring the conversation above and beyond raising the rates to discuss grassroot based interventions rather than band-aids, and to include social housing strategies to ensure that living costs be affordable. I want to extend my thanks along with many hugs to those who shared their stories, came out and showed support, as well as the wonderful team of people who organized this movement and invited me to be a part of it. We had a wonderful exchange of personal experiences, reflections the impacts on our society, and ideas on moving forward…
It is my last and final day on the challenge. I started off with the last batch of oats and raisins, heated the other half of my chickpeas and vegetable stew from yesterday and cracked the last of my two eggs on top (had to hold out until after the town hall meeting). We are in the midst of moving, so I was at the new place, we didn’t have any of the cooking utensils brought over yet, so I put the bowl of stew and two cracked eggs into the microwave. It had kind of exploded on me, I got frustrated, but cleaned it up anyways. The eggs were half-cooked so I popped it back in. Sure enough, it made another mess. I did this about three times. You’d think I would have known better by the second time, but the dots just didn’t seem to connect, especially when my hands are a little shaky from being hungry and cold. (And to think, Andrea Reimer shared her story about when her coffee maker broke, she burst to tears as well… not just the frustrations and emotions of being hungry all the time, but that there was no cooking appliance except for the coffee maker. It was the all-purpose pot for cooking Mac’n Cheese or boiling eggs – which, you might imagine, would probably take half an hour to do). By the time the meeting had ended, I had a pounding headache, but I was prepared: 1700h, I had my last quarter of a Quiche in the car.
In the short span of one week, I lost 3 lbs – Total caloric deficit of 3600-5800kcal. I was aiming to eat as healthy as I could with the $18 and prioritized the concepts of including adequate amounts of protein and appropriate carbohydrate throughout the day – which was challenging, and I may not have had it balanced at each meal, but overall daily intake was relatively adequate… Quality is a different question.
No matter how well I know my carbs, trying to carb count is too difficult a task when your mental productivity is reduced. Leaves me dumbfounded to think that some who live this day-to-day requiring insulin to manage their diabetes are asked by myself and my profession to carb count (to choose low glycemic index, complex carbohydrates), include protein at each meal, choose healthy fats, less processed foods, to have half the plate be vegetables, and to space meals 4-6hours apart or have a snack in between if it will be longer. Seems pretty unacheiveable to me, if you ask. So for those reading this in the same profession, we really need to come together and strategies better ways to be more conscious of peoples’ food insecurity and work around those barriers to develop strategies. Otherwise, it really is just a waste of their and our time…Not only that, but I can’t imagine being told to do things that are completley out of my control and never being able to meet those goals – I’d probably never show up at my future appointments.
I tried to include vegetables and dairy when I could and chose unsaturated fats for my cooking and seasoning (salted margarine, as I did not want to spend money on salt when I could purchase food with energy value). When comparing my intake the Canada’s Food Guide, I had consumed 34-45% of my recommended servings of vegetables and fruit, 55-75% of recommended grain intake, met all of the recommended amounts of meat and alternatives and added fat (limiting to 2-3 tablespoons per day), and only a quarter of the dairy alternatives. My plate was definitely never half vegetables, and I did not have a single fruit (raisins really shouldn’t count). Clearly, satiety was more of the priority as I was consuming more fats and protein in order to not be consumed by the hunger.
I assure you, as soon as today is over… I’ll probably go on a bit of a binge. Loads of fruit – which I had none of in the past week – cheesecake, and warm chocolate chip cookies with a side of ice cream. A splurge. I suspect that this is not uncommon when welfare cheques are distributed. At that point, mindful eating and healthy food choices is the last on my mind. Anything that would make me feel satisfied (probably more, if I could afford it)….
With restrictive dieting, we know that the body responds to the caloric deficit with multiple physiologic changes to counteract. For one, metabolism slows down. If you ask me, the difference between restrictive dieting and the challenge that many face week after week, is that dieting is a choice; this is not. The choice you get is between affording rent vs food, when there is a job interview, it is between having breakfast to curb the hunger pains or to get a haircut and skip the meals for the next day.
Aside from the iron deficiencies that we may see in hungry children and women, or the early (probably never diagnosed) onset of osteoporosis from a lack of vitamin D and calcium intake, we know that being hungry often precipitates a myriad of nutritional deficiencies leading to poor development and health concerns. We also know that excess body weight along with physical inactivity predisposes heart disease, diabetes, cancer and other chronic diseases. And from what I experienced in the last week, I can truly understand why 7-10 servings of fruits and vegetables, choosing whole grains, to include protein at each meal, and not to forget the 2-3 servings of dairy or alternatives daily, is not a priority – scratch that, is not possible. With all the lethargy that comes with insufficient food intake, forget physical activity. So, not only does lack of sufficient healthy food lead to specific nutrient deficiencies, but this type of hidden hunger also incubates an environment for the development of chronic diseases.
According to the 2015 report on Food Costing in BC (published by the Provincial Health Services Authority), the National Nutritious Food Basket for a family of four is $975, and in Vancouver, rates increase to $1011 (1). Per person, that is 3.5 times more than $18/ week. How do we expect someone to live with dignity and be a contributing member of society when food insecurity enables this kid of a poverty trap? And let’s be honest, $18 is a generous sum: that was without transportation costs and to be living under the roof of an SRO (single room occupancy, with no kitchen or cooking facilities). And what about the 50% of those who apply for income assistance but never receive it? At today’s town hall meeting, Fraser Stewart – a kind soul facing these challenges daily – had mentioned that “those of us with welfare are the lucky ones, we have access to food banks, and many other support services”, but what about those who are trying to raise a family surviving off of part-time work paying minimum wage ($10.85/hour)? He said “those [who do not qualify for welfare or disability assistance] are the ones that have it hard”.
If we want a healthy and productive province, for ourselves and our future generations, we must address these barriers to making healthy choices. We need timely income and disability assistance reform so that more British Columbians can afford sufficient healthy food to meet nutritional needs. Our current system is just not efficient. Take diabetes for example. If not managed well, quality of life dramatically decreases; we have premature death, morbidity and disability as outcomes, as well as eye, neurological, cardiovascular and kidney complications (2). However, managing it requires extensive use of services from a range of healthcare providers – family physicians, endocrinologists, nutritionists, nurses… the list goes on. In fact, the Public Health Agency of Canada’s Economic Burden of Illness Report estimated the cost of diabetes, not including complications, to be $2.5Billion, and that was in 2000. Since then, both prevalence and costs incurred have risen (2). We also know that “out of expenditures on hospitalizations, medications, diagnostic services, physician services and other out-of-hospital health services are higher in a population with diabetes than a without” (2). It goes on to say “reducing the prevalence of risk factors associated with diabetes… would reduce the incidence of type two diabetes, and in turn, it’s associated costs (2),” In other words, it is preventable. I know, not all those on welfare have diabetes or will develop diabetes. However, I will argue that poverty and the financial constraints of depending on today’s welfare rates compounded with rising costs of living are a risk factor. It enables an environment that facilitates a lifestyle predisposing the development of chronic diseases. So why are we spending our resources trying to manage the issue, when we could address it at the root – the risk factors – and prevent the development of the disease in the first place? With that, I quote Canada’s public health agency: “it makes economic sense to invest in effective multi-factorial strategies, early in the course of the disease to improve health outcomes and reduce future health care costs” (2).
I referred to the term: ‘hidden hunger’ throughout this entry because it is not our general conception of malnutrition from hunger, most of us probably have think of that photo from Google Images if we looked up “hunger” – a thin, emaciated child with nothing but skin and bones. Perhaps this is why it makes it easy to pass off and think that our neighbours on the streets are doing fine. However, that is the danger. It makes it too easy for us to look away and pretend the problem does not exist. We need to stop assuming by first impression that someone is well nourished without giving them our time and ears to listen to their stories; to not pass judgement and allow them to disclose their everyday struggles, so that their voices can be heard and be less of a distant unknown. The policy makers need to hear personal experiences and get a glimpse of the reality, speak with those story-tellers in order to identify what strategies are needed to eradicate this poverty trap. Healthcare professionals, we need to change the way we talk to our patients and clients, and withhold judgement to allow an open platform for disclosing this kind of personal information. Neighbours, we need to stop enabling a division between classes and remove stigma from those that are experiencing poverty and treat them as a dignified individual. Today, our streets are becoming more divided: we have those who are asking for money, and those who will do anything to avoid contact and walks to the other side of the street when passing someone who is requesting assistance. Is this the kind of community culture we want?
Food is a human right. Food is fuel. Food is also culture. And what we will do about the insecurity in our neighbourhood defines our community culture. We can no longer afford to turn a blind eye as our neighbours struggle against the physical and mental health effects of insufficient food.
A week ago, I committed to a challenge I did not expect to be this difficult. In the last seven days, I’ve lost three pounds, experienced uncontrollable cravings, and mental and physical exhaustion. I suffered anxiety with rationing my food and when being thrown off schedule when something unplanned popped up. I was hangry more often that I had liked to be and constantly had obsessive thoughts around food. I was not my best self. Became bitter and resented my usual “safe haven” (the grocery stores), because it became a site of inequality and a frustrating reminder of things I could not afford. I became socially excluded and began eating alone even in my own home, because I couldn’t bare the thought of comparing my meal to theirs. I felt guilt and disappointment when I stole a chocolate and cheated my challenge, but my cravings felt no remorse whatsoever. And I was minimally productive, making up names for my colleagues cause I wouldn’t be able to remember them, and often misplacing my valuables. This was just a week: a tip of the iceberg. That is all coming to an end for me soon. However, for the 185,000 people (likely more) or the 35,000 children, the challenge continues indefinitely. I hope that today doesn’t mark the end of the 2015 Welfare Food Challenge, but instead the beginning of a wave of momentum for change. I hope that more people will step forward and share their stories, and those of us who do not live it will open our hearts to listen. I hope that we will have a shift in culture in how we view poverty and recognize that status quo is not okay.
- Provincial Health Services Authority. (2016). Food Costing in BC 2015. Vancouver, B.C.: Provincial Health Services Authority, Population and Public Health Program.
- Public Health Agency of Canada. Diabetes in Canada: Facts and Figures from a public health perspective – Chapter 3 – The health system and economic impact of diabetes, 2011. Ottawa, ON: Public Health Agency of Canada. Accessed October 23, 2016.