Municipal policy options to reduce

childhood food insecurity in Montreal:

A literature review

Holly McGarr
Supervisors: Dr. Anna-Liisa Aunio & Hugo Martorell
The Institute for Health and Social Policy - McGill University
Background

The Montreal Policy on Children

In June 2016, the City of Montreal launched its first Policy on Children entitled, “Being born,
growing up and thriving in Montreal: From childhood to adolescence.” This policy, with a budget
of $25 million over five years, targets five thematic areas: (1) safety and accessibility of urban
environments (2) food security and healthy eating (3) school retention and educational success
(4) access to culture, sports and recreation (5) families and communities.[1] The second area of
intervention established a goal to make healthy nutrition accessible and affordable for all
Montreal children. In the 2017 Action Plan, the City of Montreal stated their target of offering a
daily balanced breakfast to 4,600 children in primary and secondary schools.[1] This literature
review identifies additional policy options beyond the proposed school breakfast program that
the City of Montreal may use to further reduce childhood food insecurity.

The State of Childhood Food Insecurity in Montreal

Montreal has the highest number of low-income neighbourhoods in all of Canada. In 2011, 35.8
% of Canada's low-income neighbourhoods i were located in Montreal, compared to 15.7% and
7.1% for Toronto and Vancouver, respectively.[2] In Greater Montreal, Statistics Canada reported
that in 2015, 16.4% of children under 18 and 37.3% of children in a single-parent family were
living in a low-income situation.[2] Due in large part to a lack of financial resources, approximately
1 in 10 Greater Montreal households experience moderate to severe food insecurity, the highest
proportion of food insecurity ii in Quebec.[2] Many Montreal children depend on food assistance
programs offered by food banks. According to Food Banks Canada, the Montreal region is
noteworthy for having the largest number of beneficiaries of food assistance programs, with
about 150,000 people assisted each month.[2] In 2016, nearly 35,000 children under 18 received
help from food assistance programs each month from Moisson Montréal, Moisson Laval or
Moisson Rive-Sud.[2] However, food assistance programs are not sufficient to make significant
progress towards reducing child food insecurity in Montreal. According to the Quebec Health
Survey of High School Students conducted in 2010–2011, 56% of Montreal high-school students
do not have breakfast before school each morning, and only one-third of students eat the
minimum number of portions of fruits and vegetables recommended by the Canada Food
Guide.[2] The objective of this literature review is to identify the jurisdiction and policy
tools available to the Montreal municipal government that can improve healthy eating and food
security among children.

i Statistics Canada define a low-income neighbourhood as "one in which 30% or more of its residents have low
income," that is, an income below the threshold of the after-tax low-income measure.
ii Food insecurity is defined as consuming food of insufficient quantity or quality.
Table 1: Indicators of Childhood Food Insecurity in Montreal

Date Indicator Value

2016 Population of children under 18 living in Montreal 821,275 children
Percentage of children under 18 living in a low-income
2015 16.4%
situation in Montreal
Percentage of children in a single-parent family living in a low-
2015 37.3%
income situation in Montreal
Montreal high-school students that DO NOT have breakfast
2012 56%
before school each morning
Proportion of Montreal high-school students that DO NOT eat
2011 the minimum number of portions of fruits and vegetables 2/3
recommended by the Canada Food Guide
Percentage of Canada’s disadvantaged neighbourhoods
2011 35.8 %
located in Montréal
Number of children under 18 receiving help from food ~35,000
2016
assistance programs in the Montreal region children/month
Proportion of Greater Montreal households that experience
2012 ~1/10 households
moderate to severe food insecurity

The Role of Municipalities in Addressing Food Insecurity

Food policy can fall within federal, provincial, regional or municipal governments, and as a result,
there is often jurisdictional overlap. However, municipal governments are uniquely positioned to
take action to improve food security because they are the forum for decision-making closest to
citizens and can respond to address concerns. Municipalities have a wide range of jurisdictional
responsibilities that can impact the food and nutrition, including public health, food inspection
activities, nutritional health promotion, zoning, waste management, urban planning, and
economic development.[3] Municipalities are important laboratories for policy innovation
related to nutrition because food security and healthy eating initiatives can be integrated into a
variety of municipal strategies, plans, and policies.[4] While this review discusses strategic and
operational policy options, it is recognized that local governments also have a key role in
encouraging and facilitating community food security programs and services such as urban
agriculture, school food programs and farmers markets.
Strategic Policy Options for Municipalities
A strategic policy option is a coordinated and systematic way to develop a course of action and
direction for policy which typically involves goal setting, determining actions to achieve the goals,
and mobilizing resources to execute the actions. This section identifies three strategic policy
options that municipalities can adopt to help reduce childhood food insecurity: strategic plans
and frameworks, cross-governmental and cross-section collaboration, and strategic funding for
intersectoral action.

Strategic Plans and Frameworks

Definition and Scope

A strategic plan sets out an overall direction for reaching defined goals and objectives and a
monitoring and assessment framework to measure progress. It is a planning tool that establishes
the framework to define policy and programs. Within the planning period, a strategic plan can
also serve to guide the mobilization and allocation of resources towards achieving the desired
results. Strategic plans and frameworks may be developed for use at the federal, provincial, or
municipal level. Below, the best practices for strategic planning related to food insecurity are
categorized into development, implementation, and evaluation.

Development of Strategic Plans

Best Practices

a) Establish Clear Nutrition Targets

• Establish clear intake targets for children for nutrients of concern.

• Establish explicit limits for children on the daily intake of saturated fat, sugar and salt.
• Use nutrition targets as a goal or measure of success for evaluation.
• Consider using data surrounding nutritional targets in the development of strategies and
policies.

b) Establish Priorities to Reduce Inequality

• Identify vulnerable populations or priority groups within strategic plans and frameworks,
 • and specify objectives or targets to reduce inequalities in relation to poverty and
nutrition.

c) Support Evidence-Based Decision Making

• Provide tools or implement specific procedures for employees to support the use of
evidence in the development of strategies and frameworks.
• Use evidence-based models, algorithms, and other evidence-based tools such as nutrition
profile modelling, to guide policy development.
• Stipulate in policies, procedures or guidelines the requirements for the establishment of
a scientific or expert committee to inform policy development.
• Consider the municipal and school-specific context, ideologies, cultures and priorities
when developing strategic plans.

d) Involve Stakeholders

• Coordinate and communicate with stakeholders at all levels, including school personnel,
students, parents or caregivers, health professionals, the non-profit sector and industry.
Coordinating with stakeholders for the development of strategic plans has been shown
to help address policy challenges and facilitate acceptance, adoption and implementation
of policies.[5]
• Consider stakeholder views, concerns, priorities, and decision-making processes when
developing strategic plans.
• Recognize that potential outcomes can benefit different sectors.
• Train staff who have a role in developing strategic plans in engagement strategies for
dealing with stakeholders.
• Ensure that the messaging surrounding the strategic plan is coherent and consistent
across all stakeholders.
• Encourage stakeholders to provide support to maintain the strategic plan or policy as a
priority in the face of competing agendas.

e) Restrict Commercial Influence

• Implement procedures to manage partnerships with private companies or bodies

representing industries.
• Implement procedures to restrict commercial influences on the development of
strategies and policies related to food environments when they have conflicts of interest
with improving population nutrition. These procedures can include policies, guidelines,
codes of conduct or other mechanisms to guide the actions and decision-making of
municipal government employees.
Examples and Resources

In Quebec, there does not exist consistent nutrient criteria for school nutrition standards
concerning fats, salt, sugars and calories per portion size.[6] For example, the Going the Healthy
Route at School Policy Framework [7] offers only general recommendations on how to prioritize
foods of good nutritional value and does not specify food or nutrient targets.

In 2002, Quebec adopted The Act to Combat Poverty and Social Exclusion. Notably, this legislation
was the first of its kind in North America to make the reduction of poverty and social exclusion
an explicit government priority.[8] It provides Quebec with strategic guidelines for implementing
the measures required to reach the Acts objectives concerning poverty and social exclusion.

The Quebec government has supported the creation of regional coalitions or roundtables to
improve cross-sectoral collaboration at the sub-provincial level.[9] The Pan Canadian Joint
Consortium for School Health published a literature review on stakeholder engagement
strategies to improve the development and implementation of school policies.[5]

Research by Atkey et al. [10] identified the lessons learned from the City of Hamilton in the
development, implementation and evaluation of their municipal healthy food and beverage
policy. A number of municipalities from across Canada have collaborated with the authors of this
research to develop a healthy food and beverage policy for their own community.[10]

McKenna [11] identified five policy options to support healthy eating in schools. These evidence-
based policy options can serve as a framework to guide the development of municipal-level
school nutrition policies.

The Quebec government committed to being more transparent and established

www.transparence.gouv.qc.ca, where information can be obtained for all public activities and
meetings with non-governmental actors attended by members of the Executive Council. The “Loi
sur la transparence et l'éthique en matière de lobbyisme” and the “Code de déontologie des
lobbyists” outline what lobbying activities are permitted.[12] Lobbying activity is published at
www.lobby.gouv.qc.ca/servicespublic/consultation/ConsultationCitoyen.aspx.
 Implementation of Strategic Plans

Best Practices

a) Comprehensive Implementation Plan

• Ensure there is a comprehensive, transparent, up-to-date implementation plan linked to

municipal needs and priorities. The implementation plan should include documented
plans with specific actions and interventions.
• Develop implementation plans using evidence to identify best practices and potential
barriers to implementation to may need to be addressed.
• Ensure implementation plans are current and endorsed by the current government.
• Use a collaborative rather than a top-down approach to implementation. Local
stakeholder groups may be more inclined to become involved if implementation
strategies are developed at the district or school level, rather than at the school-district
or provincial level.[12]

b) Strong and Visible Political Support

• Build strong and visible political support for improving food environments, improving
population nutrition, and reducing food insecurity. To be successful in sustaining and
improving the health of their citizens, elected leaders need strong partnerships with
public health officials.[13]
• This support can include statements of intent, election commitments, budget
commitments, established priori
• ties and targets, demonstrations of support in the media, other actions that demonstrate
support for strategic plans and their implementation.
• When necessary, leverage political support to apply pressure in maintaining the
implementation of the strategic plan as a priority.

Examples and Resources

In Quebec, the Framework Policy on Healthy Eating and Active Living, entitled Going the Healthy
Route at School aims to assist schools in creating environments that encourage the adoption and
maintenance of healthy eating habits and physically active lifestyles.[7] This plan included
funding for implementation, an evaluation framework and timeline for implementation, but does
not include a specific implementation plan with dates.

In 2008, the INSPQ published a knowledge synthesis on implementation processes for school
food policies.[14] This synthesis describes success factors and obstacles to implementing school
food policies and describes a systematic approach to implementation, both of which can be used
as a framework to create comprehensive implementation plans.
An article by McKenna [11] identifies barriers to the implementation of school food programs
which include a lack of support, the complexity of guidelines, and a top-down approach
(McKenna, 2010). Another article by McKenna [15] discusses specific issues to consider when
implementing school nutrition policies.

Strong political support can be found in media releases, speeches, pre-election policy papers, bill
introductions, and provincial-level strategic plans. For example, the press release for the
“Politique gouvernementale de prévention en santé” includes endorsement quotes by from five
Ministers, including the Minister of Health and Social Services.[16] The 2017 Action Plan for the
Montreal Policy on Children begins with an endorsement message from the Mayor of Montreal
at the time, Denis Coderre. The current mayor of Montreal, Valerie Plante, has also shown strong
and visible support for this policy with an announcement that the 2018 budget of the action plan
was increased from $1.5 million to $2.1 million.[17]

Monitoring and Evaluation of Strategic Plans

Best Practices

a) Establish Monitoring Systems to Collect Relevant Data

• Establish regular (every five years or less) monitoring systems that can assess the status
of food environments, nutritional intake levels, and progress on reducing health
inequalities. For example, this can include:
o Monitoring food environments against codes, guidelines, standards, or targets;
o Monitoring compliance with food provision policies in schools and early childhood
education settings;
o Monitoring nutritional quality of foods in schools and early childhood education
settings;
o and monitoring childhood nutrition statuses and intakes against specified targets.
• Stratify or separately analyze data for population groups with known health inequalities,
including Indigenous populations and those with low socio-economic status.

b) Evaluate Strategic Plans and Frameworks

• Use a comprehensive evaluation framework to ensure there is sufficient evaluation of the

strategies, plans or programs. This framework should also be used to determine the
depth, method and reporting criteria required for effective evaluation.
• In addition to routinely monitoring the progress of policies and programs, evaluate
strategic plans and frameworks broadly.
Examples and Resources

In 2014, the INSPQ released a monitoring report that examined the nutritional quality of foods
in primary and secondary schools in Québec.[18] A 2016 study examined the proximity of fast
food restaurants to schools in relation to student fast-food consumption using monitoring data
from the Québec Health Survey of High School Students.[19]

In 2017, several community foundations under the coordination of Community Foundations of

Canada published the VitalSigns report which used local Montreal data to compare the situation
of Montreal’s children to that of Canada as a whole.[2] The report provides relevant indicators
and statistics that may be useful for monitoring and evaluating strategic plans.

The evaluation assessment of the Montreal Policy on Children will be developed and carried out
by Interdisciplinary Research on Montréal (CIRM).[1]

Collinset al. [20] argue for an increase in evaluative research on municipal-level food-based
approaches. They argue that widespread support for local-level food-based approaches to
household food insecurity has impeded the critical judgement of these activities and that
comparative research is needed to ensure municipal actions are evidence-based.[20] For
example, research in Toronto by Kirkpatrick & Tarasuk [21] found no indications that the use of
food banks or children’s food programs had any impact on household food security status, which
challenges the presumption that community-based food initiatives are reaching those in need.
Kirkpatrick & Tarasuk argue that public health practitioners must critically examine the programs
they develop to assess theiractuale impact on food-insecure households.[21]

Cross-Governmental and Cross-Sector Collaboration

Definition and Scope

Food security at the community level is a complex issue that includes a broad set of economic
and physical factors, such as the environment and food system, that can impact food access and
food availability.[12] As a result, improving food security requires partnerships and inter-sectoral
cooperation, finding flexible and multidimensional solutions for complex problems, and
community participation.[12] In recognition of this, the United Nations promotes a
comprehensive and inter-sectoral approach to coordinating the development of food security
initiatives.[12]

Collaborative partnerships are typified by meaningful dialogue, transparent decision-

making and collective agreements. This section on cross-governmental and cross-sector
collaboration expands beyond local stakeholder involvement to involve synergies across levels of
government, government departments, and other sectors such as non-governmental
organizations (NGOs), the private sector, and academia. Cross-governmental or cross-
departmental collaboration can include governance structures, committees, working groups,
agreements, shared priorities, targets or objectives, strategic plans or frameworks, collaborative
planning, or consultation processes. Cross-sector collaboration can include groups, forums or
committees, platforms for commitments or agreements, and platforms for open consultations.

Best Practices

Discussed by the Public Health Agency of Canada (PHAC) [22] in more detail, enablers of
successful intersectoral collaboration include the following:

• Create a framework and approach to food security that is conducive to intersectoral

action.
• Emphasize shared values, interests, and objectives among partners and potential
partners.
• Ensure political support and build on positive factors in the policy environment.
• Engage key partners at the very beginning: be inclusive.
• Ensure appropriate horizontal linking across sectors, as well as vertical linking of levels
within sectors.
• Invest in the alliance-building process by working toward consensus at the planning stage.
• Focus on concrete objectives and visible results.
• Ensure leadership, accountability and rewards are shared among partners.
• Build stable teams of people who work well together, with appropriate support systems.
• Develop practical models, tools and mechanisms to support the implementation of
intersectoral action.
• Ensure public participation; educate the public and raise awareness about health
determinants and intersectoral action.

Additional best practices include:

• Develop an action plan to implement policies and initiatives related to cross-

governmental and cross-sector collaboration. Do not incorrectly assume thatmerelyy
having a policy is enough to ensure implementation.
• Use coordination mechanisms across departments and levels of government to ensure
coherence, alignment, and integration of policies that relate to childhood food security.
PHAC identifies such approaches to coordination.[22]
• In strategic plans or frameworks, include a map of the integration and alignment of
multiple policies or programs across governments and across departments.
• Establish formal platforms for interaction between government and the private sector
(for example, the commercial food sector) for the purpose of information sharing and
collaboration. This should include the management and monitoring of private sector
commitments or agreements.
• Use a set of ethical criteria to avoid and manage conflicts of interest.
 • Establish formal platforms for consultations with stakeholders from the NGO sector,
academia, and civil society.
• Strategies for developing successful partnerships with the NGO sector include to:
o Agree on a compelling and unique mission that will best be achieved through
collaborative action versus individuals’ efforts;
o Secure strong and consistent leadership that includes stable resources;
o Draw membership from existing successful alliances;
o And agree to and respect a code of operations while retaining organizational
flexibility.

Examples and Resources

The report “Crossing Sectors: Experiences in Intersectoral Action, Public Policy and Health” by
PHAC is part of the first phase of a Canadian initiative on intersectoral action for health. The
report provides an overview of approaches to intersectoral action, including at the community
level, and can be a useful resource for understanding intersectional collaboration and developing
action plans.[22]

In Quebec, the Government Policy of Prevention in Health (Politique gouvernementale de

prévention en santé) includes inter-ministerial involvement and intersectoral action across 15
departments and agencies from various sectors.[23] The policy identifies the specific contribution
of 15 ministries and government agencies and outlines the decisions to be made in each sector.
The policy implementation is supported by an inter-ministerial action plan for 2017-2021 that
includes a concrete timeline.[23]

The “Table Québecoise pour une saine alimentation” is a group that includes representatives
from over 35 organizations and ministries involved in the promotion of healthy eating. Their goal
is to strengthen the voice of groups who are working towardsthe promotionn, adoption, and
maintenance of healthy eating in Québec.[12]

Quebec governments have supported the creation of regional coalitions or roundtables to

increase cross-sectoral collaboration at the sub-provincial level.[9] For example, the Coalition for
Healthy School Food at Food Secure Canada is a group comprised of over 40 organizations from
across Canada who advocate for a national school food program. Additionally, the Health
Network for Quebec’s Cities, Towns and Villages (RQVVS) is a non-profit organization with 200-
member municipalities. The RQVVS relies on intersectoral partnerships to promote health and
quality of life within Quebec municipalities[24]

Regarding policy sharing across jurisdictions, a number of municipalities from across Canada have
collaborated with the authors of the research article "Stories of Policy Change: City of Hamilton's
Healthy Food and Beverage Policy" to learn how to develop a healthy food and beverage policy
for their own community.[10]
Strategic Funding for Intersectoral Action
Definition and Scope

Sufficient funding for population nutrition is required to create healthy food environments and
to reduce childhood food insecurity. Financial resources can improve food security by supporting
policies and programs, and their related research, monitoring, and evaluation. Additionally,
funding can be used to strategically promote intersectoral collaboration. This section highlights
financial tools and mechanisms that may hold promise in supporting intersectoral action to
reduce childhood food insecurity.

Promising Practices

• Provide financial allocations exclusively for intersectoral action, with clear criteria on
what does or does not constitute intersectoral action. In certain situations, the allocations
can be combined with regulations that provide legal instruments to enforce intersectoral
action.
• Use intersectoral action as a condition of funding to require sectors to work
collaboratively in addressing difficult issues related to food security.
• Use cost-sharing or resource pooling of financial contributions by a range of government
and non-government organizations for a specific population or issue that aligns with the
organizations’ mandates, such as childhood food insecurity.
• Use in-kind arrangements between organizations to contribute non-financial resources
(such a, people, information, expertise, physical space and technology) to support shared
objectives related to improving childhood food security. These agreements can offer
greater flexibility to adapt to the changing needs of intersectoral work in the different
stages of policy development, implementation, and evaluation.[22]
• Provide incentives for joint working. These can include financial incentives, flexible
decision-making, and reduced administrative and reporting burdens.

Examples and Resources

The Government of Canada uses the approach of requiring intersectoral action as a condition of
funding for the Population Health Fund, which provides grants and contributions to advance
policy and program objectives related to children, seniors and other population groups.[22]

In 2007, the “Act to establish the Fund for the promotion of a healthy lifestyle” was established
at the Ministère de la Santé et des Services sociaux to fund activities, programs and projects that
foster healthy eating and physical activity, to promote social norms that encourage a healthy
lifestyle, and to support innovation and the transfer of knowledge.[25]
Operational Policy Options for Municipalities
This section identifies three operational policy options to reduce childhood food insecurity that
relate to the routine functioning and activities of a municipality. These policy options improve
the food environment through urban planning policy, public service venue regulations, and
transportation planning. While it is recognized that local governments have a key role in
encouraging and facilitating community food programs and services such as urban agriculture,
school food programs and farmers markets, this section does not focus on the best practices of
such programs and services.

Create Healthy Food Environments with Urban Planning Policy

Definition and Scope

Municipal governments have the power to implement urban planning policies that support the
availability of healthy foods and limit the availability of unhealthy foods in communities and
commercially. There is consistent evidence that links better access to healthy food in
neighbourhoods to the likelihood of healthier eating, and vice-versa.[4] A recent report by the INSPQ
reported that students attending a school with a fast-food restaurant within 750 metres were
more likely to consume junk food at lunch.[12] In Quebec, 37% of schools have at least one fast
food restaurant within 15 minutes walking distance, and 62% have at least one convenience store
within 15 minutes walking distance.[26] Zoning laws and urban planning policies provide
mechanisms for municipal governments to place limits on the density or placement of fast-food
restaurants and to encourage the availability of outlets selling fresh fruit and vegetables.

Best Practices

• Limit fast food establishments near schools.

• Use tax incentives and other financing mechanisms to attract food businesses to low-
income neighbourhoods and to enhance the number of healthy food vendors.
• Provide subsidies on permits and fees for retail outlets offering healthy food;, for
exampl,,the e ssubsidies can promote the re-stocking of convenience stores with fresh
fruits and vegetables.
• Make requirements for the inclusion of a full-service grocery store part of a development
permit application.
Examples and Resources

The Health Network for Quebec’s Cities, Towns and Villages (RQVVS) includes nearly 200
municipalities representing more than 70% of Quebec’s population. Its mission is to promote and
support the sustainable development of healthy living environments throughout Quebec.[24]
The Quebec public health association (ASPQ) and RQVVS conducted action research in the three
municipalities of Baie-Saint-Paul, Gatineau, and Lavaltrie. This research identified municipal
policy options and best practices to improve the food environment surrounding schools using a
customized approach that includes: analyzing the local situation, identifying support, evaluating
regulatory options, and identifying the procedure for the by-law modification.[26]

PolicyLink published a report titled “Promising Strategic to Improve Access to Fresh, Healthy Food
and Transform Communities” which provides recommendations surrounding four policy options
to increase access to healthy food. These options include developing new grocery stores,
improving small stores, starting and sustaining farmers markets, and connecting local farmers to
low-income consumers.[27]

In 2016, the city council of Montreal’s Saint-Henri neighbourhood unanimously adopted a zoning
change by-law that prevents new restaurants from setting up within 25 metres of an existing one.
The goal was to restrict commercial influence to ensure the food environment includes enough
grocery stores, fruit and vegetable stores, and bakeries for those who live in the area.[28]

Create Healthy Food Environments in Public Service Venues

Definition and Scope

Hospitals, schools and other public service venues such as after-school programs, child care centres,
and recreational facilities can create healthy food environments that include cafeterias and vending
machines. This is supported by clear evidence that shows increasing access to healthy food increases
healthy eating.[4] For example, an evaluation of the BC Healthy Food and Beverage Sales in
Recreational Facilities and Local Government Buildings initiative found that the project provided a
feasible approach to enhancing healthy eating environments in recreation centres.[4]

Best Practices

• Restrict the promotion of unhealthy foods in public service settings.

• Develop and use nutrition guidelines that require vendors to provide healthy food choices
in vending machines located in all publicly funded buildings across the city, including
schools.
 • Connect with other departments to determine how to support existing policies and
initiatives (for example, no bottled water), and take into consideration current vendor
contracts for vending machines and concession stands.
• Ensure buy-in from decision makers such as city managers, recreation boards and facility
managers, industry, and the public when developing and implementing public service
venue initiatives.

Examples and Resources

In British Columbia, the Nutritional Guidelines for Vending Machines in BC Public Buildings
requires that vendors provide healthy food choices in vending machines located in all provincially
funded public buildings across the province. Additionally, the Guidelines for Food and Beverage
Sales in BC Schools requires food and beverages sold in public schools to meet minimum nutrition
standards.[4]

Montreal passed a motion to phase out sugary drinks in city buildings. As contracts are
renegotiated with vendors, sugary drinks, including soda, sports drinks and other sweetened
beverages will be prohibited from being sold in from municipal settings such as libraries, arenas,
and pools.[29]

The Health Choices in the Recreational Setting Toolkit developed by Stay Active Eat Healthy
provides best practices that can be used as a resource for planning, implementing and evaluating
initiatives to create healthy food environments in recreation centres.[30]

Pamphlet 2 of the Quebec Framework Policy on Healthy Eating and Active Living provides
guidelines and evaluation tools to develop healthy vending machines in schools.[31]

Increase Access to Healthy Food with Transportation Planning

Definition and Scope

In many low-income communities, there are limited options to purchase fresh and healthy food.
Studies have consistently shown that there are fewer supermarkets and retail outlets selling
affordable and nutritious food in low-income communities than in wealthier ones.[27]
Inadequate public transportation options can reduce a family’s access to healthy food choices,
especially for those who do not own a car. The lack of access to healthy food options creates
barriers for families to eat well and fuels childhood food insecurity. A Montreal study found that
63.6% of participants who experienced severe food insecurity reported difficulties in accessing
food due to transportation.[32] Improving transportation options to and from food sources using
transportation policies can increase community and family access to healthy foods and reduce
childhood food insecurity.[4]
Best Practices

• Identify areas in need of improved access to grocery stores. For example, data from a
census was used to locate zip codes in California with low income, low vehicle ownership,
and high population density in order to identify potential areas for supermarket shuttle
programs.[33]
• Improve transportation to food retailers in the target areas by creating new bus routes,
increasing service, or re-routing busses.
• Create joint ventures between grocery stores and the municipal government or a local
non-profit to organize and collaboratively fund supermarket shuttle services.
• Fund programs that allow small farmers to transport produce to institutional buyers like
schools and hospitals.
• Update transportation plans to include priorities that focus on improving access to
healthy food retailers.

Examples and Resources

In 2008, Montreal released their first Transportation Plan to improve its citizens’ quality of life
using public transit. This vision of this strategic plan is to “[meet] the transportation needs of all
Montreal residents by providing our community with a high quality of life and ensuring its role as
a prosperous and environmentally friendly economic powerhouse.”[34] However, there is no
mention of increasing access to food retailers for low-income communities within the strategic
plan.

In November 2018, the Thunder Bay and Area Food Strategy launched a pilot program to address
food insecurity affecting students of Lakehead University in Thunder Bay Ontario. Students are
offered a free weekly grocery bus service that takes them from the school campus to two grocery
stores and the Thunder Bay Country Market.[35]

Gottliebet al. identified transportation strategies to improve access to healthy food in their
working paper titled “Homeward Bound: Food-Related Transportation Strategies in Low Income
and Transit Dependent Communities.".[36]

A policy brief by the Center for Food and Justice titled “Transportation and Food: The Importance
of Access” provides policy options to expand transportation opportunities for small farmers.[37]
Conclusion
Approximately one in ten Greater Montreal households experience moderate to severe food
insecurity, the highest proportion of food insecurity in Quebec.[2] In June 2016, the City of
Montreal launched its first Policy on Children which identified healthy eating and food safety as
priorities for intervention.[1] The objective of this literature review was to identify municipal-
level policy options that the City of Montreal can use to reduce childhood food insecurity. This
report identifies best practices of strategic and operational policy options from peer-reviewed
literature and provided relevant examples and resources for support in their use. The strategic
policy options include the development of strategic plans and frameworks, cross-governmental
and cross-section collaboration, and strategic funding for intersectoral action. The operational
policy options identified can help improve the food environment through policy involving urban
planning, public service venues, and transportation planning. In conclusion, municipalities have
an important role in address childhood food insecurity and the policy options identified by this
literature review can help equip the City of Montreal in developing policies to improve childhood
food security.
References
1. City of Montreal. Policy on Children 2017 action plan. 2017. Available from:
http://ville.montreal.qc.ca

2. Vital Signs. Greater Montreal’s Children. 2017. Available from:

https://www.fgmtl.org/en/pdf/vitalsign2017S.pdf

3. Brynne A. Working with local government on food policy: A toolkit for civil society. BC
Food Systems Network; 2018. Available from: https://gateway2.phabc.org/wp-
content/uploads/sites/2/2018/08/Food-Policy-Toolkit-FINAL-1.pdf

4. BC Ministry of Health HASL. Evidence Review: Food Security. 2013. Available from:
https://www.health.gov.bc.ca/library/publications/year/2013/food-security-evidence-
review.pdf

5. Pan Canadian Joint Consortium for School Health. Stakeholder engagement for
improved school policy: development and implementation. Canadian journal of public health.
2010;101 Suppl 2:S20-3.

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