Management of Hunger in the United States
Kathleen C. Walker, RN BSN, MS RD
Hunger is a multifaceted phenomenon. This phenomenon in its various facets effects over one billion people in the world (1). Hunger is commonly defined as a situation when one cannot obtain an adequate amount of food. Even if this period of inadequate food is temporary and does not cause health problems it is still classified as hunger (2). In 1990 the United Nations (UN) State of the World assigned nutrition as an international statute and a human right. Two articles developed at this session of United Nations recognized that proper, adequate nutrition combats disease and malnutrition, and that every child in the world has the right to live in an environment which provides adequate food and clean, safe drinking water. These policies were incorporated and expanded in the 1992 U.N. Convention on the Rights of the Child with United Nations Children’s Fund (UNICEF) developing specific goals to reach the world’s population by the year 2000 (3). The physical aspects of hunger--starvation, delayed growth leading to mental and physical developmental deficits, and increase risk for infections and chronic diseases is very evident in third world nations. Medically hunger is defined as a chronic under consumption of adequate nutrition needed for growth and for maintaining health.(2). Looking at hunger in third world or undeveloped nations, one notices hunger causing various degrees of malnutrition, health problems, and finally death.
However, examining hunger in the developed nations, malnutrition is usually not evident. The psychosocial aspects of food insecurity is the predominate facets of hunger seen in western developed nations (2). The topic of hunger and food security as related to public health is a book in its own right; however, this chapter’s focus will be limited to certain aspects of hunger in the United States (USA). Because this chapter only refers to hunger in the United States, a few websites giving more information on world hunger and its issues are listed at the end of this chapter.
The paradox of hunger in the USA is people go without food in a rich and prosperous nation. This facet of hunger violates some of the basic assumptions and deeply cherished values held by most Americans. The fact that people are hungry makes food insecurity one of the most compelling social problems competing for attention by American society. Because hunger disturbs the conscience of most Americans, public opinion forced community organizations and governments to take action elevating hunger in the USA. Although elevating hunger is an intrinsic part of American culture, the federal government food distribution programs were not developed until the Great Depression of the 1930s (4).
History of the Development of Food Programs
A review of history reveals that during the depression of the 1920s and 1930s, the farmers had excessive amounts of grain, but could not take it to market. The fact that people were going hungry from lack of bread and food with wheat rotting in the grain elevators was a dilemma that most Americans could not accept. Nonprofit organizations, local communities and governments were the first to respond to the out cry created from this paradox. Gleaning projects, soup kitchen and food baskets provided by the community to feed the hungry. However, the Hoover administration opposed a federal relief program but did purchase large amounts of grain and cotton to supplement farmers’ income. Finally, Congress disregarded Hoover’s opposition and overwhelmingly passed a bill to release government purchased wheat to feed the hungry. When the Roosevelt administration took office, an ongoing food assistant programs was initiated. These programs included surplus commodity procurement and distribution projects that formed the policy and management procedures of the federal food assistance programs. Even today some of the principles in the government food security and research programs are based on these core principles (4).
The facets of food security reviewed in this chapter are:1.What is the best ways to evaluate food security? (community, household and individual hunger), 2. What populations are hungry? (unemployed, poor, and at risk populations), 3. What programs have been developed to elevate hunger? ( federal and state, nonprofit and community programs).
EVALUATION OF FOOD SECURITY
Evaluating food insecurity and hunger is a major problem in determining food security in the United States. The various ways of defining hunger help create this difficulty in evaluation. What facets of hunger should be included in a definition of food insecurity and hunger? Does hunger occur with food insecurity or must physical signs of hunger and malnutrition need to be present? Should the definition include inaccessibility to grocery stores and/or physical limitations in procuring and preparing meals; or are economic considerations, the only value in defining one’s inability in obtaining food? Each of the departments in the federal government involved in the national food and nutrition programs developed their own definition of hunger or food insecurity. The department then formed policies and managed their food distribution programs based on their own definition (4). With varied definitions as the base, each department used a number of food surveys to determine the defined needs of the American people and to determine if these needs were being adequately meet by their food supplementation programs. Each department maintained its own data and the exchange of the information gleaned from the surveys was discouraged by department leaders.
This attitude changed in the early 1980s with the collaboration of the Department of Health and Human Services (DHHS) and the United States Department of Agriculture (USDA), leading to the development of National Nutrition Monitoring System which measures the health and nutrition status, dietary knowledge, attitudes about diet, and food consumption of the American people (5). As more federal officials developed an attitude of collaborations and exchange, other departments began working together to prevent duplication of effort and service. In 1992 the USDA Food and Nutrition Service (FNS) began a collaborative effort with United States Bureau of the Census and other organizations researching USA hunger to develop a national benchmark to measure and determine the prevalence of hunger.
Food insecurity is best defined as the uncertain ability of acquiring adequate nutritional food in a safe and acceptable manner (2). Household food security is defined as the ability of a household to have permanent and secure access of sufficient amounts and variety of foods. In food security all individuals in the household live a healthy, active and productive life (8). Even these definitions of hunger can be viewed using several facets, as evidenced by the core principles developed from the various concepts of food security and hunger. Therefore a standard tool needed to be developed that combined the definitions and established a basic, consistent measurement of a population over a specific time period. The primary role of the tool on food security would be to consistently compare the prevalence of food insecurity and physical hunger. Using the Rasch model a scale of household status was adopted. The values measured household food security using the following categories: 1. food secure, 2. food insecure with hunger not evident, 3. food insecure with moderate hunger, and 4. food insecure with severe hunger (6). Some facets of hungry, such as, the homeless and disaster situations are not addressed in this chapter, but will be included in the websites at the end of the chapter.
When analyzing a community’s status of food security, the measures of food security are: quantity and quality of available food, the accessability of food (location of grocery stores and accessible transportation), and prices relate to the economical level of the community. The local community’s food security identifies the household and individuals with food insecurity in the community. The four aspects of food insecurity in the community that reflects household and individual hunger are: quantity, quality, psychological acceptability and social acceptability (7). Psychological and social barriers developed from food insecurity when accessability to community’s food supply are different from community convention. Some of these barriers are obtaining additional food at community food pantries; free meals provided only at community “soup kitchens” and not at restaurants; and special lines for children receiving price reduced school lunches. Because of the negative attitudes that develop from these barriers, collecting accurate data on food insecurity and hunger is difficult at the community level. Often people will report household and individual food security on a general anonymous food security survey (8). Another hindrance to preventing food insecurity is incomplete training of employees and ignorance of regulations at some food stamp offices. These situations delay or nullify eligible households from obtaining food through government programs. This barrier must be corrected at the community level since most training is done locally (9).
Households and Individuals
The Third National Health and Nutrition Examination Survey (NHANES III) found that 38 million Americans live at or below the poverty level with and additional 14 million eligible for most food assistance programs with incomes at or below the 130% of the poverty level. Six family types classified in this study were determined by sex and married status of the household head, number of children less then 17 living in household, single household head was 17 years of age or older, head of household had a job within the last 2 weeks, and if household received food stamps in the past month. The NHANES III reported finding 53.5% of individuals with food insecurity caused by insufficient amounts of food due to a lack of resources lived in households where the head was employed. Of these individuals 53 % of the households and 37% of the individuals participated in the Food Stamp Program (10). This leaves 10% of individuals with food insufficiency not in this food assistant program.
A conference in February 2000 sponsored by FNS, America’s Second Harvest and the National Child and Adult Care Food Program Forum discussed how to reach the 31 million Americans who experience food insecurity or physical hunger. Several speakers were concerned about the fact that in a booming economy several million households are experiencing food insecurity. One reason given for this increase in hunger is the decrease of food stamp recipients. Since this is a federal program operated by state and local governments, regulations, applications and restrictions vary form state to state. For example, the application form in Ohio is over 30 pages long which acts as a deterrent to those with limited education or time. Another reason given for this increase is the welfare reform law of 1996. This law has created a population called the working poor. This group of people run out of money before the next pay day and often use soup kitchens or food pantries to supplement their food supply (9).
Most individuals who use food stamps or need emergency food assistance are female (11) and the greatest percent of households with food insecurity are female headed households (12). The greatest number of clients at America’s Second Harvest network are from two high risk populations, 38% are children under 18 years old and 16% are the elderly over 64 years old (11). Geographically urban centers has the largest percent of food insecurity with hunger, but the hungry outside urban ghettos is rapidly increasing with (12) rural areas having the greatest increase. The largest growth in community hunger is found in the farming areas of the western and southern states(13).
Insufficient food or skipping meals has consequences to both the community and individuals. Some of the community consequences are: threats to community harmony, development of a two-tiered food distribution system, and a risk of reducing social and economic development. The primary consequences to the individual having food insecurity with hunger are impaired learning, increase need for health care, loss of productivity and intensified feelings of powerlessness (14). Poverty is facet of hunger and one of the leading causes of household food insecurity and individual hunger in the USA. Additional information can be obtained from several governmental websites (listed at the end of the chapter) dealing with poverty and the various food programs.
FOOD ASSISTANCE PROGRAMS
Government Programs, USDA
Most of the government programs, the policies and management of these programs are listed on governmental websites with full access to the public. Therefore, a brief description will be provided with links to the various websites listed at the end of the chapter.
The USDA is the oldest bureau to participate in food assistance. The commodity program was the first passed by Congress in the 1930s (4), It mostly operates through institutional and community food banks food programs. Today a variety of information is available from what commodities are available to recipes on how to use them (15). The programs involved at this website include: Child Nutrition Commodity Support, Commodity Supplemental Food Program, Food Assistance in Disaster Situations, Nutrition Programs for the Elderly, The Emergency Food Assistance Programs, State Processing Program and Food Distributions Program on Indian Reservations.
Other national nutrition programs operated by the USDA includes the Special Nutrition Program for Women, Infants, and Children (WIC), Food Stamp Program, and the FNS Programs and Farmers Markets. The WIC program assist women and children at high risk for specific nutrient deficits and are managed by county agencies. The Food Stamp Program, one of the core programs developed in the1930's, is managed by states and county human service departments. The main concerns in these programs are the increase number of underserved, high risk and eligible persons, especially children, experiencing food insecurity with moderate hunger. These programs can be accessed by which is the website of the National Nutrition Safety Net.
One of the best websites for developing a new nutrition assistance program is the National Nutrition Safety Nets Tool Kit which gives a step by step guidance to starting a program as well as several links to additional information and programs already established. is the website to the tool kit.
Although the government program provides food assistance to the majority of the food insecure population, some people either refuse to participate in the program or are ineligible for these programs. Therefore, several national and local organizations have developed nutrition and food assistant programs to fill in the gap. Local chapters of Second Harvest and local Hunger Task Forces provide food pantries to supplement the government commodity programs. Several religious organizations provide meals at specific times of the year. These times vary from daily to weekly, to monthly or during holiday periods. In 1999 the Catholic Charities Agencies reported an increase of 32% over the 1998 food assistant programs. Most of the increase was seen in the emergency service. This result from 1999 annual report was surprising since the economy was booming and the unemployment was declining (15).
In several communities hunger is managed by a collaboration of governmental programs and private non-profit organizations. The non-profit organization will apply for food from the government commodity programs and distribute the food to local community food pantries and meal centers. Some organizations also assist individuals in applying for governmental food assistance. Some local hunger task forces also provide information and education programs using government materials. Promotion of the positive aspects in preventing hunger and food insecurity is present to the general public. With increase public knowledge a reduction in some negative attitudes and concepts toward food distribution programs has been noticed.
Two of the national organizations dealing with eradicating hunger are Food Research and Action Center and the Second Harvest. Both websites are listed at the end of this chapter. To find the local hunger programs in your area, one can find the link for your area one a national organization or one of the government hunger center. If no link is provided check with the public health department.
A national organization that indirectly deals with hunger through the direct interventions of its members is the American Dietetic Association (ADA). The professional organization of registered dietitians, ADA approaches food insecurity and hunger by acknowledging that aggressive action is needed to end domestic hunger and to achieve food and nutrition security for all Americans. In their position statement written in 1998 and reaffirmed in 2001, the ADA states hunger should not be found among residents of the richest country in the world (16). The only way to purge hunger in the USA is by the collaboration of the federal, state and local government and the various public health, local dietetic associations and community organizations. This collaboration not only needs to provide food, but also to develop educational programs to teach persons who have food security the proper ways to assist the hungry, thus preventing negative attitudes. By preventing or diminishing negative community attitudes toward food insecurity, more households and individuals can participate in the food assistance programs and other programs to reduce poverty which will decrease food insecurity and hunger in the USA.
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