How food insecurity shapes children and families

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0:04 Jana Stewart: One of my first experiences with this actually as a Project Healthy School staff member was in Livonia, in a science teacher's classroom. All day, we teach students about micronutrients, and they learn about the importance of eating a rainbow of color. And then the culminating activity is, they make a rainbow color salad as a class, and then the students all eat it together, and they're making their own dressing, they're cutting up the vegetables, and a lot of the time, students haven't ever tried some of these ingredients before, seen them before, like the bell peppers or the spinach for you or me would be a very normal vegetable that you've seen and had a dozen times or more but for them, it's like this unique thing. It's a great lesson, we really like it. But throughout this one particular hour, there was a young boy who was sort of attached to my hip the whole time, he was helping me prep ingredients, do dishes, he just could not wait to help.

0:54 Stewart: He was so, so sweet, we had a lot of small talk together, and it was right before their winter break, so just as part of regular conversation, I just sort of asked, "Hey, are you looking forward to the holiday break?" And it was amazing, his whole body language changed and I didn't wanna probe so I shifted the conversation back to something else but at the end of class, I brought it to the teacher and asked what was going on and she said, "He doesn't like weekends, he doesn't like long breaks because when he's home, he doesn't have regular meals." And I promptly spent my lunch break crying in my car, and this was a time of year when kids are supposed to be excited and happy, and here's this sweet kid who was just dreading holiday break because he was gonna be spending the next two weeks hungry. I'm embarrassed to say that was my first time really experiencing my own privilege in person, I've spent years at that point writing about this issue, I used to be a journalist, and then I studied it as a grad student, and I worked for organizations that work on this issue. I understood it academically, but I hadn't truly absorbed it as a human being until that moment.

02:03 Narrator: That was Jana Stewart, a wellness coordinator with Project Healthy Schools, a school-based University of Michigan program that helps middle school students and staff eat healthier and understand how nutrition and activity influence lifelong health. Stewart is also an alum of the University of Michigan School of Public Health. Unfortunately, the experience of the student in Stewart's story is not unique. As of October 2020, 23% of children in the US are experiencing food insecurity, and that percentage has continued to rise dramatically throughout the COVID-19 pandemic. Of those affected, US Census data shows that food insecurity impacts families and children of color disproportionately with Black and Hispanic households reporting rates nearly double that of white households.

02:48 Speaker 2: Hello and welcome to Population Healthy, a podcast produced by the University of Michigan School of Public Health. In this season of Population Healthy, we'll examine health inequities through the lens of race in America by talking to public health researchers, experts and others to learn more about what can be done to work toward health equity in our communities and across our country.

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03:17 Narrator: To learn more about food insecurity and how it impacts children and families, particularly families of color, we spoke with two nutritional sciences experts at the University of Michigan School of Public Health. We'll discuss what food insecurity is, why it's been increasing in the United States, and what can we do to address this devastating public health crisis.

03:37 Kate Bauer: One definition of food insecurity is that it describes a household's inability to provide enough food for every person to live an active and healthy life.

03:46 Narrator: That's Kate Bauer, an associate professor of Nutritional Sciences at the University of Michigan School of Public Health.

03:52 Bauer: I think the really important pieces of this definition are enough food, so food insecurity is not only not having any food or not having enough food, but it's also not having enough of the variety of food that allows us to have a healthy life. So someone who could only afford to subsists on a diet of mac and cheese or ramen would not be considered food secure, because they can't access fruits and vegetables and proteins and all of that healthy stuff. Also, the other important piece of this is active, healthy life. Again, we want people to be able to have energy and perform their jobs and enjoy being with their family, and it takes enough calories and enough nutrition to be able to do that. Finally, an additional piece to consider is that culture is a really important piece of food security, so we want people to be able to access the foods that are culturally and socially appropriate for them. So if we went into a community and said, "Here eat this. This will make you food secure." If it didn't match what individuals wanted to eat, what they were used to eating, what gave them comfort, they would not be considered food secure. So we really need to consider, again, the variety of food, the amount of food, and culturally appropriate foods. And if someone has all of those things, then they are food secure.

05:17 Bauer: I think we can all start to imagine in our own lives having anxiety about whether you're going to be able to eat, or you're gonna be able to feed your children in and of itself is harmful even if ultimately you're able to access enough food. We know the effects of stress on our health, stress related to food is a pretty specific stressor, people become a little panicked when you're not sure the next time you're gonna eat, so defining food insecurity also as in terms of access to food and feeling confident that you can provide for yourself and your family is really important.

05:52 Narrator: And here's Susan Aaronson, a lecturer in the Nutritional Sciences Department at the University of Michigan School of Public Health.

05:58 Susan Aaronson: You can have issues of food access but not necessarily be food insecure. So for example, we know that food insecurity can happen in urban environments and it can happen in rural environments. In an urban environment, when we talk about the concept of food deserts, let's say there isn't a major grocery store within a mile, two neighbors who have that problem with food access, and one neighbor who might have easy access to a car, a working automobile, has some money to put gas in it, can go to that grocery store and can easily get the foods that they need, even though that grocery store by urban definitions may not be as easy to access. Whereas, another neighbor without a working car, living in an urban area that perhaps has really poor sidewalks or doesn't have good transportation, or there's not enough money even for public transportation, or the parent is working such hours that they can't access the grocery store while it's open, that then becomes a food access problem that can also lead to food insecurity.

07:02 Bauer: I just wanna add, too, Susan, I've had said to me, "Well, isn't food insecurity just poverty? And that people who don't have enough money are more likely to be food insecure than people who have money are more likely to be food secure?" And I think what you're bringing up is really this incredibly important point that while there is a really strong correlation between poverty and food insecurity, because if you don't have money, you don't have the ability to buy sufficient food, but there's all these other factors that even in families with what objectively might be viewed as sufficient money, they may not be able to access sufficient food for a healthy and active life. And on the other side, we do see that there are individuals with very low incomes who are able to find ways to be more food secure, maybe it's because they have better cooking skills or the ability to plan ahead of time or buy in bulk. Maybe it's because they have stronger social networks and they have family members that they know they can go and have a dinner with any time. So, again, there's not a perfect correlation between income and food security, although they are quite strongly related.

08:11 Aaronson: Right. Right, Kate, that also gets to the important factor of these families that are living in poverty, what type of access do they also have to social support networks, including do they have their children enrolled in Head Start programs that participate in backpack programs that are able to bring food home for the weekends. Do they have their children enrolled in schools that have universal breakfast and universal lunches and after-school programs, so that they have one less person in their family to worry about getting adequate nutrition during the school day?

08:46 Bauer: While there is a strong correlation between poverty, income, all those things and food insecurity, there's a number of other factors that influences the likelihood that a family or individual is food secure. You can think about, what are all those social factors? Are they part of a family? Are multiple people able to access food resources in the community, food programs like SNAP or food stamps program? Participation in those are all known to decrease food insecurity. Having family nearby, having a social network, knowing the people in your community. If you feel comfortable in your community, if you know your neighbors, not only can you share food with them, you can get access to resources, they're gonna be able to tell you where something is, they maybe able to give you a ride to the store.

09:36 Bauer: Probably 10 or more years ago, I worked on a research project on the Pine Ridge Indian Reservation in South Dakota, which experiences incredible food insecurity, it's one of the poorest areas of our country. Among the Lakota Indians living on Pine Ridge, there was a concept called Teola, which was basically helping out your neighbor, and the idea was that it was accepted that there would be a bartering system, so if I needed someone to come over and help me build a barn, I would put an informal call out to my neighbors, and it was culturally understood that I would feed everyone, and so this was really a social system that helped support food security, because you knew that on any given weekend you could trade your skill and your energy for food, and so Teola is one thing that helped improve food insecurity among the residents of the Pine Ridge Reservation.

10:31 Bauer: We can then think about what are more within the household or interpersonal individual characteristics. Women are still the primary caregivers and food providers for their families, so if mothers are experiencing depression, those families are much more likely to be food insecure, mothers are not as able to go shopping, they're not as able to plan, they're not as able to cook. When we are experiencing depression, there's a whole series of things that just don't come together often in our families, especially when it's mothers. Domestic violence is another factor. Families experiencing domestic violence are much more likely to have food insecurity, independent of their income, and we can imagine it relates to the functioning of the home and stress and an ability to engage in daily tasks. Another individual factor is cooking skills. Did someone gain the skills to be able to read recipes, write a shopping list, look for food sales? All those types of things. Do families have cars? Do families have a low-cost grocery store near them? In a lot of urban areas, in particular, people rely on convenience stores where the cost of food, if they even have healthy food, is much, much higher. So we'd like to see people have access to grocery stores, even something like Walmart.

11:45 Bauer: There's been research that when Walmart comes into communities, food security increases because Walmart has access to low-cost food. So that's just a small number of the wide range of things that can alter a family's food security. And bottom line is that a grocery store is not a panacea to all. Just because you see new or different or better looking fruits and vegetables doesn't mean that you know how cook, it doesn't mean that you are confident that you like the taste of it. So just because that grocery store is physically there does not mean you're gonna buy and prepare foods. So families that have lower incomes that have been experiencing food insecurity are less likely to try new fruits and vegetables because a family that has limited food access and limited food security can't take that risk of putting a new vegetable on their child's plate because it's probably gonna go right in the garbage. What we eat is so much more complex than why we make the food decisions we do, and we're really gonna need to tackle all of the causes of food insecurity to be able to change people's behavior, well-being and ultimately health. There's not one or two things that we can snap our fingers and fix and address this problem.

12:56 Narrator: How does food insecurity or poor nutrition impact a child's health?

13:01 Aaronson: We can see the impact on children's health in terms of inadequate or poor nutrition as early on as what's happening, like during pregnancies, there are certain factors in pregnancy that can lead to poor outcomes in children, like a lack of folate during pregnancy can lead to birth defect. So does the mom who's pregnant, does she have access to healthcare? Does the healthcare provider provide her with the prenatal vitamins that she needs in order to get adequate amounts of folate? Also we know that obesity during pregnancy has a result of perhaps poor nutrition, can also lead to gestational diabetes that can put moms at risk, that can put babies at risk, they can have poor healthcare outcomes. Children with poor nutrition often have decreased intake of iron, that can lead to iron deficiency anemia. We see also poor nutrition manifests itself in low intakes of vitamin A and other nutrients. So, that's one thing that we can talk about in terms of adequate nutrition and how that impacts a child's growth and development, success in school, physical and mental health in the future are also important.

14:11 Bauer: There's also the experience, the physical experience, the psychological experience of hunger. So if a child went to bed without dinner or didn't have access to breakfast in the morning and then they're coming into school expected to focus, it's gonna be pretty darn hard if your tummy is rumbling or if you're worried about when your next meal is coming, if you're thinking ahead about lunch, because the school lunch is the only meal you got. Teachers are incredible about providing students more food if they have the ability to do so, because they realize the impact of behavior and attention issues in the classroom. And then the other thing I want to bring up, which is related, is that really long-term impact of the uncertainty of not having food.

14:56 Bauer: So it's beyond what are you eating, and it's really getting at how did you eat. 'Cause if you're uncertain where your next meal is coming from, when there is food there, you're gonna get as much as possible, right? You're probably gonna eat past the point of fullness because you don't know if you're gonna be able to eat again. So we know that food insecurity contributes to this binging cycle of being like, "Oh, my gosh, I need to eat now, I need to eat everything I can because I don't know when this is coming again." And that's one of the reasons why we see... We sometimes call it paradoxical relationship between food insecurity and obesity. So adolescents who've experienced food insecurity and adult women who've experienced food insecurity are more likely to have obesity, and we think a large part of it is this less-healthy relationship with food. You can't listen to your hunger and fullness, you have to eat when food is available and eat perhaps less nutrient-dense foods and more comforting foods, more satisfying foods, higher-fat, higher-sugar foods because, again, you're just nervous and stressed about what's gonna come in the future.

16:07 Aaronson: Yeah, Kate, that's a really great point, that food insecurity definitely leads to reductions in quantity and quality of food, and then these fluctuations in weight that we see. We see malnourished children that have stunted growth, and then we also see children that are classified as overweight and obese that are experiencing food insecurity. When you think about the average newborn by the time they hit their first birthday has often tripled their birth weight. Think about the amount of nutrients that are necessary to foster that growth and brain development, it's really, really key critical period, and we know that inadequate nutrition during this time can result in a myriad of factors, including stunting that can affect subsequent generations. And I like those points also, Kate, that you brought up about this feeling of arriving for school hungry, perhaps it's coupling that with the parent who's running behind or a bus that didn't show up, therefore maybe you missed the school breakfast that's been provided and then nothing will be provided again until lunch time, then you are experiencing sleepiness and tiredness and irritability and anxiety, which lead to poor school achievement and cognitive deficits. And then also some of the eating behaviors that you mentioned can put you at risk for chronic disease such as diabetes and perhaps hypertension and cardiovascular disease that then can lead into adulthood.

17:36 Narrator: Food insecurity is certainly a devastating problem. So what can we do about it?

17:39 Aaronson: Unfortunately, there isn't a single strategy to ensure that young children have nutritious food, and we decrease the amount of food insecurity. We're in really troubling times right now. If we were tape recorded this podcast a year ago, we would have considered that food insecurity was perhaps even leveling off, but now with COVID, we know there's been a tremendous increase and it's disproportionately also affected families with young children. When I think about different players, I think about community organizations, and I think about various different coalitions, I think about the strong network of food banks that exist, the particular strong network that we have like Food Gatherers here in Washtenaw County, and the coalition that they've established with pantries all across the county that service the suburban and the rural areas. I think about policymakers, think about early-childhood providers that can partner with programs such as SNAP and WIC and make those more accessible for the families that participate in these early childhood programs.

18:49 Aarsonson: One example that I can give for that is that there's often misinformation or complicated information or inaccessible information in the way we even access applications for a WIC and SNAP. We do know that undocumented people cannot access SNAP, but that doesn't prevent family members from accessing SNAP that live in households that are perhaps headed by undocumented parents. So immigrant families, their children are eligible for programs such as SNAP and WIC and Slow Meals, but these early-childhood providers have to make sure that these families know how to access them, and that their immigration status won't be adversely affected by accessing programs.

19:39 Bauer: With the onset of COVID, our food insecurity statistics soared. It was unbelievable, and you can think about the confluence of people losing their job, children not being able to go to school and accessing our school nutrition programs, children not being able to go to childcare, food access issues, people could not easily go out to a store, they couldn't take the bus anymore to go to the grocery store and things like that. Since this peak in food insecurity in the US from around the spring of 2020, we've gotten a bit better as our economy has recovered a bit, but we're still at astronomical rates. Beyond the initial relief packages that Congress and the Federal government passed in the spring, we didn't have anything. We were giving children pandemic EDT, which was basically food stamps to make up for the loss of school meals, that ran out. We're in a stalemate with our government.

20:36 Bauer: The recent Recovery Act that passed brought back some federal food resources, so we're hoping that that will make a dent in food insecurity. I think as we look forward to the next year or two, as we economically recover from COVID, we will hopefully see corresponding increases in food security. The bottom line is that families, they need employment, they need income, they need to not be stressed and worrying about their health, they need to not have unfathomable healthcare expenses, so they can pay for the basic necessity of food. So we're in a really bad place right now. But I think there's a lot of hope in the future for our government to get us back on track in terms of food security.

21:17 Aaronson: In light of the gloom that we see with this dramatic increase in food insecurity as a result of COVID, there's definitely some light that we can see in the amount of pivoting from local food organizations. Since we did have children not attending school, government waivers had been issued that really helped relieve some of the rules that were associated with how children on free and reduced school meals, access their food.

22:12 Aaronson: For example, in order to participate in some of these school lunch programs, you needed to be eating your meals with your friends at a lunch table, we couldn't do that anymore, so there are waivers that were established so that we could have remote distribution where people didn't have to eat on site, some are food service programs where parents can come and pick up the meals for the children in their home. There were mobile distribution centers. Just this past summer, the summer food service program that really provides that critical gap for students that are not in school anymore, but still have a high demand for healthy and nutritious food increased by 40% from 2019.

22:58 Aaronson: There was a tremendous outpouring, at least within our county, of charitable donations. 'Cause these charitable donations allowed organizations, like Food Gatherers, to invest in their networks that actually distribute food throughout the whole county. Other organizations were able to pivot. Michigan Madison provides the meals for Meals on Wheels in the community, both to Ypsilanti and Ann Harbor. We used to make delivery six days a week, that's not safe to do anymore in light of COVID. We came up with strategies where we delivered three days a week instead of six days a week. So there's just a tremendous amount of examples of how this charitable network and the food networks were able to distribute more meals and more food to people in need.

23:42 Narrator: How do we help people struggling right now? Janice Stewart says we start by listening.

23:48 Stewart: One thing that we could do a better job of is humanizing the issue by simply asking those people what they need, rather than assuming or imagining that we as public health practitioners have all the answers. I don't see myself necessarily as an expert in this or even particularly clever, but I do think that when we've had a lot of success, it's been because we've had partnership with the community we're serving. I hope more programs will do that and pursue that because just telling people what to do, doesn't work.

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24:21 Narrator: On the next edition of Population Healthy.

24:25 Speaker: I am from Flint, Michigan, born and raised. I'm a health disparities researcher so I look at racial and ethnic health disparities. I got introduced to public health, start learning about health disparities and how people who looked like me and who lived in Flint and the communities that I lived in were dying unnecessarily from things that were totally preventable.

24:47 Narrator: Thanks for listening to this episode of Population Healthy: Race, Inequity, and Closing the Health Gap, from the University of Michigan School of Public Health. We hope you learned something that will help you make the world a healthier place. Please subscribe or follow our podcast on Apple Podcast, Google Play, Stitcher, Spotify or wherever you listen to podcasts.

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