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Defining Food Insecurity
Having access to sufficient and nutritious food is critical for an individual’s optimal growth and development.
In the US, however, 10.5% of households have experienced food insecurity in 2020. Food insecurity is defined as limited access to adequate food due to a lack of money and other resources [1].
For 2021, Feeding America estimates that 42 million people (1 in 8), including 13 million children (1 in 6), may be food insecure at some time during the year [2].
Food insecurity in the US has been measured by the Department of Agriculture (USDA) in the Food Security Supplement of the Census Bureau’s Current Population Survey (CPS-FSS) since 1995. The CPS survey includes approximately 50,000 households that are asked questions regarding their concerns about having enough food, the need to reduce or skip meals, financial hardship, and the impact on children. Example questions include [1]:
• “We worried whether our food would run out before we got money to buy more.” Was that often, sometimes, or never true for you in the last 12 months?
• “We couldn’t afford to eat balanced meals.” Was that often, sometimes, or never true for you in the last 12 months?
• In the last 12 months, did you ever eat less than you felt you should because there wasn’t enough money for food? (Yes/No)
• “The children were not eating enough because we just couldn’t afford enough food.” Was that often, sometimes, or never true for you in the last 12 months?
The information collected by this survey determines the level at which a household is food secure or food insecure. Households can be categorized as the following [3]:
Food Secure
• High Food Security
Households had no problems, or anxiety about, consistently accessing adequate food.
• Marginal Food Security
Households had problems or anxiety at times about accessing adequate food, but the quality, variety, and quantity of their food were not substantially reduced.
Food Insecure
• Low Food Security
Households reduced the quality, variety, and desirability of their diets, but the quantity of food intake and normal eating patterns were not substantially disrupted.
• Very Low Food Security
At times during the year, eating patterns of one or more household members were disrupted and food intake reduced because the household lacked money or other resources for food.
Of the 10.5% of US households (13.8 million households) that are food insecure, 3.9% (5.1 million households) had very low food security in 2020 [1].
Communities and Food Insecurity
Food insecurity may affect specific populations to a greater extent than others.
Children have been impacted by food insecurity to a significant extent.
According to the USDA, food insecurity in 2020 was higher among households with children (14.8%) versus the national average (10.5%) [1]. Historically, food insecurity among children has been declining since 2011. The concern, however, is that today’s rates are still almost as high or higher than what was seen ten years prior to the Great Recession [4].
Race and ethnicity disparities have also persisted in regard to food insecurity.
The Urban Institute notes that “since 2001, Black and Latinx households have been twice as likely to experience food insecurity as white households at any given time” [5]. Recent 2020 USDA data also shows that rates of food insecurity were higher among Black, non-Hispanic (21.7%) and Hispanic (17.2%) households compared to the national average (10.5%)[1].
Although rural communities may contribute significantly to the US food supply, many of these areas face increased food insecurity challenges in comparison to urban/metropolitan areas.
The Food Research & Action Center (FRAC) reported that 12.1% of rural households experienced food insecurity versus 10.3% of metropolitan households in 2020 [6]. In addition, although rural areas make up only 63% of counties in the US, they represent 87% of counties with the highest food insecurity [7].
Seniors (aged 60+) may also face food insecurity challenges. They may make trade-offs between food and other necessities such as medical care. Also, many seniors may qualify for food assistance programs, such as Supplemental Nutrition Assistance Program (SNAP). However, only 48% of seniors who are eligible for SNAP are enrolled [8][9].
College students may be affected by food insecurity as well. A national survey conducted in 2019 by Temple University reported that 39% of students at two-or four-year schools had experienced food insecurity in the last 30 days [10].
Additional Complexities and Food Insecurity
Food insecurity is a nuanced and complicated problem that may be influenced by several household and community factors.
Several complex factors that may affect levels of food insecurity include [11]:
• Income
• Employment status
• Disability
• Lack of full-service community grocery stores
• Inadequate transportation (public transit or personal vehicle)
• Significant travel distance to reach affordable and healthy food options and grocery stores
The Covid-19 pandemic has also worsened food insecurity in the US. Covid-19, in addition to impacting global and local supply chains, has also caused an increase in unemployment and income constraints leading to household challenges in accessing sufficient, healthy food. Also, many previously food secure families are now food insecure for the first time [12].
It is also important to note that hunger and food insecurity are not the same, though may be potentially related. The USDA estimates that approximately 38 million Americans have experienced hunger in 2020 - a physical condition that may be caused by food insecurity [13].
Food Insecurity and Health Outcomes
A lack of consistent, nutritious food can lead to detrimental health outcomes for adults and children.
Research has shown that adults who are food insecure may be at a greater risk for several chronic conditions including [14]:
• Diabetes
• Hypertension
• Asthma
• Arthritis
• Chronic bronchitis
• Emphysema
Among food insecure adults aged 50+, these chronic health conditions may be more prevalent and severe, and lead to increased health care costs compared to food secure adults aged 50+ [14].
Research has also shown that children who are food insecure may be at a greater risk for several conditions, including [15]:
• Specific birth defects (e.g. cleft palate, spina bifida)
• Anemia
• Lower nutrient intakes
• Cognitive problems
• Aggression and anxiety
Food insecure children may also have an increased risk of hospitalizations, poorer general health, asthma, behavioral problems, depression, suicide ideation, and worse oral health compared to food secure children [15].
Approaches to Address Food Insecurity
Approaches to alleviate food insecurity focus on improving access, availability and affordability of nutritious foods to families.
Several food assistance programs can be a resource for families (including children and seniors) experiencing food insecurity and include, among others [16]:
• Supplemental Nutrition Assistance Program (SNAP) - the largest federal nutrition assistance program that provides financial support to purchase food
• Women, Infants, and Children (WIC) - provides supplemental foods, health care referrals, and nutrition education for pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to the age of five
• School Lunch Program (NSLP) - provides nutritionally balanced, low-cost or free lunches to children each school day
• Commodity Supplemental Food Program (CSFP) - provides seniors aged 60+ with a monthly food package to improve health
• Food Distribution Program on Indian Reservations (FDPIR) - provides USDA Foods to eligible households living on Indian reservations and to Native American households residing in designated areas near reservations or in Oklahoma
Additional community approaches to support families with food insecurity may include:
• Local food banks
• Mobile pantries
• Farmers markets
• Food rescue programs
• Cooperative grocery stores
• Community gardens
Increasing awareness, advocating for policies and additional research may also help in addressing food insecurity.
Additional Resources
USDA Food Assistance Programs. https://www.nutrition.gov/topics/food-assistance-programs
Centers for Disease Control and Prevention (CDC) Food and Food System Resources During COVID-19 Pandemic. https://www.cdc.gov/nutrition/resources-publications/food-and-food-system-resources-during-covid-19-pandemic.html
USDA Hunger and Food Security. https://www.nal.usda.gov/fnic/hunger-and-food-security
US Department of Veteran’s Affairs Nutrition and Food Services. https://www.nutrition.va.gov/Food_Insecurity.asp
John Hopkins All Children’s Hospital Food Insecurity Assessment. https://www.hopkinsallchildrens.org/Healthy-Weight-Toolkit/Assessments/Food-Insecurity-Assessment
References
1. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh, A. 2021. Household Food Security in the United States in 2020, ERR-298, U.S. Department of Agriculture, Economic Research Service. https://www.ers.usda.gov/webdocs/publications/102076/err-298.pdf?v=9762.9
2. The Impact of the Coronavirus on Food Insecurity in 2020 & 2021. Feeding America. https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf
3. Understand Food Insecurity. Hunger + Health. Feeding America. https://hungerandhealth.feedingamerica.org/understand-food-insecurity/
4. Thomas MMC, Miller DP, Morrissey TW. Pediatrics October 2019, 144 (4) e20190397; DOI: https://doi.org/10.1542/peds.2019-0397 https://pediatrics.aappublications.org/content/144/4/e20190397
5. Feng A, Schwabish J, Spievack N. Racial and Ethnic Disparities in Food Insufficiency Persist during the Pandemic. November 10, 2020. Urban Institute. https://www.urban.org/urban-wire/racial-and-ethnic-disparities-food-insufficiency-persist-during-pandemic
6. Rural Hunger. Food Research & Action Center (FRAC). https://frac.org/hunger-poverty-america/rural-hunger
7. Hunger in Rural Communities. Feeding America. https://www.feedingamerica.org/hunger-in-america/rural-hunger-facts
8. Facts about senior hunger in America. Feeding America. https://www.feedingamerica.org/hunger-in-america/senior-hunger-facts
9. Get the Facts on SNAP and Senior Hunger. National Council on Aging. https://www.ncoa.org/article/get-the-facts-on-snap-and-senior-hunger
10. Baker-Smith C, et al. #RealCollege 2020: Five Years of Evidence on Campus Basic Needs Insecurity. February 2020 revised. The Hope Center for College, Community, and Justice. Temple University. https://hope4college.com/wp-content/uploads/2020/02/2019_RealCollege_Survey_Report.pdf
11. Healthy People 2020 Social Determinants of Health. Office of Disease Prevention and Health Promotion. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/food-insecurity#1
12. Morales DX, Morales SA, Beltran TF. Racial/Ethnic Disparities in Household Food Insecurity During the COVID-19 Pandemic: a Nationally Representative Study. J Racial Ethn Health Disparities. 2020 Oct 14 : 1–15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556612/#__ffn_sectitle
13. Facts about hunger in America. Feeding America. https://www.feedingamerica.org/hunger-in-america
14. Garcia SP, Haddix A, Barnett K. Incremental Health Care Costs Associated With Food Insecurity and Chronic Conditions Among Older Adults. Prev Chronic Dis 2018;15:180058. https://www.cdc.gov/pcd/issues/2018/18_0058.htm
15. Gundersen C and Ziliak JP. Food Insecurity And Health Outcomes. Health Affairs Vol. 34, NO. 11: Food & Health. November 2015. https://www.healthaffairs.org/doi/10.1377/hlthaff.2015.0645
16. USDA Food and Nutrition Service (FNS). FNS Nutrition Programs. https://www.fns.usda.gov/programs
Blog Contributors
Author: Bindu Muttana
Editor: Sophia Galvez
Public Health Scientist: Mercedes Martin
@werise4wellness