It would be easy to mistake the new National Food Security Strategy as a plan that will reduce food insecurity in Canada. In launching the initiative in June 2026, Prime Minister Mark Carney declared that it was meant to “address structural causes of food insecurity… particularly [for] the most vulnerable.” While the National Food Security Strategy does include important food systems initiatives, it does not address the root causes of food insecurity nor its health consequences.As food insecurity and health researchers, we join a chorus of concern, particularly stemming from charitable food sector leaders, who stress that we cannot donate our way out of a problem rooted in income inequality. This is despite promises of a generous allocation of funds both through, and complementary to, the strategy for charitable food operations.Food insecurity is a health issueFood insecurity is not the flip side of food security. Food insecurity refers to the inability to afford enough food because of financial constraints. Because the primary cause of food insecurity is insufficient or inadequate income for food, the initiatives to address it do not lie in strengthening the food system, but rather in increasing household income. Food insecurity is therefore an income problem, not a food problem.Food insecurity, when unaddressed, does not threaten only household food access and other material needs; it also becomes a health problem that befalls our already-strained health-care system. Individuals from food-insecure households are more likely to be diagnosed with depression, anxiety and serious chronic conditions, among other health concerns. Our research shows that food insecurity is associated with increased emergency department visits and hospitalizations. Similarly, a Canadian population-based study showed that food-insecure adults are more likely to be admitted to hospital, have longer lengths of stay in hospital and incur $400 to $565 more per person-year in acute care costs compared to food-secure adults.For context, Statistics Canada reported that 24 per cent of households experienced food insecurity in 2025, affecting approximately 9.8 million people. The health-care system has little capacity to absorb this added strain. Emergency departments are already overcrowded and wait times have grown. The demand for emergency services has exceeded the system’s capacity to provide timely, quality care. Conventional initiatives attempting to reduce wait times target hospital capacity but ignore what drives demand — like food insecurity. Food banks can’t address health effectsInitiatives to address food insecurity have fallen primarily to the charitable food sector. For example, HungerCount reported more than two million food bank visits in March 2025, up 99 per cent since March 2019. However, neither charitable food donations nor food system improvements, as proposed by the National Food Security Strategy, will reduce the health effects of a problem rooted in financial constraint. A strategy that prioritizes food insecurity requires at least two things absent from the National Food Security Strategy: addressing income inadequacy and creating measurable targets that hold government accountable for reducing food insecurity. One cited federal initiative that is aimed at addressing income inadequacy is the Canada Groceries and Essentials Benefit. This measure replaced the GST/HST credit in July 2026, offering people with low to modest incomes a refundable tax credit of up to $950 for individuals and $1,890 for households with two children in the 2026-27 benefit year. This type of initiative is a step in the right direction; there is evidence that income supplementation reduces food insecurity for low-income households. However, the Canada Groceries and Essentials Benefit uses the tax system, which creates an access barrier that precludes non-tax-filers, and the amount is too low to address food insecurity risk. While it’s unclear what amount of income supplementation will mitigate food insecurity, existing evidence suggests its effectiveness may increase as the amount of the income supplementation provided grows.Goals and accountabilityA second piece missing from the National Food Security Strategy is accountability. Despite the initiative’s stated aim of addressing the structural causes of food insecurity, none of the key performance indicators relate to food insecurity. Rather, they focus on measures of increased domestic food production and processing, and expansion of retail grocery competition. To ensure that food insecurity initiatives have their intended impact, food insecurity monitoring must continue as it has for two decades, but now targets for food insecurity reduction must be set. Advocates and food insecurity experts have proposed targets that include halving the prevalence of household food insecurity by 2030. The National Food Security Strategy may well have value in strengthening food system resilience and competition. But that’s a different problem than substantially reducing food insecurity. Expanding the strategy to address income inadequacy and adding accountability targets would allow it to deliver on its stated goal of addressing the structural causes of food insecurity among the most vulnerable. In addition to the immediate benefits, the impact could include fewer detrimental health effects associated with food insecurity, and fewer visits to emergency rooms.The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.