Ahead of the White House Conference on Hunger, Nutrition, and Health, food insecurity expert shares research-backed approaches for addressing hunger in the U.S.
It is estimated that hunger and food insecurity affected more than 13.5 million households in the United States in 2021. According to nonprofit organization The Urban Institute, the COVID-19 pandemic exacerbated these issues due to widespread job losses, school and child care closures, and new or worsening financial stress faced by families and individuals nationwide. On Wednesday, September 28th, members of the Biden-Harris Administration, health officials, and food access experts will come together to address this crisis at the Biden-Harris White House Conference on Hunger, Nutrition, and Health.
To learn more about the upcoming event, and solution-oriented approaches to address food insecurity, we turned to Dr. Stephanie Ettinger de Cuba. Dr. Ettinger de Cuba is a research associate professor in the Boston University School of Public Health’s Health Law, Policy, & Management Department. She also holds appointments in the Department of Community Health Sciences at SPH and the Department of Pediatrics at the Boston University School of Medicine. Additionally, she serves as the Executive Director of Children’s Healthwatch, a nonpartisan research and policy network aimed at improving the health of young children. Her research focuses on the relationships between social policy, family economic mobility and ability to meet basic needs, such as food, housing and utilities, health care, and child care.
On Wednesday, September 28, The Biden-Harris Administration is hosting a White House Conference on Hunger, Nutrition, and Health. From your perspective, what can we expect from this year’s event?
The conference is historic. It has been 50 years since the White House held a conference like this. The 1969 White House Conference on Hunger was the catalyst for creating and expanding some of the largest anti-hunger programs in the US, including: creation of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), nationwide expansion of the Food Stamp Program (now the Supplemental Nutrition Assistance Program (SNAP)), nationwide expansion of the National School Lunch Program, and the creation of the School Breakfast Program. The world has changed a lot since 1969, in some ways for the worse, in some ways for the better, however, sadly we are still fighting many of the same battles against poverty, hunger, and inequity. While the Biden-Harris Administration certainly deserves sincere credit for hosting this important conference, Congressman Jim McGovern (D-MA-2) also had a very important role in bringing this about. Congressman McGovern has been an anti-hunger leader championing the need for this conference for years.
The conference is organized into 5 pillars: 1. Improve food access and affordability; 2. Integrate nutrition and health; 3. Empower all consumers to make and have access to healthy choices; 4. Support physical activity for all; 5. Enhance nutrition and food security research. The leaders of the conference have made commitments to ensuring discussions of racial equity and root causes of food insecurity. I hope that the conference brings forward expansive, actionable cross-sector solutions to end hunger in the United States.
What is food insecurity?
Food insecurity is defined as ‘inadequate access to enough nutritious foods for all members of the household to live active, healthy lives’. It is, as the definition suggests, a household measure, which is important because it inherently recognizes the interconnections within families. When families lack enough resources to afford competing basic necessities, such as housing, utilities, health care, medication, and child care, food is often where they economize. Coping strategies include reducing the quality of food purchased, decreasing the quantity of food eaten or served to family members, and acquiring food from emergency private food assistance sources (e.g. charities and food pantries) — all of which impact health outcomes.
What are some of the main factors that contribute to food insecurity?
There are many factors that contribute to food insecurity. Certainly, there are the more obvious ones — lack of sufficient income to buy food; access barriers to food, in particular healthy foods, in places that are convenient to the household (e.g. no or few grocery store, areas where there is wide availability of unhealthy food but little else, and/or transportation challenges); and high costs of food, especially fresh foods. This set of circumstances is increasingly known as ‘food apartheid’, acknowledging the deliberate and racist choices that lead to these systematic barriers. However, there are also further, deeper reasons for food insecurity. They include wage stagnation, especially on the lower end of the income ladder; huge gaps in wealth across society, particularly by race and ethnicity, lack of reliable, high quality child care for families with young children — leading to difficulties obtaining or maintaining a job; the high cost of housing in many parts of the country, in turn occupying an outsize portion of family budgets; and widespread un- and underinsurance, which makes health care inaccessible and unaffordable, leading to high risks of serious ill health and disease. Underpinning all of these factors are persistent structural racism and systemic barriers.
How does a lack of healthy, safe, and affordable food affect our society?
Food insecurity harms cognitive function in people of all ages and the physical and mental health of children and adults. Food insecurity weakens the immune system and makes many health conditions worse, including diabetes, heart problems, respiratory conditions and more. In turn, this leads to greater need for acute health care utilization, like sick visits, hospitalizations, and ER visits. In fact, my colleagues estimated in 2016 that food insecurity cost the US $178 billion per year in avoidable health and educational costs — a figure that is certainly higher now. But ill health and health care needs arising from or exacerbated by food insecurity are not equally distributed across the population. Families with low incomes, families of color, immigrant families, and single-parent families have disproportionately high rates of food insecurity and therefore also suffer disproportionate harm to their health.
Has the COVID-19 pandemic had an impact on food accessibility within certain communities across the US and/or globally?
In the earliest days of the pandemic, food access was difficult for everyone as supply chains shut down and faced severe disruption. Millions of people lost their jobs, facing food insecurity for the first time. However, for many families, particularly those in communities of color, rural areas, and immigrant communities, the pandemic exacerbated the food insecurity and other hardships with which they were already living. When the government took swift action and instituted a variety of COVID-focused relief programs, like boosting SNAP and WIC benefits, creating the Pandemic Electronic Benefit Program (P-EBT) to provide resources to families to buy food as replacement for meals at school and in child care, issuing universal Economic Impact Payments, increasing housing assistance, providing unemployment insurance benefits to a wider group of job types, and, more recently, expanding the Child Tax Credit, food insecurity and other hardships dropped dramatically. These historic expansions of support made progress against poverty and hardship, particularly among families with children, in a way that US policy to date had not. However, many of these expansions and changes have already expired or been rolled back. We expect that when data for 2022 are released next September, we will see a return to high rates of food insecurity, unless we make different choices as a society.
You have previous experience working for Project Bread on SNAP (formerly food stamps) policy and outreach. Can you please expand a bit on your work and its impact on children and families in Massachusetts?
When I was at Project Bread (2001–2005), among other projects, I worked on two large studies funded by the United States Department of Agriculture (USDA), the federal agency that administers most of the nutrition assistance programs in the US. Widespread use of the internet was relatively new, and we were testing whether people would access information about SNAP online and whether an anonymous online eligibility calculator would be useful to people. It may seem laughable now to question this, as these days such information and tools are widespread and widely used on the internet, but it was an open question at the time. After demonstrating that there was indeed a demand for that kind of resource, we were funded to work with the Commonwealth to develop Massachusetts’ first online SNAP application, which was a huge step forward in increasing access to SNAP and the important support it provides.
After leaving Project Bread, I worked in a variety of roles as part of Children’s HealthWatch, a non-partisan research and policy network headquartered at Boston Medical Center. Our network is committed to improving children’s health in America. We do that by collecting real-time data in urban hospitals across the country on infants and toddlers from families facing economic hardship. We then analyze and share our findings with academics, legislators, and the public. Our findings help policymakers and the public better understand the social and economic factors that impact children’s health so they can make well-informed policy decisions that can give all children equal opportunities for healthy, successful lives.
With support from the Greater Boston Food Bank, my team demonstrated that, like the nation, Massachusetts is spending huge sums of money each year on avoidable costs of food insecurity — $2.4 billion in 2018, to be exact. How much more could we do with this money to prevent food insecurity if we made different choices as a state and a nation? A lot. We can make better choices — and that is what Children’s HealthWatch, and my own personal work, is all about.
How can folks help to address hunger and food insecurity at a community level?
I would like to encourage people to think beyond the usual solutions of supporting local food pantries, though these resources are, of course, extremely important and worthy of support. However, we must work toward a future when emergency food resources are no longer necessary — to achieve this goal, we must address underlying structures that result in families struggling to afford food. To that end at the community level, getting involved in local town or city government and working to make our communities more inclusive and equitable will drive long-term change. For example, think about your town or city’s policies on housing — do you know what they are? Does your town have decent, affordable, available housing for people of all income levels? What is the atmosphere in your town? Is it welcoming to immigrants, people of color, people with disabilities or with low incomes? Are your town or city’s elected officials thinking about equity, particularly child health equity, in their decisions? Voting in local, state, and federal elections is one of the most important ways that we can make change. Here’s a useful guide to help people evaluate candidates this election season. Get involved in town committees, join community listening sessions, get active in your community! The old adage, think globally, act locally applies for eliminating food insecurity too!
For additional commentary by Boston University experts, follow us on Twitter at @BUexperts. Follow Dr. Ettinger de Cuba at @stephanieedc. For research and news updates from Boston University School of Public Health, follow @BUSPH. Follow BU’s School of Medicine at @BUMedicine. Follow Children’s HealthWatch at @ChildrensHW.