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Hunger in Our Own Backyard: The Face of Hunger in the United States

Nutrition Crossroads, Concord, New Hampshire

Correspondence: Correspondence: Helen E. Costello, RD, LD, Nutrition Crossroads, 4 Wildemere Terrace, Concord, NH 03301. Electronic mail may be sent to hcostell{at}comcast.net.

The world's 864 million hungry people¹ include 36.9 million in America² who are greatly affected by their economic circumstances. The paradox of hunger in an affluent society is an encroachment on our American sensibilities, and I question why we continue to accept it. The negative effects of hunger in America are far reaching for those who experience it. Since the 1930s, the face of hunger in the United States has changed, and the psychological and physiologic impacts from poverty and hunger are found in schools, doctors' offices, hospitals, and workplaces daily. Any discussion about "hunger in our backyard" requires attention to its root causes, how we choose to define it, and the political and social will to change it.

Dorethea Lange and others used photography to document people living in poverty and with hunger during the Great Depression (Figure 1). Photos of families wearing dirty rags and living in shacks are famous and stark reminders of the severity of hunger in the United States at the time. They became the faces of hunger that many people identify with today. Later, in April 1967, Senator Robert Kennedy (D-NY) and Senator Joseph Clark (D-PA) led the Senate Subcommittee on Employment, Manpower, and Poverty on a visit to the Mississippi Delta, where they exposed the squalid living conditions and the hidden hunger in rural America. It was at that time that policy efforts to address poverty and hunger in the form of public food assistance began to expand in response to the need.³

View larger version (162K): [in this window] [in a new window]   Figure 1. Migrant agricultural worker's family. Seven hungry children. Mother aged 32. Father is a native Californian. Destitute in pea picker's camp, Nipomo, CA, because of the failure of the early pea crop. These people had just sold their tent in order to buy food. Of the 2500 people in this camp, most of them were destitute. From: Library of Congress, Prints & Photographs Division, FSA/OWI collection [reproduction number, eg, LC-USF34-9058-C]. Photo by Dorothea Lange.

The root cause of hunger in the United States is poverty, and the solutions to alleviate it must also address poverty. The Hunger in America survey 2006, in which 52,878 clients who use food pantries, soup kitchens, and shelters were interviewed, found that 52% of client households with an elderly member were food insecure, and 65% of those lived in poverty. Of client households with seniors, 28.7% have had to make a choice between food and medical care, and 31% have had to choose between food and paying for heat/utilities.⁴ In the contexts of humanity and an affluent society, no one should have to make these choices.

	The Dilemma of Defining Hunger in an Affluent Society

Top The Dilemma of Defining... Is the Problem Intractable?

 
The exercise of defining hunger and food security or, to place a finer point on the subject, food insecurity frustrates the efforts of professionals who work in this area in the United States. Allocating an abstract term such as food security to a physiologic and social construct such as hunger minimizes the urgency that the situation commands. Embedded within the definition of food security is the key to how hunger is identified in the United States and the policy structure intended to alleviate it.

On the international level, the United Nations Food and Agriculture Organization uses the term food security as one means to describe hunger that includes both the lack of access to food and undernourishment. The definition of food security has evolved, and the following definition is currently in use: Food security is a situation that exists when all people, at all times, have physical, social, and economic access to sufficient, safe, and nutritious food that meets their dietary needs and food preferences for an active and healthy life.⁵ The current definition reflects the importance of including food as a human right into the language of food security and was influenced by the work of the renowned Nobel Prize winner Amartya Sen.

In the United States, the definition includes the same elements as the United Nations definition; however, operationally it includes the concept of acquiring foods in socially acceptable ways: Food security is, at a minimum, the ready availability of nutritionally adequate and safe foods and assured ability to acquire acceptable foods in socially acceptable ways (that is, without resorting to emergency food supplies, scavenging, stealing, or other coping strategies).⁶

The word hunger is most commonly relegated to the clinical features of the physiologic sensation of feelings of discomfort from a lack of food. This was recently highlighted by the National Research Council of the National Academies' Panel to Review U.S. Department of Agriculture's (USDA) Measurement of Food Insecurity and Hunger.⁶ After 10 years of measuring hunger using this tool, the review panel recommended that the USDA remove the term hunger from the reporting terminology. A decision was made to replace hunger with the term, very low food security. The rationale for removing the term stated that the panel did not believe the 18-question survey instrument used to measure hunger within the household was a valid measure of hunger. They concluded that only an individual, not a household, can experience hunger. Their recommendation stands despite the fact that 8 questions from the instrument specifically address the words hunger or hungry in relation to a household member's experience. The recommendations ignore the painstaking work of the original committee who developed the measurement tool and carefully deliberated over the literature describing the physiologic experience of hunger (John Cook, personal conversation, April 2007; principal investigator for the original Household Food Security Measurement Project). I predict that omitting the term hunger from describing the experience of household members, when their resources are too limited to purchase food, may have a negative impact on public policy decisions about nutrition assistance programs.

The repercussions of this decision will resonate throughout programs that serve limited resource populations for a long time. The decision to replace the term hunger with the term very low food security falsely identifies the real food and nutrition needs of low-income people in America. By not acknowledging hunger at the federal level, responsibility for alleviating the problem is muddied. It hampers attempts for an honest national discussion about how to truly alleviate hunger in the United States because arbitrary terms such as very low food security confuse the issue of real needs with semantics.

There are no national or coordinated state efforts to measure hunger in the United States; however, there are several large studies that provide some assessment of hunger. The annual Food Security Supplement administered by the United States Census Bureau as part of their annual Current Population Survey measures food security, and in the 2005 report dropped the term hunger as described above. Every 4 years, the nations' largest food bank network, America's Second Harvest, conducts a survey of individuals who seek food assistance from food bank member agencies and programs.⁴ The United States Conference of Mayors conducts the Annual Survey of Hunger and Homelessness, which assesses these conditions in major U.S. cities but does not look at the issue of hunger in rural areas. It has been more than 10 years since the Community Childhood Hunger Identification Project was conducted, and since that time there have been changes to public assistance laws which are not reflected in those earlier studies. Finally, a common indicator of the measure of hunger in the United States is the prevalence of poverty. In the absence of a reliable, regular measure of hunger, poverty is used as a proxy to measure it.

In 2005, 12.6% of all Americans, or approximately 37 million people, lived in poverty. An additional 53.6 million people live between 100% and 200% of the poverty threshold.² An annual income below 200% of the poverty threshold is considered low income, and families may experience various levels of food insecurity within this income range. The poverty guideline is set by the U.S. Department of Health and Human Services to determine applicants' eligibility for federal nutrition assistance programs. In 2005, if a family of 4 had an annual income of $19,350 or less, they fell below the poverty guideline. In regions where the cost of living is high, even a family whose annual income is $40,000 may experience food insecurity. The reality is that the middle class family making between 185% and 200% of the poverty threshold is vulnerable to economic emergencies, such as a healthcare emergency, because they are not eligible for any of the support programs that assist families living at or near the poverty level.

The range of federal nutrition assistance programs for the lowest-income families is the major factor in averting widespread homelessness and malnutrition in the United States. We rarely witness severe undernutrition in the United States; however, we know there are clinical and subclinical manifestations of malnutrition.⁷ Most recently, the rise in childhood obesity, clinically defined as malnutrition, is one of many manifestations of how hunger is affecting American children.

	Is the Problem Intractable?

Top The Dilemma of Defining... Is the Problem Intractable?

 
To truly eliminate hunger, leadership is required at the federal level, along with the acknowledgment that hunger exists and is a problem in the United States. It also requires community action at the local level. There are numerous nutrition assistance programs available to low-income families (the Food Stamp Program, the Supplemental Special Nutrition Program for Women Infants and Children [WIC], Farmers' Market Nutrition Programs, Senior Farmers' Market Nutrition Program, School Breakfast and Lunch, After School Snack, Child and Adult Care Food Program, the Emergency Food Assistance Programs, senior meals and Meals on Wheels programs, among others). Reasonable people can debate the virtues and limitations of each; however, it is important that these programs remain intact. Many of them are underused, and a greater commitment to conduct outreach is critical to providing access. The programs have demonstrated improvement in the nutrition status of the people who use them. In particular, women and children receive key nutrients when they are using the WIC and Food Stamp Programs. It is critical that policy makers and private citizens understand the importance of the nutrition safety net provided by the federal nutrition assistance programs. A paradigm shift is needed to create awareness that people can consistently access nutrition-rich foods by participating in the federal nutrition assistance programs.

The definition of food security as described earlier defines emergency food assistance programs as socially unacceptable means to acquire food. This is a much different view from how low-income individuals and families view these services. Many people, especially seniors, prefer to seek help from their church food pantry rather than apply for food stamp benefits. The Hunger in America 2006 study found that 53% of the respondents said that if the agency they use was not there to help them, they would turn to another agency. Only 8% said they would turn to the government for help. This trend persists throughout the country where almost half of the people who are eligible forgo the Food Stamp Program, a program that allows autonomous choices in food purchases, for a food pantry where they are limited to what the agency can provide in any given week or month. It is a public health issue because the independent emergency food system finds it increasingly difficult to acquire foods that provide protein, healthy fats, and essential vitamins and minerals.

Food banks are large centralized warehouses where smaller emergency food programs acquire food for their pantries and kitchens. At the state and local levels, food banks often use monetary donations to leverage their purchasing power to buy nutrient-rich foods for the agencies and programs they serve. Traditional sources of donated food for many food banks across the country are dwindling as the food industry has become more efficient in food distribution and inventory. Food banks are developing creative ways to serve their member agencies. Some food banks are contracting with farmers to secure fresh fruits and vegetables. Some are taking it a step further and creating value from donated perishable food that is close to the sell-by date and processing it into frozen meals.

McCullum et al⁸ described a community food security continuum to illustrate how dietetics professionals can become involved in efforts to alleviate hunger and support local communities and local food systems. It is a practical tool that can be expanded for anyone who wants to tackle the problem of hunger without being overwhelmed by it. Important strategies include community food projects and grass-roots-level food security social marketing campaigns to address hunger and pubic health consequences. Examples such as starting effective breastfeeding campaigns to appropriate audiences can stretch a family's food budget. Support for the Food Stamp Nutrition Education Program and Operation Frontline, where food budgeting skills and money management are included in basic nutrition and cooking programs, is also important. Community and school garden programs and access to local community-supported agriculture programs all include nutrition promotion and restore dignity to low-income individuals and families. I have never met a hungry person who told me they enjoyed coming to the food pantry, soup kitchen, or welfare office. However, people who seek help from the emergency food system, such as church pantries, find a sense of community there. Rebuilding a sense of community is important to many of America's neighborhoods, both urban and rural.

Within communities, people need economic security and independence. Nationally, we need a strong commitment at the federal level to support work and work-training programs for those who are able to work. The programs must include safe and accessible childcare, availability of healthcare, and training for jobs that pay livable wages. The recent increases in minimum wages are a move forward; however, with the exception of Maryland, they are still not a livable wage. The term livable wage has different definitions, depending on the study, but they all attempt to determine the cost of meeting basic human needs as described earlier. As a nation, we need better policies to support a productive workforce.

We can find calls to action to alleviate hunger and poverty at the local, state, national, and international levels. The first goal of the United Nations Millennium Development Goals is to reduce by half the proportion of people living on less than a dollar a day and to reduce by half the proportion of people with hunger.⁹ The position statement of the American Dietetic Association position paper on food insecurity and hunger in the United States states the following: "It is the position of the American Dietetic Association that systemic and sustained action is needed to bring an end to domestic food insecurity and hunger and to achieve food and nutrition security for all in the United States."¹⁰ Eradicating hunger and its impact on public health and the human condition is an important goal for all of us. Health professionals are the ideal community leaders to create the political and social will to eradicate hunger in America. When you look around your backyard, what is your personal antihunger policy?

The author wishes to acknowledge the thoughtful review of this commentary by John A. Krakowski, RD, Community Food and Nutrition Consultant.

Top The Dilemma of Defining... Is the Problem Intractable?

 
This paper is one of hundreds of similarly themed papers being published on October 22, 2007 with the Council of Science Editor's Global Theme Issue on Poverty and Human Development. For more information, please visit http://www.councilscienceeditors.org/globalthemeissue.cfm.

1 Food and Agriculture Organization of the United Nations. Number of undernourished persons (millions) [FAO website]. June 30, 2006. Statistics Division. Food and Agriculture Organization of the United Nations. Available at: http://www.fao.org/es/ess/faostat/foodsecurity/index_en.htm. Accessed March 20, 2007.

Nutrition in Clinical Practice, Vol. 22, No. 6, 587-590 (2007)
DOI: 10.1177/0115426507022006587


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