Ontario Food And Nutrition Strategy Report

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A COMPREHENSIVEEVIDENCE-INFORMEDPLAN FOR HEALTHY FOODAND FOOD SYSTEMSIN ONTARIO

About the Ontario Foodand Nutrition StrategyThe Ontario Food and NutritionStrategy was developed by adedicated group of key actors withthe goal of strengthening Ontario’sfood systems and improving thehealth and well-being of Ontarians.Vision: Productive, equitable andsustainable food systems thatsupport the wholistic health andwell-being of all people in Ontario.Mission: To develop a crossgovernment, multi-stakeholdercoordinated approach to food policydevelopment and a plan for healthyfood and food systems in Ontario.We ValueHealth and well-being: Addressingbroader policy issues that influenceaccess to healthy food, food literacyand food systemsSustainability: Building andsupporting healthy, resilientfood systems and communitiesthroughout OntarioCollaboration: Working acrosssectors to promote evidence-basedcollective action in food and nutrition

Key ActorsAbout this ReportCanadian Cancer SocietyThis report discusses the development of theOntario Food and Nutrition Strategy, as well as itsthree strategic directions and 25 action areas thatare needed to improve the health and well-beingof Ontarians and the province’s food systems.Cancer Care OntarioCanadian Diabetes AssociationCanadian EnvironmentalLaw AssociationChiefs of OntarioDietitians of CanadaHealth Canada, First Nations & InuitHealth Branch, Ontario RegionHeart and Stroke FoundationNishnawbe Aski NationOntario Collaborative Groupon Healthy Eating andPhysical ActivityOntario Federationof AgricultureOntario First Nations IntegratedHealth Strategy Working GroupOntario HomeEconomics AssociationOntario Medical AssociationOntario PublicHealth AssociationOntario Society of NutritionProfessionals in Public HealthOrganic Council of OntarioPublic Health OntarioRyerson UniversitySustain OntarioThe body of this report provides an evidencebased rationale for each of the 25 action areasproposed in the Ontario Food and NutritionStrategy and highlights some of many initiativesoccurring in the field. Definitions agreed upon bythe Ontario Food and Nutrition Strategy Groupcan be found in the glossary.Appendix A lists stakeholders who have beencontinuously involved in the developmentof the Ontario Food and Nutrition Strategyand stakeholders who have been engagedin discussion and meetings throughout thedevelopment process.Appendix B is the Ontario Food and NutritionStrategy Action Plan Framework that wasreleased in 2014 and is supported by therationale in this report.Appendix C provides a list of key requirementsthat would make the implementation of theOntario Food and Nutrition Strategy successful,as identified by the Ontario Food and NutritionStrategy Group in 2014.Appendix D is a summary of evidenceto support each of the 25 action areasdiscussed in the strategy.Toronto Food Policy CouncilUniversity of GuelphUniversity of TorontoUniversity of WaterlooWilfrid Laurier UniversityYork UniversityWWW.SUSTAINONTARIO.COM/WORK/OFNS1

The Ontario Food and Nutrition Strategy calls for healthy,local food in several priority action areas; the intention forthis is to encourage local, municipal and provincial programsand policies to support healthy eating, while driving localeconomic development when possible.2ONTARIO FOOD & NUTRITION STRATEGY

ACKNOWLEDGEMENTSPREPARED BY:Meaghan BoddyLynn RoblinRebecca TruscottCancer Care OntarioCo-Chair Ontario Food and Nutrition Strategy Group;Ontario Public Health Association; Dietitians of CanadaCo-Chair Ontario Food and Nutrition Strategy Group;Cancer Care OntarioThank you to: Jenny Lass of Cancer Care Ontario for copy editing this report;Robin Kang of the Ontario Public Health Association and Tonja Mulder, Brooke Curtis,Shannon Lawler and Meredith Grove of Cancer Care Ontario for the design work.The authors would like to acknowledge the following reviewers who provided commentson earlier versions of the report or sections under specific strategic directions:Christian Farmers Federation of OntarioOntario Home Economics AssociationChatham-Kent Public Health Unit; Ontario Society of NutritionProfessionals in Public HealthCarol Dombrow*Heart & Stroke Foundation of Canada; nutrition consultantJanet HornerGolden Horseshoe Food and Farming Alliance; GreaterToronto Area Agricultural Action Committee; Sustain OntarioBridget KingSudbury & District Health Unit; Greater SudburyFood Policy CouncilMarc LaBerge*Ontario Ministry of Agriculture, Food, and Rural AffairsJanine LunnOntario Federation of AgricultureLisa Mardlin Vandewalle*Community member; registered dietitian; farmerKathy MacphersonGreenbelt FundPhil Mount*Laurier Centre for Sustainable Food Systems; Just FoodPaul NairnOntario Federation of AgricultureKim Ouellette*Niagara Region Public Health; Ontario Society of NutritionProfessionals in Public HealthMichelle RandAboriginal Cancer Control Unit, Cancer Care OntarioAllan RothwellOn behalf of the Ontario Professional Planners InstituteMicah Shearer-KudelFormerly Farm and Food Care CanadaFlorentina G. Stancu-Soare* Canadian Cancer Society, Ontario DivisionLeslie Whittington Carter* Dietitians of CanadaSharon Zeiler*Community memberSuzanne Armstrong*Mary Carver*Lyndsay Davidson*How to cite this document: Ontario Food and Nutrition Strategy Group. Ontario food andnutrition strategy: a comprehensive evidence informed plan for healthy food and food systemsin Ontario. Toronto: Ontario Food and Nutrition Strategy Group; 2017.* These reviewers are also part of the Ontario Food and Nutrition Strategy GroupWWW.SUSTAINONTARIO.COM/WORK/OFNS3

TABLE OF CONTENTSOntario Food &Nutrition StrategyStrategic Direction 2:Food Literacy & Skills06070810122526Executive SummaryIntroductionBackgroundStrategy Framework OverviewKey StatisticsStrategic Direction 1:Healthy Food Access141516182021224Preamble1.1 Increased individual and householdfood security1.2 Increased access to safe, healthy,local and culturally acceptable food incommunities, especially for vulnerablepopulations1.3 Increased use of healthy and local foodby public sector organizations1.4 Increased distribution and promotionof equitably-priced, healthy and local food1.5 Reduced access to high calorie,low-nutrient food, beverages and snacks1.6 Enhanced food access throughmunicipal, regional and communityland use management and planningONTARIO FOOD & NUTRITION STRATEGY27293031Preamble2.1 Increased knowledge, skills and capacityfor all people in Ontario to eat healthythroughout their lives2.2 Increased access to public informationabout healthy eating through retailers andfood service2.3 Restricted advertisement of unhealthyfood, beverages and snacks to children2.4 Increased availability of professionalnutrition services in health, community andwork settings2.5 Enhanced services to identify, referand treat people at early risk of obesityor chronic diseaseStrategic Direction 3:Healthy Food Systems33PreambleFood Production &Economic Development34353.1 Improved economic viability of foodsystems and sustainable livelihoods3.2 Increased protection and use offarmland, forests, waterways and urbanland for food production

3637383.3 Enhanced recruitment and skills buildingto expand the food systems workforce3.4 Increased production of healthy andsafe food3.5 Increased protection and support for farmand food workers, including migrant workers,to ensure health and well-beingFood Systems Excellence& Innovation394041423.6 Increased demand and preference forOntario food products in all markets3.7 Improved regulations, compliance andopportunities for innovation to ensure a safe,environmentally sound, healthy, robust andgrowing food and farming sector3.8 Increased innovative financing for the foodand farming sector3.9 Improved infrastructure and resources tosupport the continued growth of the food andfarming sectorEnvironmental Protection434444453.10 Reduced waste throughout Ontario’sfood systems3.11 Increased use of resilient practicesto protect and conserve land, soil, water andbiodiversity from environmental degradation3.12 Increased sustainability and safetyof fisheries3.13 Improved management of forest andfreshwater food systems to provide asustainable source of food463.14 Increased recognition of and rewardsfor ecosystem goods and services providedby the food chainFinal Words4749ConclusionGlossaryAppendix A5354Ontario Food and Nutrition StrategyStakeholdersAchievements to DateAppendix B56Ontario Food and Nutrition StrategyAction Plan FrameworkAppendix C64Key Requirements for an Ontario Foodand Nutrition StrategyAppendix D677582Healthy Food AccessFood Literacy and SkillsHealthy Food OM/WORK/OFNS5

Central tothe strategyare its goals,which includepromoting thewholistic healthand well-beingof all Ontarians,reducing theburden of obesityand chronicdisease amongOntarians and theOntario healthcare system,strengthening theOntario economyand promotingresiliency ofOntario’s foodsystems.EXECUTIVESUMMARYThe Ontario Food and Nutrition Strategy isan expert and evidence-informed plan forhealthy food and food systems in Ontario.Central to the strategy are its goals, whichinclude promoting the wholistic healthand well-being of all Ontarians, reducingthe burden of obesity and chronic diseaseamong Ontarians and the Ontario healthcaresystem, strengthening the Ontario economyand promoting resiliency of Ontario’s foodsystems. Presently, high rates of chronicdisease and suboptimal diets are prevalentacross the province. Food insecurity isimpacting the health of our most vulnerablepopulations, and communities are strivingto be able to access safe and personallyacceptable nutritious foods produced in asustainable way. Ontario’s food system isalso aiming to grow and improve to betterpreserve, use and protect land, forests andwaterways; more effectively produce foodand handle waste; support training and skillsthroughout the agri-food sector, and ensurefood systems workers have viable livelihoods.To address the complex and interconnectedrelationships between the food systemsand health and well-being, a whole-systemperspective was applied in the developmentof the Ontario Food and NutritionStrategy and resulted in the followingstrategic directions:1) HEALTHY FOOD ACCESSPeople in Ontario have access toand the means to choose and obtainsafe, healthy, local and culturallyacceptable food.6ONTARIO FOOD & NUTRITION STRATEGY2) FOOD LITERACY AND SKILLSPeople in Ontario have the information,knowledge, skills, relationships, capacityand environments to support healthyeating and make healthy choices wherethey live, gather, work, learn and play.3) HEALTHY FOOD SYSTEMSOntario has diverse, healthy andresilient food systems that promotehealth and contribute to an equitableand prosperous economy.Twenty-five priority action areas have beendeveloped to guide work across these threestrategic directions. Together, the proposedaction areas constitute a comprehensiveprovincial food and nutrition strategyframework that was released in October2014. This report provides evidencebased rationales for each of the 25 actionareas, suggests actions to support theirimplementation, and highlights key initiativespresently occurring in the field.In the past few years, Ontario has made anumber of strides in food systems planningthrough the implementation of severalcommunity, organizational and governmentinitiatives. However, there are still many areasthat require improvement in food systemswork. Realizing these important changeswill require everyone, including civil society,to play a role in creating and sustaininghealthy food systems in Ontario. Theimplementation of a coordinated cross-sector,multi-stakeholder food and nutrition strategysupports alignment and collaboration toensure healthy food systems are strengthenedand maintained in Ontario for the health ofpresent and future generations.

INTRODUCTIONONTARIO FOOD AND NUTRITION STRATEGYThe concept of an Ontario Food and Nutrition Strategy was initiated by the OntarioCollaborative Group for Healthy Eating and Physical Activity in 2009 and finalized bythe Ontario Food and Nutrition Strategy Group in 2014.1, 2 Due to the interconnectednature of food systems, a whole-system perspective is critical for creating a healthyand sustainable food environment. Food systems include everything from foodproduction and procurement, to food processing, food distribution, food access, foodconsumption, farmland preservation and stewardship, food skills and education, andwaste management.3 Therefore, the strategy was developed in collaboration with manyexperts and stakeholders representing agriculture, food, health, First Nations, Inuitand Métis communities and organizations, from sectors spanning not-for-profit, publichealth, academia and government. Consultations, discussions, face-to-face meetingsand outreach initiatives were among the many formats used to collaborate acrossOntario (Appendix A). The resulting Ontario Food and Nutrition Strategy Framework is acomprehensive approach to provincial food systems planning; it consists of three strategicdirections encompassing healthy food access, food literacy and skills, and healthy foodsystems (refer to page 12), and 25 action areas (refer to page 13). Suggested actions foreach of the action areas were also part of the framework and have been updatedslightly since their release based on discussions with key informants (Appendix B).2The Ontario Food and Nutrition Strategy is intended to work acrossgovernment, fostering an inter-ministerial and multi-stakeholdercoordinated approach to decision-making around food policy andprogram development. For it to succeed it requires 1) a coordinatedprovincial office and advisory council to address food and nutritionpolicy and programming, 2) a systematic approach to measurement,monitoring and analysis of key indicators and 3) sufficient capacityand resources to support all elements of the strategy (Appendix C).Once implemented, the recommended action areas called for inthe Ontario Food and Nutrition Strategy would promote the wholistichealth and well-being of all people in Ontario, reduce the burden ofchronic disease, and strengthen Ontario food systems and the economy.This report providesrationale and evidence foreach of the 25 priority actionareas recommended to createproductive, equitable andsustainable food systems thatsupport the wholistic health andwell-being of the peopleof Ontario.This report provides rationale and evidence for each of the 25 priority actionareas recommended to create productive, equitable and sustainable food systemsthat support the wholistic health and well-being of the people of Ontario. A literature review,guided by subject matter experts, was conducted for each action area and key supportingreferences were summarized in evidence tables (Appendix D). The evidenced-basedrationales provide a foundation for the strategy and a guide to action in these areas.The report also highlights some of the many initiatives already occurring in the provincethat are working to strengthen the food systems and the well-being of Ontarians.

BACKGROUNDThe Ontario Food and Nutrition Strategy is a plan forhealthy food and food systems in the province. Poornutrition and access barriers to healthy food are importantrisk factors contributing to the alarming health, economicand social burdens of chronic disease in Ontario. Theprovince has seen a rise in the prevalence of childhoodobesity and chronic disease in the population. Chronicdiseases, such as cardiovascular disease, cancer anddiabetes, are the number one killer in Ontario, accountingfor a mortality rate of 79 per cent.4 These conditions havenumerous impacts on the quality of life of individualOntarians, community strength and well-being,and the economy through lost labour and theresulting increased costs on the healthcaresystem. Preventable illnesses, to whichunhealthy eating contributes, make upan estimated 25 per cent of healthcarecosts in Ontario.5 Total healthcare costsare projected to reach 70 per cent of theprovince’s total operating budget by 2022.6Poor nutritionand access barriersto healthy food areimportant risk factorscontributing to thealarming health, economicand social burdens ofBehaviours such as physical activity andhealthy eating can reduce the risk of thesechronic diseasechronic conditions. For example, eating five orin Ontario.more servings of vegetables and fruit a day canreduce the risk of heart disease and stroke by about20 per cent.7 However, only 38 per cent of Ontariansage 12 and over reported that they consumed fruit andvegetables five or more times a day, with females (45per cent) more likely to do so than males (31 per cent).8Furthermore, 45 per cent of children (ages 12 to 17) inCanada report that they consumed fruit or vegetables atleast five times per day9 and 24 per cent of children (agesthree to 17) report drinking soft drinks, fruit drinks or sportdrinks every day,10 indicating a need for a healthier dietthroughout the lifecycle. Complicating matters further,8WWW.SUSTAINONTARIO.COM/WORK/OFNS

The Ontario Food and Nutrition Strategy recognizes that a healthy diet is made upof nutritious foods from all four food groups: vegetables and fruit, grains, milk andalternatives, and meat and alternatives, as well as small amounts of unsaturated fats.As a health indicator, consuming five or more servings of vegetables and fruit perday is associated with improved dietary quality.23 For this reason, this report focusesheavily on vegetable and fruit consumption and production.12.5 per cent of Ontario households are food insecure,meaning they do not have a high enough income topurchase an adequate quantity and quality of foodto lead a healthy life.11 Being food insecure increasesthe risk of chronic disease,12 impacts mental health13, 14and is associated with becoming a high-cost userof healthcare.15, 16 These statistics exemplify the direneed for a cross-cutting, comprehensive approach toimproving well-being.possible, which includes the community; municipality;bio-region; province; or country where the food isconsumed.”20, 22 Promoting local food can supportOntario farm and food system workers, and strengthenthe Ontario economy. Changes towards an optimaldiet based on Canada’s Food Guide could increaseconsumption and demand of fruit and vegetables;cause greater local food production, storage andprocessing; and increase job creation.17Concurrently, attention needs to be focused onOntario’s food systems to ensure that they areproductive, equitable and sustainable for theenvironment and the livelihood of its workers, andto support the health and well-being of all people inOntario. Ontario’s food systems have a large economicimpact, contributing to 63 billion in sales per year17and are the number one employer in the province,providing more than 767,000 jobs.17, 18 Much workhas been done in the agriculture sector to addressfood system concerns. However, more can be doneto preserve and expand this sector for present andfuture generations, including supporting training andrecruitment of food systems workers; job safety andsustainable livelihoods; infrastructure growth andinnovation; environmental protection of land,forests and waterways; and sustainable practices.A whole-system approach is needed to improve thehealth and well-being of Ontarians and support ourfood systems. Programs and initiatives that impactOntario’s food systems are presently offered by severalorganizations and ministries, as well as at various levelsof government, but an overall cohesive food andnutrition strategy for the province is lacking. Improvedlinkages and strengthened multi-sectoral planningthrough the strategy can improve the outcomesof various efforts and lead to a healthier and moreproductive population, as well as lower healthcareand social costs downstream. This strategy suggestsimproving collaboration and coordination aroundshared objectives by investing differently. Throughexisting and new policies and programs, and sharingobjectives and resources, there is potential to realizemore gains and reduce duplication. Working togetherto prioritize actions, address gaps and minimizedisparities will result in healthier food systemsand Ontarians.Many communities and organizations are alreadyworking together at the municipal and regional levelsto improve and strengthen local food systems. Localfood has been defined by the Local Food Act as foodproduced or harvested in Ontario, including forestor freshwater food,19 and by other organizations as"food that has been grown or caught, processed anddistributed as near to the point of consumption asWWW.SUSTAINONTARIO.COM/WORK/OFNS9

ONTARIO FOOD & NUTRITIONSTRATEGY FRAMEWORK OVERVIEWMANDATE To promote wholistic health and well-being To reduce the burden of obesity and chronic diseaseon people in Ontario and the Ontario healthcare system To strengthen the Ontario economy and theresiliency of food systemsMISSION A cross-government, multi-stakeholder coordinatedapproach to food policy development A plan for healthy food and food systems in OntarioVISION Productive, equitable and sustainable foodsystems that support the wholistic health andwell-being of all people in OntarioSTRATEGIC DIRECTIONS:HEALTHY FOOD ACCESSPeople in Ontario have access to and the means tochoose and obtain safe, healthy, local and culturallyacceptable foods.FOOD LITERACY & SKILLSPeople in Ontario have the information, knowledge,skills, relationships, capacity and environment tosupport healthy eating and make healthy choiceswhere they live, gather, work, learn and play.HEALTHY FOOD SYSTEMSOntario has diverse, healthy and resilient foodsystems that promote health and contribute to anequitable and prosperous economy.EXPECTED OUTCOMESIncreased individual, household andcommunity food securityHealthy, local food is available andaccessible in all communitiesIncreased food literacy and food skillsIncreased consumption of healthyand local foodEngaged citizensImproved wholistic health outcomesIncreased demand for and productionof healthy and local foodStrengthened economySafe and resilient food systems10ONTARIO FOOD & NUTRITION STRATEGY

STRATEGIC DIRECTION 1STRATEGIC DIRECTION 2HEALTHY FOOD ACCESSFOOD LITERACY AND SKILLS1.1 Increased individual and household2.1 Increased healthy eating knowledge,1.2 Increased access to safe, healthy, local2.2 Increased access to public informationfood securityskills and capacityand culturally acceptable food1.3 Increased use of healthy, local food bypublic sector organizations1.4 Increased distribution and promotion ofequitably-priced healthy, local foodabout healthy eating through retailersand food services2.3 Restricted advertisement of unhealthyfood and beverages to children2.4 Increased availability of professionalnutrition services1.5 Reduced access to high calorie, lownutrient food, beverages and snacks2.5 Enhanced services for at-risk populations1.6 Enhanced food access through land usemanagement and planningSTRATEGIC DIRECTION 3HEALTHY FOOD SYSTEMSFOOD PRODUCTION ANDECONOMIC DEVELOPMENTFOOD SYSTEMS EXCELLENCEAND INNOVATIONENVIRONMENTALPROTECTION3.1 Improved economic3.6 Increased demand and3.10 Reduced food waste3.11 Increased protection andviability and sustainablelivelihoods3.2 Increased protection anduse of farmland, forests,waterways and urban landfor food production3.3 Enhanced recruitment andskills building to expandfood systems workforce3.4 Increased production ofhealthy and safe food3.5 Increased protection forpreference for Ontariofood in all markets3.7 Improved regulation,compliance andopportunities forinnovation3.8 Increased innovativefinancing3.9 Improved infrastructureand resources tosupport growthconservation of land, soil,water and biodiversity3.12 Increased sustainabilityand safety of fisheries3.13 Improved managementof forest and fresh waterfood systems3.14 Increased recognitionof ecosystem goodsand servicesfarm and food workersWWW.SUSTAINONTARIO.COM/WORK/OFNS11

Lifestyle changesrelated to increasedphysical activity,healthy eating,reduction in highrisk drinking, and theelimination of tobaccouse can prevent 80per cent of heartdisease, stroke andtype 2 diabetes cases.These same factors,in addition to healthypublic policies, canalso prevent half of allcancers in Ontario12KEY STATISTICS In Ontario, 12.5 per cent of households are food insecure, puttingthem at increased risk of chronic health problems.11 Individuals and families who receive support from social assistanceprograms do not have sufficient income to pay for shelter, food andbasic needs.24 Overweight and obesity rates for children, ages two to 17 years,are higher in Ontario (27.5 per cent) than Alberta (21.8 per cent),Quebec (22.6 per cent) and British Columbia (26.4 per cent).25 Chronic diseases, including cancer, cardiovascular disease,chronic respiratory disease and diabetes are the leading causesof death in Ontario.4 The Ontario government spends nearly 50 per cent of the provincialbudget on healthcare to treat those who are already sick, but only0.35 per cent of the current budget is set aside for health promotionto prevent illness and chronic disease.26, 27 Lifestyle changes related to increased physical activity, healthy eating,reduction in high risk drinking, and the elimination of tobacco use canprevent 80 per cent of heart disease, stroke and type 2 diabetes cases.These same factors, in addition to healthy public policies, can alsoprevent half of all cancers in Ontario.28, 29 Food skills and healthy eating are lacking in children and adults alike.30 Vegetable and fruit consumption is an indicator of diet quality; intakeshave been declining and only 38.1 per cent of individuals aged 12years and over in Ontario report consuming vegetables and fruit five ormore times per day.8 The agriculture and agri-food sector is the largest employer inOntario, employing 11 per cent of the work force.17, 18 One-third of the fruit and over 40 per cent of the vegetablesgrown in Canada are produced by Ontario farmers; however,the closing of food processing facilities is resulting in a declinein produce cultivation.31 In the past 20 years, 25,000 Ontario farms have been lost dueto increases in the size of farms and the use of farmland forother purposes.31ONTARIO FOOD & NUTRITION STRATEGY

1STRATEGICDIRECTION

HEALTHYFOODACCESSPEOPLE IN ONTARIO SHOULDHAVE ACCESS TO & THEMEANS TO CHOOSE ANDOBTAIN SAFE, HEALTHY,LOCAL & CULTURALLYACCEPTABLE FOOD.Diet can greatly impact health and wellbeing, yet people in Ontario can face manycomplex barriers in accessing healthyfoods. Addressing these challengesinvolves ensuring that food is economicallyand physically accessible, culturallyacceptable and sustainably sourcedso that long-term food security can beachieved for everyone in the province.Economic constraints prevent manyhouseholds in Ontario from purchasinghealthy, culturally acceptable food,while the food environmentcan provide minimal accessto appropriate healthyfood outlets and foodoptions. Furthermore,sustainable productionand distributionpractices, andland conservationplanning need to beconsidered for longterm access to healthy,local food for presentand future generations.Improving long-term accessto healthy food will require amulti-pronged approach to programsand policies that will address the uniqueneeds of individuals, households andcommunities throughout the province.Diet can greatlyimpact health andwell-being, yetpeople in Ontario canface many complexbarriers in accessinghealthy foods.14ONTARIO FOOD & NUTRITION STRATEGY

ACTIONAREA1.1INCREASED INDIVIDUAL &HOUSEHOLD FOOD SECURITYFood insecurity is defined as "the inability to acquire or consume an adequate dietquality or sufficient quantity of food in socially acceptable ways, or the uncertainty thatone will be able to do so.”32 In 2013, 12.5 per cent of households in Ontario experiencedincome-related food insecurity, with experiences ranging in severity from worryingthat food will run out and not having money to purchase more (marginal), to going awhole day without eating (severe).11 While these data do not include people living onFirst Nations reserves and Crown lands or people who are in the Canadian Forces, the2008/10 First Nations Regional Health Survey found that close to half (47.6 per cent)of First Nations people living on-reserve were moderately to severely food insecure.33First Nations living off-reserve and Métis people also experienced higher rates of foodinsecurity in 2008/10 than the rest of the Ontario population, at 19 per cent and 13 percent respectively.33 These numbers do not include people who experienced marginalfood insecurity, meaning rates of food insecurity are even higher than reported for FirstNations and Métis peoples.The cost of a Nutritious Food Basket, calculated annually by Ontario’s public health units,demonstrates that social assistance rates do not provide adequate support to cover allcosts of living and food. For example, in 2015, the Eastern Ontario Health Unit calculatedthat a family of four receiving Ontario Works would have 391 remaining monthly forall other expenses after rent and food were accounted for; a single person receivingOntario Works would not have any money left over and would need an extra 128 permonth just to pay for both expenses.34 Evidence of this shortfall is demonstrated by the69.5 per cent of social assistance recipients reporting experiences of food insecurity.13While social assistance recipients are particularly vulnerable, 57.5 per cent ofhouseholds in Ontario that are food insecure obtain income from employment, so itis not solely an issue with social assistance rates.11 High costs of living, coupled withinsufficient wages, underemployment, job insecurity and inadequate social assistancesystems, which are worsened by systemic inequality, have contributed to a reality wheremany households have to worry about providing

the Ontario Food and Nutrition Strategy Group can be found in the glossary. Appendix A lists stakeholders who have been continuously involved in the development of the Ontario Food and Nutrition Strategy and stakeholders who have been engaged in discussion and meetings throughout the development process. Appendix B is the Ontario Food and Nutrition

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