Death Lurks in an Empty Cupboard

[Editor's note: This is the second of two features on food security in Vancouver's Downtown Eastside. Yesterday we visited the nutrition-conscious chef of the Carnegie Kitchen.]

Why, in a country as wealthy as Canada, are people going hungry? When Dr. Graham Riches first looked into the issue of "food insecurity" in the early 1980s, he was interested in that question. Nearly three decades later, Riches, emeritus professor of social work at the University of British Columbia, is still trying to find the answer.

This much hasn't changed: For millions of low-income Canadians, finding -- and affording -- nutritious food is a daily battle.

And more and more, charities are expected to meet the need.

"What we've seen is the growth of public acceptance in Canada, that hunger is an issue for charity and not a matter of right," explains Riches. "It's complicated because obviously there are hungry people and there's a moral right to feed the hungry, but rights are also political, rights are also legal."

Most Canadians have plenty of healthy food to eat. In fact, Canada is one of the world's largest food exporters. Yet the HungerCount survey of food banks found 2.7 million Canadians -- more than the population of Metro Vancouver -- experienced food insecurity at some point during 2008.

In any given month, over 700,000 people, nearly 80,000 of them British Columbians, turn to food banks, and over three million meals are served in soup kitchens, emergency shelters and meal programs across the country.

Riches, who has spent much of his career pushing for the adoption of a rights-based approach to food security, says the proliferation of charitable food services in Vancouver's Downtown Eastside is a strong indication that the right to food is not being upheld in Canada.

"If you go to the Downtown Eastside," he says, "one of the most striking things is that there isn't really a normally functioning food economy like most of us participate in. It's what we call a food desert; there are no grocery stores and the local food economy is really made up of charitable food."

Riches and others see a dark irony in this. By taking on the growing task of feeding the hungry, they say, charitable food providers unwittingly have helped undermine the right to adequate food in Canada -- a right enshrined in a UN covenant ratified by Canada.

Riches says we're not living up to that agreement as a nation. And as a result, people may be dying in Vancouver. "You go into the Downtown Eastside and think, 'Oh, it's the drugs that are killing everyone.' Well what if it's not the drugs? What if it's the poor diet day after day after day that's slowly killing people? No doctor will sign that on the death certificate but maybe that's what's happening."

Addicted and on her own

When Stephanie walks through the door of The Lookout Emergency Aid Society on a rainy Thursday morning, it's as if a tornado has just spun in. "I'm getting the fuck out of here and moving in with my sister," she announces, looking around the room manically and rocking from foot to foot. I'm sitting with two outreach workers in the cramped office of Lookout's emergency shelter on Alexander Street, where three desks have been crammed into a space the size of a walk-in closet. Stacks of beige file folders haphazardly climb the walls.

The Lookout is just one of the 50 or so charitable organizations tending to the Downtown Eastside's ailing population. Life expectancy here is five to 10 years lower than the city's average -- for women and men respectively, and residents are considered senior citizens at 45. As a result of widespread deinstitutionalization beginning in the 1980s and steadily gaining momentum ever since, mental illness is prevalent throughout the neighbourhood, and addiction and infectious disease continue to plague a community where several thousand, including Stephanie, live with HIV and Hepatitis C.

Stephanie's hair is a short, muddy brown, and her blue, wide-set eyes are lined with black eyeliner, now smudged by the rain. Stephanie has agreed to sit and talk with me, but I can tell by the way she's fidgeting in her chair and biting at her chipped nail polish that our conversation is not destined to be a long one.

"I'm on disability for my HIV but it's still not enough money to eat, it's never enough," she says, picking listlessly at a handful of soggy cheezies.

The sores on Stephanie's face indicate possible formication, a common sign of crystal meth addiction. Also known as meth mites, formication is the tingling sensation likened to insects crawling under the skin, causing addicts to scratch themselves raw, which then breaks the skin and produces the familiar ugly, red sores. She is 21 years old.

'You never see a fresh vegetable'

Stephanie grew up in Surrey, but left home as a teen and eventually found herself living on the streets of downtown Vancouver. Like most people in the neighbourhood, Stephanie was drawn to the Downtown Eastside because of its close proximity to most of Vancouver's social services, including its charitable food providers.

For Stephanie, eating means standing in food lines everyday, so like her fellow Downtown Eastsiders, she "shops" around at the various food outlets; wandering from the Dugout on Powell Street for 7 a.m. soup and coffee, to the Harbour Light centre or the Franciscan Sisters of Atonement for lunch, and then the Union Gospel Mission for dinner. It's a well-beaten path between food providers and it certainly gets tiresome.

"I hate waiting," she says, swivelling back and forth in her chair. "And when you finally get your meal there's no nutrition in the food you get; it's just spoiled meat and white bread -- you never see a fresh vegetable."

Stephanie's frustration with poor food quality is something that is consistently echoed by both the recipients and the providers of charitable food alike. Though the food providers fail to keep records, spoiled donations are a common topic of discussion throughout the neighbourhood. The outreach workers at the Lookout shelter, which serves breakfast, lunch and dinner, voiced their concerns over the poor quality of donated food, though they seemed resigned to it.

"Virtually everything we get donated has expired," explained Heidi Klassen, Stephanie's outreach worker. "We'll get called to pick up a donation and the vegetables are literally blue."

Malnourished immune system

As a registered nurse and the director of Education and Care Evaluation at the BC Centre for Excellence in HIV/AIDS, Irene Goldstone argues that with aggressive nutrition, the immune system can support itself longer, postponing the need to start antiretroviral therapy. "We're putting all this money into a pharmaceutical response to HIV without meeting people's most basic needs," she explains. "There is such an emphasis on just getting the pills out to people, but we also need to recognize that the pills don't work if you're hungry."

Goldstone, who also teaches courses to health-care professionals, always includes the vital role played by good nutrition in her HIV course content. "We do this to try and increase awareness and responsiveness to patient needs in light of the realities of the Downtown Eastside," she explains.

Poor nutritional health is one of the major contributors to sickness in low-income neighbourhoods like the Downtown Eastside, and socio-economic status is among the most important factors associated with health disparities in Canada. For Stephanie, an unhealthy diet will soon take its toll. The Hepatitis C, which limits her liver's ability to absorb nutrients, will further rundown her immune system and reduce her body's ability to respond to HIV-related infections. This means increased hospital visits and additional strain on the public purse.

The financial cost is borne by every Canadian who pays taxes. Health-care spending in Canada is roughly $120 billion a year. According to a 2004 study by the Health Disparities Task Group, the poorest 20 per cent of the general public (people like Stephanie) accounts for 31 per cent of health spending on people who aren't institutionalized. That's double the average spent on the richest 20 per cent.

Because a fifth of health-care spending can be attributed to income disparities alone, the study maintains that big savings could be had by raising the health status of low-income Canadians to middle income levels.

Stephanie's HIV and Hep C mean she will undoubtedly incur significant health-care costs in the future. A Simon Fraser University study estimates that each HIV positive person will cost B.C. taxpayers $750,000 in treatment expenses over their lifetime. But good nutrition could go a long way to reduce those costs by keeping her healthy and out of the hospital.

Stephanie tells me she's moving home to Surrey to go back to school and become a youth care counsellor. Then she stands up. "Are we done here?" And without a backward glance she whirls out of the office. An outreach worker suddenly pokes his head in the door: "I hear Stephanie is moving to Surrey again. Are we actually believing her?"

Falling through the cracks

With wispy blonde hair and silver bangles lining her wrists, Ellie Schmidt's smile is casual, but her eyes are searching, daring you to look away. Schmidt is the nutritionist at the Downtown Community Health Centre, a primary care clinic for people in the Downtown Eastside. She tells me about patient she saw earlier that day.

Let's call him John. He is in his early 60s and according to Schmidt, is "falling through the cracks." Though he suffered two heart attacks in the past year, John is only eligible to receive basic income assistance, and according to the provincial government, falls under the "expected to work" category, which requires him to be actively seeking employment.

When the BC Liberals came into power in 2001, the number of people receiving income assistance in the province was already on the decline -- down 29 per cent from 1995. The Campbell government tightened restrictions further. Since 2002, over 107,000 British Columbians have dropped (or been pushed) off welfare rolls, though studies now show that rather than returning to the work force, many of these people have wound up on the streets.

John teeters on the edge of joining those homeless. He pays $450 a month to rent a room in a five-storey SRO with no elevator. With the help of two canes, he makes the slow climb to his fifth-floor room in "excruciating pain," says Schmidt.

For John, the $375 a month that the government provides for his shelter cost doesn't cover his $450 monthly rent, which means he diverts $75 from his $235 support allowance to pay rent each month. John is then left with just $160 for all his other monthly costs, including food.

Payments fall far short

Each year, the Dieticians of Canada estimate the cost of a healthy food basket in British Columbia. In 2007, the last year for which data is available, a man between the ages of 50 and 74 could expect to spend $196.56 a month on groceries, meaning that even if John had access to kitchen facilities in his building (which he doesn't), his $160 in support allowance would not even cover a healthy diet, to say nothing of his other monthly expenses.

Though John lives just a stone's throw away from most of Vancouver's free food outlets, his heart condition makes waiting in food lines impossible. "He's a huge, huge cardiac risk," says Schmidt. "He can barely make it up and down those stairs, he could have a heart attack at any time, and he simply cannot stand in food line-ups because he just can't stand to stand."

John, says Schmidt, "has no money to buy groceries, and even if he did have money he can't cook because he has no access to a kitchen. He's living with severe depression and suicidal ideations, and I would too if I were him."

Though she couldn't do much to help John, Schmidt did talk him through some of his, albeit limited, options. "I encouraged him to apply for disability or persons with multiple barriers, which would help immensely," she explains. "In a year from now he'll be 65 and get a pension, if he can live that long."

Get in line

John's story is a testament to B.C.'s income assistance levels are too low to allow many low-income Canadians to purchase adequate food.

Rich Coleman, the Minister of Housing and Social Development, was unavailable for an interview for this article, but he has made it clear that the province has no plans to raise income assistance rates, telling the Vancouver Sun, "We're the payer of last resort, we're not to be seen as an unemployment insurance program."

Other ministries with power to affect the food budgets of low-income British Columbians were shy about answering my questions as well.

The Ministry of Labour and Citizens Services, which maintains B.C.'s $8 an hour minimum wage despite protests by labour and poverty rights groups, repeatedly brushed off enquiries.

A spokesperson at the Ministry of Health Services told me that any questions related to food security should be directed to the Ministry of Healthy Living and Sport, who in turn told me that their ministry is about health promotion, and that I should call the Attorney General.

At the provincial level of government, the issue of food security for the British Columbia's poorest citizens would seem to be an orphan.

Related Tyee stories:

• Michael Pollan, Garden Fresh
  Interview with In Defense of Food author Michael Pollan.
• Crucible of Poverty (photo essay)
  Duane Prentice spent five years documenting lives in Vancouver's Downtown Eastside. He urges "the courage to see things as they are."
• Downtown Eastside Seeks Foreign Aid
  Vancouver group asks UN to help homeless Canadians.