Date Presented 04/22/2023
Because of inequitable distribution of resources, rates of homelessness and food insecurity continue to rise in high-income countries. We completed a systematic review and meta-aggregation to understand the experiences of food insecurity during and after homelessness in high-income countries. Our findings suggest that food insecurity is a serious occupational issue for individuals who are unhoused and housed after homelessness. Implications from an OT perspective will be discussed.
Primary Author and Speaker: Corinna Easton
Contributing Authors: Abe Oudshoorn, Tracy Smith-Carrier, Cheryl Forchuk, Carrie Anne Marshall
PURPOSE: Rates of homelessness and food insecurity continue to rise in high income countries. While these countries have sufficient resources to address such social issues, income inequality leaves millions of residents across high-income countries deprived of housing (OECD, 2019) and experiencing a high prevalence of food insecurity (Pollard & Booth, 2019). A growing number of occupational therapists’ support individuals who experience homelessness who may also face food insecurity and related occupational issues. Persons who experience homelessness face high rates of food insecurity, which is likely to contribute to the numerous physical and mental health issues they experience. While access to food is a problem for this population, being unhoused can present unique barriers from an occupational perspective. A lack of access to refrigeration, food storage, utensils, and cooking facilities can prevent individuals who experience homelessness from storing and preparing nutritious food. Researchers have evaluated the effectiveness of interventions for improving food security in severely food insecure households and found little success.
METHOD: We conducted a systematic review and meta-aggregation guided by the research question: ‘what is the experience of food security during and following homelessness in high income countries as reported in existing interdisciplinary research?’ This study was designed to capture and consolidate findings of qualitative literature on food insecurity during and following homelessness to guide future research and better inform policies and practice approaches for food insecurity in this population. We used the Joanna Briggs Institute (JBI) methodology for systematic reviews of experience which employs PRISMA guidelines (Moher et al., 2010).
RESULTS: We included 24 studies in our final review, representing 462 participants. We generated four themes in our meta-aggregation: 1) imposed food options as a determinant of health out of my control; 2) obtaining food for survival despite stigma or other consequences; 3) situated within a system that maintains food insecurity; and 4) surviving hardships. Informed by health equity, our findings highlight the nuanced layering of inequities that persons experience during and following homelessness within experiences of food insecurity and the impacts of such experiences that should be considered by clinicians supporting these individuals.
CONCLUSIONS: Our findings highlight food security as an occupational and health equity issue and suggest a need for options that allow individuals during and following homelessness to enact agency in their food choices for their own physical and psychosocial well-being. Previous research has demonstrated the meaning and importance of food and related occupations to persons during experiences of homelessness (Pettinger et al., 2017) and we highlight a need for occupational therapists to consider food insecurity as a relevant issue to practice with persons who experience homelessness. Occupational therapy researchers may consider attending to the impacts of food insecurity on psychosocial well-being and work to identify solutions to mitigate this experience in the lives of this population. Occupational therapy practitioners, have a critical role in advocating for increased food security during and following homelessness within services, and choice in food and how it is accessed. Considering power dynamics related to food security in service provision is key to lessening the oppression faced by this population daily. Policies aimed at addressing food insecurity at a population level, along with funding initiatives that allow for enabling personal choice and healthy food options are needed.
Organization for Economic Cooperation and Development. (2019). Under Pressure: The Squeezed Middle Class. https://www.oecd-ilibrary.org/sites/689afed1-en/index.html?itemId=/content/publication/689afed1-en.
Pollard, C. M., & Booth, S. (2019). Food Insecurity and hunger in rich countries-it is time for action against inequality. International journal of environmental research and public health, 16(10), 1804. https://doi.org/10.3390/ijerph16101804.
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2010). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg, 8(5), 336-341. http://dx.doi.org/10.1016/j.ijsu.2010.02.007.
Pettinger, C., Parsons, J. M., Cunningham, M., Withers, L., D’Aprano, G., Letherby, G., ... Ayres, R. (2017). Engaging homeless individuals in discussion about their food experiences to optimize wellbeing: A pilot study. Health Education Journal, 76(5), 557. https://doi.org/10.1177/0017896917705159.