Review of 2021 Census Topics

Australia’s Right to Food Coalition (RtFC) proposes the inclusion of three questions on household food security, to quantify the prevalence and severity of this pertinent public health issue. The one existing question provides an indication of the prevalence while the proposed additional two questions will provide insight into the continuum of experience of food insecurity. Understanding the severity of food insecurity will support targeted action to address the issue.

The wording for the three proposed and validated questions:
QUESTION 1
1a. In the past 12 months was there anytime when (you [or members of your household]) ran out of food and couldn't afford to buy more?
Response options:
Yes
No

1b. If yes how often did this happen?
a. Yes - Once or more a week
b. Yes- Once every 2 weeks
c. Yes- Once a month
d. Yes -Less than once a month

Response options:
A or B or C or D

1c. If yes, when this happened, did (you [or members of your household]) go without food?
Response options:
Yes
No

QUESTION 2
In the last 12 months, we worried whether our food would run out before we got any money to buy more.
Response options:
Often true
Sometimes true
Never true

QUESTION 3
In the last 12 months, the food we bought just didn’t last and we didn’t have money to get more.
Response options:
Often true
Sometimes true
Never true

If only one question can be asked for the sake of space, then we recommend QUESTION 1:
Q1
1a. In the past 12 months was there anytime when (you [or members of your household]) ran out of food and couldn't afford to buy more?

Response options:
Yes
No

1b. If yes how often did this happen?
a. Yes - Once or more a week
b. Yes- Once every 2 weeks
c. Yes- Once a month
d. Yes -Less than once a month

1c. If yes, when this happened, did (you [or members of your household]) go without food?
Response options:
Yes
No

● Food security, as defined by the FAO (2012), exists ‘when all people at all times have physical, social and economic access to food, which is safe and consumed in sufficient quantity and quality to meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and care, allowing for a healthy and active life’1.
● This definition encompasses the four dimensions of food security; utilisation, availability, access and stability. The absence or disruption of any of these dimensions results in food insecurity.
● Food insecurity has negative implications across the lifespan which affect health (obesity, mental illness, malnutrition, chronic diseases) and social (homelessness, social isolation, childhood development, academic performance) outcomes.2 These implications are associated with an economic and public system burden. For example, obesity alone contributes 7% of the total burden of disease in Australia3. In addition, the costs of food insecurity have been reported to be $60 million per annum in Tasmania alone.4
● The Australian Health Survey data (2011-2012) revealed that 4% of our population were experiencing food insecurity, with 1.5% living in a household where someone went without food when they couldn't afford to buy more.5 However, further exploration has revealed prevalence is as high as 36% in recent national research.6
● Given that the influencing factors of obesity and food insecurity are similar,7 improved understanding of food insecurity and potential solutions may also positively impact obesity prevalence.
● Accurate measurement of the prevalence and severity of household food insecurity in Australia is imperative to understand the magnitude of this public health problem, so policy interventions and strategic solutions are appropriately targeted and effective. Further, resulting policies to reduce the prevalence of food insecurity will be economically beneficial.8




1Food and Agriculture Organisation (2012). Coming to terms with technology. http://www.fao.org/docrep/meeting/026/MD776E.pdf
2 Ramsey et al. Food insecurity among adults residing in disadvantaged urban areas: Potential health and dietary consequences. Public Health Nutrition;
2012.
3Australian Institute of Health and Welfare (2017). A picture of overweight and obesity in Australia in 2017. Cat. No. PHE 216. Canberra: AIHW.
4 Healthy Food Access Tasmania. Submission to Healthy Tasmania: 5 year strategic plan. 2016.
5Australian Bureau of Statistics (2013). Australian Health Survey, State and Territory Results 2011-2012. http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/3A04B813D2132333CA257E5F0016080D/$File/australian%20health%20survey-%20nutrition%20-%20state%20and%20territory%20results.pdf
6Butcher, L.M., O’Sullivan, T., Ryan, M.M., Lo, J., Devine, A. (2018). Using a multi-item questionnaire to assess household food security in Australia. Health Promotion Journal of Australia. Early View, 10.1002/hpja.61.
7 Innes-Hughes C, Bowers K, King L, Chapman K, Eden B. (2010). Food security: The what, how, why and where to of food security in NSW. Discussion Paper.
PANORG, Heart Foundation NSW and Cancer Council NSW : Sydney.
8Food And Agricultural Organisation Of The United Nations Household food security and community nutrition. FAO; 2010 Available from:
http://www.fao.org/ag/agn/nutrition/household_en.st

● The Australian Health Survey has included a single-item question on food security for a number of years, ‘In the last 12 months was there any time you have run out of food and not been able to purchase more?’1.
● While helpful, there are limitations to the data obtained from this question in isolation; as it fails to indicate the severity and temporality of the experience of food insecurity. Additionally, this question underestimates the prevalence of food insecurity by approximately 5 percentage points.2
● The inclusion of food security measurement in the Australian Census is imperative to understand the manifestation and severity of food insecurity amongst the population.
● Research has demonstrated food insecurity is more likely to affect specific population groups such as low and middle income groups (20-25%)3, university students (25%)4, Aboriginal and Torres Strait Islander people (24%)5, and refugees (70%)6. Further, people living in rural and remote locations are often at higher risk of food insecurity due to food availability, access issues.7,8
● To date, much food security research has by and large been on the urban population and with small samples. Therefore, a nationally representative survey that includes questions to measure food security is vitally important, in order to improve understanding about how food insecurity impacts at risk population groups.
● Researchers and policy makers require greater insight into the affected population groups and the severity of food insecurity in order to design and implement effective solutions.


1 Australian Bureau of Statistics. National Nutrition and Physical Activity Survey (NNPAS) in the Australian Health Survey 2011-13. 2014; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Key%20Findings~1
2 McKechnie, R., et al., Single-item measure of food insecurity use in National Health Survey may underestimate prevalence in Australia. Australian and New Zealand Journal of Public Health, 2018 Online.
3 Nolan, M., et al., Food insecurity in three socially disadvantaged localities in Sydney, Australia. Health Promotion Journal of Australia, 2006. 17: p. 247-254
4 Roger, H., et al., Student food insecurity: The skeleton in the university closet. Nutrition & Dietetics, 2011. 68(1): p. 27-32.
5Australian Institute of Health and Welfare (2008). Aboriginal and Torres Strait Islander Health Performance Framework 2008 Report, Detailed Analysis, Cat. No. IHW 22.
6 Gallegos, D., P. Ellies, and J. Wright, Still there's no food! Food in a refugee population in Perth, Western Australia. Nutrition & Dietetics, 2008. 65: p. 78-83.
7Murray, S., Ahuja, KDK, Auckland, S., Ball, MJ. (2014). The 2014 Tasmanian Healthy Food Access Basket (FAB) Survey. School of Health Sciences, University of Tasmania.
8Godrich, S.L., Davies, C.R., Darby, J., Devine, A. (2017). What are the determinants of food security among regional and remote Western Australian children? Australian and New Zealand Journal of Public Health; 41; 2; 172-177.

● The proposed questions are sufficient for self-completion in the household, as food security questions have been demonstrated to be appropriate in self-administered surveys.1
● The topic of food security can be collected using these simple questions, with little time required to complete the questions.
● The question wording relates to running out of food, which is likely to be understood by participants.

1Lee, J.S, Jonhson, M.A., Brown, A., Nord, M. (2010). Measuring Food Security Using a Self-Administered Mail Survey Method among Older Georgians Requesting Older Americans Act Nutrition Program: Georgia Advanced Performance Outcomes Measures Project. The Federation of American Societies for Experimental Biology; 24;1.
 

• The proposed food security questions are anticipated to be acceptable, given they are brief.
• Respondents in previous research have participated in surveys enquiring about food security.
• This question has been used in previous Australian surveys, to our knowledge, without incident.1


1 Australian Bureau of Statistics. National Nutrition and Physical Activity Survey (NNPAS) in the Australian Health Survey 2011-13. 2014; Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.007~2011-12~Main%20Features~Key%20Findings~1

 

As the questions are short, and respondents will be able to read and answer the questions quickly, it will not add significantly to respondent burden or the cost of the Census.

As the proposed questions have only dichotomous responses, it is anticipated that these will not present difficulties in coding or interpreting the data collected.

Food prices have risen by about 20% between 2003 and 2010 and the Consumer Price Index (CPI) for food and alcoholic beverages increased by 2.5% in 2012-2013, and 1.9% in 2017-2018, the total CPI remained 0.4% for both periods. This suggests price pressure will continue in the future and policy makers will require data on the impact.

Furthermore the Australian burden of disease has moved from the communicable diseases of the past, to chronic diseases such as Type 2 diabetes and chronic conditions like poor mental health. Food insecure adults are more likely to report back pain, mood/anxiety disorders and have multiple chronic conditions compared to food secure populations. In children experiencing food insecurity, there is evidence of lower fruit and vegetable consumption when compared with food-secure children, and increased risk of truancy from school and developmental delays. There are strong associations between food insecurity and poor adherence to treatment recommendations and care in chronic conditions. In summary, food insecurity is a modifiable risk factor for chronic disease and monitoring over time is essential to identify new vulnerable populations and assess the effects of policy decisions.

 

While information about food insecurity was collected in the Australian Health Survey (2011-12) and Australian Aboriginal and Torres Strait Islander Health Survey ( 2012–13 ), the 2021 census will enable the data to be captured again a decade after the 2011-13 round, and more than two decades since the 1995 National Nutrition Survey.

In addition, the Census data can be linked to mortality records, which provides much more accurate estimates of prevalence and severity in populations known to be at higher risk such as Aboriginal and Torres Strait Islander Australians, the socioeconomically disadvantaged and people experiencing homelessness.