About This Literature Summary
This summary of the literature on Food Insecurity as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Access to Foods that Support Healthy Dietary Patterns literature summary.
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Literature Summary
Food insecurity is defined as a household-level economic and social condition of limited or uncertain access to adequate food.1 In 2020, 13.8 million households were food insecure at some time during the year.2 Food insecurity does not necessarily cause hunger,i but hunger is a possible outcome of food insecurity.3
The United States Department of Agriculture (USDA) divides food insecurity into the following 2 categories:1
- Low food security: “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
- Very low food security: “Reports of multiple indications of disrupted eating patterns and reduced food intake.”
Food insecurity may be long term or temporary.4,5,6 It may be influenced by a number of factors, including income, employment, race/ethnicity, and disability. The risk for food insecurity increases when money to buy food is limited or not available.7,8,9,10,11 In 2020, 28.6 percent of low-income households were food insecure, compared to the national average of 10.5 percent.2 Unemployment can also negatively affect a household’s food security status.10 High unemployment rates among low-income populations make it more difficult to meet basic household food needs.10 In addition, children with unemployed parents have higher rates of food insecurity than children with employed parents.12 Disabled adults may be at a higher risk for food insecurity due to limited employment opportunities and health care-related expenses that reduce the income available to buy food.13,14 Racial and ethnic disparities exist related to food insecurity. In 2020, Black non-Hispanic households were over 2 times more likely to be food insecure than the national average (21.7 percent versus 10.5 percent, respectively). Among Hispanic households, the prevalence of food insecurity was 17.2 percent compared to the national average of 10.5 percent.2 Potential factors influencing these disparities may include neighborhood conditions, physical access to food, and lack of transportation.
Neighborhood conditions may affect physical access to food.15 For example, people living in some urban areas, rural areas, and low-income neighborhoods may have limited access to full-service supermarkets or grocery stores.16 Predominantly Black and Hispanic neighborhoods may have fewer full-service supermarkets than predominantly White and non-Hispanic neighborhoods.17 Convenience stores may have higher food prices, lower-quality foods, and less variety of foods than supermarkets or grocery stores.16,18 Access to healthy foods is also affected by lack of transportation and long distances between residences and supermarkets or grocery stores.16
Residents are at risk for food insecurity in neighborhoods where transportation options are limited, the travel distance to stores is greater, and there are fewer supermarkets.16 Lack of access to public transportation or a personal vehicle limits access to food.16 Groups who may lack transportation to healthy food sources include those with chronic diseases or disabilities, residents of rural areas, and some racial/ethnicity groups.15, 16,19 A study in Detroit found that people living in low-income, predominantly Black neighborhoods travel an average of 1.1 miles farther to the closest supermarket than people living in low-income predominantly White neighborhoods.20
Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. For example, a study found that food-insecure adults may be at an increased risk for obesity.21 Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 years and 65 years.22 Food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity.23,24,25 They also face a higher risk of developmental problems compared with food-secure children.12,25,26 In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on children’s mental health.27
Food assistance programs, such as the National School Lunch Program (NSLP); the Women, Infants, and Children (WIC) program; and the Supplemental Nutrition Assistance Program (SNAP), address barriers to accessing healthy food.28,29,30,31 Studies show these programs may reduce food insecurity.29,30,31 More research is needed to understand food insecurity and its influence on health outcomes and disparities. Future studies should consider characteristics of communities and households that influence food insecurity.32 This additional evidence will facilitate public health efforts to address food insecurity as a social determinant of health.
Endnotes
i The term hunger refers to a potential consequence of food insecurity. Hunger is discomfort, illness, weakness, or pain caused by prolonged, involuntary lack of food.
Citations
U.S. Department of Agriculture, Economic Research Service. (n.d.). Definitions of food security. Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/
U.S. Department of Agriculture, Economic Research Service. (n.d.). Key statistics & graphics. Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx
Carlson, S. J., Andrews, M. S., & Bickel, G. W. (1999). Measuring food insecurity and hunger in the United States: Development of a national benchmark measure and prevalence estimates. Journal of Nutrition, 129(2S Suppl), 510S–516S. doi: 10.1093/jn/129.2.510S
Jones, A. D., Ngure, F. M., Pelto, G., & Young, S. L. (2013). What are we assessing when we measure food security? A compendium and review of current metrics. Advances in Nutrition, 4(5), 481–505.
Food and Agriculture Organization. (2008). An introduction to the basic concepts of food security. Food Security Information for Action Practical Guides. EC–FAO Food Security Programme.
Nord, M., Andrews, M., & Winicki, J. (2002). Frequency and duration of food insecurity and hunger in U.S. households. Journal of Nutrition Education and Behavior, 34(4), 194–201.
Sharkey, J. R., Johnson, C. M., & Dean, W. R. (2011). Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women. Women & Health, 51(5), 442–460.
Seefeldt, K. S., & Castelli, T. (2009). Low-income women’s experiences with food programs, food spending, and food-related hardships (no. 57). USDA Economic Research Service. https://naldc.nal.usda.gov/download/35894/PDF
Nord, M., Andrews, M., & Carlson, S. (2007). Measuring food security in the United States: household food security in the United States, 2001. Economic Research Report (29).
Nord, M. (2007). Characteristics of low-income households with very low food security: An analysis of the USDA GPRA food security indicator. USDA-ERS Economic Information Bulletin (25).
Klesges, L. M., Pahor, M., Shorr, R. I., Wan, J. Y., Williamson, J. D., & Guralnik, J. M. (2001). Financial difficulty in acquiring food among elderly disabled women: Results from the Women’s Health and Aging Study. American Journal of Public Health, 91(1), 68.
Nord, M. (2009). Food insecurity in households with children: Prevalence, severity, and household characteristics. USDA-ERS Economic Information Bulletin (56).
Coleman-Jensen, A., & Nord, M. (2013). Food insecurity among households with working-age adults with disabilities. USDA-ERS Economic Research Report (144).
Huang, J., Guo, B., & Kim, Y. (2010). Food insecurity and disability: Do economic resources matter? Social Science Research, 39(1), 111–124.
Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health, 95(4), 660–667.
Ploeg, M. V., Breneman, V., Farrigan, T., Hamrick, K., Hopkins, D., Kaufman, P., Lin, B.-H., Nord, M., Smith, T. A., Williams, R., Kinnison, K., Olander, C., Singh, A., & Tuckermanty, E. (n.d.). Access to affordable and nutritious food-measuring and understanding food deserts and their consequences: Report to congress. Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=42729
Powell, L. M., Slater, S., Mirtcheva, D., Bao, Y., & Chaloupka, F. J. (2007). Food store availability and neighborhood characteristics in the United States. Preventive Medicine, 44(3), 189–195.
Crockett, E. G., Clancy, K. L., & Bowering, J. (1992). Comparing the cost of a thrifty food plan market basket in three areas of New York State. Journal of Nutrition Education, 24(1), 71S–78S.
Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010). Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition, 140(2), 304–310.
Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health, 95(4), 660–667.
Hernandez, D. C., Reesor, L. M., & Murillo, R. (2017). Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities. Appetite, 117, 373–378.
Gregory, C. A., & Coleman-Jensen, A. (n.d.). Food insecurity, chronic disease, and health among working-age adults. Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=84466
Gundersen, C., & Kreider, B. (2009). Bounding the effects of food insecurity on children’s health outcomes. Journal of Health Economics, 28(5), 971–983.
Metallinos-Katsaras, E., Must, A., & Gorman, K. (2012). A longitudinal study of food insecurity on obesity in preschool children. Journal of the Academy of Nutrition and Dietetics, 112(12), 1949–1958.
Cook, J. T., & Frank, D. A. (2008). Food security, poverty, and human development in the United States. Annals of the New York Academy of Sciences, 1136(1), 193–209.
Cook, J. T. (2013, April). Impacts of child food insecurity and hunger on health and development in children: Implications of measurement approach. In Paper commissioned for the Workshop on Research Gaps and Opportunities on the Causes and Consequences of Child Hunger.
Burke, M. P., Martini, L. H., Çayır, E., Hartline-Grafton, H. L., & Meade, R. L. (2016). Severity of household food insecurity is positively associated with mental disorders among children and adolescents in the United States. Journal of Nutrition, 146(10), 2019–2026.
Bhattarai, G. R., Duffy, P. A., & Raymond, J. (2005). Use of food pantries and food stamps in low‐income households in the United States. Journal of Consumer Affairs, 39(2), 276–298.
Huang, J., & Barnidge, E. (2016). Low-income children's participation in the National School Lunch Program and household food insufficiency. Social Science & Medicine, 150, 8–14.
Kreider, B., Pepper, J. V., & Roy, M. (2016). Identifying the effects of WIC on food insecurity among infants and children. Southern Economic Journal, 82(4), 1106–1122.
Ratcliffe, C., McKernan, S. M., & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity? American Journal of Agricultural Economics, 93(4), 1082–1098.
Larson, N. I., & Story, M. T. (2011). Food insecurity and weight status among U.S. children and families: A review of the literature. American Journal of Preventive Medicine, 40(2), 166–173.
