In Canada, nearly equal proportions of men and women draw on food banks . Our sample of participants was similar in this regard, with 5 females and 6 males taking part in our follow-up interviews.
Our findings corroborated those of other studies, that reliance on food banks as a long-term resource to help meet one’s basic needs was routine for our participants across different food banks and over time. Food banks were created as emergency short-term responses aimed at helping people cope with financial challenges such as temporary job lay-offs. However, they are habitually utilized as long-term resources by individuals with inadequate income to meet their fundamental household needs . One of the participants (#4) in our study voiced this contradiction during her interview: “it's an emergency only food bank, I can only go once a month” – even though, like the other participants, she had relied on the food bank since the start of the 18-month study.
The prevalence of long-term food bank access by the interview participants was also consistent with the results of our parallel quantitative study, which found that 63.8% of the 271 participants at the 18-month endpoint reported either moderate or severe food insecurity, compared to 73.0% of the 401 participants at baseline . The serious extent of food insecurity after 18 months of receiving food assistance helps to understand the need to continue to rely on food banks, as was the case for most of our interview participants.
Similarities as well as differences can be noted in comparing the current 18-month follow-up study to the previous 6-month follow-up. For example, at the 6-month time point, participants reported the associated stress of living with a low-income and not being able to afford a cup of coffee, bus fare, and struggling to cope with restricted social/recreational activities due to inadequate income, which was corroborated in our findings at the 18-month time point. We found evidence of participants subsisting with the hardships linked to a limited income, especially when there were children in the home. There were several instances reported of mothers forfeiting meals or struggling to stretch the food received from the food bank to make it go further. This is consistent with other findings  that show that mothers in food-insecure households often forgo their meals so that their children can have more.
In addition to the stress of financial constraints, several of the participants described negative psychosocial impacts of having to rely on food banks, which people in food secure populations would not encounter. Frustration was often reported, resulting from long wait times, inconsistent proof-of-identity requirements, unavailability of diet-specific food items, and food running out before the participant’s turn came up. Our previous findings at the 6-month time point described instances of people acquiring food that either did not meet their dietary needs or had passed the best-before date . Our results at the 18-month follow-up supported this finding with participant accounts of receiving food that was close to the best-before date which had to be consumed the same day. Perhaps even more serious were the participants’ perceptions that they received unwanted food – and even to get the unwanted food, the recipients had to compete by showing up at the food bank early. Van der Horst et al. noted that the “compulsory gratitude” can also feel degrading, even when recipients are able to obtain food they need . Thus, despite all the valuable and commendable work that food banks accomplish, the people who need to rely on them over the long-term may come to feel that they belong to a social class that is less deserving than the general population.
Paralleling the results of the 6-month time point of our previous study, in which 19 out of 20 participants were continuing to rely on food banks to augment their limited income, our current results found 10 out of 11 participants in a similar situation. One difference noteworthy in our results at the 18-month time point was a slight improvement in the amounts of fruits and vegetables offered at some food banks, although the frustrations associated with long line-ups and protracted wait times were reported at both six months and eighteen months.
Since prior research on the lived experiences of regular and long-term use of food banks is scarce, our findings contribute new evidence attesting to the struggles that people face in trying to augment their food supply on a limited budget. A 25-year study conducted in Vancouver, Canada  did examine demographic and physical health factors that were correlated with extended food bank reliance, but that study did not look at the lived experiences of the food bank clients. One could describe the Vancouver study as a look “from the outside-in” whereas our study gives a long-term perspective on how food banks work, as seen through the eyes of the people who access food banks. The participants’ unique personal accounts provide poignant glimpses into their experiences of food insecurity and accessing food banks while having to also cope with the presence of chronic health conditions such as diabetes, fibromyalgia, heart disease, osteoarthritis, depression, and anxiety.
Taken together, our findings revealed a common theme of recurring and persistent food bank access at the 18-month time point, with all participants reporting chronic use except one, who had begun to receive his pension. A comparison of the interviews from the 6-month follow-up with this one demonstrates negligible change in food insecurity and food bank access, with little to no reported improvements in health.
Our findings are consistent with previous evidence suggesting that people who rely on food banks have typically experienced prolonged poverty, low incomes, and adverse life events , as well as chronic health issues such as diabetes and heart disease [2,3,4]. In our 18-month follow-up, all eleven participants reported long-standing physical and/or mental health conditions.
As defined above, food insecurity is due to financial constraints, and income has been found to be a strong determinant of health and well-being [2, 30]. Furthermore, health problems due to hunger – an extreme outcome of food insecurity – can develop early in life, as shown by a 10-year study which found that any experiences of hunger in childhood were associated with poorer general health at the endpoint of the study, whereas repeated experiences of hunger were associated with increased risk of chronic diseases . Chronic health problems can also worsen over time among people who experience food insecurity if they are not able to afford the therapeutic diets and medications that are prescribed for their conditions . A large 4-year study found that severe maternal depression increased the likelihood of household food insecurity by 69% . Bi-directional relationships between food insecurity and health may exist and further research is needed to elucidate them. For example, poor health could preclude obtaining or retaining well-paid employment and the cost of treatment could be financially devastating, while conversely, food insecurity could lead to stress-induced compromised health.
The onset of chronic illnesses early in life and the limited ability to self-manage these conditions due to factors related to poverty are likely significant factors in the finding that public healthcare expenses for a severely food-insecure adult in Ontario (Canada’s largest province) are, on average, more than double those of a food secure adult . Tarasuk and colleagues found that, compared to food-secure households, those facing moderate food insecurity incurred 49% higher health care costs, while those who were severely food-insecure incurred 121% higher health care costs . Prior research has suggested that income support programs may be linked with improved health and reduced healthcare costs. For example, a large study in Canada found significant improvements in the self-reported physical and mental health of low-income Canadians after the age of 65 when they started to receive old age pensions . A study conducted in Manitoba found that the number of hospitalizations declined by 8.5% after a five-year guaranteed annual income experiment (MINCOME) .
According to the HungerCount 2018 report from Food Banks Canada, people who report social assistance or disability-related benefits as their main source of income account for 59% of population who rely on food banks . The Food Banks Canada report also describes “a cycle of poverty that is extremely difficult to escape” among people who receive social assistance as their main source of income (p. 21), a problem which was corroborated in our original 6-month study where participants described having to live on a monthly cycle . A mixed-methods study conducted in Vancouver using surveys and focus groups  also found that financial constraints related to insufficient income, when receiving social assistance benefits as the primary source of income, combined with rising housing costs and chronic health issues, reinforced the participants’ perception of food banks as a resource they would need to rely on over the long term.
Based on the results of this 18-month follow-up study and those of other larger studies, it is evident that the current systems of food banks cannot provide a reliable and adequate supply of food to meet the long-term nutritional needs of food-insecure Canadians. This finding highlights the need for programs that target long-term food insecurity and its underlying causes, including poverty.
The present study was restricted to people who accessed food banks in Ottawa, Ontario, Canada. As a result, the findings may not be generalizable to people who access food banks in other geographic regions.
Because we were only able to contact 11 of the original 29 participants from the baseline point of our previous study, the small sample size in this 18-month follow-up may limit the completeness of our findings; that is, other important themes may have emerged if more participants had been interviewed. As such, the small sample size prevented checking for data saturation (when additional interviews no longer yield substantial new information).
The high rate of attrition in itself may suggest a high degree of housing instability among people who rely on food banks, and this potentially raises further concerns for their well-being. Further research on food insecurity and housing stability may be very helpful.