Nova Scotia households report among the highest rates of “food insecurity” in the country, according to a Nova Scotia-based study recently published in the Canadian Journal of Public Health. And Halifax had the highest rate among big cities, with one in five households at risk. The Nova Scotia study comes as the percentage of Canadians on minimum wage continues to climb, and amid a North America-wide debate about tying minimum wage to inflation to better address the growing concern around the issue of income inequality. As economists, academics and activists debate the causes and consequences of growing income inequality, the most basic of issues remains the ability to put food on the table – not wieners and macaroni, but nutritious food for optimal health outcomes.

“We often think that if you’re employed full-time you should be able to meet all your basic needs, but our research shows that it’s still a problem,” says Dr. Patricia Williams, the Mount Saint Vincent University professor who co-wrote the report. Kelly, 37, – who doesn’t want her name used – suffers from anxiety and depression, as she struggles daily to provide nutritious food for her kids, scanning for deals on chicken and ground beef, and relying on the monthly food bank. On Thursday night she served her family spaghetti with meat sauce. Friday night was leftovers. Once a week, there is a hot dog and Kraft Dinner night and for another meal she will serve either chicken thighs or legs “because they are the cheapest.”

According to the Nova Scotia study, a single mother with three children in the province, earning the minimum wage, will be nearly $500 in the red every month if she were to purchase nutritional food (that’s after paying for other basic living costs such as rent, heat, hydro). A family of four, meanwhile, with two adults working for minimum wage, would face a monthly deficit of $44.89. The study looked at minimum-wage data from 2002 to 2014, and used the National Nutritious Food Basket, a Health Canada measurement of 67 foods easily found in grocery stores, eaten by most Canadians and considered nutritionally balanced, to cost the food. And it concluded that the “risk of food insecurity is a critical public-health issue for low wage earners.”

Dr. Valerie Tarasuk, a professor at the University of Toronto’s Department of Nutritional Sciences, has done significant research on food insecurity and the consequences for Canadians’ health, and on the health care system. “If we look at any point in time … people exposed to food insecurity are in worse health and they are less able to manage their health problems, so they are absolutely costing the taxpayer money,” she says. “We can see that people who are food-insecure are more likely to report having been diagnosed with a whole range of chronic conditions.”