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2A Food Insecurity

Description | Specific Indicators | Ontario Public Health Standards (OPHS)Corresponding Health Indicator from Statistics Canada and CIHI | Corresponding Indicator(s) from Other Sources  |  Data Sources | Survey Questions | Analysis Check List  |  Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-References to Other Indicators | Cited References | Other References | Changes Made | Acknowledgements


  • Proportion of households that were food insecure in the past 12 months due to lack of money.

Specific Indicators

  • Income-related household food insecurity

Ontario Public Health Standards (OPHS)

The Ontario Public Health Standards (OPHS) establish requirements for the fundamental public health programs and services carried out by boards of health, which include assessment and surveillance, health promotion and policy development, disease and injury prevention, and health protection. The OPHS consist of one Foundational Standard and 13 Program Standards that articulate broad societal goals that result from the activities undertaken by boards of health and many others, including community partners, non-governmental organizations, and governmental bodies. These results have been expressed in terms of two levels of outcomes: societal outcomes and board of health outcomes. Societal outcomes entail changes in health status, organizations, systems, norms, policies, environments, and practices and result from the work of many sectors of society, including boards of health, for the improvement of the overall health of the population. Board of health outcomes are the results of endeavours by boards of health and often focus on changes in awareness, knowledge, attitudes, skills, practices, environments, and policies. Boards of health are accountable for these outcomes. The standards also outline the requirements that boards of health must implement to achieve the stated results.  

Outcomes Related to this Indicator

  • Societal Outcome (Chronic Disease Prevention): An increased proportion of the population lives, works, plays, and learns in healthy environments that contribute to chronic disease prevention.

Assessment and/or Surveillance Requirements Related to this Indicator

  • The board of health shall use population health, determinants of health and health inequities information to assess the needs of the local population, including the identification of populations at risk, to determine those groups that would benefit most from public health programs and services (i.e., priority populations) (Foundational Standard).
  • The board of health shall conduct epidemiological analysis of surveillance the area of healthy eating (Chronic Disease Prevention).

Corresponding Health Indicator from Statistics Canada and CIHI

Corresponding Indicators from Other Sources

  • United States (US) Department of Agriculture
    Household food security status is defined using an 18-item questionnaire. The household food security status categories are different from the Core Indicator, using different thresholds to define three household status situations.  The three status situations from the US Department of Agriculture are: food secure, low food security and very low food security.  Prior to 2006, households with low food security were described as "food insecure without hunger" and households with very low food security were described as "food insecure with hunger."  Changes in these descriptions were made in 2006 at the recommendation of the US Committee on National Statistics.

Data Sources

Numerator & Denominator: Canadian Community Health Survey (CCHS)  
Original source: Statistics Canada
Distributed by:
1. Ontario Ministry of Health and Long-Term Care
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Ontario Ministry of Health and Long-Term Care
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada

Survey Questions

The optional food security module consists of a series of 18 questions that are derived into a variable to indicate whether household members were able to afford the food they needed in the previous 12 months.  The questions range in severity from worrying about running out of food, to children not eating for a whole day.  Ten of the 18 questions are specific to the experiences of adults in the household, or the household in general, while eight are specific to the experiences of children in the household. 

Data Source



Response Categories




Food security

Household Food Security Status - Modified version

Food secure,
Moderately food insecure,
Severely food insecure,
Not stated


May be derived (syntax file available)



2009/10 FSCDHFS2

The derived indicator categorizes three household status situations:

Food Security Status

Category Labels

Category Description

10-Item Adult Food Security Scale

8-Item Child Food Security Scale

Food Secure

no, or one, indication of difficulty with income-related food access
(0 or 1 affirmed responses)

no, or one, indication of difficulty with income-related food access
(0 or 1 affirmed responses)

Food Insecure, Moderate

indication of compromise in quality and/or quantity of food consumed
(2 to 5 affirmed responses)

indication of compromise in quality and/or quantity of food consumed
(2 to 4 affirmed responses)

Food Insecure, Severe

indication of reduced food intake and disrupted eating patterns
(≥6 affirmed responses)

indication of reduced food intake and disrupted eating patterns
(≥5 affirmed responses)

Source: Health Canada, 2007.

Alternative Data Sources

  • none

Analysis Check List


  • The syntax file called "Food Insecurity Status CCHS 2005 (cycle 3.1)" provides syntax for deriving food insecurity status for CCHS 2005 based on the CCHS 2007 Household Food Security Status (HC) derived variable.
  • The categories for ‘Moderately Food Insecure' and ‘Severely Food Insecure' should be grouped together as ‘Food Insecure Households'.  Public health units with sufficient sample size may be able to report these two categories separately. 
  • Beginning in 2007, the entire 24-month sample may be needed by some health units to allow for reporting with ‘Acceptable' CVs, considered for general unrestricted release.  If the sample size still is not sufficient, food secure households could be reported instead of food insecure households.
  • It is recommended that public health units use the Share File provided by the Ministry of Health and Long-Term Care rather than Public Use Microdata File (PUMF) provided by Statistics Canada. The Share File has a slightly smaller sample size because respondents must agree to share their information with the province to be included; however, the share file has more variables and fewer grouped categories within variables. The Share File is a cleaner dataset for Ontario analysis because all variables that were not common content, theme content or optional content for Ontario have been removed.
  • Not applicable respondents should be excluded; however, it is important to understand who these respondents are from the questionnaire skip patterns to be able to describe the relevant population.
  • Users need to consider whether or not to exclude the ‘Refusal, 'Don't Know' and ‘Not Stated' response categories in the denominator. Rates published in most reports, including Statistics Canada's publication Health Reports generally exclude these response categories.  In removing not stated responses from the denominator, the assumption is that the missing values are random, and this is not always the case.  This is particularly important when the proportion in these response categories is high.
  • Since Household Food Security Status is a derived variable, respondents who did not answer any one required question were "not stated".  In CCHS 2007, 3.2% of Ontario respondents were "not stated".
  • Estimates must be appropriately weighted using the household weight (i.e. WTS_SHH) and rounded.
  • Users of the CCHS Ontario Share File must adhere to Statistics Canada's release guidelines for the CCHS data when publishing or releasing data derived from the file in any form. Refer to the appropriate user guide for guidelines for tabulation, analysis and release of data from the CCHS. In general, when calculating the CV from the share file using the bootstrap weights, users should not use or release weighted estimates when the unweighted cell count is below 10. For ratios or proportions, this rule should be applied to the numerator of the ratio.  Statistics Canada uses this approach for the tabular data on their website. When using only the Approximate Sampling Variability (CV) lookup tables for the share file, data may not be released when the unweighted cell count is below 30. This rule should be applied to the numerator for ratios or proportions.  This provides a margin of safety in terms of data quality, given the CV being utilized is only approximate.
  • Before releasing and/or publishing data, users should determine the CV of the rounded weighted estimate and follow the guidelines below: 
    • Acceptable (CV of 0.0 - 16.5) Estimates can be considered for general unrestricted release. Requires no special notation.
    • Marginal (CV of 16.6 - 33.3) Estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning subsequent users of the high sampling variability associated with the estimates. Such estimates should be identified by the letter E (or in some other similar fashion).
    • Unacceptable (CV greater than 33.3) Statistics Canada recommends not to release estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged with the letter F (or in some other fashion) and the following warning should accompany the estimates: "The user is advised that...(specify the data) not meet Statistics Canada's quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.

Health Region Level Analysis with Household Weights in CCHS

  • Statistics Canada creates household weights for analysis at the provincial level. Therefore, when conducting analyses at the health region level using these weights, only proportions, not counts, should be reported (see Indicator Comments).
    • As noted in the CCHS_Household_Weights.pdf, the last step in creating the CCHS household weight is calibration. Calibration is done using provincial household size counts.  Calibration is done to ensure that the sum of the final weights corresponds to the household estimates defined at the provincial level by household size groups. These groups of interest are defined by the sizes: 1-person household, 2-person household and at least 3-person household. At the same time, the weights are seasonally adjusted to ensure that the each collection period (two-month period) is equally represented within the sample. In terms of geography, all calibration is at the provincial level only.
    • The Statistics Canada demographic division provides population estimates by household size only at the provincial level and not at the health region level. Therefore household weights can only be calibrated at the provincial level and not at the health region level.
    • Since (household) estimates calculated using household weights calibrated at the provincial level are only representative of the population of the province, these estimates may result in increased variability in the estimates and over- or under-representation of households in the health regions. It is therefore recommended that when conducting analyses at the health region level using provincial level household weights only proportions, not counts, should be reported.
  • Because calibration is only done at the provincial level, when we use variables pertaining to households at the health region level, there is a potential problem:
    • If the variable of interest is related to household size – e.g. the more people in a household, the greater likelihood that there is food insecurity – there is a difference between the estimate that comes from a calibrated household weight and the estimate that comes from a non-calibrated weight.  As calibration only occurs at the provincial level and not at the PHU level, the proportions of households estimated at the health region level may not be accurate.
    • If the variable of interest does not relate to household size, it is appropriate to do analysis of proportions at PHU level.
    • E.g. Among the three household size groups (one, two, three or more), the proportion of households which were food insecure was significantly higher in household size = 1 (see 95% confidence intervals highlighted in yellow).  The proportion of households with a size of one was significantly lower than the provincial average in a few health regions.
    • Based on these two observations, the effect of confounding may mask the underlying relationship between household size and food insecurity, and hinder comparison across health regions or over time.
  • For further information, please refer to the CCHS documentation, located in the Data Sources section of the APHEO website.

Method of Calculation

Weighted number of moderately or severely food insecure households

Weighted total number of households
 X 100

Basic Categories

  1. Geographic areas: public health unit

Indicator Comments

  • Income-related food security is an important public health issue in Canada and is a key social determinant of health.  Food security is essential for healthy eating without consistent economic access to sufficient nutritious food, healthy eating cannot be achieved, increasing the risk of poor health.  From a population health perspective, understanding the patterns of food security in Canada over time is critical in developing and evaluating policies and programs.2
  • Statistics Canada reports, at the provincial and health region level, estimates of the numbers and proportions of individuals in households that are food insecure.  They do not report estimates of numbers or proportions of households that are food insecure at the health region level – they do provide this at the provincial level.  In extensive discussions with Statistics Canada personnel, it was resolved that when conducting analyses at the health region level, it is appropriate to calculate estimates of the proportion of households that are food insecure, but not estimates of the numbers of households that are food insecure (see Analysis Checklist: Health Region Level Analysis with Household Weights in CCHS).
  • The Food Insecurity indicator recommended for use here is the same indicator that has been used in Health Canada reports on food security.2  Although there are other indicators available in the CCHS and Rapid Risk Factor Surveillance System (RRFSS) (see table below), Household food security status - Modified Version was selected as the Core Indicator as it is considered to be a better measure of food insecurity by leading experts in the field.

Data Source







Food Insecurity

Flag indicating food insecurity (past 12 mo.)



Only selected by 8 public health units in 2003.


Food Security

Household food security status



Uses U.S. standard method.



Household food security status - Modified Version

May be derived (syntax file available)


Uses Health Canada thresholds to determine household food security status.



FSCDHFS2 2009/10


Food Access and Security

Food insecurity

Derived from FOOD_A1 to FOOD_A3

As selected by health unit

Survey questions are the same as those in CCHS 2000/01 & 2003

Food access

Derived from FOOD_A4_ to FOOD_A6

As selected by health unit

  • As shown in the table, the derived variable for this indicator was included in the CCHS 2007, but not in earlier cycles of the CCHS.  It uses different thresholds to define food insecurity than the U.S. standard method which was included in the Ontario Share File for CCHS 2005.
  • The former method (US standard method) used a threshold of "three or more" affirmative responses to indicate food insecurity.  Research found that this method was overly stringent and that two affirmative responses suggested the presence of some degree of food insecurity.
  • The change to a less conservative threshold was made based on advice from leading experts in nutrition and food security, taking into consideration both the cognitive content of the items and research findings on health, nutrition and child development conditions in households in this marginally secure/insecure range.
  • Even with this less conservative threshold, the small percentage of households that affirmed one item actually may have marginal food security status at the adult, child or household level.
  • The food security questions included in the CCHS since 2004, and the methods used to determine food security status, were adapted from the 18-item U.S. model of food security status levels published by U.S. Department of Agriculture in 2000.3,4
  • The food security module focuses on self-reports of uncertain, insufficient or inadequate food access, availability and utilization due to limited financial resources, and the compromised eating patterns and food consumption that may result.2 The module is not designed to capture other possible reasons for compromised food consumption, for example, voluntary dieting or fasting.2
  • This measure of food security is a household measure, so it does not determine the food security status of each individual member residing in the household.  It cannot be assumed that all members of a household share the same food security status.2
  • Food security was optional content in CCHS 5.1 (2009-2010) and was selected by Ontario.
  • As certain populations at high risk of income-related food insecurity are not included in the survey-for example, the homeless, Aboriginal people living on-reserve and those living in remote and isolated communities-the prevalence of income-related household food insecurity may be underestimated.2
  • In 2007, 8.1% of Ontario households were food insecure (‘Not Stated' responses were excluded from the analysis).


  • Food Security - The Food and Agriculture Organization (FAO) defines food security as "...when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.5"

Cross-References to Other Indicators

Cited References

  1. Statistics Canada. Household food insecurity, 2007-2008. Canadian Community Health Survey. Health Fact Sheet (Catalogue 82-625-X). Available online at: Accessed 2011 Jun 27.
  2. Health Canada.  Office of Nutrition Policy and Promotion, Health Products and Food Branch. Canadian Community Health Survey, Cycle 2.2, Nutrition (2004) - Income-Related Household Food Security in Canada. (Catalogue No. H164-42 / 2007E). Ottawa, Ontario: Health Canada, 2007.
  3. Statistics Canada. Canadian Community Health Survey (CCHS) Cycle 2.2 (2004) Nutrition: General Health File. Master and Share Files Derived Variables Documentation, April 2008.
  4. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised 2000.  Alexandria VA: U.S. Department of Agriculture, Food and Nutrition Service, 2000.  Available online at:
  5. FAO. Rome Declaration on World Food Security and World Food Summit Plan of Action. (Catalogue No. W3613/E). 1998. Available online at:

Other References

  • Vogt J, Tarasuk V. Analysis of Ontario sample in Cycle 2.2 of the Canadian Community Health Survey (2004).  Toronto: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, 2007.  Available online at:

Changes made


Type of Review(Formal or Adhoc)

Changes made by


April 17, 2009


Healthy Eating and Active Living subgroup

The indicator for food insecurity was created, replacing an out-dated indicator which used an older module in the CCHS that is no longer used.

January 4, 2011  FormalHealthy Eating and Active Living subgroupIndicator was revised to reflect recommendations from Statistics Canada regarding health region level analysis of variables pertaining to households.


Lead Authors

Shanna Hoetmer, Regional Municipality of York

Peggy Patterson, Renfrew County and District Health Unit

Fangli Xie, Durham Region Health Department

Jennifer Skinner, Haliburton, Kawartha, Pine Ridge District Health Unit

Elsa Ho, Ontario Ministry of Health and Long-Term Care

Elizabeth Rael, Ontario Ministry of Health Promotion and Sport

Contributing Author(s) 

JoAnn Heale, Ministry of Health and Long-Term Care

Julie Stratton, Region of Peel Public Health

Emma Tucker, Halton Region Health Departmetn

Brenda Wannell, Statistics Canada

Gregory Christ, Statistics Canada

Steven Thomas, Statistics Canada

Sylvain Tremblay, Statistics Canada

Amy Gartner, Ministry of Health Promotion and Sport

Shanna Hoetmer, Regional Municipality of York


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