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I thank Tarasuk and colleagues for contributing further evidence to the body of research linking socioeconomic conditions to health outcomes.1 The findings stand out from other studies in this area, which often rely solely on self-reported data.
Although I recognize that the primary aim of the study was to examine the association between household food insecurity status and annual heath care costs, the relationship between higher education level, food security status and health care costs was unexpected and deserving of further discussion.
When the characteristics of the respondents were stratified by food security status, it was surprising to see that, with respect to education level, the highest percentage of participants who were marginally, moderately and severely food insecure had graduated from postsecondary school. For example, among those with severe food insecurity, 44.6 % had graduated from postsecondary school, compared with 25.5% who had graduated from less than secondary school. Because this is not aligned with what is generally known to be true about the social determinants of health, some discussion of this finding may be warranted.
Education is often considered a key indicator of socioeconomic status. It is highly correlated with income, employment security and working conditions, such that higher levels of education help people move up the socioeconomic ladder and allow for better access to societal and economic resources like food.2,3 Although it is recognized that upward of 64% of the Canadian population have postsecondary qualifications, and the majority of the respondents in the study have the same, it is still alarming to see that people with higher education make up the majority of those with food insecurity in the study. They also have higher health care costs than those with only secondary schooling or some postsecondary school. Again, these unexpected observations are interesting and worth further discussion, since they challenge what is generally known to be true.