When one conjures up an image of hunger or starvation, what comes to mind may be that of an emaciated Somali child whose enormous eyes stare back in bleak hopelessness. Or perhaps it is an image of a foreign child whose thin arms and legs stick out like tree branches from a disproportionately large belly swollen up from protein malnutrition. But the face of hunger caused by food insecurity is not that dramatic or located in faraway places. It is here in our own country, which is undoubtedly one of the wealthiest countries in the world. It is among our own neighbors, students, and people we pass by on the streets.
According to the Economic Research Service (ERS) data by the United States Department of Agriculture (USDA), 38.3 million Americans lived in food insecure households in 2020.1,2 In other words, 38.3 million people living in the United States in 2020 belonged to households that did not have consistent access to sufficient food to live an active, healthy life. Of those, 11.7 million were children, who need access to adequate nutrition to grow into healthy adults.1
In fact, studies show that food insecurity leads to poor health outcomes at multiple levels. For example, food insecurity is associated with increased risk of anemia, asthma, birth defects, cognitive problems, aggression, anxiety, and depression.3 Children living in food insecure households are at least twice as likely to report being in fair or poor health compared to their counterparts in food secure households.3 At the other end of the age spectrum, seniors who are food-insecure have limitations in activities of daily living equivalent to those of food-secure seniors fourteen years older.3 From young children to older adults, food insecurity has detrimental effects on their health and wellbeing.
Not surprisingly, the COVID-19 pandemic further exacerbated the problem of food insecurity with the pandemic-induced economic difficulties and the disruption of the food supply chain.4 Loss of income from unemployment caused by the pandemic pushed already vulnerable families into more severe food insecurity. School closures to mitigate the spread of the coronavirus meant that the tens of millions of children who relied on the National School Lunch Program and the School Breakfast Program to provide them with their only meals went hungry.5
To address this problem of worsening food insecurity, the United States government implemented various policies during the pandemic. For example, the Families First Coronavirus Response Act (FFCRA) increased benefit amounts for the Supplemental Nutrition Assistance Program (SNAP; previously known as the Food Stamp Program) up to the maximum allowable amount as an emergency measure in many states.6 However, one drawback to this emergency aid was that 7 million families (nearly 40% of total SNAP families) were already receiving the maximum monthly benefit prior to the pandemic due to their very low income status, thereby not receiving any additional benefit with this measure despite being in need.6 The FFCRA also enabled states to issue special pandemic Electronic Benefits Transfer (P-EBT) for households with children eligible to receive free or reduced-price school meals since schools were closed due to the pandemic.6 There were initially some technical delays in getting the P-EBT into the hands of those who desperately needed it, but it was a lifesaver once received.6,7
Unfortunately, many of these policy measures were temporary and set to expire so the American Rescue Plan Act (ARPA), which was signed into law on March 11, 2021, further extended the P-EBT for the duration of the federal public health emergency (PHE) for the COVID-19 pandemic, including through the summer.8 Of note, the PHE is currently effective through October 13, 2022, and many experts believe that it will likely be extended for another 90 days.
One day, however, the PHE will end and so will these extra measures for the vulnerable members of our country. In thinking ahead, some states such as California have come up with state-level policies and programs to address the issue of food insecurity. For example, California became the first state in the nation to implement a statewide universal meals program for all school-age students regardless of income to ensure that no school-age child is left hungry.9 On June 30, 2022, Governor Gavin Newsom signed the Budget Act of 2022 (SB/AB 178), which allocates funding for some food assistance programs in the state.10 At the federal level, President Biden signed into law the Keep Kids Fed Act of 2022 on June 25, 2022, extending some of the flexibilities provided through the FFCRA.11,12 These are all important steps in addressing the problem of food insecurity, but they are not enough. Policymakers need to consider the root causes of food insecurity in our country and take upstream measures to ensure that no child, adult or elderly in our country suffers from food insecurity in a land of plenty.
Wonha Kim, MD, MPH, CPH, FAAP
Dr. Kim is the Director of the Institute for Health Policy and Leadership. She is also an Assistant Professor of Pediatrics and of Preventive Medicine at the School of Medicine and an Assistant Professor for the School of Public Health. Her research interests include pediatric obesity, social determinants of health, global health and policy approaches to addressing health issues faced by vulnerable populations.