Management of
Hunger in the United States
Kathleen C.
Walker, RN BSN, MS RD
INTRODUCTION
Hunger
is a multifaceted phenomenon. This phenomenon in its various facets effects
over one billion people in the world (1). Hunger is commonly defined as a
situation when one cannot obtain an adequate amount of food. Even if this
period of inadequate food is temporary and does not cause health problems it is
still classified as hunger (2). In 1990 the United Nations (UN) State of the
World assigned nutrition as an international statute and a human right. Two
articles developed at this session of United Nations recognized that proper,
adequate nutrition combats disease and malnutrition, and that every child in
the world has the right to live in an environment which provides adequate food
and clean, safe drinking water. These policies were incorporated and expanded
in the 1992 U.N. Convention on the Rights of the Child with United Nations Children’s
Fund (UNICEF) developing specific goals to reach the world’s population by the
year 2000 (3). The physical aspects of hunger--starvation, delayed growth
leading to mental and physical developmental deficits, and increase risk for
infections and chronic diseases is very evident in third world nations.
Medically hunger is defined as a chronic under consumption of adequate
nutrition needed for growth and for maintaining health.(2). Looking at hunger
in third world or undeveloped nations, one notices hunger causing various
degrees of malnutrition, health problems, and finally death.
However,
examining hunger in the developed nations, malnutrition is usually not evident.
The psychosocial aspects of food insecurity is the predominate facets of hunger
seen in western developed nations (2). The topic of hunger and food security as
related to public health is a book in its own right; however, this chapter’s
focus will be limited to certain aspects of hunger in the United States (USA).
Because this chapter only refers to hunger in the United States, a few websites
giving more information on world hunger and its issues are listed at the end of
this chapter.
BACKGROUND
The
paradox of hunger in the USA is people go without food in a rich and prosperous
nation. This facet of hunger violates some of the basic assumptions and deeply
cherished values held by most Americans. The fact that people are hungry makes
food insecurity one of the most compelling social problems competing for
attention by American society. Because hunger disturbs the conscience of most
Americans, public opinion forced community organizations and governments to
take action elevating hunger in the USA. Although elevating hunger is an
intrinsic part of American culture, the federal government food distribution
programs were not developed until the Great Depression of the 1930s (4).
History of the Development of Food
Programs
A
review of history reveals that during the depression of the 1920s and 1930s,
the farmers had excessive amounts of grain, but could not take it to market.
The fact that people were going hungry from lack of bread and food with wheat
rotting in the grain elevators was a dilemma that most Americans could not
accept. Nonprofit organizations, local communities and governments were the
first to respond to the out cry created from this paradox. Gleaning projects,
soup kitchen and food baskets provided by the community to feed the hungry.
However, the Hoover administration opposed a federal relief program but did
purchase large amounts of grain and cotton to supplement farmers’ income.
Finally, Congress disregarded Hoover’s opposition and overwhelmingly passed a
bill to release government purchased wheat to feed the hungry. When the
Roosevelt administration took office, an ongoing food assistant programs was
initiated. These programs included surplus commodity procurement and
distribution projects that formed the policy and management procedures of the
federal food assistance programs. Even today some of the principles in the
government food security and research programs are based on these core
principles (4).
The
facets of food security reviewed in this chapter are:1.What is the best ways to
evaluate food security? (community, household and individual hunger), 2. What
populations are hungry? (unemployed, poor, and at risk populations), 3. What
programs have been developed to elevate hunger? ( federal and state, nonprofit
and community programs).
EVALUATION OF FOOD SECURITY
Evaluating
food insecurity and hunger is a major problem in determining food security in
the United States. The various ways of defining hunger help create this
difficulty in evaluation. What facets of hunger should be included in a
definition of food insecurity and hunger? Does hunger occur with food
insecurity or must physical signs of hunger and malnutrition need to be
present? Should the definition include inaccessibility to grocery stores and/or
physical limitations in procuring and preparing meals; or are economic
considerations, the only value in defining one’s inability in obtaining food?
Each of the departments in the federal government involved in the national food
and nutrition programs developed their own definition of hunger or food
insecurity. The department then formed policies and managed their food distribution
programs based on their own definition (4). With varied definitions as the
base, each department used a number of food surveys to determine the defined
needs of the American people and to determine if these needs were being
adequately meet by their food supplementation programs. Each department
maintained its own data and the exchange of the information gleaned from the
surveys was discouraged by department leaders.
This
attitude changed in the early 1980s with the collaboration of the Department of
Health and Human Services (DHHS) and the United States Department of
Agriculture (USDA), leading to the development of National Nutrition Monitoring
System which measures the health and nutrition status, dietary knowledge,
attitudes about diet, and food consumption of the American people (5). As more
federal officials developed an attitude of collaborations and exchange, other
departments began working together to prevent duplication of effort and
service. In 1992 the USDA Food and Nutrition Service (FNS) began a
collaborative effort with United States Bureau of the Census and other
organizations researching USA hunger to develop a national benchmark to measure
and determine the prevalence of hunger.
Food
insecurity is best defined as the uncertain ability of acquiring adequate
nutritional food in a safe and acceptable manner (2). Household food security
is defined as the ability of a household to have permanent and secure access of
sufficient amounts and variety of foods. In food security all individuals in
the household live a healthy, active and productive life (8). Even these
definitions of hunger can be viewed using several facets, as evidenced by the
core principles developed from the various concepts of food security and
hunger. Therefore a standard tool needed to be developed that combined the
definitions and established a basic, consistent measurement of a population
over a specific time period. The primary role of the tool on food security
would be to consistently compare the prevalence of food insecurity and physical hunger. Using the Rasch model a
scale of household status was adopted. The values measured household food
security using the following categories: 1. food secure, 2. food insecure with
hunger not evident, 3. food insecure with moderate hunger, and 4. food insecure with severe hunger (6).
Some facets of hungry, such as, the homeless and disaster situations are not
addressed in this chapter, but will be included in the websites at the end of
the chapter.
Community Level
When
analyzing a community’s status of food security, the measures of food security
are: quantity and quality of available food, the accessability of food
(location of grocery stores and accessible transportation), and prices relate
to the economical level of the community. The local community’s food security
identifies the household and individuals with food insecurity in the community.
The four aspects of food insecurity in the community that reflects household
and individual hunger are: quantity, quality, psychological acceptability and
social acceptability (7). Psychological and social barriers developed from food
insecurity when accessability to community’s food supply are different from
community convention. Some of these barriers are obtaining additional food at
community food pantries; free meals provided only at community “soup kitchens”
and not at restaurants; and special lines for children receiving price reduced
school lunches. Because of the negative attitudes that develop from these
barriers, collecting accurate data on food insecurity and hunger is difficult
at the community level. Often people will report household and individual food
security on a general anonymous food security survey (8). Another hindrance to
preventing food insecurity is incomplete training of employees and ignorance of
regulations at some food stamp offices. These situations delay or nullify
eligible households from obtaining food through government programs. This
barrier must be corrected at the community level since most training is done locally
(9).
Households and Individuals
The
Third National Health and Nutrition Examination Survey (NHANES III) found that
38 million Americans live at or below the poverty level with and additional 14
million eligible for most food assistance programs with incomes at or below the
130% of the poverty level. Six family types classified in this study were
determined by sex and married status of the household head, number of children
less then 17 living in household, single household head was 17 years of age or
older, head of household had a job within the last 2 weeks, and if household
received food stamps in the past month.
The NHANES III reported finding 53.5% of individuals with food
insecurity caused by insufficient amounts of food due to a lack of resources
lived in households where the head was employed. Of these individuals 53 % of
the households and 37% of the individuals participated in the Food Stamp
Program (10). This leaves 10% of individuals with food insufficiency not in
this food assistant program.
THE HUNGRY
A conference in February 2000 sponsored by
FNS, America’s Second Harvest and the National Child and Adult Care Food
Program Forum discussed how to reach the 31 million Americans who experience
food insecurity or physical hunger. Several speakers were concerned about the
fact that in a booming economy several million households are experiencing food
insecurity. One reason given for this increase in hunger is the decrease of
food stamp recipients. Since this is a federal program operated by state and
local governments, regulations, applications and restrictions vary form state
to state. For example, the application form in Ohio is over 30 pages long which
acts as a deterrent to those with limited education or time. Another reason
given for this increase is the welfare reform law of 1996. This law has created
a population called the working poor. This group of people run out of money
before the next pay day and often use soup kitchens or food pantries to
supplement their food supply (9).
Most
individuals who use food stamps or need emergency food assistance are female
(11) and the greatest percent of households with food insecurity are female
headed households (12). The greatest number of clients at America’s Second
Harvest network are from two high risk populations, 38% are children under 18
years old and 16% are the elderly over 64 years old (11). Geographically urban
centers has the largest percent of food insecurity with hunger, but the hungry
outside urban ghettos is rapidly increasing with (12) rural areas having the
greatest increase. The largest growth in community hunger is found in the
farming areas of the western and southern states(13).
Insufficient
food or skipping meals has consequences to both the community and individuals.
Some of the community consequences are: threats to community harmony,
development of a two-tiered food distribution system, and a risk of reducing
social and economic development. The primary consequences to the individual
having food insecurity with hunger are impaired learning, increase need for
health care, loss of productivity and intensified feelings of powerlessness
(14). Poverty is facet of hunger and one of the leading causes of household
food insecurity and individual hunger in the USA. Additional information can be
obtained from several governmental websites (listed at the end of the chapter)
dealing with poverty and the various food programs.
FOOD ASSISTANCE PROGRAMS
Government Programs, USDA
Most
of the government programs, the policies and management of these programs are
listed on governmental websites with full access to the public. Therefore, a
brief description will be provided with links to the various websites listed at
the end of the chapter.
The
USDA is the oldest bureau to participate in food assistance. The commodity
program was the first passed by Congress in the 1930s (4), It mostly operates
through institutional and community food banks food programs. Today a variety
of information is available from what commodities are available to recipes on
how to use them (15). The programs
involved at this website include: Child Nutrition Commodity Support, Commodity
Supplemental Food Program, Food Assistance in Disaster Situations, Nutrition
Programs for the Elderly, The Emergency Food Assistance Programs, State
Processing Program and Food Distributions Program on Indian Reservations.
Other
national nutrition programs operated by the USDA includes the Special Nutrition
Program for Women, Infants, and Children (WIC), Food Stamp Program, and the FNS
Programs and Farmers Markets. The WIC program assist women and children at high
risk for specific nutrient deficits and are managed by county agencies. The
Food Stamp Program, one of the core programs developed in the1930's, is managed
by states and county human service departments. The main concerns in these
programs are the increase number of underserved, high risk and eligible
persons, especially children, experiencing food insecurity with moderate hunger.
These programs can be accessed by which is the
website of the National Nutrition Safety Net.
One
of the best websites for developing a
new nutrition assistance program is the National Nutrition Safety Nets Tool Kit
which gives a step by step guidance to starting a program as well as several links to additional
information and programs already established. is the website
to the tool kit.
Non-profit Organizations
Although
the government program provides food assistance to the majority of the food
insecure population, some people either refuse to participate in the program or
are ineligible for these programs. Therefore, several national and local
organizations have developed nutrition and food assistant programs to fill in
the gap. Local chapters of Second Harvest and local Hunger Task Forces provide
food pantries to supplement the government commodity programs. Several
religious organizations provide meals at specific times of the year. These
times vary from daily to weekly, to monthly or during holiday periods. In 1999
the Catholic Charities Agencies reported an increase of 32% over the 1998 food
assistant programs. Most of the increase was seen in the emergency service.
This result from 1999 annual report was surprising since the economy was
booming and the unemployment was declining (15).
In
several communities hunger is managed by a collaboration of governmental
programs and private non-profit organizations. The non-profit organization will
apply for food from the government commodity programs and distribute the food
to local community food pantries and meal centers. Some organizations also
assist individuals in applying for governmental food assistance. Some local
hunger task forces also provide information and education programs using
government materials. Promotion of the positive aspects in preventing hunger
and food insecurity is present to the general public. With increase public knowledge
a reduction in some negative attitudes and concepts toward food distribution
programs has been noticed.
Two
of the national organizations dealing with eradicating hunger are Food Research
and Action Center and the Second Harvest. Both websites are listed at the end
of this chapter. To find the local hunger programs in your area, one can find
the link for your area one a national organization or one of the government
hunger center. If no link is provided check with the public health department.
CONCLUSION
A national organization that indirectly deals
with hunger through the direct interventions of its members is the American
Dietetic Association (ADA). The professional organization of registered
dietitians, ADA approaches food
insecurity and hunger by acknowledging that aggressive action is needed to end
domestic hunger and to achieve food and nutrition security for all Americans.
In their position statement written in 1998 and reaffirmed in 2001, the ADA
states hunger should not be found among residents of the richest country in the
world (16). The only way to purge hunger in the USA is by the collaboration of
the federal, state and local government and the various public health, local
dietetic associations and community organizations. This collaboration not only
needs to provide food, but also to develop educational programs to teach
persons who have food security the proper ways to assist the hungry, thus
preventing negative attitudes. By preventing or diminishing negative community
attitudes toward food insecurity, more households and individuals can
participate in the food assistance programs and other programs to reduce
poverty which will decrease food insecurity and hunger in the USA.
References
1.
The Salaya Statement on Ending Hunger. on the HungerWeb website.
Available at
http://www.brown.edu/Departments/World_Hunger_Program/hungerweb/WHP/bri.../salaya.htm.
Accessed February 16, 2001.
2.
Cloud HH. Clients with special needs. In Own AL, Splett PL, Owen GM,
eds. Nutrition in the Community: the Art and Sciences of Delivering
Services. 4th ed. Boston, MA: McGraw-Hill; 1999:344-375.
3.
Lewis S. Food security, environment, poverty, and the world’s children. J
Nutr Ed. 1992;24 (suppl 1):S3-S5.
4.
Poppendieck JE. Hunger and public policy: Lessons from the Great
Depression. J Nutr Ed. 1992;24 (suppl 1):S6-11S.
5.
Boyle MA, Morris DH. Community Nutrition in Action: an
Entrepreneurial Approach. Minneapolis/St Paul, MN: West Publishing Co.;
1994.
6.
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:S510-S516.
7.
Leidenfrost NB. Definitions of food insecurity. on HungerWeb website.
Available at http://www.brown.edu/Departments/World_Hunger_Program/hungerweb.../food-insecurity.htm
Accessed February 16, 2001.
8.
Lorenzana PA, Sanjur D. Abbreviated measures of food sufficiency validly
estimate the food security level of poor households: Measuring household food
security. J Nutr. 1999;129:687-692.
9.
Anderson GM. Hungry in American: Thirty-one million people in the United
States experience either food insecurity or actual hunger. America
(April 22, 2000). on find articles.com website. Available at Accessed
February 16, 2001.
10.
Alaimo K, Briefel RR, Frongill, Jr., EA, Olson CM. Food insufficiency
exists in the United States: Results from the Third National Health and
Nutrition Examination Survey (NHANES III). Am J Public Health.
1998;88:419-426.
11.
Who we serve. on American’s Second Harvest Who’s Hungry website.
Available at Accessed
February 16, 2001.
12.
Community Nutrition Institute. USDA: 12 million U.S. households are food
insecure. Nutrition Week. 1997;27(38):4,5.
13.
Hunger in rural America. on American’s Second Harvest Who’s Hungry
website. Available at Accessed
February 16, 2001.
14.
Hamelin A, Habicht J, Beaudry M. Food insecurity: Consequences of the
household and broader social implications. J Nutr. 1999;129:S525-S528.
15.
Request for food at catholic charities agencies surge 32 percent. on
website Current News & Analyses. Available at
16.
American Dietetic Association. Domestic food and nutrition
security–Position of ADA. J Am Diet Assoc. 1998;98:337-342.
Websites
World Hunger
Networking
Global Hunger Solutions
Homeless
National
Student Campaign Against Hunger & Homelessness
Nutrition & Program Resources
Food
Security, part of the USDA Food and Nutrition Service
Food
Research and Action Center
USDA
Economic Research Service
Poverty Programs