Abstract and Keywords
This entry provides an overview of current knowledge and thinking about the nature, causes, and consequences of food insecurity as well as information about the major policies and programs aimed at alleviating food insecurity in the United States. Food insecurity is considered at the nexus of person and environment, with discussion focusing on the biological, psychological, social, and economic factors that are interwoven with people’s access to and utilization of food. The diversity of experiences of food insecurity is addressed, with attention to issues of age, gender, culture, and community context. Finally, implications for social work professionals are suggested.
Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways (Andersen, 1990). At the extreme level, food insecurity can result in chronic hunger and undernourishment, which affected 842 million people (about one in eight people in the world) between 2011 and 2013 (Food and Agriculture Organization of the United Nations, International Fund for Agricultural Development, & World Food Programme, 2013). Although the majority of the undernourished live in developing countries, even in the resource-rich United States food insecurity is troublingly prevalent, impacting more than 1 in 5 children, and nearly 15% of all households (Coleman-Jensen, Nord, & Singh, 2013). The reasons for food insecurity and hunger are many, including challenges with food production related to climate change, natural disasters, lack of investment in agriculture, war and displacement (World Food Programme, 2014). But the world currently produces enough food for everyone (World Food Programme, 2014), and food insecurity is as much a social problem as an agricultural one, reflecting at its core a societal failure to make adequate food meaningfully accessible to all.
Food insecurity occurs at the nexus of socioeconomic, contextual, and individual factors. Food insecurity is reciprocally related to poverty; a lack of money constrains the ability to purchase adequate food, and a lack of adequate food reduces one’s ability to learn, to work, and ultimately to earn money (Food and Agriculture Organization of the United Nations, 2008). However, more than half of poor Americans are food secure, and nearly a quarter of those who are food insecure have incomes above 185% of the federal poverty line (Coleman-Jensen et al., 2013), reflecting the complex interactions of person and environment that undergird experiences of food insecurity. Indeed, causes, correlates, and consequences of food insecurity are diverse, spanning biological, psychological, social, and contextual domains, including factors such as physical health, mental health, family dysfunction, social isolation, lack of social and human capital, lack of nutrition education, and concentrated neighborhood poverty. Adding to the complexity, food insecurity has different causes and impacts at different stages in human development, and it may be experienced differently depending on characteristics such as gender, household role, and culture.
The social work profession has historically been concerned with issues of hunger and material deprivation, but nuanced attention to food insecurity is relatively new, particularly in the United States, where a tendency exists to assume that serious material deprivation is rare. The recent recession has seen a resurgence of attention to basic needs, and new programs and approaches to effectively identify, assess, and respond to the needs of those experiencing food insecurity are emerging; much is still unknown about food insecurity and how best to alleviate it. This entry provides an overview of current knowledge and thinking about the nature, causes, and consequences of food insecurity as well as information about the major policies and programs aimed at alleviating food insecurity in the United States. Because food insecurity is in many ways quite different in developed versus developing countries (Pelletier, Olson, & Frongillo, 2012), the focus here is primarily on food insecurity in the United States, but readings and resources that address food insecurity globally and in developing countries are included. The entry concludes with a discussion of implications for social work professionals.
The Nature of Food Insecurity
What is food (in)security?
Food insecurity is the limited or uncertain availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways (Andersen, 1990). At the individual and household levels, food insecurity is characterized by four dimensions: (1) inadequate quantity of food, (2) inadequate quality of food, (3) psychological unacceptability of food and ways of obtaining food, and (4) social unacceptability of food and ways of obtaining food (Radimer, 2002).
Food insecurity is related to, yet distinct from, hunger and malnutrition:
Hunger is usually understood as an uncomfortable or painful sensation caused by insufficient food energy consumption. Scientifically, hunger is referred to as food deprivation.
Malnutrition results from deficiencies, excesses or imbalances in the consumption of macro- and/or micro-nutrients. Malnutrition may be an outcome of food insecurity, or it may be related to non-food factors, such as: inadequate care practices for children; insufficient health services; and an unhealthy environment.
(Food and Agriculture Organization of the United Nations, 2008)
Food insecurity does not necessarily result in hunger or malnutrition; it may be limited to worries about having enough food and/or using socially undesirable ways of obtaining food (e.g., eating at a soup kitchen, borrowing food from family or friends, selling plasma or pawning household items to get money for food). At the same time that not all food insecurity results in hunger, not all experiences of hunger are related to food insecurity. For instance, people who can afford and access ample food may experience hunger if they are dieting to lose weight. Similarly, malnutrition can be the result of extreme food insecurity, but it can also be the result of a variety of other health and/or socioemotional problems. Finally, in the context of the current obesity epidemic, it is important to note that malnutrition includes both deficiencies and excesses in nutrient consumption. Some research indicates that food insecurity is associated with increased risk of overweight and obesity (Dinour, Bergen, & Yeh, 2007; Jyoti, Frongillo, & Jones, 2005; Townsend, Peerson, Love, Achterberg, & Murphy, 2001), as compromises in the quality of food (reliance on cheap filling foods like pasta) often lead to greater energy consumption as people try to feel full while conserving money.
Food (in)security can be conceptualized at a global, national, household, or individual level, with each level representing the food resource context in which narrower levels unfold. The figure below (adapted from Pelletier et al., 2012), represents these dynamics at global, national, household, and individual levels, but it could easily include additional intermediate levels. For instance, within a nation, different regions, communities, and neighborhoods have different availability of food; this will be discussed later in the section on determinants of food insecurity and “food deserts.”
Food insecurity is often addressed at the household level, based on the assumption that the household is the economic unit in which resources are allocated for food and in which food is distributed equitably among members (Becker, 1981). For instance, the United States monitors food insecurity at the household level only, and the U.S. Supplemental Nutrition Assistance Program (SNAP) provides benefits to households, with the intention that a household benefit will be used to meet the food needs of all household members. Research indicates, however, that households do not necessarily meet all members’ needs equally well (Maxwell & Smith, 1992; Pinstrup-Andersen, 2009). For instance, depending on cultural norms and contextual factors, males may receive more food than females (Hadley, Lindstrom, Tessema, & Belachew, 2008; Holmes, Jones, & Marsden, 2009), parents may cut back their food consumption to protect children’s diets (Oluyemisi, Gundersen, & Garasky, 2011), and children may eat less to try to protect parents (Fram et al., 2010). This vein of research demonstrates the importance of considering individual as well as household experiences of food (in)security.
Food Insecurity in the United States: Who Is Effected and How?
The national prevalence of household food insecurity has been monitored annually starting in 1995 using the USDA Household Food Security Survey Module (HFSSM) (National Research Council, 2006). Since that time, the rate of household food insecurity in the United States has varied between a low of 10.1% in 1997 and a high of 14.9% in 2011 (Coleman-Jensen et al., 2013). The most recent national monitoring data indicates that 14.5% of all U.S. households experienced food insecurity at some time in 2012. This includes 8.8% of households that were categorized as having “low food security” and 5.7% having “very low food security.” These categories technically reflect how many indications of food insecurity a respondent affirms on the USDA Household Food Security Survey Module (HFSSM). Substantively, low food security involves reductions in the “quality, variety, and desirability” of diet, while very low food security also involves reduced food consumption and disrupted eating patterns (Coleman-Jensen et al., 2013). Since the HFSSM does not directly assess whether reductions in food consumption result in feelings of hunger, the term “hunger” is not used in relation to official, national food insecurity statistics in the United States (United States Department of Agriculture, Economic Research Service, 2013).
Rates of household food insecurity vary with household composition, race/ethnicity, and place of residence. Food insecurity is most prevalent among households with children (20%) and particularly those headed by a single mother (35.4%). In comparison, 9.1% of households with elderly living alone, and 11.9% of households with no children reported food insecurity. Based on parent report, 8.3 million children lived in households where children, along with adults, experienced food insecurity, and 977,000 children lived in households where children experienced food cutbacks or disrupted eating (e.g., very low food security) (Coleman-Jensen et al., 2013). These estimates may be too low. Although recent research has shown that children are better reporters of their food insecurity experiences than are their parents, and that parents are likely to underreport child food insecurity (Fram, Frongillo, Draper, & Fishbein, 2013), national prevalence data using child self-report is not yet being collected. Food insecurity is more prevalent among black and Hispanic households (24.6% and 23.3%, respectively) than among white non-Hispanic (11.2%) households. A higher proportion of households in the South (16%) experienced food insecurity than in any other area, and the lowest regional proportion was in the Northeast (11.9%). Looking at data from the last three years (2010–2012) reveals considerable state-level variation in household food insecurity, ranging from 8.7% in North Dakota to 20.9% in Mississippi (Coleman-Jensen et al., 2013)
Determinants of Food (In)security
As the top levels of figure 2 show, food insecurity is a product of a range of contextual factors and the food management and coping strategies through which individuals balance multiple and complex household needs.
Food insecurity can be a reflection of poverty when a household does not have enough money to pay for all the necessary food. More than 40% of households with incomes below the federal poverty line experienced food insecurity in 2012, compared with only 6.8% of households with incomes exceeding 185% of poverty. The USDA estimates that the cost for a minimally adequate diet for a family consisting of a mother, father, and two pre-school aged children is $552.70/month, based on the “Thrifty Food Plan” (United States Department of Agriculture, Center for Nutrition Policy and Promotion, 2013). This estimate may be too low, since the Thrifty Food Plan relies on the purchase of basic, cheap, unprocessed foods that do not fit well with current, mainstream food norms, and which require substantial time and knowledge to turn into nutritious meals (Caswell & Yaktine, 2013). But even accepting the USDA estimate, food insecurity is hard to avoid for some Americans. For instance, a full-time, minimum-wage worker earns $1,250/month. With a median rent of $717/month (U.S. Census Bureau, 2014), this would leave a food budget shortfall of $19.30/month if that worker is supporting a spouse who stays at home to care for two young children—and this shortfall would occur even if the household spent no money for expenses other than shelter and food.
While poverty clearly contributes to food insecurity, 23% of all food insecure households in 2012 had incomes exceeding 185% of poverty, indicating that factors other than poverty are important as well. Food insecurity can occur when food cannot be acquired or used efficiently. Distance from grocery stores offering low-cost healthy foods, lack of reliable transportation (Holben, McClincy, Holcomb, Dean, & Walker, 2004), and lack of refrigeration (Fram et al., 2010) can all contribute to inefficiencies, such as reliance on prepared foods, single meal shopping, and compromised diet quality. Low-income and minority neighborhoods are less likely than middle-class and predominantly white neighborhoods to have chain supermarkets, which typically have both lower prices and greater selection of healthy foods (Powell, Slater, Mirtcheva, Bao, & Chaloupka, 2007). The term “food desert” refers to “urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food” (United States Department of Agriculture, Agricultural Marketing Service, 2014). Research on the existence and impact of food deserts is still emerging, as is development and evaluation of strategies to improve food access and diet quality in these areas (Walker, Keane, & Burke, 2010). In part, it remains unclear the extent to which food markets cause versus respond to local food purchasing patterns, with research suggesting, for instance, that greater presence of fast-food restaurants is associated with greater fast food consumption, while greater presence of supermarkets selling affordable fresh produce is not associated with greater fruit and vegetable consumption (Boone-Heinonen et al., 2011).
Even when enough money is available to purchase food, and desired food is available in nearby stores, people can experience food insecurity if they have functional limitations that keep them from shopping and/or preparing food. Older adults are vulnerable to food insecurity and hunger due to health problems, special dietary needs, and restricted mobility. Difficulty walking or driving inhibits grocery shopping as well as food preparation, and even basic tasks such as spreading peanut butter on crackers can become impossible when a cycle of escalating poor health/lack of food access leads to weakness (Wolfe, Olson, Kendall, & Frongillo, 1998). People with disabilities and physical and mental health challenges are also at higher risk for food insecurity, both due to generally lower incomes and higher costs of meeting health-care needs and to functional limitations that interfere with food acquisition and preparation (Huang, Guo, & Kim, 2010; Tarasuk, Mitchell, McLaren, & McIntyre, 2013).
Cultural norms and the food environment.
Dietary norms in the United States have changed dramatically in recent decades, as evidenced by the rise in fast food consumption, increasing portion sizes, and the normalization of soft drink consumption in daily life (Rosenheck, 2008; St. Onge, Keller, & Heymsfield, 2003; Young & Nestle, 2002). These trends extend across the socioeconomic spectrum, but they may have a particularly damaging impact on people with limited economic resources. Healthier foods tend to cost more than do added sugars and fats (Drewnowski & Darmon, 2005). In addition, high-fat, high-sugar, and high-sodium foods are aggressively marketed to children (Nestle, 2006), and the low cost of many of these foods places low-income parents in a bind. They are priced out of the market for many things their children desire (e.g., toys, clothes, extracurricular activities), but they can sometimes afford the soda or candy their children request. While economic constraints can drive unhealthy food preferences, food preferences and nutrition knowledge are also interwoven with food insecurity. For instance, when examining how women managed their food needs on a food stamp budget, Wiig and Smith (2008) found that beliefs in the importance of meat and a preference for ready-to-eat foods were prevalent and were associated with little money being spent on whole grains and fresh fruits and vegetables. Food preferences are often culturally grounded. Sealy (2010) found that African-American, Caribbean, and Hispanic parents used culturally syntonic food preparation approaches, frying foods, and using large amounts of salt, sugar, and fat. These decisions were grounded in cultural discourse, with statements such as “I’m used to Southern cooking,” “We’re Hispanic and we were raised in a Hispanic home,” “My people didn’t know how to cook anything else besides rice and beans,” and “. . . my basic meal is Spanish food” (Sealy, 2010, pp. 6–7). When combined with time constraints, parents’ cultural knowledge about food led to food preparation choices that were less healthy and which could be changed through nutrition education and without increasing food costs.
At times of food insecurity, people use a variety of coping strategies to meet their needs. These strategies fall into two domains: (1) ways of acquiring food and the resources needed to purchase food, and (2) ways of managing food once it is acquired. Food acquisition strategies involve reliance on community resources (e.g., SNAP, school meals programs, food pantries, church meals), interactions with informal support systems (e.g., borrowing food, cooking together, bringing food home from work), supplementing financial resources (e.g., pawning items, selling blood, informal labor market participation, illegal activities), and lowering food costs through shopping strategies (e.g., purchasing bulk foods, cheap foods, near expired or damaged foods, and using coupons) (Kempson, Keenan, Sadani, & Adler, 2003). People also report generating food through gardening, hunting, and fishing (Loring & Gerlach, 2009; Quandt, Arcury, Early, Tapia, & Davis, 2004) as well as taking food from dumpsters, eating other people’s left-overs, and cooking road-kill animals (Kempson et al., 2003). Food management strategies involve managing the food supply (e.g., fixing low-cost meals, carefully allocating each person’s share of food, canning and preserving food, and removing mold, insects, and spoiled portions from foods), and regulating eating patterns (e.g., cutting back portions, skipping meals, overeating when food is available) (Kempson et al., 2003).
Household expenses and food related trade-offs.
Food is an ongoing, pressing need—people get hungry quickly and feelings of hunger create a sense of urgency that makes meeting food needs a priority. However, food costs are more elastic than are other household expenses. Reducing the food budget is generally easier than reducing rent or a car payment, so food spending may be constrained to cope with both ongoing budget challenges and unusual expenses such as medical bills or car repairs. On the other hand, obtaining food cannot be delayed as easily as can paying the power bill—people feel hungry before the power company could cut off services. Consequently, food insecurity is related to a variety of budgetary trade-offs (Tarasuk, 2001), balancing food quality and quantity compromises with foregoing medical care (Bengle et al., 2010), and cutting back on heating or cooling costs.
Consequences of Food Insecurity
Food insecurity effects well-being through nutritional pathways (reduced quality and quantity of food) and non-nutritional pathways (e.g., experiences of stress, social isolation, anger, hunger) (see Figure 2). In some ways these pathways look similar for all people, but there are also some specific effects for different population groups.
Food insecurity is associated with less healthy diet (Drewnowski, 2009; Kirkpatrick & Tarasuk, 2008) and with health problems that flow from less healthy diet (Cook & Frank, 2008). Food insecurity is also associated with a host of social and psychological strains, including overall worse mental health (Stuff et al., 2004), more depression and more anxiety (Whitaker, Phillips, & Orzol, 2006). Because food is an important context for social life, food insecurity compromises both the quantity and the quality of social interaction. People may avoid social activities where serving or purchasing food is an expectation (e.g., inviting friends over, hosting holiday or celebratory meals, going out with friends) (Hamelin, Habicht, & Beaudry, 1999). Parents may avoid “family meals” so that children will not observe parent food cutbacks or parental distress about the food situation (Hamelin et al., 2002). During times of food insecurity, worries about food supply and feelings of hunger and tiredness can make people irritable, leading to more conflict and strain when social interaction does occur. Food insecurity also results in feelings of alienation, powerlessness, guilt, and shame (Hamelin et al., 2002).
Consequences for children.
Food insecurity is associated with a variety of negative developmental consequences for children. Children in food-insecure households demonstrate lower levels of academic achievement, more behavioral and mental health problems, and greater likelihood of iron deficiency anemia (Skalicky et al., 2006) as well as of being overweight than do their food-secure peers (Alaimo, Olson, & Frongillo, 2001, 2002; Jyoti et al., 2005; National Research Council, 2006; Slack & Yoo, 2005). In addition, social relationships are often affected in food-insecure households with consequences such as strained parent-child relationships and adverse family social patterns (Hamelin, Beaudry, & Habicht, 2002). In part these negative effects may be associated with experiencees of hunger, although information from parents’ reports of child food insecurity indicates that “Parents often are able to maintain normal or near-normal diets and meal patterns for their children, even when the parents themselves are food insecure” (Coleman-Jensen, McFall, & Nord, 2013). However, when children report on their own experiences, they discuss a variety of serious consequences across all four adult-specified domains (quality of food, quantity of food, psychological effects, and social effects). Specifically, children report reduced eating, feelings of shame and fear, and using social networks to obtain food. Work by Fram et al. (2010) reveals additional child-specific domains such as heightened vigilance, anxiety and sadness about parental hardships, and taking on responsibility for solving adult problems. This research also finds that child reports often differ from the reports of the parent or primary caregiver. For example, Fram et al.(2010) found that when children employ food-saving strategies such as eating less and eating away from home, parents are not always aware that children are being effected by (or even aware of) food problems.
Food insecurity and gendered consequences.
Household food insecurity is experienced differently in some key ways depending on gender, in part due to women’s traditional roles in feeding others and caring for children. Gender bias in food insecurity may be most overt in countries where food availability is low and where gender discrimination is culturally normative and girls are given less food than their male relatives (Hadley et al., 2008), but it occurs, perhaps through more subtle mechanisms, in the United States and other industrialized countries as well. For instance, mothers prioritize children’s food needs over their own as indicated in one woman’s assertion that, “If it gets down to it, we buy to feed the kids” (DeVault, 1991, p. 191). Consequently, women in food insecure households are more likely to experience nutrient deficiencies (McIntyre et al., 2003) and to be overweight (Townsend et al., 2001). Teen mothers may be at particular nutritional risk due to the instability of their living arrangements, lack of power within family and formal helping systems, and the broader developmental challenges of early parenting (Stevens, 2010). Women also experience unique non-nutritional consequences. For instance, Hernandez, Marshall and Mineo (2013) report a pathway from intimate partner violence (IPV) to women’s depression to food insecurity as women’s experiences of IPV lead to feelings of helplessness and diminished motivation and “managerial capacity,” which become obstacles to the ability of mothers to maintain food security.
Consequences for older adults.
Although the prevalence of food insecurity among older adults is lower than among other age groups, the consequences of food insecurity when it does occur are serious. Older adults experience greater risk of malnutrition, unhealthy weight, anemia, depression, anxiety, and diminished cognitive and physical functioning when they are food insecure (Lee, Fischer, & Johnson, 2010; Lee & Frongillo, 2001). Because older adults are more likely than other age groups to experience multiple and costly health problems, they can be forced to make trade-offs between purchasing prescription medications and other health services versus adequate food (Bengle et al., 2010). Moreover, older adults “have a diminished physiologic ability to preserve the homeostatic mechanisms that govern hunger and satiety, energy balance, and weight maintenance” (Lee et al., 2010).
Responses to Food Insecurity
The United States has several major food and nutrition programs that aim, at least in part, to improve dietary quality and/or to reduce food insecurity. Taken together, this set of programs has made chronic undernutrition and related problems of stunting and wasting very rare in the United States. However, as the earlier discussion of prevalence of food insecurity shows, these programs do not provide a complete food safety net and many Americans are left struggling to have enough to eat.
Supplemental Nutrition Assistance Program (SNAP).
SNAP provides near-cash benefits to income eligible individuals and families, allowing them to purchase many foods using electronic benefit transfer (EBT) cards that are accepted at most groceries, food markets, and many farmers’ markets. In 2013, an average of 47,636,000 people participated in the SNAP program each month, with an average monthly benefit of $133.07/person (United States Department of Agriculture, Food and Nutrition Service, 2014a). SNAP benefits are not adequate for meeting many households’ food needs, in part due to benefit levels being set in relation to the USDA’s Thrifty Food Plan, which assumes time for food preparation, dietary norms, and non-food costs such as rent and health care that are not realistic today (Caswell & Yaktine, 2013). Nonetheless, SNAP is effective at reducing poverty (Tiehen, Jolliffe, & Gundersen, 2012) and food insecurity (Ratcliffe, McKernan, & Zhang, 2011).
The first food stamp program (FSP) was implemented from 1939 to 1943 and allowed low-income people to purchase stamps that could be used to buy food. For $1 spent on orange stamps, which could be used to buy any foods, people received an additional 50 cents of blue stamps that could be used only for purchase of foods that the Department of Agriculture identified as being surplus (United States Department of Agriculture, Food and Nutrition Service, 2013c). This model addressed dual goals of improving nutrition among poor people and stabilizing agricultural markets, a split purpose that has continued throughout the policy’s history. Federal legislation since the 1940s has changed in relation to fluctuating political and economic contexts, but overall the FSP moved toward greater reach to diverse populations, consistency across state program standards, prohibition of discrimination, an end to the purchase requirement, and a transition from paper coupons to Electronic Benefit Transfer (EBT) cards to reduce fraud, streamline purchasing processes, and reduce stigma.
Supplemental Nutrition Program for Women, Infants and Children (WIC) and the Commodity Supplemental Food Program (CSFP).
WIC began in 1972 with an amendment to the Child Nutrition Act of 1966, and it provides nutritious foods to low-income pregnant, post-partum, or lactating women, and infants and children younger than age five (Currie, 2003). In addition to income criteria, WIC participation requires a determination of “nutritional risk” and aims at preventing malnutrition among women and children at times when the health and developmental consequences of malnutrition are particularly high. WIC benefits are in the form of nutrition education sessions and coupons for specific products such as milk, cereal, peanut butter, and other foods deemed important during the targeted developmental periods. Like WIC, the CSFP programs a package of nutritious foods to low-income individuals who, due to life stage, are at particular nutritional risk. CSFP has some overlap with WIC, serving pregnant and breast-feeding and post-partum mothers, infants, and children under age six. The bulk of CSFP participants, however, are adults age 60 and older. CSFP is a federal program that distributes commodity foods, primarily through the food bank system. Food banks receive the food, box it according to CSFP guidelines, and either deliver or make boxes available for pick-up to those eligible (United States Department of Agriculture, Food and Nutrition Service, 2014b).
National School Lunch Program (NSLP) and School Breakfast Program (SBP).
Most U.S. children spend much of their time each day at school, making this an ideal setting for promoting food security through direct provision of services. The NSLP is offered in over 100,000 schools and residential child care institutions, and it served more than 31 million children in 2012 (United States Department of Agriculture, Food and Nutrition Service, 2013a). The SBP serves more than 10 million children each day at over 89,000 schools and educational/child care institutions (United States Department of Agriculture, Food and Nutrition Service, 2013b).
Both programs provide eligible children with meals that meet the latest dietary guidelines for Americans standards at either a reduced cost or for free, depending generally on household income. One exception is that some schools have moved to universal school breakfast programs, serving all students (usually in a high-need school) rather than determining individual eligibility. This approach increases participation, avoiding the stigma that occurs when only income-eligible children are seen eating breakfast in the school (Food Research and Action Center, 2009).
The school meals programs provide a critical resource for many families experiencing, or at risk for, food insecurity. Children report that school meals are very important to meeting their food needs during times of household food insecurity (Connell, Lofton, Yadrick, & Rehner, 2005; Fram et al., 2010), and child hunger increases during the summer months when fewer children have access to school meals (Nord & Romig, 2007). Given the importance of school meals to combating food insecurity, questions raised about the nutritional quality of school meals are particularly concerning (Clark & Fox, 2009). A policy change in 2012 sought to improve nutritional quality, with new guidelines for offering fresh fruits and vegetables, whole grain foods, low-fat or non-fat dairy products, and limiting calories, saturated fats, and sodium (United States Department of Agriculture, Office of Communications, 2013). After complaints of students disliking the new food choices and feeling hungry due to smaller portions, the new rules were relaxed (CBS/Reuters, 2014). Since children who are food insecure are at greater risk for hunger, and may also be at greater risk for overweight (Casey et al., 2006), it is unclear what effect the school meals program changes will ultimately have on child food insecurity and its consequences, even if the core of these changes survives complaints and public backlash.
Charity food programs.
With public programs that do not fully meet household food needs, private nonprofit organizations play an ongoing role in providing emergency and supplemental food. An extensive network of food banks provides an organizational core for distributing free food through food pantries and other front-line services (e.g., soup kitchens, church meals programs). Food banks receive food through individual donations (e.g., canned goods drives), the Emergency Food Assistance Program (TEFAP), and donations from the for-profit food chain, including farmers with surplus or product that does not meet aesthetic standards for sale and grocers who can off-load products that are not selling well, were over-ordered, or that have damaged packaging or are past their “sell-by” date.
This process accomplishes multiple goals for different actors: People who need food receive it, people who donate food or volunteer get to feel that they are helping others (Poppendieck, 1998), and food producers reduce costs of dumping unsellable foods and receive tax benefits (Daponte & Bade, 2000). However, some negative unintended consequences with regard to this system are found as well. First, the normalization of food bank use may depress advocacy for more just social policies that would prevent the conditions in which food insecurity and hunger occur. Second, studies indicate that the quality of food people receive through food pantries is often low: Food tends to be energy-dense and high in fat, sugar, and salt (Companion, 2010). Third, while some people have positive experiences of receiving food pantry services (Molnar, Duffy, Claxton, & Bailey, 2001), others find food pantry participation to be stigmatizing and inefficient, as people often have to travel much farther than to their local grocery store, wait in long lines (often during the work day), and disclose sensitive and embarrassing personal information to volunteers (Poppendieck, 1998). And finally, when people receive food from traditional food pantries rather than shopping for themselves, they are likely to be given foods that do not fit well with their families’ tastes, cultural food norms, or specific dietary needs. Some food pantries have moved to a client choice model in which participants select from available foods in different food categories, but choices are often still restrictive since they are constrained by the foods that have been donated (Ohio Association of Second Harvest Foodbanks, 2009).
The school “backpack” program is an increasingly popular service model, aimed at reducing child food insecurity and hunger. Children who are thought to be food insecure are given a backpack of nonperishable, easy-open, ready-to-eat foods at school at the end of each week. They bring the food home and can use it over the weekend when no school breakfast or lunch is available. The backpacks are returned empty the following Monday to be refilled. Of yet there is no rigorous research evaluating the effects of these programs on food insecurity or on child and family well-being, and although the urgency of ensuring that children do not go hungry is very real, social workers should be thoughtful and cautious about potential unintended consequences of this response to child hunger. Making children responsible for contributing to household food supply may have unintended consequences, including increased child stress, disrupted parent/child relationship and role confusion, child experiences of stigma, and reduced parental control over child nutrition. Research is urgently needed on these programs.
Implications for Social Work Practice
Social work professionals can be involved in preventing and responding to food insecurity in a variety of ways.
• Be aware of potential food-related challenges. Social workers should be aware of the possibility of food insecurity in working with clients across the socioeconomic spectrum and at different life stages. Food insecurity can be expressed in the form of social, emotional, behavioral, and physical health problems; failure to identify food insecurity as an underlying problem can lead to inadequate and/or inappropriate interventions. In addition, food insecurity can be a marker of other challenges with living. For instance, child food insecurity can be an indicator of family poverty, housing problems, child neglect, or other difficulties that are difficult to observe in typical interactions (e.g., at school, doctor’s office, church, community settings).
• Respond to food insecurity respectfully and avoid stigma. Food and eating are deeply interwoven with cultural, social, and religious life. Not having enough food is therefore a strain on all these aspects of well-being. In addition, feeding one’s family is seen as a basic responsibility, and the inability to meet food needs carries great stigma both within a family and as the family engages the broader community. Social workers should identify and respond to problems of food insecurity with sensitivity, providing services in ways that protect privacy, communicate positive regard, and aim at long-term solutions. Social workers should also ensure that food-related services are culturally appropriate and responsive to unique individual needs.
• Food provision is not always the answer. A simplistic approach to food insecurity suggests that when food resources are low, the answer is to provide additional food. However, food insecurity flows from a variety of social, economic, contextual, and individual challenges. Holistic assessment and flexible response options are essential to improving food security, and they may include attention to nonfood-related needs, such as housing quality, lack of transportation, parental mental health, social isolation, and functional limitations.
• Focus on community-level as well as individual and household food challenges. Efforts to improve community access to affordable, healthy foods can promote food security, particularly when community members take a lead role to ensure that efforts fit well with community priorities and respond to people’s beliefs and knowledge about nutrition and food utilization.
• Promote food security without contributing to the risk of overweight/obesity. The obesity epidemic spans the socioeconomic spectrum and has many, complex causes. Much still needs to be learned about how to effectively improve dietary health in the United States, but it is clear that overreliance on energy-dense, high-fat, high-sugar, high-sodium foods contributes to overweight. Responses to food insecurity should prioritize healthy diet rather than just having “enough” to eat.
• Advocate for policies that improve families’ economic well-being so that they can have adequate money to purchase food within the private sector. Improving the adequacy of wages and SNAP benefits is essential to long-term reduction of food insecurity.
• Contribute actively to the growing research on food insecurity, ensuring that a social work strengths perspective and a dynamic of attention to the person in environment are central to emerging understandings of food insecurity and to new programmatic and policy responses.
Alaimo, K., Olson, C. M., & Frongillo, E. A. (2001). Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics, 108, 44–53.Find this resource:
Alaimo, K., Olson, C. M., & Frongillo, E. A. (2002). Family food insufficiency, but not low family income, is positively associated with dysthymia and suicide symptoms in adolescents. Journal of Nutrition, 132, 719–725.Find this resource:
Andersen, S. A. (1990). Core indicators of nutritional state for difficult-to-sample populations. Journal of Nutrition, 120(11 Suppl.), 1555–1600.Find this resource:
Becker, G. (1981). A treatise on the family. Cambridge, MA: Harvard University Press.Find this resource:
Bengle, R., Sinnett, S., Johnson, T., Johnson, M. A., Brown, A., & Lee, J. S. (2010). Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia. Journal of Nutrition for the Elderly, 29(2), 170–191. doi:10.1080/01639361003772400Find this resource:
Boone-Heinonen, J., Gordon-Larsen, P., Kiefe, C. I., Shikany, J. M., Lewis, C. E., & Popkin, B. M. (2011). Fast food restaurants and food stores: Longitudinal associations with diet in young to middle-aged adults: The CARDIA study. Archives of Internal Medicine, 171(13), 1162–1170.Find this resource:
Casey, P. H., Simpson, P. M., Gossett, J. M., Bogle, M. L., Champagne, C. M., Connell, C., et al. (2006). The association of child and household food insecurity with childhood overweight status. Pediatrics, 118(5), e1406–e1413. doi:10.1542/peds.2006-0097Find this resource:
Caswell, J. A., & Yaktine, A. L. (2013). Supplemental nutrition assistance program: Examining the evidence to define benefit adequacy. Washington, DC: National Academies Press.Find this resource:
CBS/Reuters. (2014). U.S. to relax healthy school lunch rules after student complaints. CBS News. Retrieved January 17, 2014, from http://www.cbsnews/com/news/us-to-relax-healthy-school-lunch-rules-due-to-student-complaintsFind this resource:
Clark, M. A., & Fox, M. K. (2009). Nutritional quality of the diets of U.S. public school children and the role of the school meal programs. Journal of the American Dietetic Association, 109(2), s44–s56.Find this resource:
Coleman-Jensen, Alisha, McFall, William, and Nord, Mark. Food Insecurity in Households With Children: Prevalence, Severity, and Household Characteristics. 2010-11, EIB-113, U.S. Department of Agriculture, Economic Research Service, May 2013.Find this resource:
Coleman-Jensen, A., Nord, M., & Singh, A. (2013). Household food security in the United States in 2012, Economic Research Report, ERR-1544. U.S. Department of Agriculture.Find this resource:
Companion, M. (2010). Constriction in the variety or urban food pantry donations by private individuals. Journal of Urban Affairs, 32, 633–646.Find this resource:
Connell, C. L., Lofton, K. L., Yadrick, K., & Rehner, T. A. (2005). Children’s experiences of food insecurity can assist in understanding its effects on their well-being. Journal of Nutrition, 135, 1683–1690.Find this resource:
Cook, J. T., & Frank, D. A. (2008). Food security, poverty, and human development in the United States. Annals of the New York Academy of Sciences, 1136, 193–209.Find this resource:
Currie, J. (2003). U.S. Food and Nutrition Programs. In M. R. A. (Ed.), Means-tested transfer programs in the United States (pp. 199–290). Chicago: University of Chicago Press.Find this resource:
Daponte, B., & Bade, S. (2000). The evolution, cost, and operation of the private food assistance network discussion paper series (Vol. 1211-00). Madison, WI: Institute for Research on Poverty.Find this resource:
DeVault, M. L. (1991). Feeding the family. Chicago: University of Chicago Press.Find this resource:
Dinour, L., Bergen, D., & Yeh, M. (2007). The food insecurity-obesity paradox: A review of the literature and the role food stamps may play. Journal of the American Dietetic Association, 107(11), 1952–1961.Find this resource:
Drewnowski, A. (2009). Obesity, diets, and social inequalities. Nutrition Reviews, 67(s1), s36–s39.Find this resource:
Drewnowski, A., & Darmon, N. (2005). Food choices and diet costs: An economic analysis. Journal of Nutrition, 135(4), 900–904.Find this resource:
Food and Agriculture Organization of the United Nations. (2008). An introduction to the basic concepts of food security. Retrieved January 13, 2014, from www.fao.org/docrep/013/al936e/al936e.00/pdfFind this resource:
Food and Agriculture Organization of the United Nations, International Fund for Agricultural Development, & World Food Programme. (2013). The state of food insecurity in the world 2013: The multiple dimensions of food security. Rome: Food and Agriculture Organization.Find this resource:
Food Research and Action Center. (2009). Why offer school breakfast free to all children? Retrieved January 16, 2014, from frac.org/wp-content/uploads/2009/09/universal_sbp.pdfFind this resource:
Fram, M. S., Frongillo, E. A., Draper, C. L., & Fishbein, E. M. (2013). Development and validation of a child report assessment of child food insecurity and comparison to parent report assessment. Journal of Hunger & Environmental Nutrition, 8(2), 128–145.Find this resource:
Fram, M. S., Frongillo, E. A., Jones, S. J., William, R. C., Burke, M. P., DeLoach, K. P., et al. (2010). Children are aware of food insecurity and take responsibility for managing food resources. Journal of Nutrition, 141, 1114–1119.Find this resource:
Hadley, C., Lindstrom, D., Tessema, F., & Belachew, T. (2008). Gender bias in the food insecurity experience of Ethiopian adolescents. Social Science & Medicine, 66, 427–438.Find this resource:
Hamelin, A. M., Beaudry, M., & Habicht, J. P. (2002). Characterization of household food insecurity in Quebec: Food and feelings. Social Science & Medicine, 54(1), 119–132.Find this resource:
Hamelin, A. M., Habicht, J. P., & Beaudry, M. (1999). Food insecurity: Consequences for the household and broader social implications. Journal of Nutrition, 129(2), 525s–528s.Find this resource:
Hernandez, D., Marshall, A., & Mineo, C. (2013). Maternal depression mediates the association between intimate partner violence and food insecurity. Journal of Women’s Health, 23(1), 29–37.Find this resource:
Holben, D. H., McClincy, M. C., Holcomb, J. P., Dean, K. L., & Walker, C. E. (2004). Food security status of households in Appalachian Ohio with children in Head Start. Journal of the American Dietetic Association, 104(2), 238–241.Find this resource:
Holmes, R., Jones, N., & Marsden, H. (2009). Gender vulnerabilities, food price shocks and social protection responses: Improving social protection effectiveness: Understanding social and economic risks and gender inequalities. London: Overseas Development Institute, Department for International Development, and AusAid.Find this resource:
Huang, J., Guo, B., & Kim, Y. (2010). Food insecurity and disability: Do economic resources matter? Social Science Research, 39(1), 111–124. doi:10.1016/j.ssresearch.2009.07.002Find this resource:
Jyoti, D. F., Frongillo, E. A., & Jones, S. J. (2005). Food insecurity affects school children’s academic performance, weight gain, and social skills. Journal of Nutrition, 135, 2831–2839.Find this resource:
Kempson, K., Keenan, D. P., Sadani, P. S., & Adler, A. (2003). Maintaining food sufficiency: Coping strategies identified by limited-resource individuals versus nutrition educators. Journal of Nutrition Education & Behavior, 35(4), 179–188.Find this resource:
Kirkpatrick, S. I., & Tarasuk, V. (2008). Food insecurity is associated with nutrient inadequacies among Canadian adults and adolescents. Journal of Nutrition, 138(3), 604–612.Find this resource:
Lee, J. S., Fischer, J. G., & Johnson, M. A. (2010). Food insecurity, food and nutrition programs, and aging: Experiences from Georgia. Journal of Nutrition for the Elderly, 29(2), 116–149.Find this resource:
Lee, J. S., & Frongillo Jr., E. A. (2001). Nutritional and health consequences are associated with food insecurity among U.S. elderly persons. Journal of Nutrition, 131(5), 1503–1509.Find this resource:
Loring, P. A., & Gerlach, S. C. (2009). Food, culture, and human health in Alaska: An integrative health approach to food security. Environmental Science & Policy, 12, 466–478.Find this resource:
Maxwell, S., & Smith, M. (1992). Household food security: A conceptual review. In S. Maxwell & T. Frankenberger (Eds.), Household food security: concepts, indicators, measurements (pp. 1–72). Rome and New York: IFAD and UNICEF.Find this resource:
McIntyre, L., Glanville, T., Raine, K. D., Dayle, J. B., Anderson, B., & Battaglia, N. (2003). Do low-income lone mothers compromise their nutrition to feed their children? Canadian Medical Association Journal, 168(6), 686–691.Find this resource:
Molnar, J., Duffy, P., Claxton, L., & Bailey, C. (2001). Private food assistance in a small metropolitan area: Urban resources and rural needs. Journal of Sociology & Social Welfare, 187, 187–210.Find this resource:
National Research Council. (2006). Food insecurity and hunger in the United States: An assessment of the measure. In G. S. Wunderlich & J. L. Norwood (Eds.), Panel to review the U.S. Department of Agriculture’s measurement of food insecurity and hunger. Washington, DC: Committee on National Statistics, Division of Behavioral and Social Sciences and Education.Find this resource:
Nestle, M. (2006). Food marketing and childhood obesity: A matter of policy. New England Journal of Medicine, 354, 2527–2529.Find this resource:
Nord, M., & Romig, K. (2007). Hunger in the summer. Journal of Children & Poverty, 12(2), 141–158.Find this resource:
Ohio Association of Second Harvest Foodbanks. Making the switch: A guide for converting to a client choice food pantry. (2009). Columbus: Ohio Association of Second Harvest Foodbanks. Retrieved January 23, 2014, from http://tafb.org/documents/ChoicePantryGuide.pdfFind this resource:
Oluyemisi, K., Gundersen, C., & Garasky, S. (2011). Differences in food insecurity between adults and children in Zimbabwe. Food Policy, 36(2), 311–317.Find this resource:
Pelletier, D. L., Olson, C. M., & Frongillo, E. A. (2012). Food insecurity, hunger and undernutrition. In J. Erdman, I. Macdonald, & S. Zeisel (Eds.), Present Knowledge in Nutrition (10th ed., pp. 1165–1181). Oxford: Wiley-Blackwell.Find this resource:
Pinstrup-Andersen, P. (2009). Food security: Definition and measurement. Food Security, 1(1), 5–7.Find this resource:
Poppendieck, J. (1998). Sweet charity: Emergency food and the end of entitlement. New York: Penguin Group.Find this resource:
Powell, L. M., Slater, S., Mirtcheva, D., Bao, J., & Chaloupka, F. J. (2007). Food store availability and neighborhood characteristics in the United States. Preventive Medicine, 44(3), 189–195.Find this resource:
Quandt, S. A., Arcury, T. A., Early, J., Tapia, J., & Davis, J. D. (2004). Household food security among migrant and seasonal Latino farmworkers in North Carolina. Public Health Reports, 119(6), 568–576.Find this resource:
Radimer, K. L. (2002). Measurement of household food security in the USA and other industrialised countries. Public Health Nutrition, 5(6a), 859–864.Find this resource:
Ratcliffe, C., McKernan, S. M., & Zhang, S. (2011). How much does SNAP reduce food insecurity? American Journal of Agricultural Economics, 93(4), 1082–1098.Find this resource:
Rosenheck, R. (2008). Fast food consumption and increased caloric intake: A systematic review of a trajectory towards weight gain and obesity risk. Obesity Reviews, 9(6), 535–547.Find this resource:
Sealy, Y. M. (2010). Parents’ food choices: Obesity among minority parents and children. Journal of Community Health Nursing, 27(1), 1–11.Find this resource:
Skalicky, A., Meyers, A. F., Adams, W. G., Yang, A., Cook, J. T., & Frank, D. A. (2006). Child food insecurity and iron-deficiency anemia in low-income infants and toddlers in the United States. Maternal and Child Health Journal, 10(2), 177–185.Find this resource:
Slack, K. S., & Yoo, J. (2005). Food hardship and child behavior problems among low-income children. Social Service Review, 79, 511–536.Find this resource:
St. Onge, M. P., Keller, K. L., & Heymsfield, S. B. (2003). Changes in childhood food consumption patterns: A cause for concern in light of increasing body weights. American Journal of Clinical Nutrition, 78(6), 1068–1073.Find this resource:
Stevens, C. A. (2010). Exploring food insecurity among young mothers (15–24 years). Journal for Specialists in Pediatric Nursing, 15(2), 163–171.Find this resource:
Stuff, J. E., Casey, P. H., Szeto, K. L., Gossett, J. M., Robbins, J. M., Simpson, P. M., et al. (2004). Household food insecurity is associated with adult health status. Journal of Nutrition, 134(9), 2330–2335.Find this resource:
Tarasuk, V. (2001). Household food insecurity with hunger is associated with women’s food intakes, health and household circumstances. Journal of Nutrition, 131(10), 2670–2676.Find this resource:
Tarasuk, V., Mitchell, A., McLaren, L., & McIntyre, L. (2013). Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity. Journal of Nutrition, 143(11), 1785–1793.Find this resource:
Tiehen, L., Jolliffe, D., & Gundersen, C. (2012). Alleviating poverty in the United States: The critical role of SNAP benefits. Washington, DC: United States Department of Agriculture, Economic Research Service.Find this resource:
Townsend, M. S., Peerson, J., Love, B., Achterberg, C., & Murphy, S. P. (2001). Food insecurity is positively related to overweight in women. Journal of Nutrition, 131(6), 1738–1745.Find this resource:
U.S. Census Bureau. (2014). Table 11a. Median asking rent/sales price for the US and regions: 1988 to present (actual dollars). Washington, DC.Find this resource:
United States Department of Agriculture, Agricultural Marketing Service. Food deserts Retrieved January 14, 2014, from http://apps.ams.urda.gov/fooddeserts/foodDeserts.aspxFind this resource:
United States Department of Agriculture, Center for Nutrition Policy and Promotion. (2013). Official USDA food plans: Cost of food at home at four levels, U.S. average, November 2013. Alexandria, VA.Find this resource:
United States Department of Agriculture, Economic Research Service. (2013). Definitions of Food Security. Retrieved January 13, 2014, from www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security.aspxFind this resource:
United States Department of Agriculture, Food and Nutrition Service. (2013a). National School Lunch Program. Retrieved January 16, 2014, from http://www.fns.usda.gov/sites/default/files/NSLPFactSheet.pdfFind this resource:
United States Department of Agriculture, Food and Nutrition Service. (2013b). The School Breakfast Program. Retrieved January 16, 2014, from http://www.fns.usda.gov/sites/default/files/NSLPFactSheet.pdfFind this resource:
United States Department of Agriculture, Food and Nutrition Service. (2013c). Supplemental Nutrition Assistance Program (SNAP): A short history of SNAP. Retrieved January 14, 2014, from http://www.fns.usda.gov/snap/short-history-snapFind this resource:
United States Department of Agriculture, Food and Nutrition Service. (2014a). Supplemental Nutrition Assistance Program: National level annual summary: Participation and costs, 1969–2013. Retrieved January 14, 2014, from http://www.fns.usda/gov/PD/SNAPMAIN.HTMFind this resource:
United States Department of Agriculture, Food and Nutrition Service. (2014b). Commodity Supplemental Food Program (CSFP). Retrieved January 20, 2014, from www.fns.usda.gov/csfp/commodity-supplemental-food-program-csfpFind this resource:
United States Department of Agriculture, Office of Communications. (2013). USDA unveils historic improvements to meals served in America’s schools. Release No. 0023.12 Retrieved January 17, 2014, from www.fns.usda.goc/pressrelease/002312Find this resource:
Walker, R. E., Keane, C. R., & Burke, J. G. (2010). Disparities and access to healthy food in the United States: A review of food deserts literature. Health & Place, 16, 876–884.Find this resource:
Whitaker, R. C., Phillips, S. M., & Orzol, S. M. (2006). Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics, 118(3), e859–e868.Find this resource:
Wiig, K., & Smith, C. (2008). The art of grocery shopping on a food stamp budget: Factors influencing the food choices of low-income women as they try to make ends meet. Public Health Nutrition, 12(10), 1726–1734.Find this resource:
Wolfe, W. S., Olson, C. M., Kendall, A., & Frongillo, E. A. (1998). Hunger and food insecurity in the elderly: Its nature and measurement. Journal of Aging and Health, 10(3), 327–350.Find this resource:
World Food Programme. (2014). What causes hunger? Retrieved January 13, 2014, from http://www.wfp.org/hunger/causesFind this resource:
Young, L. R., & Nestle, M. (2002). The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 92(2), 246–249.Find this resource: