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The United States is viewed by the world as a country with plenty of food, yet not all households in America are food secure, meaning access at all times to enough food for an active, healthy life. A proportion of the population experiences food insecurity at some time in a given year because of food deprivation and lack of access to food due to economic resource constraints. Still, food insecurity in the United States is not of the same intensity as in some developing countries. Since 1995 the U.S. Department of Agriculture (USDA) has annually published statistics on the extent of food insecurity and food insecurity with hunger in U.S. households. These estimates are based on a survey measure developed by the U.S. Food Security Measurement Project, an ongoing collaboration among federal agencies, academic researchers, and private organizations. USDA requested the Committee on National Statistics of the National Academies to convene a panel of experts to undertake a two-year study in two phases to review at this 10-year mark the concepts and methodology for measuring food insecurity and hunger and the uses of the measure. In Phase 2 of the study the panel was to consider in more depth the issues raised in Phase 1 relating to the concepts and methods used to measure food security and make recommendations as appropriate. The Committee on National Statistics appointed a panel of 10 experts to examine the above issues. In order to provide timely guidance to USDA, the panel issued an interim Phase 1 report, Measuring Food Insecurity and Hunger: Phase 1 Report. That report presented the panel's preliminary assessments of the food security concepts and definitions; the appropriateness of identifying hunger as a severe range of food insecurity in such a survey-based measurement method; questions for measuring these concepts; and the appropriateness of a household survey for regularly monitoring food security in the U.S. population. It provided interim guidance for the continued production of the food security estimates. This final report primarily focuses on the Phase 2 charge. The major findings and conclusions based on the panel's review and deliberations are summarized.
Food insecurity rates, which skyrocketed with the Great Recession, have yet to fall to pre-recession levels. Food pantries are stretched thin, and states are imposing new restrictions on programs like SNAP that are preventing people from getting crucial government assistance. At the same time, we see an increase in obesity that results from lack of access to healthy foods. The poor face a daily choice between paying bills and paying for food.
How to focus anti-hunger efforts not on charity but on the root causes of food insecurity, improving public health, and reducing income inequality. Food banks and food pantries have proliferated in response to an economic emergency. The loss of manufacturing jobs combined with the recession of the early 1980s and Reagan administration cutbacks in federal programs led to an explosion in the growth of food charity. This was meant to be a stopgap measure, but the jobs never came back, and the “emergency food system” became an industry. In Big Hunger, Andrew Fisher takes a critical look at the business of hunger and offers a new vision for the anti-hunger movement. From one perspective, anti-hunger leaders have been extraordinarily effective. Food charity is embedded in American civil society, and federal food programs have remained intact while other anti-poverty programs have been eliminated or slashed. But anti-hunger advocates are missing an essential element of the problem: economic inequality driven by low wages. Reliant on corporate donations of food and money, anti-hunger organizations have failed to hold business accountable for offshoring jobs, cutting benefits, exploiting workers and rural communities, and resisting wage increases. They have become part of a “hunger industrial complex” that seems as self-perpetuating as the more famous military-industrial complex. Fisher lays out a vision that encompasses a broader definition of hunger characterized by a focus on public health, economic justice, and economic democracy. He points to the work of numerous grassroots organizations that are leading the way in these fields as models for the rest of the anti-hunger sector. It is only through approaches like these that we can hope to end hunger, not just manage it.
At some point during 2009, more than 17 million households in the United States had difficulty providing enough food for all their members because of a lack of resources. In more than one-third of these households, the food intake of some household members was reduced and normal eating patterns were disrupted due to limited resources. The Workshop on Understanding the Relationship Between Food Insecurity and Obesity was held to explore the biological, economic, psychosocial, and other factors that may influence the relationship between food insecurity, overweight, and obesity in the United States. Hunger and Obesity examines current concepts and research findings in the field. The report identifies information gaps, proposes alternative approaches to analyzing data, recommends new data that should be collected, and addresses the limitations of the available research.
Food insecurity poses one of the most pressing development and human security challenges in the world. In Feeding the Hungry, Michelle Jurkovich examines the social and normative environments in which international anti-hunger organizations are working and argues that despite international law ascribing responsibility to national governments to ensure the right to food of their citizens, there is no shared social consensus on who ought to do what to solve the hunger problem. Drawing on interviews with staff at top international anti-hunger organizations as well as archival research at the United Nations Food and Agriculture Organization, the UK National Archives, and the U.S. National Archives, Jurkovich provides a new analytic model of transnational advocacy. In investigating advocacy around a critical economic and social right—the right to food—Jurkovich challenges existing understandings of the relationships among human rights, norms, and laws. Most important, Feeding the Hungry provides an expanded conceptual tool kit with which we can examine and understand the social and moral forces at play in rights advocacy.
Updates for many countries have made it possible to estimate hunger in the world with greater accuracy this year. In particular, newly accessible data enabled the revision of the entire series of undernourishment estimates for China back to 2000, resulting in a substantial downward shift of the series of the number of undernourished in the world. Nevertheless, the revision confirms the trend reported in past editions: the number of people affected by hunger globally has been slowly on the rise since 2014. The report also shows that the burden of malnutrition in all its forms continues to be a challenge. There has been some progress for child stunting, low birthweight and exclusive breastfeeding, but at a pace that is still too slow. Childhood overweight is not improving and adult obesity is on the rise in all regions. The report complements the usual assessment of food security and nutrition with projections of what the world may look like in 2030, if trends of the last decade continue. Projections show that the world is not on track to achieve Zero Hunger by 2030 and, despite some progress, most indicators are also not on track to meet global nutrition targets. The food security and nutritional status of the most vulnerable population groups is likely to deteriorate further due to the health and socio economic impacts of the COVID-19 pandemic. The report puts a spotlight on diet quality as a critical link between food security and nutrition. Meeting SDG 2 targets will only be possible if people have enough food to eat and if what they are eating is nutritious and affordable. The report also introduces new analysis of the cost and affordability of healthy diets around the world, by region and in different development contexts. It presents valuations of the health and climate-change costs associated with current food consumption patterns, as well as the potential cost savings if food consumption patterns were to shift towards healthy diets that include sustainability considerations. The report then concludes with a discussion of the policies and strategies to transform food systems to ensure affordable healthy diets, as part of the required efforts to end both hunger and all forms of malnutrition.
New evidence this year corroborates the rise in world hunger observed in this report last year, sending a warning that more action is needed if we aspire to end world hunger and malnutrition in all its forms by 2030. Updated estimates show the number of people who suffer from hunger has been growing over the past three years, returning to prevailing levels from almost a decade ago. Although progress continues to be made in reducing child stunting, over 22 percent of children under five years of age are still affected. Other forms of malnutrition are also growing: adult obesity continues to increase in countries irrespective of their income levels, and many countries are coping with multiple forms of malnutrition at the same time – overweight and obesity, as well as anaemia in women, and child stunting and wasting.
With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.