Executive Summary
In 2012, 15.898 million children in America (or 21.6 % of children) lived in food insecure households, and more than half of these children experienced food insecurity themselves.33 Until 2007, food insecurity rates in the U.S. were relatively stable, between 15.6% and 17.6%, but the extent of food insecurity increased dramatically in 2008, from 15.8% to 21.0%.34 Despite the end of the Great Recession in June 2009, the prevalence of food insecurity remained at an all‐time high from 2009 to 2012, with the highest rates among households with children, households of persons with disabilities, and racial and ethnic minorities. Despite public, private, and community responses to food insecurity, these disturbing trends suggest that we lack a fundamental understanding of the landscape of factors that influence the rates of food insecurity, rates that ultimately have serious health and economic consequences on millions of Americans. In response to the magnitude and seriousness of the food insecurity problem in the U.S., an extensive food insecurity literature has emerged.34 Understanding and awareness of food insecurity have come a long way in the last two decades, yet questions remain and, to a large degree, we have been unable to translate this extensive research into policy and program design.35
Current and Prospective Scope of Hunger and Food Security in America: A Review of Current Research | ES-1
This report on hunger and food security in America was prepared by RTI International in response to Section 743 of the Consolidated Appropriations Act, 2014 (P.L. 113‐76). During the 11 week project, RTI conducted an extensive literature review and environmental scan of the research conducted on food insecurity from the Great Recession in 2008 to the present time (a detailed description of the methodology may be found in Appendix A). To avoid duplicating previous studies, the report is intentionally brief in its description of the research data on the scope of hunger and food insecurity in the US. Instead, the report seeks to advance the understanding of key determinants, consequences, and responses to food insecurity, establishing a framework that will drive the development of policy and programming recommendations. The duration of this project prevented us from conducting “deeper dives” into a number of areas of interest (e.g., physiological mechanisms connecting key determinants to health outcomes), areas that may require additional study to inform the dialogue on hunger and food insecurity. Nevertheless, we believe that this report will serve as a jumping off point for the National Commission on Hunger, and provide the President, Congress, and the public with a deeper understanding of the myriad risk factors that influence the food security of Americans. It should be noted that the recommendations provided in Section 5 are intended only to capture the major themes that emerged from this report. Over the next year and a half, the bipartisan National Commission on Hunger will be engaged in deliberations leading to the development of policy recommendations that reflect their diverse experience in hunger and food security, and draw on the results of additional studies and analyses that they direct RTI to perform.
The report begins with an Introduction that (1) establishes definitions for hunger, food security, and food insecurity, (2) presents a simplified framework that highlights major themes (e.g., household composition) discussed throughout the report, (3) describes how food insecurity is measured, (4) summarizes research on the current scope of food insecurity in America, and (5) offers some thoughts on the prospective scope of food insecurity in America given the paucity of research on the topic. Key findings presented in this section include:
Food insecurity jumped sharply at the start of the Great Recession in 2008, and remains at historically high levels
Starting in 2008, the prevalence of food insecurity increased quickly to 14.5% (17.6 million households) and has remained around that level through 2012, the most recent year with data available
The most recent assessment of household food security (2012) shows that food security disproportionately affects vulnerable populations, including children, the elderly, minorities, and low‐income households
Twenty percent of U.S. households with children (7.8 million households) experienced food insecurity in 2012; in half of those households, only adults were considered food insecure because adults often shield children from food insecurity
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Food insecurity tends to be episodic; in 2012, a food insecure household was food insecure for an average of 7 months out of the year
Households in certain geographic regions (e.g., the South) and environments (e.g., metropolitan areas) experience higher than average rates of food insecurity
There is very little research on the prospective scope of hunger and food security in America; however, future perturbations of the system (e.g., climate change; economic downturns) may increase the household rates of food insecurity.
Section 2, Key Determinants of Food Insecurity, discusses the “risk factors” for food insecurity that fall into two major categories (1) individual and household characteristics (e.g., socioeconomic status, race and ethnicity, household composition, disability) and (2) contextual factors (e.g., geographic location, food and energy prices, unemployment rates). The section highlights a critical theme in food security research, namely, that food insecurity is a function of the complex interactions among and between multiple risk factors, and that the association between food insecurity and these factors is, at best, incompletely understood. Significant determinants of food insecurity presented in this section include
Prevalence of food insecurity among households with children (20%) is higher than the national average (14.5%)
Low socioeconomic (SES) predicts food insecurity, and income (a key component of SES) consistently correlates with household food insecurity, but does not predict it perfectly
African American, American Indian, and Hispanic households experience food insecurity at higher rates than white, non‐Hispanic households
Economic hardships, including unemployment status and low SES, are key determinants of food insecurity among racial and ethnic minorities
Prevalence of food insecurity among immigrant households is estimated to be nearly twice as high as the prevalence of food insecurity among nonimmigrant households in the United States
Children in households headed by single women are disproportionally affected by food insecurity; approximately half of all households with food insecure children are headed by single women
Households that include persons with disabilities experience higher rates of food insecurity; nearly one‐third of food insecure households include a working‐age adult with a disability
Current and Prospective Scope of Hunger and Food Security in America: A Review of Current Research | ES-3
The relationship between food security and health is often bidirectional—poor health is both an outcome and a risk factor for food insecurity
Increasing energy and food prices have been shown to negatively affect the food security status of households, leading to poor child health outcomes and increased hospitalizations
When neighborhood housing costs are high and exceed a significant portion of the household income, families have higher chances of experiencing food insecurity
Experiencing prolonged unemployment and underemployment can contribute to a “financial cascade” which increases the number of food insecure households that rely on private and/or public food assistance programs.
Section 3, Consequences of Food Insecurity, summarizes research on outcomes that have been shown to be associated with food insecurity, including (1) health, development and education for children, (2) health of adults, (3) economic, (4) workforce, and (5) health care. In the popular media, food insecurity is frequently limited to discussions of child health which, although extremely important in both the near‐term and long‐term, represent only one dimension of the consequences of food insecurity. Thus, this section seeks to broaden awareness of the range and potential severity of the consequences of food insecurity. Some of the important consequences identified in this section include
Studies have shown that poor maternal nutrition during food‐insecure times can lead to a reduced intake of micronutrients, such as calcium, iron, and folate, which are important for fetal development
Children in food‐insecure households are more likely to experience risk of hospitalization, iron deficiency anemia, decreased bone mineral content in boys, and overall fair/poor health
Children experiencing hunger in kindergarten had lower test scores in reading and math by third grade
Once food‐insecure children reach school age, studies have shown that they struggle with mental health issues, lower cognitive development, challenges with peer interactions, and lower grades
Individuals that experience chronic food insecurity have higher prevalence of diabetes, increased inflammation, and cardiovascular disease and higher odds of being obese
In part because of lower and inadequate nutrient intakes, food insecure older adults and seniors, especially those with poor health, can experience declines in health
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Shepard et al. estimated that “hunger costs our nation at least $167.5 billion due to the combination of lost productivity per year, more expensive public education because of the rising costs of poor education outcomes, avoidable health care costs, and the cost of charity to keep families fed”
Food insecurity can increase educational costs because food‐insecure children are more likely to receive special educational services, nearly doubling the education costs relative to children without special needs
Health conditions associated with food insecurity can translate into limited labor force participation and more absenteeism, presenteeism, and turnover—all of which are costly for the employer.
Section 4, Responses to Food Insecurity, describes programs and strategies that have been developed to provide assistance to the food insecure; these include (1) public assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), (2) private assistance programs, commonly referred to as “emergency food providers” that represent, primarily, charitable organizations, and (3) the food environment as defined by the physical structures in the local community such as food stores, restaurants, schools, and worksites. The scope of this report precluded any sort of program evaluation and, therefore, the information presented in this section is intended to promote an understanding of what food “safety net” programs are available. To the extent allowed by published research, this section points out what has worked well, and what has not worked well using household food security status as an outcome. This section describes several innovative strategies developed through different programs, for example
Innovative strategies used in the Supplemental Nutrition Assistance Program (SNAP) include expanding eligibility, increasing benefits, revising asset rules and performing outreach activities
Innovative strategies used in child‐focused programs include expanding eligibility in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), simplifying the application process for school meals, expanding eligibility for school meals, increasing availability of school breakfast, offering universal‐free breakfast, and enhancing summer food benefits
Innovative strategies used by private food providers include creating resource hubs to integrate services and placing food pantries in schools
Innovative strategies used in the food environment include conducting community assessments, promoting community supported agriculture, locating supermarkets in low SES neighborhoods, and providing nutrition and financial management education.
Current and Prospective Scope of Hunger and Food Security in America: A Review of Current Research | ES-5
Section 5, Potential Strategies to Reduce and Prevent Food Insecurity, presents potential approaches that can help households approaching the food insecurity threshold remain food secure, and enable those who have already crossed into food insecurity to escape. The section mirrors Section 4 to some degree, and describes approaches to strengthen (1) household economic security, (2) federal food and nutrition assistance programs, and (3) private food and nutrition assistance programs. As suggested above, RTI proposed these strategies based on major themes that emerged from the literature review and synthesis. Thus, these recommendations represent our understanding of what the current research suggests, rather than the comprehensive set of policy recommendations that the National Commission on
Hunger
will develop. Examples of potential strategies discussed in this section include
Improve economic security by encouraging lower‐middle income employment and increased wages, improving the affordability of housing and health insurance and developing financial incentives specifically targeted to low income residents
Maintain and strengthen federal food and nutrition assistance programs, providing more stable resources for families trying to provide a better life for themselves
Promote collaborations both among and within public and private service providers
Incentivize charitable donations
Support nutrition and financial management education.
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