the gateway to other ills - institute of politicsiop.pitt.edu/sites/default/files/documents/hunger...

hunger THE GATEWAY TO OTHER ILLS

presented by:

The University of Pittsburgh

Institute of Politics

Greater Pittsburgh

Community Food Bank

The Pittsburgh Foundation

UNIVERSITY OF PITTSBURGH INSTITUTE OF POLITICS

GREATER PITTSBURGH COMMUNITY FOOD BANK

THE PITTSBURGH FOUNDATION

welcome you to the

hunger

The Gateway to Other Ills

Thursday, November 9, 2017 8:00 am to 12:00 pm

The Rivertowne Brewing Hall of Fame Club

PNC Park

1

Contents Program Agenda ........................................................................................................................................... 3

Speaker Biographies...................................................................................................................................... 4

Frank Coonelly .......................................................................................................................................... 4

Craig Gundersen........................................................................................................................................ 4

A. J. Harper ................................................................................................................................................ 4

Laura Karet ................................................................................................................................................ 5

Maxwell King ............................................................................................................................................. 5

Catherine Lobaugh .................................................................................................................................... 6

Rebecca Lucore ......................................................................................................................................... 6

Teresa Miller ............................................................................................................................................. 7

Terry Miller................................................................................................................................................ 8

Lisa Scales .................................................................................................................................................. 9

For Further Reading .................................................................................................................................... 10

2

Program Agenda University of Pittsburgh

Institute of Politics, Greater Pittsburgh Community Food Bank, and

The Pittsburgh Foundation Present

Hunger – the Gateway to Other Ills

Thursday, November 9, 2017

8:00 – 8:30 am Registration and Continental Breakfast

8:30 – 8:40 Welcome by Frank Coonelly, President, Pittsburgh Pirates

8:40 – 8:50 Overview and Introductions by Terry Miller, Director, University of

Pittsburgh Institute of Politics and Elsie Hillman Civic Forum

8:50 – 9:20 Food Insecurity in America: By the Numbers by Craig Gundersen, Soybean Industry Endowed Professor of Agricultural Strategy, Department of Agricultural and Consumer Economics, University of Illinois at Urbana-Champaign, and Member, Technical Advisory Group, Feeding America

9:20 – 9:50 Closing the Gap: Food Security in Pennsylvania by Teresa Miller,

Secretary, Pennsylvania Department of Human Services

9:50 – 10:20 Open Discussion moderated by Maxwell King, President and CEO, The

Pittsburgh Foundation

10:20 – 10:30 Break

10:30 – 11:30 Local Impacts of Food Insecurity: Health, Education, and Workforce

Development

A.J. Harper, President and CEO, Healthcare Council of Western PA

Laura Karet, CEO, Giant Eagle

Catherine Lobaugh, Assistant Executive Director, Early Childhood,

Family and Community Services Division, Allegheny Intermediate

Unit

Rebecca Lucore, Director of Sustainability and Corporate Social

Responsibility, Covestro

Terry Miller

11:30 – 11:50

11:50 – 12:00 pm

Open Discussion

Closing Remarks by Lisa Scales, CEO, Greater Pittsburgh Community Food

Bank

3

Speaker Bios

Frank Coonelly Frank Coonelly is responsible for the day-to-day operations of the organization. Frank leads the Pirates' senior management team and is accountable for the organization's success on and off the field.

Prior to joining the Pirates on September 13, 2007, Frank served as Senior Vice President and General Counsel of Labor in the Commissioner's Office where he negotiated and administered collective bargaining agreements with the Major League Baseball Players Association and the World Umpires Association. Frank led a staff of attorneys who represented the Commissioner and the 30 Clubs in the litigation and arbitration of labor matters and provided contract and economic advice to the 30 Clubs.

Prior to joining the Commissioner's Office in 1998, Coonelly practiced labor and employment law as a Partner in the Washington, D.C. office of Morgan, Lewis & Bockius. A large part of Frank's practice at Morgan Lewis consisted of the representation of Major League Baseball as outside labor counsel. In that role, Frank assisted the Commissioner in collective bargaining and other litigation matters. He also represented several individual Clubs in salary arbitration matters.

Craig Gundersen Craig Gundersen is the Soybean Industry Endowed Professor in Agricultural Strategy in the Department of Agricultural and Consumer Economics at the University of Illinois, is on the Technical Advisory Group for Feeding America, is the lead researcher on Feeding America’s Map the Meal Gap project, and is the Managing Editor for Applied Economic Perspectives and Policy. He is also a Round Table Member of the Farm Foundation, a Non-Resident Senior Fellow at the Chicago Council on Global Affairs, and a Faculty Affiliate of the Wilson Sheehan Lab for Economic Opportunities (LEO) at the University of Notre Dame. His research concentrates on the causes and consequences of food insecurity and on the evaluation of food assistance programs, with an emphasis on SNAP.

A. J. Harper A. J. Harper assumed the position of president of the Hospital Council of Western Pennsylvania in July 2005.

During his 25-year career in Cleveland, Ohio, Mr. Harper worked in the community and tertiary setting. His operations experience includes serving as administrative director of Medical Operations at the Cleveland Clinic Foundation; vice president, Care Management at Marymount Hospital; a member of the Cleveland Clinic Health System; and, administrator for the Lake/University Ireland Cancer Center, a freestanding comprehensive cancer center.

Mr. Harper gained association experience while serving as vice president, Professional Services at the Greater Cleveland Hospital Association.

Mr. Harper earned a bachelor’s of science in Health Information Management, School of Allied Health, College of Medicine at The Ohio State University, and a master’s in Business Administration from Baldwin-Wallace College in Berea, Ohio.

4

Laura Karet Laura Karet leads and oversees Giant Eagle, Inc., one of the nation’s largest multi-format food, fuel and pharmacy retailers with approximately 34,000 Team Members and approximately $9.5 billion in annual sales. Karet was appointed Chief Executive Officer on January 9, 2012.

Giant Eagle is on Forbes magazine’s largest private corporations list. Founded in 1931, Giant Eagle has grown to be the number one supermarket retailer in the region with more than 420 corporate and independently-owned and operated supermarkets and fuel and convenience stores throughout western Pennsylvania, Ohio, north central West Virginia, western Maryland and Indiana.

Prior to leading the company’s day-to-day operations, Karet served as Chief Strategy Officer and Senior Executive Vice President. In that role, Karet developed and managed Giant Eagle’s short and long-term strategic business plans, set the direction for the Company’s corporate priorities and was also directly responsible for the manufacturing ventures, including its fresh food production facilities.

Karet joined Giant Eagle in 2000 as Vice President of Marketing, and was later promoted to Sr. Vice President of Marketing and President of New Formats. During that time, Karet led the development, branding and implementation efforts behind the launch of the new innovative Market District format in 2006, which has grown to 13 locations, including five in the Pittsburgh area, seven in Ohio, and one in Greater Indianapolis.

For her numerous leadership roles in food retailing, marketing and manufacturing, Laura received the 2011 Ernst & Young Entrepreneur Of The Year Western Pennsylvania and West Virginia Award. She was also recognized as one of Progressive Grocer magazine’s 2010 Top Women in Grocery. Prior to joining Giant Eagle, Karet held marketing executive positions at Sara Lee from 1997 to 2000, including Director of Branded Marketing for the bakery division. Karet also served in several brand management roles at Procter and Gamble from 1990 to 1997 for household name products such as Crisco shortening, Folgers coffee, Giorgio Beverly Hills fragrances and Secret antiperspirant.

Karet is currently an active member on the board of directors for various organizations, some of which include: The Allegheny Conference on Community Development; United Way of Allegheny County; Allegheny County Parks Foundation; and, Holy Family Foundation.

A native of Pittsburgh, Karet graduated from Amherst College with a Bachelor’s degree in English, and now resides in the Pittsburgh area with her husband and three children.

Maxwell King Maxwell King's four-decade career includes the presidencies of two of the country’s largest philanthropies and the editorship of one of its most influential daily newspapers.

King joined The Pittsburgh Foundation, with assets of more than $1 billion, in 2014 as president and CEO.

His strong advocacy for including vulnerable groups – at least 30 percent of the region’s population – in the benefit streams of a resurgent Pittsburgh anchors a signature organizing principle, 100 Percent

5

Pittsburgh. In addition, King is expanding the Foundation’s investment in its Center for Philanthropy, which combines the charitable passions of donors with expert program staff and grantees to improve lives in the Pittsburgh region.

Before that, King served for two years as director of the Fred Rogers Center for Early Learning and Children's Media at Saint Vincent College in Latrobe, Westmoreland County.

As president of the Pittsburgh-based Heinz Endowments from 1999 to 2008, he led the disbursement of about $500 million in grants to projects, organizations and initiatives primarily in western Pennsylvania.

From 1990 to 1998, King was editor of the Philadelphia Inquirer. During that period, the Inquirer was recognized by Time magazine as one of the five best newspapers in America.

King has served on boards and committees for many national and regional organizations, including the national Council on Foundations which he led as the first chair of its Ethics and Practices Committee and then as chair of the full board from 2006 to 2008.

Catherine Lobaugh Dr. Catherine Lobaugh is the AIU’s Assistant Executive Director for Early Childhood, Family and Community Services. She is a member of the AIU’s Executive Leadership Team and is responsible for the implementation of high-quality, cost-effective, and meaningful early childhood and community programs that serve learners in Allegheny County. Dr. Lobaugh oversees a division that includes AIU’s Head Start, Early Head Start, Pre-K Counts, Alternative Education, Adult Education and Workforce Development, and Family and Community Education Programs.

Dr. Lobaugh holds a doctorate in administrative and policy studies, as well as a master’s degree in education from the University of Pittsburgh. She earned her bachelor’s degree from Clarion State University. She began her career in education as an elementary classroom teacher and also served as an elementary school principal. She served as the Coordinator of Early Childhood Education and later the Director of Early Childhood Education and Elementary Curriculum at the McKeesport Area School District.

A dedicated educator, Dr. Lobaugh was named one of the Mon River Fleet 2012 Women of Achievement and was recognized for her efforts with an Educational Leader Award. In addition to her duties in public and community education, Dr. Lobaugh also serves as an adjunct professor at California University of Pennsylvania, and is an instructor at the University of Pittsburgh. She was appointed to the Pennsylvania Early Learning Council in 2010.

Rebecca Lucore Rebecca L. Lucore is Head of Sustainability and CSR for Covestro LLC’s America’s region, responsible for innovating new approaches to social programs, philanthropy and donations, community relations and partnerships and sustainability initiatives in North and South America.

Lucore oversees i3 (ignite, imagine, innovate) Covestro’s companywide CSR program that aims to spark curiosity, to envision what could be and to help create it. Its three focus areas, i3 STEM, i3 Engage and i3

Give, leverage the company’s current and future workforce, the communities in which it operates, and its partners and collaborators – all to create sustainable and lasting impacts.

6

Lucore is a leading voice in Corporate America for the transformation of traditional corporate volunteerism to next gen Skills-Based Volunteerism (SBV) in which teams of employees working on short-term consulting projects with nonprofit organizations to help them address organizational issues and build capacity. In 2015, she was instrumental in the establishment of the Covestro Employee Engagement Institute at Robert Morris University in Pittsburgh which trains employees in SBV and how to share their expertise and knowledge to assist nonprofit organizations in meeting needs ranging from IT, accounting, marketing, systems and communications, among others.

Prior to this, Lucore worked for 20 years in various capacities in corporate citizenship, philanthropy, environment/sustainability and STEM education and diversity. From 2012 to 2015 she served as Chief of Staff at Bayer MaterialScience (BMS) LLC where she was responsible for leading and streamlining organizational initiatives, including talent management; donations; and community, executive and employee engagement.

Before that, for more than a decade, Lucore served as Executive Director of the Bayer USA Foundation and Head of U.S. CSR for Bayer Corporation. In these dual roles, she was responsible for directing all CSR initiatives including the company’s STEM education partnerships with the United Nations Environment Programme, the National Governor’s Association and the National Science Teachers Association, among others, and was a lead architect of Bayer’s flagship CSR program, Making Science Make Sense. Led by national spokesperson, Dr. Mae Jemison, the first woman of color to orbit the Earth, Making Science Sense was one of the first corporate initiatives to advocate for science literacy and science education reform.

As part of this work, Lucore helped introduce and then drive the national conversation about the issue of gender and racial equity in the nation’s STEM fields through annual research and periodic summits and reports on the issue. In recognition, Bayer was awarded two Presidential Awards – President’s Service Award (President William J. Clinton) and the Ron Brown Award (President George W. Bush) – as well as the National Science Board’s highest honor – the National Public Service Award.

A leader in the Pittsburgh community, she was instrumental in Pittsburgh being named World Environment Day North American Host City in 2010 and host of One Young World in 2012 She is currently on the Board of Directors of Sustainable Pittsburgh, the Three Rivers Workforce Investment Board and is Advisory Board President for the Bayer Center for Nonprofit Management at Robert Morris University where she also co-chairs the Center’s 74% Project which examines women and leadership in the nonprofit sector.

Ms. Lucore has spoken widely at national CSR conferences including the Social Innovation Forum, CGI America, National Governor’s Association, U.S. Chamber of Commerce and Conference Board and is a regular contributor to the Huffington Post on CSR and employee engagement issues.

She resides in Pittsburgh with her husband and three boys.

Teresa Miller Teresa D. Miller assumed duties as acting secretary of the Pennsylvania Department of Human Services on August 21, 2017. Previously, Miller served as Pennsylvania’s insurance commissioner since January 2015, where she worked on a range of issues, including the administration’s top priorities – fighting the heroin and opioid epidemic and helping seniors.

7

Under her leadership, Miller made it clear that one of her top priorities at the Insurance Department was enforcing mental health parity laws, ensuring consumers have access to the mental health and substance use disorder treatments they need.

Teresa has been a leader in the Wolf Administration’s efforts to protect seniors. Her work to ensure seniors in Western Pennsylvania were protected and would not lose access to their doctors helped prevent disruption in care for 180,000 by ensuring UPMC providers continued participation in Highmark’s Medicare networks through the end of the consent decrees, which expire in 2019.

In 2017, Teresa was named chair of the National Association of Insurance Commissioners (NAIC) Senior Issues Task Force. Also at the NAIC, Teresa has been a leader in taking on the current challenges of the long term care insurance markets. At her request, the NAIC created the Long Term Care Innovation Subgroup, which she chaired, to work to increase long-term care funding options for consumers, including increasing the number of affordable asset protection options available.

Prior to coming to Pennsylvania, Miller served as acting director of the State Exchanges Group, the Oversight Group, and the Insurance Programs Group in the federal government’s Centers for Medicare and Medicaid Services.

Before going to Washington, Miller worked in Oregon where she fought for state adoption of mental health parity legislation, representing drug and alcohol treatment providers, social workers, the Arc of Oregon and other advocates for people with disabilities. Then, as the insurance regulator in Oregon, she worked to ensure consumers received the benefits of that law.

Miller received her J.D. from Willamette University College of Law, and her B.A., magna cum laude, from Pacific Lutheran University.

Terry Miller In September 2005, Chancellor Emeritus Mark A. Nordenberg named Terry Miller director of the University of Pittsburgh Institute of Politics.

The Institute delivers timely information about the great issues affecting our region to elected officials and community leaders, and provides a neutral forum where that knowledge and associated diverse viewpoints are debated and consensus built to improve the quality of lives of the citizens of our home region.

In 2014, Miller received a special honor to also serve as director of the Institute’s newly established Elsie H. Hillman Civic Forum. Supported by a generous endowment from Mr. Henry Hillman, the Elsie Forumbrings community leaders and young people together for educational programs, research projects, andmentoring opportunities designed to foster student interest and involvement in fueling civic progress inthe Pittsburgh region.

Miller also has served as a consultant on special initiatives to The Pittsburgh Foundation, Allegheny County Department of Human Services, the Power of 32 Regional Visioning Initiative, and has served as an adjunct faculty member at the University of Pittsburgh School of Social Work and Graduate School of Public and International Affairs.

8

Miller serves on a number of boards and advisory councils including: Advisory Board of BehAIvior, a technology start-up that is developing predictive-modeling artificial intelligence designed to prevent relapse in individuals living with Opioid Use Disorder by forecasting stress and craving responses; Greater Pittsburgh Chapter, Albert Schweitzer Fellowship Program; The Grace Ann Geibel Institute of Justice and Social Responsibility, the Hazelwood Center of Life Community Empowerment Organization, POWER, and Allegheny County Health Department Community Health Improvement Plan Advisory Committee. Miller also is a member of the United Way of Allegheny County Women’s Leadership Council.

Prior to her tenure at the Institute of Politics, Miller was founder and first executive director of POWER, the Pennsylvania Organization for Women in Early Recovery, a non-profit organization she established in Allegheny County to provide gender- and culturally-specific treatment & support services to women who are changing their lives through recovery from addiction to alcohol and other drugs. In 1995 Miller won the J. C. Penney Golden Rule Award for her work to create POWER, and in 1998 she received a letter of commendation from President Bill Clinton for her work to establish POWER.

Miller also has been the recipient of a number of other awards, including the League of Women Voter’s Good Government Award in 2001 for her work on a three-year national welfare-to-work research project with The Pittsburgh Foundation, and again in 2003 for her work at the Institute of Politics. In 2004 she received the Racial Justice Award from the Urban League of Greater Pittsburgh for her overall work with at-risk and vulnerable populations, was a 2004 “Strong, Smart, Successful Woman” Honoree of the University of Pittsburgh Alumnae Council, the 2012 recipient of the POWER Window of Hope Award, and is a 2017 recipient of the Moe Coleman Award for Excellence in Community Service.

Miller has presented at national and local conferences on issues of race, gender and public policy, community organizing, addictions counseling, and gender-specific substance use disorder treatment.

Lisa Scales Lisa Scales, who earned a Juris Doctor (J.D.) degree from Boston University School of Law and Bachelor of Arts degree in Social Sciences from Seton Hill University, began her career as assistant corporation counsel for the City of Chicago and worked as an associate in a Greensburg law firm before joining Just Harvest and then Greater Pittsburgh Community Food Bank. Throughout her career, Ms. Scales has held many positions on boards and committees for organizations such as the Community Food Security Coalition, Hunger-Free Pennsylvania, Bayer Center for Nonprofit Management at Robert Morris University and the Joint State Government Commission Obesity Study Advisory Committee. In her current role as president and CEO at the Food Bank, Ms. Scales leads the organization in distributing more than 31 million meals annually throughout 11 counties of southwestern Pennsylvania.

9

For Further Reading

Craig Gundersen and James P. Ziliak, “Food Insecurity and Health Outcomes,” Health Affairs, 34, no. 11 (2015): 1830-1839.

11

Greater Pittsburgh Community Food Bank, “Feeding People. Saving Lives.” 21

Greater Pittsburgh Community Food Bank, “Child Hunger Hurts Pennsylvania.” 23

Greater Pittsburgh Community Food Bank, “Hunger Costs Pennsylvanians.” 27

10

By Craig Gundersen and James P. Ziliak

Food Insecurity And HealthOutcomes

ABSTRACT Almost fifty million people are food insecure in the UnitedStates, which makes food insecurity one of the nation’s leading healthand nutrition issues. We examine recent research evidence of the healthconsequences of food insecurity for children, nonsenior adults, andseniors in the United States. For context, we first provide an overview ofhow food insecurity is measured in the country, followed by apresentation of recent trends in the prevalence of food insecurity. Thenwe present a survey of selected recent research that examined theassociation between food insecurity and health outcomes. We show thatthe literature has consistently found food insecurity to be negativelyassociated with health. For example, after confounding risk factors werecontrolled for, studies found that food-insecure children are at least twiceas likely to report being in fair or poor health and at least 1.4 times morelikely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparableto those of food-secure seniors fourteen years older. The SupplementalNutrition Assistance Program (SNAP) substantially reduces the prevalenceof food insecurity and thus is critical to reducing negative healthoutcomes.

Food insecurity, a condition in whichhouseholds lack access to adequatefood because of limited money orother resources, is a leading healthand nutrition issue in the United

States. In 2013 almost fifty million Americans(14.3 percent) were food insecure.1 About one-third of these were at amore serious level knownas “very low food security.”The fact that somanypeople are food insecure is important in and ofitself, but potentially more concerning are thepossible negative health consequences of foodinsecurity. In this article we focus on recent re-search that examined the association of foodinsecurity and health.We begin with an overview of how food inse-

curity is measured in the United States, followedby a presentation of recent trends in the preva-

lence of food insecurity.We thenprovide a select-ed review of the literature that has examined theimpacts of food insecurity on health outcomesfor children, nonsenior adults, and seniors.Research on food insecurity and health ema-

nates froma broad cross-section of disciplines inboth the social and health sciences, and spacelimitations prohibit a meta-analysis. We there-fore concentrate on papers that reflect the mostrecentwork in this area, especially in the fields ofeconomics, internal medicine, nutrition, publichealth, and social work. Within these areas, weemphasize research that reflects the central find-ings of the literature and that, in many cases,uses state-of-the-art methods.Although the literature has grown consider-

ably in the past few years, there are still someimportant gaps in our knowledge base.We there-

doi: 10.1377/hlthaff.2015.0645HEALTH AFFAIRS 34,NO. 11 (2015): 1830–1839©2015 Project HOPE—The People-to-People HealthFoundation, Inc.

Craig Gundersen ([email protected]) is the SoybeanIndustry Endowed Professor inAgricultural Strategy in theDepartment of Agriculturaland Consumer Economics,University of Illinois, inUrbana.

James P. Ziliak is the CarolMartin Gatton Endowed Chairin Microeconomics in theDepartment of Economics,University of Kentucky, inLexington.

1830 Health Affairs November 2015 34: 1 1

Food & Health: An Overview

This article PDF is provided only for noncommercial use & limited distribution by the Institute of Politics (University of Pittsburgh) at its event

"Hunger: The Gateway to Other Ills" on 11/9/2017 at PNC Park. It may not be posted on the inter/intranet or otherwise shared without further permission from Health Affairs.

11

fore suggest future research directions.We con-clude with policy recommendations for alleviat-ing food insecurity, with a particular emphasison the current andpotential roles of the federallyfunded Supplemental Nutrition Assistance Pro-gram (SNAP, formerly known as the Food StampProgram) in reducing food insecurity and withrecommendations for health care professionals.

Defining Food InsecurityThe Department of Agriculture (USDA) mea-sures food insecurity through responses to a se-ries of eighteen survey questions and statementsfielded to roughly 45,000 households in theFood Security Supplement of the Census Bu-reau’s Current Population Survey (CPS-FSS).1

The first item addresses worries about food run-ning out, while the remaining items addresspossible reductions in food intakes because offinancial constraints. Eight of the items are fo-cused on children and thus are not used withhouseholds that contain no children under ageeighteen. The items include: “I worried whetherour food would run out before we got money tobuy more” (the least severe), “Did you or theother adults in your household ever cut the sizeof your meals or skipmeals because there wasn’tenough money for food?,” “Did you ever cut thesize of any of the children’s meals because therewasn’t enoughmoney for food?,” and “Didanyofthe children ever not eat for a whole day becausethere wasn’t enoughmoney for food?” (themostsevere for households with children).Based on the responses to the survey, the

USDA divides households into the following cat-egories: high food secure (all household mem-bers had access at all times to enough food for anactive, healthy life), with no affirmative re-sponses to any of the eighteen items; marginalfood secure (some members reported anxietyabout food sufficiency or shortage of food in thehouse, but there was no indication of changes indiet or food intake), 1–2 affirmative responses;low food secure (at least some household mem-bers reported reduced quality, variety, or desir-ability of diet but not necessarily reduced foodintake), 3–7 affirmative responses; and very lowfood secure (one or more household membersreported multiple indications of disrupted eat-ing patterns and reduced food intake), 8 ormoreaffirmative responses. For households withoutchildren, low food security is 3–5 affirmativeresponses, and very low food security is 6 ormore affirmative responses.In most research and policy discussions, the

categories of low and very low food secure arecombined into a category called food insecure.1

In some applications, however, a broader mea-

sure of marginal food insecurity is used, whichcombines marginal, low, and very low food se-cure.2–4 In nearly all cases, researchers report arate or percentage of thosewhoare food insecureby dividing the number of food-insecure peopleor households in a given population or subpop-ulation by the relevant population or subpopula-tion of interest. For example, the household foodinsecurity rate is foundby totaling thenumber ofhouseholds that are low or very low food secureand dividing by the total number of householdsin the population.

Food Insecurity In The United StatesFrom 2001 to 2007 the food insecurity rate forUS households was relatively steady, at about11 percent for all households and almost 18 per-cent for thosewith children(Exhibit 1). The ratesfor both groups increased more than 30 percentafter the onset of the Great Recession in Decem-ber 2007, from 11.1 percent in 2007 to 14.6 per-cent in 2008 for all households and from16.9 percent to 22.5 percent for households withchildren. Despite the official end of the GreatRecession in June 2009, rates of food insecurityhave remained at these elevated levels.Within the US population there is a great deal

of heterogeneity in the probability of food inse-curity.1 For example, before other factors arecontrolled for, households with lower incomesand households headed by an African Americanor Hispanic person, a never-married person, adivorcedor separatedperson, a renter, a youngerperson, or a less-educated person are all morelikely to be food insecure than their respectivecounterparts. In addition, households with chil-dren are more likely to be food insecure thanthose without. Research using multivariatemethods has generally found that the character-istics listed above are positively associated withfood insecurity, even after other factors are con-trolled for. This general set of findings holdswhether the sample is households with or with-out children, including households headed by asenior.2–4

Food Insecurity And Negative HealthOutcomesThe USDA, in consultation with other federalagencies, academics, and members of the policycommunity, developed the food insecurity mea-sure used in the United States in part because ofthe myriad negative health outcomes that werethought to be associated with food insecurity.Understanding the existence of certain negativehealth outcomes that stem from food insecurityis of direct importance to health care profession-

November 2015 34: 1 1 Health Affairs 1831



12

als and to the policymakers and programadmin-istrators charged with improving health andwell-being. After the introduction of the CPS-FSS, dozens of papers have examined whetherfood insecurity is associated with poor healthoutcomes. Controlling for other confoundingfactors, such as income, is especially importantbecause many of the determinants of food inse-curity are also determinants of health.

Study Data And MethodsIn what follows, we review some of the majorfindings from the literature examining food in-security and health that takes into account bothself-reports of health and clinical outcomes.Webreak the major findings down into three broadage categories: children, nonsenior adults, andseniors.Within each of these categories, wehigh-light work that illustrates salient points regard-ing the relationship between food insecurity andhealth.Our review is confined to research on food

insecurity and health in the United States and,to a limited extent, in Canada, since these twocountries measure food insecurity in a similarfashion. A parallel literature has examined thistopic in non-high-income countries, but that isbeyond the scope of this article.Along with this geographical concentration,

our review concentrates on research that withfew exceptions has appeared in peer-reviewedjournals since 2001. While most of the papersuse the USDA’s measure of food insecurity (de-fined above) as the key variable of interest, insome cases we include papers that used variantson this measure of food insecurity. To reflect theinterdisciplinary nature of food insecurity re-

search, we include papers in journals in disci-plines that reflect the most recent work in thisarea, especially in the fields of economics, agri-cultural economics, internal medicine, pediat-rics, nutrition, public health, and social work.Because different disciplines focus on differentaspects of food insecurity and health, our keysearch terms included food insecurity and healthand food insufficiency and health. We also con-ducted more refined searches in which we re-placed thewordhealthwithwell-being,depression,child (or senior) health, and so on.Because of space limitations, we were unable

to include all papers that examined the relation-ship between food insecurity and health out-comes. Thus, ours was not a meta-analysis. In-stead, we cite at least one paper for each healthoutcome that has been found to be associatedwith food insecurity. When multiple papersfound similar results, we restricted our coverageto more recent papers that used state-of-the-artmethods and the standard food insecurity mea-sure. As a result, most of the work we cite hasbeen published in the past seven years.

Study ResultsChildren The majority of research examiningfood insecurity in general and its effects onhealth outcomes has concentrated on children.This research has found that food insecurity isassociated with increased risks of some birthdefects,5 anemia,6,7 lower nutrient intakes,8 cog-nitive problems,9 andaggression andanxiety.10 Itis also associated with higher risks of being hos-pitalized8 and poorer general health8,11,12 andwith having asthma,13 behavioral problems,10,14

depression,15 suicide ideation,16 and worse oralhealth.17,18 Exhibit 2 gives details about the datasets andmethods used in a subset of these papersand, in some cases, the magnitude of the effectsreported. For example, compared to children infood-secure households, children in food-inse-cure households had 2.0–3.0 times higher oddsof having anemia,6,7 2.0 times higher odds ofbeing in fair or poor health,8 and 1.4–2.6 timeshigher odds of having asthma, depending on theage of the child.13

Most of these papers used binary comparisonsof children in food-insecure households (thosewith three or more affirmative responses toitems in the CPS-FSS) with children in food-secure households (those with zero, one, ortwo affirmative responses). However, house-holds with one or two affirmative responses(those in the category of marginal food secure)may be more similar to the food-insecure house-holds than to the food-secure households andmay also be at risk of suffering from negative

Exhibit 1

Trends In Food Insecurity In The United States, 2001–13

SOURCE Authors’ analysis of data from Coleman-Jensen A, et al. Household food security in theUnited States in 2013 (Note 1 in text).

◀

23%Food insecureEven after the GreatRecession ended in 2009,22.5 percent of UShouseholds with childrenremain food insecure.





13

health outcomes.For example, data from Children’s Health-

Watch—a sentinel study of over 40,000 childrenyounger than age four in five large urban hospi-tals, which began in 1998—indicate that com-pared to children in fully food-secure house-holds, those in marginal-food-securehouseholds are more likely to be in fair or poorhealth and more likely to have a mother whoreported one or two substantial concerns aboutthe child’s development on the Parent’s Evalua-

tion of Developmental Status.19 One implicationis that some research examining the impact offood insecurity on health outcomes might haveunderestimated the consequences by ignoringhouseholds that are marginally food secure.Nonsenior Adults There has been less re-

search on the impacts of food insecurity onhealth outcomes among nonsenior adults. How-ever, some of the studies in this limited set haveshown that food insecurity is associated withdecreased nutrient intakes;20–25 increased rates

Exhibit 2

Summary Of Research On Food Insecurity And Health Among Children In The United States And Canada Published During 2006–14

Authors Title Data source Central findings

Eicher-Miller et al.(Note 6)

Food insecurity is associatedwith iron deficiency anemiain US adolescents.

1999–2004 NHANES Odds of having iron deficiency anemia among 12–15-year oldchildren in households with food insecurity were 2.95 timeshigher (p = 0.02) than among children in households withoutfood insecurity.

Cook et al. (Note 8) Child food insecurityincreases risks posed byhousehold food insecurityto young children’s health.

1998–2004 Children’sHealthWatch, variouscities

Odds of fair or poor health among children ≤36 months old withhousehold and child food insecurity were 2.14 (95% CI: 1.81,2.54) times higher than among children in food-securehouseholds.The odds among nonrecipients of food stamps were1.72 (95% CI: 1.34, 2.21) times higher than among food stamprecipients.

Howard (Note 9) Does food insecurity at homeaffect non-cognitiveperformance at school? Alongitudinal analysis ofelementary studentclassroom behavior.

1999–2003 ECLS-K Noncognitive performance among children in grades 1, 3, and 5was about 0.068 (SE: 0.039) to 0.079 (SE: 0.039) units lower forchildren with any food insecurity, compared to food-securechildren.

Whitaker et al.(Note 10)

Food insecurity and the risksof depression and anxietyin mothers and behaviorproblems in theirpreschool-aged children.

1998–2000 FragileFamilies and ChildWellbeing Study

Food-insecure mothers had 2.2 (95% CI: 1.6, 2.9) times higherrates of mental health issues than fully food-secure mothers.The odds of behavioral problems among children with food-insecure mothers were 2.1 (95% CI: 1.6, 2.7) times higher thanamong children with food-secure mothers.

Kirkpatrick et al.(Note 13)

Child hunger and long-termadverse consequences forhealth.

1994–2005 CanadianNLSCY

Odds of asthma among children ages 10–15 in households everexperiencing hunger were 1.41 (95% CI: 0.79, 2.51) times higherthan among children in households never experiencing hunger.Odds of asthma among youth ages 16–21 were 2.66 (95% CI:0.93, 7.63) times higher for those ever experiencing hunger.

Melchior et al.(Note 15)

Food insecurity and children’smental health: aprospective birth cohortstudy.

1997–2005 QuébecLongitudinal Study ofChild Development

Odds of having high depression or anxiety among children ages4–8 in food-insecure households were 1.79 (95% CI: 1.15, 2.79)times higher than among children in food-secure households.

McIntyre et al.(Note 16)

Depression and suicideideation in late adolescenceand early adulthood are anoutcome of child hunger.

1994–2009 CanadianNLSCY

Odds of depression or suicide ideation among youth ages 14–25in households experiencing hunger were 2.3 times higher(p = 0.01) than among youth in households without hunger.

Chi et al. (Note 17) Socioeconomic status, foodsecurity, and dental carriesin US children: Mediationanalyses of data from theNational Health andNutrition ExaminationSurvey, 2007–2008.

2007–2008 NHANES Odds of tooth decay among children with low food security were2.00 times higher (p = 0.03) than among children with full foodsecurity when socioeconomic status was held constant.

SOURCE Authors’ summary of information from articles cited in the text. NOTES If no mention is made of p values, standard errors, or confidence intervals, they were notreported or the results in the article were not statistically different from zero. CI is confidence interval. SE is standard error. NHANES is the National Health and NutritionExamination Survey. ECLS-K is Early Child Longitudinal Study–Kindergarten Class. NLSC is National Longitudinal Survey of Children. NLSCY is National LongitudinalSurvey of Children and Youth.




14

of mental health problems and depression,10,26–30

diabetes,31,32 hypertension,33 and hyperlipid-emia;32 worse outcomes onhealth exams;33 beingin poor or fair health;23,34 and poor sleep out-comes35 (Exhibit 3). In terms of effect sizes,mothers who are food insecure are over twiceas likely to report mental health problems10

and over three times as likely to report oralhealth problems, compared to their food-securepeers.18

Seniors In general, there has been a great dealof research on the health status of seniors butsurprisingly little work on food insecurity and

health. The work that has been done has found,for example, that compared food-insecure se-niors report lower nutrient intakes,2,36,37 aremore likely to be in poor or fair health2,36,37

and to be depressed,2,38 and are more likely tohave limitations in activities of daily living,2 com-pared to their food-secure peers (Exhibit 4).In terms of effect sizes, food-insecure seniors

were2.33 timesmore likely to report being in fairor poor health, compared to food-secure se-niors.37 Moreover, a senior who is marginallyfood insecure compared to one who is fully foodsecure has reduced nutrient intakes roughly

Exhibit 3

Summary Of Research On Food Insecurity And Health Among Nonsenior Adults In The United States And Canada Published During 2004–14


Whitaker et al.(Note 10)

Food insecurity and the risksof depression and anxietyin mothers and behaviorproblems in theirpreschool-aged children.

1998–2000 Fragile Familiesand Child Wellbeing Study

Food-insecure mothers had 2.2 (95% CI: 1.6, 2.9) times higherrates of mental health issues than fully food-secure mothers.The odds of behavioral problems among children with food-insecure mothers were 2.1 (95% CI: 1.6, 2.7) times higher thanamong children with food-secure mothers.

Muirhead et al.(Note 18)

Oral health disparities andfood insecurity in workingpoor Canadians.

2007 nationallyrepresentative stratifiedrandom sample of workingpoor Canadians ages 18–64

Odds of oral health problems among the working poor with foodinsecurity were 3.31 times higher (p < 0:001) than amongthose with food-secure households.

Park et al.(Note 25)

Iron deficiency is associatedwith food insecurity inpregnant females in theUnited States: NationalHealth and NutritionExamination Survey 1999–2010.

1999–2010 NHANES Odds of iron deficiency (classified by ferritin status) amongpregnant women ages 13–54 with food insecurity were 2.90times higher (p < 0:05) than among pregnant women whowere food secure.

Heflin et al.(Note 26)

Food insufficiency andwomen’s mental health:findings from a 3-yearpanel of welfare recipients.

Women’s Employment Study,1997–99

Women’s changing food insufficiency status was positivelyassociated with a change in major depression status(p < 0:01). No apparent results were found for theassociation of food-insufficiency status and a woman’s senseof mastery, or being a causal agent in her environment.

Casey et al.(Note 29)

Maternal depression,changing public assistance,food security, and childhealth status.

Children’s Sentinel NutritionalAssessment Programhousehold-level survey,1998–2001 (at emergencydepartments and primarycare clinics)

Self-report of maternal depression was associated with loss orreduction of welfare support (50% [95%CI: 3, 125]) as well asbeing two times more likely to experience household foodinsecurity.

Seligman et al.(Note 31)

Food insecurity is associatedwith diabetes mellitus:results from the NationalHealth Examination andNutritional ExaminationSurvey (NHANES) 1999–2002.

1999–2002 NHANES Food-insecure individuals have approximately twice the odds ofexperiencing diabetes (95% CI: 1.1, 4.0), compared to food-secure individuals. Diabetes was reported in 10% ofindividuals with mild, and 16% of individuals with severe, foodinsecurity.

Seligman et al.(Note 32)

Food insecurity is associatedwith chronic disease amonglow-income NHANESparticipants.

1999–2004 NHANES Food insecurity is associated with a 20% (95% CI: 4, 38)increase in the risk of self-reported measures of hypertensionand a 30% (95% CI: 9, 55) increase in risk of self-reportedhyperlipidemia but not self-reported diabetes. Food-insecureindividuals have 2.4 (95% CI: 1.44, 4.08) times higher risk ofdiabetes and hypertension.

SOURCE Authors’ summary of information from articles cited in the text. NOTES If no mention is made of values, standard errors, or confidence intervals, they were notreported or the results in the article were not statistically different from zero. CI is confidence interval. NHANES is National Health and Nutrition Examination Survey.





15

equivalent to having $15,000 less income.2 Sim-ilarly, the effect of being marginally food inse-cure on having a limitation in an activity of dailyliving (ADL) is roughly equivalent to being four-teen years older.2 Unfortunately, most of theother papers covered in our reviewdidnot reportthe full set of coefficients in the multivariatemodels, so we cannotmake similar comparisonsin those cases.

Possible MechanismsResearchers do not always carefully articulatethemechanisms by which food insecurity causesnegative health outcomes. A good counterexam-ple is the work of Hilary Seligman and co-authors,32 who considered why food insecurityis more likely to increase a person’s odds of de-veloping diabetes than hypertension. Theyargued that diabetes ismore affected thanhyper-tension by limitations in diet, while hyperten-sion is more affected than diabetes by medica-tion adherence. Peripheral insulin resistance, aprecursor to diabetes, may emerge as a result offood scarcity,39 and the stress associated withfood insecurity may lead to increases in cortisoland, hence, central adiposity, which is often as-sociated with diabetes.Another mechanism whereby food insecurity

can influence health outcomes is through its ef-fect on adherence to medical recommendations.Again considering diabetes, Seligman and co-authors showed that food-insecure adults re-

ported more difficulties affording a diabetic dietand lower abilities to address issues pertainingto diabetes, compared to those who are foodsecure.40

Some of the mechanisms by which food inse-curity adversely affects health outcomes are in-direct. For example, there has been an interest inwhether or not food insecurity is associated withobesity, which in turn is associated with othernegative health outcomes, including diabetes.A recent review by Nicole Larson and Mary

Story41 examined the literature looking at foodinsecurity and obesity across various categories.For men and children, the consensus in the lit-erature is that there is no association betweenfood insecurity and obesity status, after relevantconfounding factors are controlled for. Forwom-en, however, there is some limited evidence thatfood insecurity is associatedwith obesity, at leastin the short run. One study found that womenwho are very low food secure are 10.8 percentagepoints more likely than women who are fullyfood secure to be obese.42 However, after oneyear those who were persistently food insecurewere found to benomoreor less likely than food-secure women to be obese.43–45

DiscussionAlthough our review of the literature was neces-sarily limited to more recent studies, a compel-ling picture of food insecurity’s association withnegative health outcomes has emerged based on

Exhibit 4

Summary Of Research On Food Insecurity And Health Among Seniors In The United States Published During 2001–08


Ziliak et al.(Note 2)

The causes, consequences, and futureof senior hunger in America.

CPS 2001–5, NHANES1999–2002, PSID 1999–2003

Seniors experiencing food insecurity are more likely tohave limitations in activities of daily living (p < 0:05)akin to a food-secure senior 14 years older. Food-insecure seniors have lower nutrient intakes thanfood-secure seniors (p < 0:05), similar to a food-secure senior earning $15,000 less per year.

Lee and Frongillo(Note 36)

Factors associated with foodinsecurity among U.S. elderlypersons: importance of functionalimpairments.

NHANES 1988–1994,National Survey of theElderly in New York State1994

Seniors with limitations in activities of daily living havehigher odds of 1.94 (95% CI: 1.34, 2.80) to 2.8 (95%CI: 1.04, 7.54) of facing food insecurity, and those withlimitations in instrumental activities of daily livingface higher odds of 1.4 (95% CI: 0.82, 2.36) to 2.2(95% CI: 1.04, 4.56).

Lee and Frongillo(Note 37)

Nutritional and health consequencesare associated with food insecurityamong U.S. elderly persons.

NHANES 1988–1994,National Survey of theElderly in New York State1994

Seniors are more likely than others to have lower intakesof eight nutrients. Food-insecure elderly individualswere 2.33 (95% CI: 1.73, 3.14) times more likely thantheir food-secure peers to report fair or poor healthstatus and had higher nutritional risk.

SOURCE Authors’ summary of information from articles cited in the text. NOTES If no mention is made of p values, standard errors, or confidence intervals, they were notreported in the article or the results were not statistically different from zero. CI is confidence interval. CPS is Current Population Survey. NHANES is National Health andNutrition Examination Survey. PSID is Panel Study of Income Dynamics.




16

a wide array of data sets and empirical methods.However, this literature has not always effective-ly addressed the issues of causality and endo-geneity.Causality In many of the cases discussed

above, the causal relationship between food in-security and health is clear. For example, itwould be difficult to construct a scenario inwhich limited nutrient intakewas a cause of foodinsecurity instead of the other way around.How-ever, in other cases, the causality is not as clear.Consider depression. In several studies, food

insecurity is seen as leading to depression—thatis, in the multivariate regression model, depres-sion is the dependent variable and food insecu-rity is one of the independent variables.2 Fromour perspective, this is plausible—the inability,say, of parents to feed their children could lead todepression. In contrast, others haveuseddepres-sion as a predictor of food insecurity, treatingfood insecurity as the dependent variable anddepression as one of the independent var-iables.46,47

Future research using longitudinal data withthe appropriate econometric techniques shouldaddress these causality issues. A recent exampleof researchers who considered this issue in aconvincing manner is Kelly Noonan and co-authors.46 They used data from the Early Child-hood Longitudinal Study Birth Cohort, whichconducted four interviews of the parents andcaregivers (including early childhood teachers)of 14,000 children born in 2001 between birthand the start of kindergarten. The researchersfound that when mothers are moderately to se-verely depressed, the risk of child and householdfood insecurity rises by 50–80 percent, depend-ing on the measure of food insecurity.Endogeneity In virtually all of the work men-

tioned above, the authors implicitly assumedthat the effect of food insecurity was properlyidentified after other observed characteristicsfrom the data set were controlled for. In otherwords, they assumed that there were no unob-served characteristics that led a household bothto bemore (or less) likely to be food insecure andto be more (or less) likely to suffer from a nega-tive health outcome. This assumption is unlikelyto hold, since we expect that multiple factors arenot included as covariates in any givenmodel. Asa consequence, the results found in these papersare subject to some level of bias. The extent ofthis bias and its direction are unclear.To address this issue, wemake a suggestion. A

number of econometric techniques could beused to reduce or eliminate endogeneity bias.For example, Craig Gundersen (one of the au-thors of this article) and Brent Kreider11 used aneconometric method that establishes bounds re-

garding the potential impact of food insecurityon health in the presence of unobserved charac-teristics that would lead one to be food insecureand in poor health. This approach does not al-low, in general, for point estimates of the impact.However, the bounds are more reasonable inso-far as they do not explicitly ignore unobservedcharacteristics. In some cases, there may be var-iables that influence food insecurity but nothealth outcomes, and in those cases, standardinstrumental variable techniques could be usedto derive point estimates of the impact of foodinsecurity on health outcomes.

RecommendationsFood insecurity and its health consequencespresent a serious challenge to policy makers,program administrators, and health care pro-viders in the United States. In this section weemphasize one central policy mechanism thatis used to alleviate food insecurity in the UnitedStates, and we make two suggestions for healthcare providers.Obviously, the most direct way to ameliorate

the health consequences associated with foodinsecurity is to reduce food insecurity. In theUnited States, SNAP has been used successfullyfor over fifty years to reduce food insecurity.48

The scope of SNAP is reflected in both its reachand the size of its benefits. In 2014 over forty-sixmillion people participated in the program,which had total expenditures of over $74 bil-lion.49 The maximum monthly SNAP benefit is$649 for a family of four; the average benefit perrecipient is about 60 percent of this level.50

Households are eligible for SNAP if they meetthree criteria. First, their gross monthly incomemust be less than 130 percent of the federal pov-erty level. In recent years some states have optedto use a cutoff that is above 130 percent of pov-erty. Second, a household’s net monthly incomemust be below poverty. Net income is defined as

The most direct wayto ameliorate thehealth consequencesassociated with foodinsecurity is to reducefood insecurity.





17

gross income minus certain deductions, such asa 20percent earned incomededuction, amedicalcosts deduction for elderly and disabled people,and an excess shelter cost deduction. The netincome test is the same in all states. Third, SNAPapplicants need to have assets of less than$2,000, except that households with at leastone senior and households that include at leastone person with a disability can have more as-sets. In recent years, however, most states haverequested and received waivers to eliminate theasset test in their states.A number of studies have demonstrated

SNAP’s success in achieving its central goal ofalleviating food insecurity.51,52 In addition, theprogram has been found to reduce poverty.48

However, recent proposals to change the fun-damental structure of SNAP, such as the call byHouse Budget Committee Chairman Rep. PaulRyan (R-WI) to make SNAP a block-grant pro-gram,53 could diminish its role in alleviating foodinsecurity. SNAP isnowanentitlementprogram,which means that federal spending on benefitsincreases and decreases along with a house-hold’s need. If it became a block-grant program,a fixed annual appropriationwould be allotted tostates, thereby reducing the program’s potentialresponsiveness to changes in need, such as thoseresulting from amidyear economic recession. Inaddition, the experience of the Temporary Assis-tance for Needy Families program (TANF)—afederal block-grant program to states targetedto low-income families with dependent childrenunder age eighteen that replaced an entitlementprogram, Aid to Families with Dependent Chil-dren, as part of the 1996 welfare reform—sug-gests that changing the financial structure ofSNAP bymaking it a block-grant programwouldlikely lead to the cutting of significant numbersof currently eligible families from the program.54

Other members of Congress and the public

health community have argued for imposing fur-ther restrictions on the types of items that SNAPbenefits can be used to purchase. SNAP benefitsmust be redeemed on food to be prepared in thehome, and hot prepared food is the only ineligi-ble food item.Imposing additional restrictions would likely

lead to reductions in participation in SNAP be-cause of increases in stigma (for example, bybeing refused purchases when paying for fooditems) and transaction costs (such as the highercosts associated with having to ascertain whichfoods are eligible for SNAP), both of which canbe seen in the recent experience of TANF.54,55

Since SNAP participants are less likely to be foodinsecure than nonparticipants who are eligiblefor SNAP,51,52 a fall in SNAP participation couldlead to an increase in food insecurity and itsresulting health consequences. Simply put,SNAP should be viewed as an important healthcare intervention for low-income Americans.That said, many SNAP recipients remain food

insecure even after receiving benefits. Further-more, many people who are eligible for SNAP donot receive benefits. This is especially trueamong seniors, a population in which over60 percent of those eligible do not receive assis-tance. These facts suggest that there is room formodifications to the current SNAP program.First, for some SNAP recipients, benefit levels

are not high enough to remove them from foodinsecurity. Consistent with the recommenda-tions of an expert panel of the Institute of Medi-cine, it may be worthwhile to increase benefitlevels for at least a subset of participants, espe-cially those in high-cost urban areas.56

Second, reducing the barriers to applying forSNAP and recertifying eligibility for theprogram—including the barriers related to stig-ma and transactions costs—would further re-duce food insecurity.Third, a substantial portion of food-insecure

households have incomes above the gross in-come limit of 130 percent of poverty, whichmakes them ineligible for SNAP in many states.This suggests that setting a higher gross-incometest for eligibility could reduce food insecurity ofthe so-called near-poor and, in turn, improvetheir health outcomes.

ConclusionWe conclude with two suggestions for howhealth care professionals might use the centralfindings of this review in their work. First, theyshould recognize the possibility that food inse-curitymay be one determinant, amongothers, ofa patient’s health challenges. Other nutrition-related health determinants, such as obesity,

Recent proposals tochange thefundamental structureof SNAP coulddiminish its role inalleviating foodinsecurity.




18

have received quite a bit of attention within thecontext of the doctor-patient relationship, butfood insecurity has not received nearly as much.Second, tomore fully ascertainwho is at risk of

food insecurity during visits to health care set-tings, health care professionals could ask forinformation about food insecurity along withother intake information. This is likely more im-portant now than before, with the implementa-tion of the Affordable Care Act and the concomi-tant expansion of Medicaid, which are bringingmillions of low-income people into the healthcare system.

A two-item food-security questionnaire takenfrom the eighteen items in the CPS-FSS has beenshown to be successful at identifying people in aclinical settingwho are at risk of food insecurity,and the two-item questionnaire could be morewidely tested nationally.57 This would then givehealth care professionals onemore tool to use inidentifying food-insecure patients and offeringcare options. One option, not ordinarily consid-ered in the context of an office visit, would be torefer patients to food assistance programs suchas SNAP to alleviate food insecurity and, in turn,its associated poor health consequences. ▪

The authors thank the editors and threeanonymous reviewers for many helpfulcomments on earlier versions of thisarticle. They also gratefully acknowledge

the Economic Research Service and theFood and Nutrition Service in theDepartment of Agriculture for financialsupport while this article was being

written. The opinions and conclusionsare solely those of the authors and donot reflect those of any sponsoringagency.

NOTES

1 Coleman-Jensen A, Gregory C, SinghA. Household food security in theUnited States in 2013 [Internet].Washington (DC): Department ofAgriculture, Economic ResearchService; 2014 Sep [cited 2015Sep 11]. (Economic Research ReportNo. 173). Available from: http://www.ers.usda.gov/media/1565415/err173.pdf

2 Ziliak JP, Gundersen C, Haist M. Thecauses, consequences, and future ofsenior hunger in America [Internet].Lexington (KY): University of Ken-tucky, Center for Poverty Research;[cited 2015 Sep 11]. Available from:http://www.mowaa.org/document.doc?id=13

3 Gundersen C, Ziliak JP. Childhoodfood insecurity in the U.S.: trends,causes, and policy options [Inter-net]. Princeton (NJ): Future ofChildren; 2014 fall [cited 2015Sep 11]. (Research Report). Availablefrom: http://www.princeton.edu/futureofchildren/publications/docs/ResearchReport-Fall2014.pdf

4 Gundersen C, Kreider B, Pepper J.The economics of food insecurity inthe United States. Appl Econ Per-spect Policy. 2011;33(3):281–303.

5 Carmichael SL, Yang W, Herring A,Abrams B, Shaw GM. Maternal foodinsecurity is associated with in-creased risk of certain birth defects. JNutr. 2007;137(9):2087–92.

6 Eicher-Miller HA, Mason AC,WeaverCM, McCabe GP, Boushey CJ. Foodinsecurity is associated with irondeficiency anemia in US adolescents.Am J Clin Nutr. 2009;90(5):1358–71.

7 Skalicky A, Meyers AF, Adams WG,Yang Z, Cook JT, Frank DA. Childfood insecurity and iron deficiencyanemia in low-income infants andtoddlers in the United States. MaternChild Health J. 2006;10(2):177–85.

8 Cook JT, Frank DA, Levenson SM,

Neault NB, Heeren TC, Black MM,et al. Child food insecurity increasesrisks posed by household food inse-curity to young children’s health. JNutr. 2006;136(4):1073–6.

9 Howard LL. Does food insecurity athome affect non-cognitive perfor-mance at school? A longitudinalanalysis of elementary studentclassroom behavior. Econ Educ Rev.2011;30(1):157–76.

10 Whitaker RC, Phillips SM, Orzol SM.Food insecurity and the risks of de-pression and anxiety in mothers andbehavior problems in their pre-school-aged children. Pediatrics.2006;118(3):e859–68.

11 Gundersen C, Kreider B. Boundingthe effects of food insecurity onchildren’s health outcomes. J HealthEcon. 2009;28(5):971–83.

12 Hernandez DC, Jacknowitz A. Tran-sient, but not persistent, adult foodinsecurity influences toddler devel-opment. J Nutr. 2009;139(8):1517–24.

13 Kirkpatrick SI, McIntyre L, PotestioML. Child hunger and long-termadverse consequences for health.Arch Pediatr Adolesc Med. 2010;164(8):754–62.

14 Huang J, Oshima KM, Kim Y. Doesfood insecurity affect parental char-acteristics and child behavior? Test-ing mediation effects. Soc Serv Rev.2010;84(3):381–401.

15 Melchior M, Chastang J-F, FalissardB, Galéra C, Tremblay RE, Côté SM,et al. Food insecurity and children’smental health: a prospective birthcohort study. PLoS One. 2012;7(12):e52616.

16 McIntyre L, Williams JV, LavoratoDH, Patten S. Depression and sui-cide ideation in late adolescence andearly adulthood are an outcome ofchild hunger. J Affect Disord. 2013;150(1):123–9.

17 Chi DL, Masterson EE, Carle AC,Manci LA, Coldwell SE. Socioeco-nomic status, food security, anddental carries in US children: medi-ation analyses of data from the Na-tional Health and Nutrition Exami-nation Survey, 2007–2008. Am JPublic Health. 2014;104(5):860–64.

18 Muirhead V, Quiñonez C, FigueiredoR, Locker D. Oral health disparitiesand food insecurity in working poorCanadians. Community Dent OralEpidemiol. 2009;37(4):294–304.

19 Cook JT, Black M, Chilton M, CuttsD, Ettinger de Cuba S, Heeren TC,et al. Are food insecurity’s healthimpacts underestimated in the U.S.population? Marginal food securityalso predicts adverse health out-comes in young U.S. children andmothers. Adv Nutr. 2013;4(1):51–61.

20 Dixon LB, Winkleby MA, RadimerKL. Dietary intakes and serum nu-trients differ between adults fromfood-insufficient and food-sufficientfamilies: Third National Health andNutrition Examination Survey,1988–1994. J Nutr. 2001;131(4):1232–46.

21 Tarasuk VS, Beaton GH. Women’sdietary intakes in the context ofhousehold food insecurity. J Nutr.1999;129(3):672–9.

22 Kirkpatrick SI, Tarasuk V. Food in-security is associated with nutrientinadequacies among Canadianadults and adolescents. J Nutr.2008;138(3):604–12.

23 McIntyre L, Glanville NT, Raine KD,Dayle JB, Anderson B, Battaglia N.Do low-income lone mothers com-promise their nutrition to feed theirchildren? CMAJ. 2003;168(6):686–91.

24 Ziliak JP, Gundersen C. Food inse-curity among older adults: full report[Internet]. Washington (DC): AARPFoundation; 2011 Aug [cited 2015





19

Sep 14]. Available from: http://www.aarp.org/content/dam/aarp/aarp_foundation/pdf_2011/AARPFoundation_HungerReport_2011.pdf

25 Park CY, Eicher-Miller HA. Iron de-ficiency is associated with food in-security in pregnant females in theUnited States: National Health andNutrition Examination Survey 1999–2010. J Acad Nutr Diet. 2014;114(12):1967–73.

26 Heflin CM, Siefert K, Williams DR.Food insufficiency and women’smental health: findings from a 3-yearpanel of welfare recipients. Soc SciMed. 2005;61(9):1971–82.

27 Heflin CM, Ziliak JP. Food insuffi-ciency, food stamp participation,and mental health. Soc Sci Q.2008;89(3):706–27.

28 Tarasuk VS. Household food inse-curity with hunger is associated withwomen’s food intakes, health, andhousehold circumstances. J Nutr.2001;131(10):2670–6.

29 Casey P, Goolsby S, Berkowitz C,Frank D, Cook J, Cutts D, et al.Maternal depression, changingpublic assistance, food security, andchild health status. Pediatrics.2004;113(2):298–304.

30 Hromi-Fiedler A, Bermúdez-MillánA, Segura-Pérez S, Pérez-EscamillaR. Household food insecurity is as-sociated with depressive symptomsamong low-income pregnant Lat-inas. Matern Child Nutr. 2011;7(4):421–30.

31 Seligman HK, Bindman AB,Vittinghoff E, Kanaya AM, KushelMB. Food insecurity is associatedwith diabetes mellitus: results fromthe National Health Examinationand Nutritional Examination Survey(NHANES) 1999–2002. J Gen InternMed. 2007;22(7):1018–23.

32 Seligman HK, Laraia BA, Kushel MB.Food insecurity is associated withchronic disease among low-incomeNHANES participants. J Nutr. 2010;140(2):304–10.

33 Stuff JE, Casey PH, Szeto KL, GossettJM, Robbins JM, Simpson PM, et al.Household food insecurity is asso-ciated with adult health status. JNutr. 2004;134(9):2330–5.

34 Vozoris NT, Tarasuk VS. Householdfood insufficiency is associated withpoorer health. J Nutr. 2003;133(1):120–6.

35 Ding M, Keiley MK, Garza KB, DuffyPA, Zizza CA. Food insecurity is as-sociated with poor sleep outcomesamong US adults. J Nutr. 2015;145(3):615–21.

36 Lee JS, Frongillo EA Jr. Factors as-

sociated with food insecurity amongU.S. elderly persons: importance offunctional impairments. J GerontolB Psychol Sci Soc Sci. 2001;56(2):S94–9.

37 Lee JS, Frongillo EA Jr. Nutritionaland health consequences are asso-ciated with food insecurity amongU.S. elderly persons. J Nutr.2001;131(5):1503–9.

38 Laraia BA, Borja JB, Bentley ME.Grandmothers, fathers, and depres-sive symptoms are associated withfood insecurity among low-incomefirst-time African-American mothersin North Carolina. J Am Diet Assoc.2009;109(6):1042–7.

39 Reaven GM. Hypothesis: muscle in-sulin resistance is the (“not-so”)thrifty genotype. Diabetologia. 1998;41(4):482–4.

40 Seligman HK, Jacobs EA, López A,Tschann J, Fernandez A. Food inse-curity and glycemic control amonglow-income patients with type 2 di-abetes. Diabetes Care. 2012;35(2):233–8.

41 Larson NI, StoryMT. Food insecurityand weight status among U.S. chil-dren and families: a review of theliterature. Am J Prev Med. 2011;40(2):166–73.

42 Hanson KL, Sobal J, Frongillo EA.Gender and marital status clarifyassociations between food insecurityand body weight. J Nutr. 2007;137(6):1460–5.

43 Jones SJ, Frongillo EA. Food inse-curity and subsequent weight gain inwomen. Public Health Nutr. 2007;10(2):145–51.

44 Whitaker RC, Sarin A. Change infood security status and change inweight are not associated in urbanwomen with preschool children. JNutr. 2007;137(9):2134–9.

45 Jones SJ, Frongillo EA. The modify-ing effects of Food Stamp Programparticipation on the relation be-tween food insecurity and weightchange in women. J Nutr. 2006;136(4):1091–4.

46 Noonan K, Corman H, ReichmanNE. Effects of maternal depressionon family food insecurity. Cambridge(MA): National Bureau of EconomicResearch; 2014 May. (NBER Work-ing Paper No. 20113).

47 Garg A, Toy S, Tripodis Y, Cook J,Cordella N. Influence of maternaldepression on household food inse-curity for low-income families. AcadPediatr. 2015;15(3):305–10.

48 Bartfeld J, Gundersen C, SmeedingTM, Ziliak JP, eds. SNAP matters:how food stamps affect health andwell-being. Redwood City (CA):

Stanford University Press; forth-coming.

49 Department of Agriculture, Food andNutrition Service. SupplementalNutrition Assistance Program par-ticipation and costs [Internet].Washington (DC): USDA; 2015 [cit-ed 2015 Sep 23]. Available from:http://www.fns.usda.gov/sites/default/files/pd/SNAPsummary.pdf

50 Department of Agriculture, Food andNutrition Service. SupplementalNutrition Assistance Program(SNAP) eligibility [Internet]. Wash-ington (DC): USDA; [last published2014 Oct 3; cited 2015 Sep 23].Available from: http://www.fns.usda.gov/snap/eligibility

51 Gregory C, Rabbitt M, Ribar D. TheSupplemental Nutrition AssistanceProgram and food insecurity. In:Bartfeld J, Gundersen C, SmeedingTM, Ziliak JP, editors. SNAP mat-ters: how food stamps affect healthand well-being. Redwood City (CA):Stanford University Press; forth-coming. p. 74–106.

52 Kreider B, Pepper JV, Gundersen C,Jolliffe D. Identifying the effects ofSNAP (food stamps) on child healthoutcomes when participation is en-dogenous and misreported. J AmStat Assoc. 2012; 107(499):958–75.

53 House Budget Committee. The pathto prosperity: fiscal year 2015 budgetresolution [Internet]. Washington(DC): The Committee; 2014 Apr[cited 2015 Sep 14]. Available from:https://budget.house.gov/uploadedfiles/fy15_blueprint.pdf

54 Ziliak JP. Temporary Assistance forNeedy Families. Cambridge (MA):National Bureau of Economic Re-search; 2015 Mar. (NBER WorkingPaper No. 21038).

55 Gundersen C. SNAP and obesity. In:Bartfeld J, Gundersen C, SmeedingTM, Ziliak JP, editors. SNAP mat-ters: how food stamps affect healthand well-being. Redwood City (CA):Stanford University Press; forth-coming. p. 161–85.

56 Caswell JA, Yaktine AL, editors.Supplemental Nutrition AssistanceProgram: examining the evidence todefine benefit adequacy.Washington(DC): National Academies Press;2013.

57 Hager ER, Quigg AM, Black MM,Coleman SM, Heeren T, Rose-JacobsR, et al. Development and validity ofa 2-item screen to identify families atrisk for food insecurity. Pediatrics.2010;126(1):e26–32.




20

Feeding People. Stabilizing Lives.

THE NUMBERSFood Insecure People: 322,730 or 1 in 8Children Facing Hunger: 84,860 or 1 in 5Counties Served: Allegheny, Armstrong, Beaver, Butler, Cambria, Fayette, Greene, Indiana, Lawrence, Somerset and WashingtonFresh Produce Distributed: 8 million poundsMeals provided: 33 million or 8 meals per month for each neighbor in need

1 North Linden Street • Duquesne, PA 15110p: (412) 460-3663 • f: (412) [email protected]

The number of families and individuals who live in hunger in the United States is on the rise. Many come from our most vulnerable populations — children and seniors. Every day thousands of neighbors in our region are making tough choices. Seniors are choosing between buying groceries or medicine. Parents are skipping meals so their children can eat. Working families are juggling utility bills, costs to get work or school, rent or mortgage payments and providing healthy meals to feed their families.

In southwestern Pennsylvania, no one has to face those tough choices alone.

Greater Pittsburgh Community Food Bank was formed in 1980 by a group of community leaders who made a commitment to provide emergency food to our neighbors in need. Today in addition to providing food and other essential items to member hunger-relief programs, the Food Bank enrolls neighbors in SNAP (Food Stamps), builds connections to healthcare and employment, strengthens Summer Feeding programs and encourages full participation in school meals.

Providing nutritious food through a network of nearly 400 food pantries, hot meal sites, shelters and other hunger-relief programs is the core of our work. It is also essential that we do more to stabilize lives and communities.

We may never see a day where no one among us is hungry, but we can be a community that is there for you when you find yourself in need. Where you know your neighbors are there to help because you step up to help.

21

Donate.When you donate to Greater Pittsburgh Community Food Bank, you are helping the one in eight of our neighbors who struggle to put enough food on the table. The Food Bank is effective and efficient—94% of donations go directly to our hunger-relief activities. With your help, we’re building healthy, food secure communities. Every dollar you give helps provide five meals in our community.

Volunteer. Your time is a gift to kids, seniors and others who may not have enough to eat. Volunteers produce the equivalent of a meal a minute while helping the Food Bank sort, process and pack food. And it’s fun! You can repackage food in our warehouse, distribute fresh food, share cooking tips and produce samples, harvest crops at local farms, help out in our offices, lend a hand at events and more.

Speak Out.When you join our advocacy efforts and speak out to your elected officials, you help us build a powerful movement. Through the concerted efforts of people like you, we can ensure that legislators get the message: helping our neighbors in need is a priority today, and addressing hunger’s root causes is vital to reducing hunger tomorrow.

For Our Neighbors. For All of Us.Think of the impact you make for neighbors like Pat. She started volunteering for us a few years ago when the company she worked with for 33 years let her go. At 62, she was not prepared financially or emotionally to retire. The stress was too much and she began volunteering to keep busy.

“Realistically you have people making decisions about what they can afford in their monthly budget, and it isn’t fresh food,” says Pat. “They’re making choices about buying food or medicine. The Food Bank removes the worry of being able to afford fresh fruit and vegetables. It’s just amazing.”

Pat has now found herself in need of a little extra help too. Pete, her husband of 42 years was diagnosed with dementia a few years ago. Then his health took an even worse turn with an ALS diagnosis. His need for constant care and wheelchair upgrades for their home has put an incredible strain on their finances.

When Pat finishes her volunteer shift our Produce to People distribution, she gets in line. “To be able to bring a huge box of produce home every month—it means everything to us.”

Whether it’s by advocating and raising awareness, making donations or volunteering, we can help you find the way that is right for you to make a difference.

Email us: [email protected] us: (412) 460-3663Find us: 1 North Linden Street, Duquesne, PA 15110

Our MissionFeed people in need and mobilize our community to eliminate hunger.

Updated: 11/6/2017

Our VisionA hunger-free southwestern Pennsylvania.

22

Lifelong Consequences of Child Hunger

Undernourished children are at risk of serious

health, social, and educational problems

carrying into adulthood.

Child hunger causes

BEHAVIOR

PROBLEMS

Studies link hunger with

social, behavioral, and mental

health problems.

→ 1.9x more likely to suffer

from ADHD.7

→ 3x more likely to be

suspended from school.8

→ 5x more likely to commit

suicide as a teen.9

Child hunger causes

EDUCATION

PROBLEMS

For emotional,

cognitive, and

physical reasons, a

hungry child faces

significant educational

challenges.

→ 1.6x more likely to

miss days of

school.10

→ 2x more likely to

repeat a grade.11

→ 2x more likely to

require special

education.12

Child hunger causes

HEALTH

PROBLEMS

Hungry children are

sick more often,

frequently experiencing

headaches, stomach-

aches, colds, and

fatigue.


suffer from poor

health.3


be iron deficient.4


be hospitalized

and require longer

in-patient stays.5

Child hunger causes

POOR JOB

READINESS

Adults who experienced

hunger as children are

ill-prepared mentally,

emotionally, and

physically for the work

environment, leading to

greater absenteeism and

turnover.6

Greater Pittsburgh Community Food Bank

LONG-TERM

COSTS

Hunger causes a

chain reaction of

negative impacts.

Compared to their food

secure peers, children

experiencing 4 years of

food insecurity have a:

209% increase in

their likelihood of

lower health status.13

c h i l d H U N G E R

Pennsylvania’s Children

→ 521,750 (19.3%) children are foodinsecure.1

→ 47% of households receivingSNAP benefits (food stamps)have children.2

23

Food assistance

programs reduce

food insecurity and

its negative impacts:

WIC enrollment from birth

increases iron levels and lowers

iron-deficiency anemia.14

Families at risk of hunger who

participate in SNAP are twice

as likely to be healthy than

those who do not.15

The Child and Adult Care

Food Program provided nearly

70 million nutritious meals

and snacks at child care centers

and homes in Pennsylvania

during 2014-2015, improving

the overall quality of care.16

Over 109 million free or

reduced-price lunches were

served to PA children during

the 2014-15 school year -

frequently their only meal.17

Only 51 million breakfasts

were served to the same

eligible children that school

year.18 Breakfast has been

shown to stave off obesity.19

Even fewer meals - just under

7 million - were served

through the Summer Food

Service Program, designed to

fill the nutrition gap left when

school ends.20

Serenity has big blue eyes and giggles with a grin so wide that it

takes up most of her tiny face. She and her mother wait in line

with hundreds of other families. They’ve come to one of the Food

Bank’s Produce to People distribution locations, where they can

take home fresh produce and groceries.

At only 10 months old, Serenity doesn’t know where dinner comes

from, but she knows what hunger feels like. Even though she’s

very young, she has experienced times when her parents have had

to choose between paying the heating bill and buying groceries.

Serenity hasn’t lived long enough to make mistakes or wrong

decisions; she was simply born into poverty.

Serenity’s parents moved from Houston, Texas when her

father got work in construction. Despite his new job, they’re still

struggling to get reestablished. “It’s hard,” her mother confesses.

“Serenity’s father is working, but it’s hard to pay all of those bills

and buy diapers and formula. You just can’t do it all.”

Born into Poverty

For more information on hunger and food insecurity visit www.pi<sburghfoodbank.org

Revised May 2016

24

Greater Pi<sburgh Community Food Bank


Bibliography

1 Feeding America. (2016). Map the Meal Gap - Child Food Insecurity Rates in 2014 - Pennsylvania. Retrieved May 9, 2016 from http://map.feedingamerica.org/county/2014/overall

2 U.S. Census Bureau. (2016). Table B22002—Receipt of Food Stamps/SNAP in the Past 12 Months by Presence of Children Under 18 Years by Household Type for Households—

Pennsylvania—2014 American Community Survey 1-Year Estimates. Retrieved May 9, 2016 from http://factfinder.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t

3 Brown, J. L., Shepard, D., Martin, T. & Orwat, J. (2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Founda-tion. Retrieved May 3, 2013 from http://www.sodexofoundation.org/hunger_us/Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

4 Ibid.

5 Hunger-Free Minnesota. (2010). Cost/Benefit Hunger Impact Study. Retrieved May 4, 2013 from http://www.hungerfreemn.org/sites/default/files/HFMN%20-%20Cost-Benefit%20Research%20Study%20FULL%20%28Low%20Res%29%20-%209.27.10.pdf

6 Brown, J. L., Shepard, D., Martin, T. & Orwat, J. (2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved May 3, 2013 from http://www.sodexofoundation.org/hunger_us/Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

7 Ibid.

8 Ibid.

9 Hunger-Free Minnesota. (2010). Cost/Benefit Hunger Impact Study. Retrieved May 4, 2013 from http://www.hungerfreemn.org/sites/default/files/HFMN%20-%20Cost-Benefit%20Research%20Study%20FULL%20%28Low%20Res%29%20-%209.27.10.pdf

10 Brown, J. L., Shepard, D., Martin, T. & Orwat, J. (2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved May 3, 2013 from http://www.sodexofoundation.org/hunger_us/Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

25

For more information on hunger and food insecurity visit www.pi<sburghfoodbank.org

Bibliography continued

11 Ibid.

12 Ibid.

13 Jeong-Hee, R. & Bartfeld, J.S. (2012). “Household Food Insecurity During Childhood and Subsequent Health Status: The Early Childhood Longitudinal Study-Kindergarten Cohort.” American Journal of Public Health, Research and Practice, November 2012, Vol. 102, No. 11, pp. e50-e55.

14 Partnership for America’s Economic Success. (2008). Reading, Writing and Hungry: The Consequences of Food Insecurity on Children, and on our Nation’s Success. Washington, D.C.: Lee, G. November 2008, Issue Brief #8. Retrieved May 6, 2013 fromhttp://www.readynation.org/docs/researchproject_foodinsecurity_ 200811_brief.pdf

15 Children’s HealthWatch. (2012). The SNAP Vaccine: Boosting Children’s Health. Retrieved May 10, 2013 from http://www.centerforhungerfreecommunities.org/sites/default/files/pdfs/SNAP_FINAL1.pdf

16 Pennsylvania Department of Education, Division of Food and Nutrition. (2016). Claim Meal Count and Net Reimbursements, Child and Adult Care Food Program, Federal Fiscal Year 2014-2015.

17 Pennsylvania Department of Education, Division of Food and Nutrition. (2016). YTD and Monthly Eligibility Report, Program Year 2014-2015.

18 Ibid.

19 Gleason, P. M. & Dodd, A. H. (2009). “School Breakfast Program but not School Lunch Program Participation is Associated with Lower Body Mass Index.” Journal of the American Dietetic Association, 109(2 Supplement 1), S118-S128.

Millimet, D. L., Tchernis, R., & Husain, M. (2010). “School Nutrition Programs and the Incidence of Childhood Obesity.” Journal of Human Resources, 45(3), 640-654.

Millimet, D. L. & Tchernis, R. (2013). “Estimation of Treatment Effects without an Exclusion Restriction: with an Application to the Analysis of the School Breakfast Program.” Journal of Applied Economics, 28, 982-1017.

20 Pennsylvania Department of Education, Division of Food and Nutrition. (2016). Claim Meal Count and Net Reimbursements, Summer Food Service Program and Seamless Summer Option, Fiscal Year 2014-2015.


26

Greater Pittsburgh Community Food BankGreater Pittsburgh Community Food BankGreater Pittsburgh Community Food BankGreater Pittsburgh Community Food Bank

$6.12 Billion$6.12 Billion$6.12 Billion$6.12 Billion *does not include administration costsof key food and nutrition programs. 1

3X more likely to be SUSPENDEDSUSPENDEDSUSPENDEDSUSPENDED from school 5

2X more likely to REPEAT A GRADE REPEAT A GRADE REPEAT A GRADE REPEAT A GRADE 6

2X more likely to require SPECIAL EDUCATION SPECIAL EDUCATION SPECIAL EDUCATION SPECIAL EDUCATION 7

2.5X more likely for women to be OBESE OBESE OBESE OBESE 3

2X more likely to develop DIABETES DIABETES DIABETES DIABETES 4

3X more likely to su4er from POOR HEALTH POOR HEALTH POOR HEALTH POOR HEALTH 2

Hunger’s ConsequencesHunger’s ConsequencesHunger’s ConsequencesHunger’s Consequences TO HEALTH & EDUCATIONTO HEALTH & EDUCATIONTO HEALTH & EDUCATIONTO HEALTH & EDUCATION

Pennsylvania’s Hunger Bill: Growing Hunger, Growing CostsGrowing Hunger, Growing CostsGrowing Hunger, Growing CostsGrowing Hunger, Growing Costs

As hunger grows, so does the economic cost. Pennsylvania is 1 of 12 states whose hunger costs rose more than $1 billion since 2007. 8

Education Costs: Education Costs: Education Costs: Education Costs: $704 million $704 million $704 million $704 million 14

• 3 out of 5 K-8 public school teachersin the U.S. report seeing childrenregularly coming to school hungry.15

• Children from food insecure house-holds are more likely to struggle inschool, fail, be held back, or drop outaltogether.16

• Earning capacity is largelydetermined by an individual’seducational achievement. Whenhunger interferes, a lifetime of earningcapacity is impacted. A high schoolgraduate earns, on average, $8,915more each year than someone whonever graduated.17

Health CostsHealth CostsHealth CostsHealth Costs: : : : $4.77 billion $4.77 billion $4.77 billion $4.77 billion 9

• Malnutrition compromises theimmune system, making the hungrymore vulnerable to disease.10

• Hospital stays are 3X longer formalnourished patients.13

• Hungry individuals are 1.3X morelikely to be hospitalized.11

• Healthcare for malnourishedpatients costs 3X more compared tohealthy patients.12

27

Food assistance Food assistance Food assistance Food assistance programs reduce programs reduce programs reduce programs reduce food insecurity food insecurity food insecurity food insecurity and its negative and its negative and its negative and its negative

impacts:impacts:impacts:impacts:

• For every $5 of SNAPFor every $5 of SNAPFor every $5 of SNAPFor every $5 of SNAPbenefits used for food,up to $9 in economicactivity is generated. 18

• SNAP helped 1.89SNAP helped 1.89SNAP helped 1.89SNAP helped 1.89million Pennsylvaniansmillion Pennsylvaniansmillion Pennsylvaniansmillion Pennsylvaniansavoid hunger bysupplementing thefamily’s monthly foodbudget. 19

• WIC saves betweenWIC saves betweenWIC saves betweenWIC saves between$1.77 and $3.13 forevery dollar spent inMedicaid costs. 20

• Research shows thatResearch shows thatResearch shows thatResearch shows thatthe National SchoolBreakfast Programhelps children performbetter in school,concentrate in class,and visit the schoolnurse less often. 21

• CommodityCommodityCommodityCommoditySupplementalSupplementalSupplementalSupplemental NutritionNutritionNutritionNutritionProgram (CSFP) Program (CSFP) Program (CSFP) Program (CSFP) helpslow-income seniorsmaintain the propernutrition needed toreduce the risk ofchronic illness. 22

Hunger: A Loss For AllHunger: A Loss For AllHunger: A Loss For AllHunger: A Loss For All

For more information on hunger and food insecurity visit www.pittsburghfoodbank.orgFor more information on hunger and food insecurity visit www.pittsburghfoodbank.orgFor more information on hunger and food insecurity visit www.pittsburghfoodbank.orgFor more information on hunger and food insecurity visit www.pittsburghfoodbank.org

It is Laura’s first time at a food pantry and she’s a bit nervous. Since losing her job two months ago, her family—including her husband and seven year old son—have struggled to make ends meet. “My husband has worked at the same place, full time, for eight years, but doesn’t earn enough to support our family. I need to work, too,” said Laura.

Since losing her job, Laura and her husband were forced to file for bankruptcy on their home and now face tough choices between basic necessities like food and heat. “We want to pay our bills, but we also need to eat,” said Laura, who is seated shoulder to shoulder with others waiting for food. Her son, Max, receives a free lunch at school, which he qualified for even before Laura lost her job. “We are hard working people, but that doesn’t seem to be enough to make ends meet; it’s tough,” said Laura. Laura is not alone; over two hundred people were served at the food pantry that day.

June 2016

28


BibliographyBibliographyBibliographyBibliography

1 Shepard, D.S., Setren, E., & Cooper, D. (2011). Hunger in America: Su�ering We All Pay For. Washington, D.C.: Center for American Progress. October. Retrieved from http://www.americanprogress.org/issues/2011/10/pdf/hunger_paper.pdf

2 Brown, J.L., Shepard, M.T., & Orwat, J.(2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved from http://www.sodexofoundation.org/hunger_us/ Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

3 Townsend, M. S., Peerson, J., Love, B., Achterberg, C., & Murphy, S. P. (2001). “Food Insecurity is Positively Related to Overweight in Women.” Journal of Nutrition. June 1, 2001, vol. 131, pp. 1738–1745.

4 Seligman, H. K., Bindman, A. B., Vittingho4, E., Kanaya, A. M., & Kushel, M. B. (2007). “Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002.” Journal of General Internal Medicine. April 11, 2007, vol. 22, no. 7, pp. 1018-1023.

5 Brown, J.L., Shepard, M.T., & Orwat, J.(2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved from http://www.sodexofoundation.org/hunger_us/ Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

6 Ibid.

7 Ibid.

8 Shepard, D.S., Setren, E., & Cooper, D. (2011). Hunger in America: Su�ering We All Pay For. Washington, D.C.: Center for American Progress. Retrieved from http://www.americanprogress.org/issues/2011/10/pdfhunger_paper.pdf

9 Shepard, D.S., Setren, E., & Cooper, D. (2011). Hunger in America: Su�ering We All Pay For. Washington, D.C.: Center for American Progress. October. Retrieved from http://www.americanprogress.org/issues/2011/10/pdf/hunger_paper.pdf

10 Ibid.

11 Brown, J.L. Shepard, M.T., & Orwat, J.(2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved from http://www.sodexofoundation.org/hunger_us/ Images/Cost20of20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

12 Corkins, M. R., Guenter, P., Dimaria-Ghalili, R. A., Jensen, G. L., Malone, A., Miller, S., & Resnick, H.E. (2014). “Malnutrition diagnoses in hospitalized patients: United States, 2010.” JPEN Journal Of Parenteral & Enteral Nutrition, 38(2), 186-195.

29


Bibliography continuedBibliography continuedBibliography continuedBibliography continued

13 Ibid.

14 Shepard, D.S., Setren, E., & Cooper, D. (2011). Hunger in America: Su�ering We All Pay For. Washington, D.C.: Center for American Progress. Retrieved from http://www.americanprogress.org/issues/2011/10/pdfhunger_paper.pdf

15 Share Our Strength. (2012). Hunger in Our Schools: Share Our Strength’s Teachers Report 2012. Retrieved March 25, 2013 from http://join.strength.org/site/ DocServer/2012-teacher-report-final.pdf?docID=8901

16 Brown, J.L. Shepard, M.T., & Orwat, J. (2007). The Economic Cost of Domestic Hunger: Estimated Annual Burden to the United States. Gaithersburg, MD: The Sodexo Foundation. Retrieved from http://www.sodexofoundation.org/hunger_us/ Images/Cost%20of%20Domestic%20Hunger%20Report%20_tcm150-155150.pdf

17 U.S. Census Bureau. Table B20004: Median Earnings in the Past 12 Months (in 2014 Inflation-Adjusted Dollars) by Sex by Educational Attainment for the Population 25 Years and Over. 2014 American Community Survey 1-Year Estimates. Retrieved May 9, 2016 from http://factfinder.census.gov/faces/nav/jsf/pages/ index.xhtml

18 Hanson, K. (2010). The Food Assistance National Input-Output Multiplier (FANIOM) Model and Stimulus E�ects of SNAP. Report No. ERR-103. U.S. Department of Agriculture, Economic Research Service. Retrieved from http://www.ers.usda. gov/Publications/ERR103/ERR103.pdf

19 Pennsylvania Department of Human Services, Bureau of Program Support. (2016). Number of Adults and Children Eligible for Assistance, by County, March 2016.

20 Partnership for America’s Economic Success. (2008). Reading, Writing and Hungry: The Consequences of Food Insecurity on Children, and on our Nation’s Success. November 2008, Issue Brief #8. Washington, D.C.: Lee, G. Retrieved from http:// www.readynation.org/docs/researchproject_foodinsecurity_200811_brief.pdf

21 U.S. Department of Agriculture, Food and Nutrition Service. (2012). USDA School Meals: Healthy Meals, Healthy Schools, Healthy Kids. Retrieved from http://www.fns.usda.gov/sites/default/files/school_meals.pdf

22 U.S. Department of Agriculture, Food and Nutrition Service (n.d.). Commodity Supplemental Food Program. Retrieved March 1, 2012 from http://www.fns.usda. gov/fdd/programs/csfp/

30

the gateway to other ills - institute of politicsiop.pitt.edu/sites/default/files/documents/hunger...

Documents