The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:
- Economic Stability
- Health and Health Care
- Neighborhood and Built Environment
- Social and Community Context
Food Insecurity is a key issue in the Economic Stability domain.
Food insecurity is defined as the disruption of food intake or eating patterns because of lack of money and other resources.1 In 2014, 17.4 million U.S. households were food insecure at some time during the year.2 Food insecurity does not necessarily cause hunger, but hungeriii is a possible outcome of food insecurity.3
The United States Department of Agriculture (USDA) divides food insecurity into the following 2 categories:4
- Low food security: “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
- Very low food security: “Reports of multiple indications of disrupted eating patterns and reduced food intake.”
Food insecurity may be long term or temporary.5, 6, 7 It may be influenced by a number of factors including income, employment, race/ethnicity, and disability. The risk for food insecurity increases when money to buy food is limited or not available.2, 8, 9, 10, 11, 12 In 2016, 31.6% of low-income households were food insecure, compared to the national average of 12.3%.13 Unemployment can also negatively affect a household’s food security status.11 High unemployment rates among low-income populations make it more difficult to meet basic household food needs.11 In addition, children with unemployed parents have higher rates of food insecurity than children with employed parents.14 Racial and ethnic disparities exist related to food insecurity. In 2016, black non-Hispanic households were nearly 2 times more likely to be food insecure than the national average (22.5% versus 12.3%, respectively). Among Hispanic households, the prevalence of food insecurity was 18.5% compared to the national average (12.3%).13 Disabled adults may be at a higher risk for food insecurity due to limited employment opportunities and health care-related expenses that reduce the income available to buy food.15, 16
Neighborhood conditions may affect physical access to food.17 For example, people living in some urban areas, rural areas, and low-income neighborhoods may have limited access to full-service supermarkets or grocery stores.18 Predominantly black and Hispanic neighborhoods have fewer full-service supermarkets than predominantly white and non-Hispanic neighborhoods.19 Communities that lack affordable and nutritious food are commonly known as “food deserts.”20 Convenience stores and small independent stores are more common in food deserts than full-service supermarkets or grocery stores.20 These stores may have higher food prices, lower quality foods, and less variety of foods than supermarkets or grocery stores.18, 20, 21 Access to healthy foods is also affected by lack of transportation and long distances between residences and supermarkets or grocery stores.18
Residents are at risk for food insecurity in neighborhoods where transportation options are limited, the travel distance to stores is greater, and there are fewer supermarkets.18 Lack of access to public transportation or a personal vehicle limits access to food.18 Groups who may lack transportation to healthy food sources include those with chronic diseases or disabilities, residents of rural areas, and some minority groups.17, 18, 22 A study in Detroit found that people living in low-income predominantly black neighborhoods travel an average of 1.1 miles farther to the closest supermarket than people living in low-income predominantly white neighborhoods.23
Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. For example, a study found that food-insecure adults may be at an increased risk for obesity.24 Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 and 65.22 Food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity.25, 26, 27 They also face a higher risk of developmental problems compared with food-secure children.14, 27, 28 In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on children’s mental health.29
Food assistance programs, such as the National School Lunch Program (NSLP), the Women, Infants, and Children (WIC) program, and the Supplemental Nutrition Assistance Program (SNAP), address barriers to accessing healthy food.30, 31, 32, 33 Studies show these programs may reduce food insecurity.31, 32, 33 More research is needed to understand food insecurity and its influence on health outcomes and disparities. Future studies should consider characteristics of communities and households that influence food insecurity.34 This additional evidence will facilitate public health efforts to address food insecurity as a social determinant of health.
Disclaimer: This summary of the literature on food insecurity as a social determinant of health is a narrowly defined review that may not address all dimensions of the issue.i, ii Please keep in mind that the summary is likely to evolve as new evidence emerges or as additional research is conducted.
i Terminology used in the summary is consistent with the respective references. As a result, there may be variability in the use of terms, for example, black versus African American.
ii The term minority, when used in a summary, refers to racial/ethnic minority, unless otherwise specified.
iii The term hunger refers to a potential consequence of food insecurity. Hunger is discomfort, illness, weakness, or pain caused by prolonged, involuntary lack of food.
1 Nord M, Andrews M, Carlson S. Household food security in the United States, 2005 [Internet]. Washington: USDA Economic Research Service; 2005 [cited 2017 Nov 27]. Report No.: ERR-29. Available from: https://www.ers.usda.gov/webdocs/publications/45655/29206_err29_002.pdf?v=41334 [PDF – 880 KB]
2 Coleman-Jensen A, Gregory C, Singh A. Household food security in the United States in 2013. Washington: USDA Economic Research Service; 2014. Report No.: ERR-29.
3 Carlson SJ, Andrews MS, Bickel GW. Measuring food insecurity and hunger in the United States: Development of a national benchmark measure and prevalence estimates. J Nutr. 1999;129(2):510S-516S.
4 USDA Economic Research Service [Internet]. Washington: USDA Economic Research Service; [updated 2017 Nov 27]. Definitions of Food Insecurity; [updated 2017 Oct 4; cited 2017 Nov 27]. Available from: https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/
5 Jones A, Ngure F, Pelto G, Young S. What are we assessing when we measure food security? A compendium and review of current metrics. Adv Nutr. 2013;4:481-505. doi: 10.3945/an.113.004119.
6 Food and Agriculture Organization. An introduction to the basic concepts of food security [Internet]. Rome: Food and Agriculture Organization of the United Nations; 2008 [cited 2017 Nov 27]. Available from: http://www.fao.org/docrep/013/al936e/al936e00.pdf [PDF – 83 KB]
7 Nord M, Andrews M, Winicki J. Frequency and duration of food insecurity and hunger in US households. J Nutr Educ Behav. 2002;34(4):194-201.
8 Sharkey JR, Johnson CM, Dean WR. Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women. Women Health. 2011;51(5):442-60.
9 Seefeldt KS, Castelli T (University of Michigan). Low-income women's experiences with food programs, food spending, and food-related hardships [Internet]. Washington: USDA Economic Research Service; 2009 Aug [cited 2017 Nov 27]. Report No.: 57. Contractor No.: 59-5000-6-0103. Available from: https://naldc.nal.usda.gov/download/35894/PDF [PDF – 249 KB]
10 Nord M, Andrews M, Carlson S. Household food security in the United States, 2007 [Internet]. Washington: USDA Economic Research Service; 2007 [cited 2017 Nov 27]. Report No.: ERR-66. Available from: https://www.ers.usda.gov/webdocs/publications/46084/11227_err66.pdf?v=41056 [PDF – 497 KB]
11 Nord M. Characteristics of low-income households with very low food security: An analysis of the USDA GPRA food security indicator. USDA-ERS Economic Information Bulletin No. 25. 2007.
12 Klesges L, Pahor M, Shorr R, Wan J, Williamson J, Guralnik J. Financial difficulty in acquiring food among elderly disabled women: Results from the women’s health and aging. Am J Public Health. 2001;91:68-75.
13 Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household food insecurity in the United States in 2016. USDA-ERS Economic Research Report No. (ERR-237). 2017.
14 Nord M. Food insecurity in households with children: Prevalence, severity, and household characteristics [Internet]. Washington: USDA Economic Research Service; 2009 [cited 2017 Nov 27]. Report No.: EIB-56. Available from: https://www.ers.usda.gov/webdocs/publications/44419/9360_eib56_1_.pdf?v=41055 [PDF – 1.4 MB]
15 Coleman-Jensen A, Nord M. Food insecurity among households with working-age adults with disabilities [Internet]. Washington: USDA Economic Research Service; 2013 [cited 2017 Nov 27]. Report No.: ERR-144. Available from: https://www.ers.usda.gov/webdocs/publications/45038/34589_err_144.pdf?v=41284 [PDF – 1 MB]
16 Huang J, Guo B, Kim Y. Food insecurity and disability: Do economic resources matter? Soc Sci Res. 2010;39:111-24.
17 Zenk SN, Schultz AJ, Israel BA, James SA, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95(4):660-7.
18 USDA Economic Research Service. Access to affordable and nutritious food: Measuring and understanding food deserts and their consequences [Internet]. Washington: USDA Economic Research Service; 2009 [cited 2017 Nov 27]. Available from: https://www.ers.usda.gov/webdocs/publications/42711/12698_ap036fm_1_.pdf?v=41055 [PDF – 237 KB]
19 Powell LM, Slater S, Mirtcheva D, Bao Y, Chaloupka FJ. Food store availability and neighborhood characteristics in the United States. Prev Med. 2007;44(3):189-195.
20 Beaulac J, Kristjansson E, Cummins S. A systematic review of food deserts, 1966-2007. Prev Chron Dis. 2009;6(3):A105.
21 Crocket EG, Clancy KL, Bowering J. Comparing the cost of a thrifty food plan market in three areas of New York state. J Nutr Educ. 1992;24(1):71S-78S.
22 Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants [Internet]. J Nutr. 2010 [cited 2017 Nov 27];140(2):304-10. Available from: http://doi.org/10.3945/jn.109.112573
23 Zenk SN, Schulz AJ, Israel BA, James SA, Bao S, Wilson ML. Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. Am J Public Health. 2005;95(4):660-667.
24 Holben DH, Pheley AM. Diabetes risk and obesity in food-insecure households in rural Appalachian Ohio [Internet]. Prev Chronic Dis. 2006[cited 2017 Nov 27];3(3). Available from: http://www.cdc.gov/pcd/issues/2006/jul/05_0127.htm
25 Gundersen C, Kreider B. Bounding the effects of food insecurity on children’s health outcomes. J Health Econ. 2009;28(5):971-983.
26 Metallinos-Katsaras E, Must A, Gorman K. A longitudinal study of food insecurity on obesity in preschool children. J Acad Nutr Diet. 2012;112(12):1949-58.
27 Cook JT, Frank DA. Food security, poverty, and human development in the United States. Ann N Y Acad Sci. 2008;1136(1):193-209.
28 Cook JT. Impacts of child food insecurity and hunger on health and development in children: Implications of measurement approach. In paper commissioned for the Workshop on Research Gaps and Opportunities on the Causes and Consequences of Child Hunger. 2013 April.
29 Burke MP, Martini LH, Çayır E, Hartline-Grafton HL, Meade RL. Severity of household food insecurity is positively associated with mental disorders among children and adolescents in the United States. J Nutr. 2016;146(10):2019-26. doi: 10.3945/jn.116.232298.
30 Bhattarai GR, Duffy PA, Raymond J. Use of food pantries and food stamps in low‐income households in the United States. J Consum Aff. 2005;39(2):276-98.
31 Huang J, Barnidge E. Low-income children's participation in the National School Lunch Program and household food insufficiency. Soc Sci Med. 2016;150:8-14.
32 Kreider B, Pepper JV, Roy M. Identifying the effects of WIC on food insecurity among infants and children [Internet]. Lexington: University of Kentucky Center for Poverty Research; 2012 Oct [cited 2017 Nov 27]. Available from: http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1027&context=ukcpr_papers [PDF – 1.2 MB]
33 Ratcliffe C, McKernan S, Zhang S. How much does the Supplemental Nutrition Assistance Program reduce food insecurity? Am J Agric Econ. 2011;93(4):1082-98. doi: 10.1093/ajae/aar026.
34 Larson NI, Story MT. Food insecurity and weight status among US children and families: A review of the literature. Am J Prev Med. 2011;40(2):166-73.