Going Hungry In The USA: The Innumerable Costs Of Food Insecurity

How food insecurity is affecting Americans

Despite America's historic abundance, the specter of food insecurity continues to shadow the lives of 34 million people in the US, including 9 million children. Insufficient access to food triggers long-term health effects, endangers the development of generations, and adds to the total cost of healthcare.

One of the most consequential social determinants of health, food insecurity is defined as the lack of consistent access to enough safe, nutritionally adequate food to support normal development and growth and to live a healthy, active life.

Black Americans and single moms at higher risk of food insecurity

Just over 10% of US households experience food insecurity, either periodically or chronically, according to the U.S. Department of Agriculture (USDA). The good news is that the rate has fallen from a peak of 15% in 2011. Even so, food insecurity remains twice as high among single-mom households (24%) and Black households (20%), and also is substantially higher among Hispanic households (16%). Among White households, just 7% are food insecure.

Variability between states

Food insecurity rates also vary by state, from a high of 15.3% in Mississippi to a low of 5.4% in New Hampshire. The differences reflect population characteristics, governmental policies, and economic conditions. Although the reported rate of food insecurity nationally hasn't yet risen due to ongoing inflation, many Americans face increasingly difficult tradeoffs when it comes to purchasing food versus other necessities.

Hard choices between food and medical care

A recent survey conducted by the Harris Poll found that 14% of Americans have cancelled or postponed plans to see a medical specialist, 11% have skipped an annual physical, and 10% have not taken prescribed medication due to inflation. Among Gen Z and Millennials, 17% and 19%, respectively, have cancelled or postponed plans to see a mental health professional. The same survey found that 1 in 5 Americans have skipped meals or did not buy groceries due to high inflation. The harsh reality is that many low-income Americans increasingly confront an untenable dilemma: put food on the table or pay for necessary healthcare and medications.

Complex causes of food insecurity

As with most social determinants, the root causes of food insecurity are complex and systemic, although poverty is central. Unemployment, low income, a lack of affordable housing, racial and ethnic discrimination, poor healthcare access, and chronic health conditions all can contribute to difficulty in consistently providing adequate food. By the numbers, 35.3% of households with income below the federal poverty line are food insecure, with many low-income families spending upward of 27% of their income on food. That's nearly 3 times the 10.3% average spent on food by all US consumers, according to the USDA.

Food insecurity can be exacerbated by food deserts, which are defined as geographic areas where residents live a mile or more from a supermarket in urban settings and 10 miles or more in rural areas. Because food deserts reduce access to healthy food, families and individuals are often forced to rely on less healthy convenience store and fast food meals.

Negative health effects of food insecurity

The health consequences of food insecurity are considerable and lasting. Among children, food insecurity creates higher risks for a range of conditions, including weakened immune systems, some birth defects, anemia, cognitive problems, aggression and anxiety, asthma, depression, and suicide. The risk of anemia is 2-3 times higher, for example, and the risk of developing asthma is 1.4-2.6 times higher, depending on the age of the child.

Even worse, the effects of early food insecurity can be difficult to undo and may lead to a range of serious problems in adulthood, most notably chronic diseases like obesity, heart disease, diabetes, as well as mental health disorders. One recent study found that food insecurity, a poor-quality diet, and being a member of a racial or ethnic group all correlated with a higher risk of uncontrolled Type 2 diabetes.

Food insecurity worsens healthcare costs

Because food insecurity triggers or worsens chronic diseases and fuels emergency room visits, hospitalizations and readmissions, it adds $53 billion annually to healthcare costs, according to a 2019 study by Feeding America. Another recent study found that food-insecure families paid $2,500 more annually in healthcare costs than families with sufficient food.

The report looked at the experiences of 6,600 families, 10% of which were considered food insecure in 2016. Among that group, average family health expenditures were 20% higher than those of non-food-insecure families in the following year.

Keys to eliminating food insecurity

Food security can be reduced, if not completely eliminated, through key policy changes, according to Poverty USA. These include:

• Modernize the Supplemental Nutrition Assistance Program (SNAP) to better reflect actual food costs, particularly in areas with higher costs of living, and to conform with the federal government's own nutrition standards. According to a recent study, the USDA's Thrifty Food Plan–the basis for SNAP benefits–is “badly out of date with the most recent dietary recommendations and the economic realities most struggling households face when trying to buy and prepare healthy food." The Thrifty Food Plan was last revised in 2006.
• Reduce food waste, which currently accounts for between 30-40% of the US food supply. One way to accomplish this, according to Poverty USA, is to standardize labeling conventions. Discrepancies between best-by, use-by, and sell-by dates frequently cause confusion and lead to food being unnecessarily discarded. There's also interest in protecting grocery retailers from liability so they can more freely donate surplus or unsold product to charities and local food banks.
• Offer free lunches for all public school students. The federal government made free meals available to the nation's 50.6 million public school students during the COVID-19 pandemic. But that program expired in September 2022 and the lunch program reverted to a process that requires families to submit applications and income information to continue to qualify for free or reduced-cost meals. Universal free lunches would reduce stigma around needing a school lunch, improve the quality and variety of children's diets, improve health and lower obesity rates, and generate higher attendance rates from food-insecure students.

More broadly, federal, community and private-sector efforts to reduce poverty through economic growth and living wages can help mitigate food insecurity by raising the standard of living for those long trapped in poverty.

“Millions of Americans who work full-time or even at multiple jobs still find themselves in poverty due to low wages, unstable work schedules, and the high costs of childcare, housing, education, transportation, and healthcare," writes the Center for American Progress.

RTI Health Advance is fighting against food insecurity

Contact us to learn more about preventing food insecurity and take meaningful action toward building a more equitable and food-secure society.