Food Insecurity, Hunger and Child Health

1. Food Insecurity, Hunger and Child Health John T. Cook, Ph.D., MA Ed. BUSM Department of Pediatrics Hunger 101: A Blueprint for Building a Prosperous Future NERAHN’s Anti-Hunger Program and Policy Conference October 27, 2008

2. Children’s Sentinel Nutrition Assessment Program (C-SNAP) A research center made up of a national network of clinicians and public health specialists for research in multiple pediatric settings on the effect of U.S. social policy on young, low-income children’s health and nutrition. Research sites in: • Little Rock, AR, Boston, MA, Baltimore, MD, Minneapolis, MN, Philadelphia, PA (Active) • Los Angeles, CA, Washington, D.C. (Inactive)

3. OverviewFood Insecurity, Hunger and Child Health • What are food insecurity and hunger? • How are they measured? • How prevalent are they? • What are their causes?

4. Overview (cont’d)Food Insecurity, Hunger and Child Health • What are their consequences? • For health • For the U.S. economy • What are the policies that can address these problems? • Alternative Futures: • Envisioning the future we want • Creating a prosperous future by eliminating child food insecurity and hunger

5. Hunger as a Social Problem is a Radical Idea Anytime a radical idea is co-opted by the government it will inevitably be diluted, changed and moderated. Idea articulated by, but not a quote from: Fred Buttel (deceased), Rural Sociologist, Cornel University

6. A Drama in 3, 4 or 5 Acts: “The Food Security Measurement Project” (1990-2008) • Cast of Characters: • Hungry Americans • Anti-Hunger Advocates • The U.S. Congress • The US Department of Agriculture • The National Center for Health Statistics • The Life Sciences Research Office (LSRO) of the Federation of American Societies for Experimental Biology (FASEB) • Interested academicians/scientists/researchers • The Committee on National Statistics of the National Academies, National Research Council (CNSTAT) • Office of Management & Budget (OMB) • Others

7. A Drama in 3, 4 or 5 Acts (Cont’d): “The Food Security Measurement Project” (1990-2008) • Periods • Prior to 1990: Commodity cheese, ketchup is a vegetable, and hunger is a serious social problem. • 1990 to 1997: A new consensus (?), the Food Security Measurement Project is born. • 1998 to 2004: Adapting to “food insecurity” language – and holding onto hunger. • 2005 to 2008: Adapting to “low food security” language – but what happened to hunger? • Back into the Future! What did really happen to hunger?

8. LSRO Conceptual Definitions of Food Security Food Security: Access to enough food for a healthy life; includes (1) ready availability of nutritionally adequate safe foods, (2) assured ability to acquire acceptable foods in socially acceptable ways (e.g., not from emergency food supplies, scavenging, stealing, or other coping strategies).

9. LSRO Conceptual Definitions of Food Insecurity Food Insecurity: Limited or uncertain availability of nutritionally adequate and safe foods or limited ability to acquire acceptable foods in socially acceptable ways.

10. LSRO Conceptual Definition of Hunger Hunger: The uneasy or painful sensation caused by a lack of food. The recurrent and involuntary lack of access to food. Hunger may produce malnutrition over time . . . Hunger . . . is a potential, although not necessary, consequence of food insecurity.

11. Operational Definitions of Food Security and Hunger • Food Secure: Household shows no or minimal signs of food insecurity. • Food Insecure Without Hunger: Food insecurity is evident in household adults’ concerns and in adjustments to household food management, including reduced quality of diets. Little or no evidence of reduction in quantity of household members’ food intake is reported.

12. Operational Definitions (Con.) • Food Insecure with Moderate Hunger: Food intake for adults in the household has been reduced to an extent that adults have repeatedly experienced the physical sensation of hunger. Such reductions are not observed at this stage for children in the household.

13. Operational Definitions (Con.) • Food Insecure with Severe (Child) Hunger: Households with children have reduced the children’s food intake to an extent that it implies that the children have experienced the physical sensation of hunger. Adults in households with and without children have repeatedly experienced more extensive reductions in food intake at this stage.

14. Questions Comprising the U.S. Food Security Scale (Adult Questions – 10 of 18)

15. Questions Comprising the U.S. Food Security Scale (Child Questions – 8 of 18)

16. What Is Hunger? • Relationship Between “Normal” Hunger and “Undesirable” Hunger • What is “normal hunger?” • When does hunger become problematic? • Can Individuals Self-Report Hunger Accurately? • Do we know when we are hungry? • Do we know how severe our hunger is?

17. How is Hunger Evidenced? • Subjective Reporting of Hunger • Existence, or presence of hunger, and severity • Location and severity of the sensations • Hunger – satiety continuum • Objective Measures of Hunger • Gastric emptying, presence/absence of food and nutrients in the upper GI tract • Time since last food intake • Reduction of intake below “normal” levels • Cutting size of meals, skipping meals

18. USDA’s Current Terminology • Food Secure = High food security • Food insecurity without hunger = Low food security • Food insecurity with hunger = Very low food security

19. Proportion of U.S. Households that are Food Insecure, By Race/Ethnicity: 1999-2006* *Includes households with and without children. Source: USDA\ERS Food Security in the U.S., various years.

20. Prevalence of Adult Food Insecurity in the U.S., 1995-2006* *By food security status of household

21. Prevalence of Child Food Insecurity in the U.S., 1995-2006* *By food security status of household

22. What are the Proximal Causes of Food Insecurity and Hunger? • Poverty • Lack of sufficient jobs that pay a living wage • Lack of supports when jobs are not available • Market Failures • Failure to acknowledge and accept external costs • Failure to support public infrastructure and systems • Clinging to False Myths • Myth of the “Free Market” • Myth of “Individual Responsibility”

23. What Influences Poverty? • Household Income • Human Capital (E.g., education, health) • Social Capital (E.g., civic engagement, community support) • Social Infrastructures/Policies (E.g., cash, energy, housing, food assistance, tax policy, labor and wage policies, farm bill) • Household Costs & Expenditures • Type of Household (E.g., marital status, children) • Living Arrangements (E.g., Rent, own, house, apartment) • Geography & Climate (E.g., Region, rural-urban, HDD/CDD) • Other factors • Environmental change (Global climate disruption) • Resources (Global resource supplies & demand; peak oil) • Interdependence of global markets

24. Poverty Thresholds by Family Size and Number of Children Under Age 18 Years, 2007

25. The Economic Self-sufficiency Measure ProjectHow much income is actually needed? • Diana Pearce and Wider Opportunities for Women • Estimates of economic self-sufficiency income levels for most states and counties within states • Economic self-sufficiency income levels fall between 200% and 300% of the poverty thresholds ($21,027 for family of 4 with 2 kids in 2007) • 2003 ESS Standard for Boston: $54,612 = 2.9 X poverty • 2003 poverty threshold: $18,660

26. Proportion of U.S. Families with Incomes Below Poverty By Race/Ethnicity, 1999-2006* *Includes households with and without children. Source: U.S. Census Bureau, Current Population Survey, various years.

27. Potential Health-Related Correlates of Food Insecurity • Micro-nutrient deficiencies • Overweight and obesity • Growth retardation (FTT) • Immune system impairment • Increased morbidity • Cognitive impairment • Psycho-social/behavioral dysfunction • Developmental problems • Learning disabilities • Impaired education attainment • Oral health problems

28. What We Have Learned About Ways Food Insecurity and Hunger are Bad for Children • Brain architecture/cognitive development, perinatal period, (0-3 yrs) • School-readiness (0-5 yrs), • Learning, academic performance and educational attainment (6-17 yrs) • Physical, mental, and social development, growth and health (0-17 yrs) • Psychosocial and behavior problems, and mental health (6-17 yrs) • Child health related quality of life; perceived functionality, efficacy and “happiness/satisfaction,” (6-17 yrs) • Some, not yet clear associations with obesity (0-17 yrs)

29. Possible Interventions • Healthy eating • Public infrastructure investments • Living wage laws • Federal food assistance programs (WIC, SNAP, NSLP, SBP, SFSP etc.) • Federal and state cash assistance (TANF, LIHEAP, SSI, etc.) • Nutrition education • Affordable healthcare (Medicaid, SCHIP, etc.) • Family empowerment • Job/work training and assistance • Unemployment insurance • Private infrastructure investments • Private food assistance programs • Food as medicine & supplementation (FTT) • Community food security & food system reform • Community building (building a global community movement?)

30. The Greatest Threats to Children’s Food Security & Health • Rising costs of energy • Energy market dynamics; demand is far exceeding supply • Energy prices and food prices • Energy costs and household stress • Energy costs and capacity of the Emergency Food Assistance Systems (Public and Private) • Housing/financial market crisis & the dollar • Global climate change • Lack of vision

31. Peak Oil: Global Forecast of World Oil Production: Campbell, 1996

32. Global Climate Disruption is in Process, and we are not Responding • The scientific evidence is unequivocal • Best estimates indicate a need for 80% reduction in greenhouse gas emissions • Congress failed to pass a bill that would mandate a 15% reduction • Hanson, Watson, Stern, et al. are advising nations to prepare for a 4 degree Celsius overall average increase in global temperatures. • This will lead to sea-level rise measured in meters. • Implications for food supply, infectious disease, environmental refugees, and overall health are unprecedented.

33. Public Infrastructures for Addressing Food Insecurity and Hunger • Public Food Assistance Programs • Farm Bill implementation (and prep for 2013) • Child Nutrition Act reauthorization, 2009 • Annual Budget Battles • Private Food Assistance System needs greater support (TEFAP, CACFP, etc.) • LIHEAP & other energy assistance • Housing assistance • Section 8, public housing, vouchers, etc. • Efficient development policies (in-filling, affordable housing policies, etc. • Income supports (TANF) and living wage policies • Energy policy is desperately needed

34. Summary & Conclusion • Food insecurity is a health issue, and an economic prosperity issue • US Food Security Module provides measures and prevalence estimates annually • 35.5 million people food insecure in 2006 • 22.9 million adults; 12.6 million children • Adult and child prevalence increased from 2000-2004 but declined slightly from 2004-2006 • Healthy eating is the treatment • Eliminating poverty • Jobs paying livable wages • Support for existing public infrastructures • Food system reform and sustainable food production

35. Alternative Futures • A downward spiral into chaos; it all falls apart? • Propping up the system, limping along? • Fortress America, tightening the grip? • Global citizens’ movement, community? • WAITT - We’re all in this together • Recognize global interdependence • Enough is enough, “Solution C”