Coronavirus and Food Access: How the Pandemic Impacts Food Insecurity

Leung: A couple weeks ago, my colleague in the School of Public Health, Julia Wolfson, and I conducted an online survey to try to understand how food insecure families were being impacted by COVID-19 and what we saw was that a lot of our respondents who expressed they had underlying health conditions or they were immunocompromised, they were terrified about going to the grocery store and risk getting sick. They were also worried that their health appointments were getting cancelled. And so if they were going to the store before to purchase food, now they were feeling like they had a food shortage because they were not able to get the store because they didn't wanna risk their own health.

We also had a couple of families provide some more details about their own experiences, specifically with the intersection of financial insecurity and housing insecurity. And so one of the respondents to our survey said “We are looking at having to move in the middle of all this because we can no longer afford our rent. It has become unnecessarily stressful. We need reassurance that we can take care of our health and we will still be able to take care of our bills.”

There was another person who was a parent of two children who said “I'm terrified that I will have to ration my children's food. My wife and I are already only eating every other day and only once.” So it just shows how food insecure families are trying to respond to not having enough food in their home because of shortages in their community or because of a lack of resources. And so, the adults are eating every other day to make sure that their kids have enough food.

And finally, there was a participant in our survey, who just said “It's scaring the hell out of me.” And I think that's true for a lot of people, regardless of their food insecurity status, but especially if you're a food insecure, you have an underlying health condition, you're worried about your basic needs, paying for housing, paying for your utilities, paying for food. It is definitely frightening.

Speaker 1: According to the USDA, there are nearly 40 million Americans, including 11 million children, who are food insecure. And that means they don't have reliable, consistent access to the nutritious quality food that they need to lead healthy lives. With growing pressure on the food supply chain and tens of millions of Americans now unemployed, the coronavirus pandemic could cause that 40 million number to climb.

Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast, focusing on the ongoing coronavirus pandemic. Cindy Leung is a nutrition epidemiologist and an assistant professor of Nutritional Sciences at the University of Michigan School of Public Health. Her research focuses on diet and health disparities in vulnerable populations. We spoke with her about the ways COVID-19 is impacting those experiencing food insecurity.

Leung: Right now we're seeing that COVID-19 is basically magnifying any food and nutrition-related disparities that were already in existence in our communities. So there's a couple of reasons why food insecurity is being exacerbated. One is that there are public health recommendations to stock up on extra food, so this is impacting our food retailers. Basically our food landscape in our communities is changing. And so people across socio-economic backgrounds, whether you're a high income, medium income or low-income, everyone's finding it harder to purchase staple foods like breads and pastas, canned beans, canned fruits and vegetables or frozen foods, a lot of items that are shelf-stable. They're not perishable, so you can store them for a long period of time, if you have the space and the equipment.

So, for a family who's already experiencing food insecurity who might be living month-to-month or paycheck-to-paycheck, they're finding it harder to access these foods that they rely on to feed their families and to stretch their food budget just because the foods are available in their environment are no longer stocked up as they were maybe a month ago because everyone is now buying these foods.

Another reason is that there is just more and more families now who are at risk of food insecurity who previously might have had a stable income, but maybe they lost their job or they were furloughed or something happened with their employment and their primary source of income. And now they're experiencing signs of food insecurity. And we already see this with the record unemployment claims being filed. We know that economic instability is a predictor of food insecurity. We saw this in 2008, the Great Recession. And I'll just add it in 2008, it took 10 years of strong economic policies to bring any increases in food insecurity back down to levels before the Great Recession. And so many of us who study food insecurity were very worried to know how levels of food insecurity in our communities and our country were going to be impacted with COVID-19. 

There have been a couple of studies now that have been released to the public around what food insecurity looks like. Before the pandemic, last year food insecurity at the national level was 11%. A study that was conducted last month shows that the national rate is close to the 38%. It's more than tripled in just a few short months because of more unemployment, food shortages and so forth.

And Michigan is right at that level. So Michigan was 37% and if you look state-by-state, no state is under 25%. So every state is seeing these increases in food insecurity at double or triple what it was just a few months ago.

There was another study that was published by Mlive earlier this month and they found that one in four Michiganders we're worrying about putting food on their table or paying their rent or mortgage. So about 28%. But if you look at certain groups like people who are furloughed or recently laid off, African-American adults under 30, it was closer to one in two.

I give a lecture in one of my courses about food insecurity and the social determinants of health. If you think of the five domains of social determinants of health being economic stability, education, health and healthcare, the neighborhood environment, the social context, basically COVID-19 is exacerbating every one of these domains. So it's affecting your economic stability, it's affecting how we provide and receive education, it's overloading our healthcare system, it's shaping our neighborhood environments and any neighborhood inequities that we're already there now are being magnified, and just even the ways that we connect with each other socially and how we provide social support to each other are being disrupted. All of these things also affect food insecurity and it's not surprising but it is sad to see how much higher food insecurity levels have gotten in just a few short weeks.

If we think about why does food insecurity cause some of these poor health outcomes, it's not just a lack of nutrients or a lack of calories. There's definitely more going on in a food insecure household that is leading to some of these psychosocial or mental health outcomes that we're seeing in both children and adults. One of the reasons why I think this is is just because food insecurity is inherently stressful. Just like any of our insecurities, like financial insecurity or housing insecurity. If you're worrying that your basic needs aren’t going to be met, that triggers a very physiological reaction. And for children a behavioral reaction if they're worrying that they're not going to have enough to eat at their next meal or they're seeing the stress that their parents have for putting food on the table it impacts their development in negative ways. And so all of these situations are stressful.

COVID-19 is magnifying the stress that these families are under because of the increase in economic instability, the higher levels of unemployment. And so I'm worried that in addition to some of the diet-related outcomes of food insecurity we're also going to see greater mental health and psychosocial outcomes as a result of children and adults being more food insecure.

Speaker 1: Susan Aronson is the director of the didactic program in dietetics and a lecturer at the University of Michigan School Public Health in the department of nutritional sciences. We spoke with her about how community and government organizations are adapting to serve their communities in the wake of COVID-19.

Aaronson: I'm on the board of Food Gatherers and Ypsilanti Meals on Wheels, so I've been pretty intimately involved in some of the changes and the pivoting that they've had to do regarding COVID and how they distribute meals and how they have been impacted. Our local school districts and many school districts we're quickly able to receive waivers so that they didn't need to honor the requirement of feeding kids in cafeterias and where they're all eating together and they're sitting around the table together. The USDA was very quick to react in issuing those waivers so that the schools could provide meals to the students in each district, including Ann Arbor Public sShools and Ypsilanti Public Schools, have their own way of distributing meals. And the beautiful thing about that is also that's available to all children under 18. So it actually can fold in these kids that are in the head start programs that are extremely vulnerable.

You have to have a car, which can be an issue in some households, but you have to get to these sites. Ypsilanti I know is distributing seven days of meals and Ann Arbor public schools is offering three days of meals, and then you go back a couple of days later and you can get another three days of meals. So I feel like our schools are meeting that need and then extra need that these families have is also being provided by all of the food pantries that are available in particular here in Washtenaw County that are serviced by Food Gatherers.

One thing to think about is we might be currently meeting the needs of the students in terms of the food that they would have normally received had they been in school. But you have to think a little bit about what are the long-term impacts of perhaps children staying home and families who don't have the luxury of working from home. So who is actually minding the kids to do the online education that's going on right now. Those students might not necessarily even have access to computers to be able to log in and do the lessons that are necessary.

Meals on Wheels is distributing food to seniors and they've changed the way they distribute foods for safety reasons. But one thing that we're seeing is that when we go to these vulnerable senior households who are sheltering in place, many of them are taking care of their grandchildren and great-grandchildren who would have been involved in head start programs or early elementary education and these vulnerable adults, that qualify for Meals on Wheels are housing in place with vulnerable kids so that their parents can work outside of the home, going into jobs that increase their exposure. It's really kind of a terrible perfect storm. Because what we know about COVID is that kids can be asymptomatic carriers, but they're going and living in households with senior citizens who are at high risk. I think I just read the statistic today that in the state of Michigan the average age is 74 of people who are dying from COVID.

I've been really impressed with our local schools and what they've done to meet the majority of people's needs and there's one other program that it's now offered to people who are on free and reduced lunches and that is the Pandemic EBT Program. So, Michigan was the first state to receive approval. What it does is it increases benefits to people who are already receiving SNAP benefits, on their Bridge Card or their EBT card. And it also allows students that were receiving free and reduced lunches at school, but might not have met the criteria for qualifying for SNAP benefits, it actually provides them with additional money via these mailed EBT cards that they will be receiving so that they'll have additional funds to spend on food throughout the months of May and June and it's actually retroactive to when COVID started. It’s kind of this extra safety net that that has been provided to the most vulnerable kids within the community. I think it’s great that the state of Michigan has done this, and again, it's been the first to receive approval.

I'm so honored to serve on each one of these boards. Because in normal times, they do amazing work and what I've seen them do in the last month has just been incredible.

I’ll speak for a moment about Food Gatherers, which is the Washtenaw County Food Bank. They have 170 different partners within the community that distribute food. They have a large warehouse where they receive food and then they process and package that food and they distribute the food.

The biggest source of the food that they receive,50% of the food they receive, is actually from retail sources. When you think about what happened to the retail sources of food over the last month, anybody who's been to a grocery store knows that the way we shop is completely different. The availability of food is different. People are hoarding food, theres surges in buying and not just things like toilet paper but a lot of the shelf-stable items that are easier for Food Gathers to procure and to store. They don't go bad. They don't have limited refrigeration needs. Those haven't been available. So they haven't been able to actually procure those so that they can distribute them to their pantry.

So one, the amount of food that's available has decreased dramatically because average citizens are out there and buying more of it and stock piling it. We've had problems with supply chain. They can't get supplies into the grocery stores fast enough. And then additionally, Food Gatherers is known for its food rescue. So they have arrangements with all of the major grocery stores throughout Washtenaw County where they pick up food that would normally go into the trash or would be wasted. And it's perfectly good food and it's safe food, and it's often high quality because they pride themselves on food that's high protein and lots of produce, but because of COVID and the safety concerns for their staff, they almost immediately had to stop picking up that extra produce and there wasn't a whole lot of extra food because people were buying so much of it and the supply chains were disrupted.

The other thing that's interesting about food gathers, and how their model has changed is that 55% of their workforce is volunteer. So over the course of the year they have like 7,000 volunteers that come in and help with the packaging and the distribution of food. And they had to shut that down, their volunteer operation, again because of safety concerns. You can't have too many people in the warehouse interacting and packing foods.

We might have also heard the National Guard came in, they are now actually serving all the volunteer jobs that previously were held by the variety of members of the community. And additionally, the volunteers that worked at Food Gatheres, they we're also people that were at the highest risk so a lot of retirees, people are 65 and older, so we didn't want the volunteers coming in to pack food and may be having to hire exposure.

Food Gatheres just have to work like crazy in order to get the food that they need to be able to distribute it to the communities, to increase the amount that they have, to work with limited numbers of volunteers and staff that are available and to also be concerned about the safety of the close contact that people have as they're procuring and distributing food impacting that.

They've done an incredible job of still being able to work with their partners in the community and provide. Most of the pantries that we provide to within the community remain open. And you might have seen on the news, long lines of cars of people waiting to pick up food at various different pantries across this country. We haven't seen that in Washtenaw County. One, the county is smaller, Food Gatherers only services Washtenaw County. But they've also over the 30 years that they've been open they've built incredible network so that they are able to have these various different posts within the community that are distributing food, so that we don't have to experience those long lines in one central distribution area. You take what we're seeing in Washtenaw County and fortunately, we haven't seen a lot of COVID in the Upper Peninsula but because of the rural nature of the Upper Peninsula, there's one large food rescue organization that covers the Upper Peninsula and they would have distribution sites that will be hundreds of miles apart, so they wouldn't be able to have that same network that we've created here at Food Gathers.

The Meals on Wheels provides meals to vulnerable seniors in the community. In Washtenaw County here we have an Ann Arbor Meals on wheels program and we have an Ypsilanti Meals on Wheels program, and both of them receive their food from Michigan Medicine which is kind of interesting. So the Michigan Medicine main kitchen prepares food for both of them, and they've over time, worked out a great way to pick up the food and distribute it and Michigan Medicine is just really increased the quality of the food that they were able to distribute. But beginning in late March when COVID hit, all of a sudden we didn't have the ability or the volunteers to be able to deliver the meals to the home-bound seniors six days a week like we had done previously. So the way that they pivoted is that now Ypsilanti Meals on Wheels is delivering food Monday, Wednesdays and Fridays, when they'll deliver two days worth of meals and then alternate days, Tuesday, Thursday, Saturday is when the Ann Arbor Meals on Wheels program distributes their food.

Additionally, they've been able to provide everybody at the very beginning of this with 10 frozen meals, so that they would have a little bit of a buffer in case there were some disruption in the delivery. They supplied people with Ensure packets, Ensure cans, so that again, if a meal had to be skipped because there wasn't food in the house that the seniors would have something that they could nourish themselves with.

And then, additionally, we've completely modified how we deliver meals because not only is the mission of Meals on Wheels to deliver food and to nourish the seniors, but it's all social contact because many of these seniors are living alone and they don't have somebody checking in on them. So, just eye-balling somebody every day when you're delivering the meal, the seniors get to know the person who's delivering the food because there's a lot of regularity to that.

So because we had to go down to this three-day system with seniors who are already socially isolating and a really high risk population, we decided to have our staff and our board members and various different volunteers reach out and provide weekly kind of social call check-ins with the clients just to make sure that A.)  they're not experiencing any symptoms of COVID, B.) they have enough food in their house. If there's a disruption in service, do they know somebody that they could call to provide services? Are they getting their prescriptions? What are they doing to spend their long, long days?

So I'm actually one of the people that's making some of these phone calls and I've had just the most amazing conversations, learning about some of the home-bound seniors that we service and how they spend their day. And they're just so appreciative to have that type of outreach. It doesn't necessarily involve food, but it assures that they have enough food in their house and it also just assures that they're okay. That they don't need a medical provider at that moment and they have somebody who they can rely on. I know many of the people that I talk to will say that their primary caregiver isn't coming anymore, because they don't want to risk exposing the senior to COVID. Or their primary caregiver is taking care of somebody else in their family who has COVID, so can't come. There's just a lot of loneliness that's associated with this social isolation specifically in that high-risk community.

When I reflect upon this, after teaching this undergraduate course this past semester on food insecurity and recognizing going into COVID how under-resourced and under-funded some of the programs that exist for the most vulnerable, programs like Head Start. Our class visited Head Start and WIC before COVID hit and it was remarkable to learn that wait lists exist for this program. These are the most extremely vulnerable children within our community. In light of what's happened with COVID, this bump that we've seen in food insecurity, it's not gonna go away when we get our economy open again because there are people that are not gonna be able to go back to work. There are people that may have incurred debt, maybe might have sacrificed homes or cars, or whatever they needed in order to survive during this time. So we're going to see this continued need and we're still gonna be faced with the dilemma of not having enough funding during what used to be prosperous, normal times.

So I just only hope as public health professionals that we can advocate even more for increasing resources and funding. It's great that we live in a community that's incredibly generous but across the United States, not every community can give like that in times of need. We need better funding of the programs that exist that are safety nets for the most vulnerable. People don't often really think alot about public health until something like a pandemic hits, and I'm hoping that the future of public health will be brighter and will be better funded and people will go into a mode of not reacting but being proactive. There's just so many things to think about in terms of how we can improve access and decrease health disparities and improve food security within our community. But, we need action and we need advocacy and we need support and we need people to recognize that this was a problem, and it will continue to be even more of a problem in light of what's happened to many people in their livelihood.

Speaker 1: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we’ll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in between special edition episodes, be sure to check out our website publichealth.umich.edu, subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter and follow us on Twitter, Instagram, and Facebook @umichsph.