Childhood hunger before and after COVID

RICK WEISS: Thank you, Josh. And welcome, everyone, to this SciLine media briefing. For those of you who may be first-timers, SciLine is a free, editorially independent service for reporters based at the nonprofit American Association for the Advancement of Science. We’re funded entirely by philanthropies to achieve one overarching goal, and that is to help reporters like you get access to scientists and research-backed evidence to include in your stories, whether those stories are about the science itself or just about things going on in your communities that could be strengthened by including some science in those stories. Everything we do is free. And I encourage you to go to sciline.org to see all the ways that we can help you, including our popular matching service through which we can find you a perfect scientist source for whatever story you’re working on.

Today’s briefing is on a topic that we are all, I think, seeing increasingly in the news, the growing problem of food insecurity and hunger in the United States with a special emphasis on children. But while this subject is showing up in the news, it’s not always being told through rigorous social science-based framing, the kind that we’re going to be introduced to today by the experts we have on our panel. I think one of the challenges of covering food insecurity in America is that, yes, it’s very much a local story. It’s about real families in your communities, about local food banks and charities, but it’s also a much bigger than local story. And in fact, as we will hear and as the research shows, it’s about much more than food, actually. So we’re going to hear today from three experts with deep expertise in this topic who can help make your coverage more research based and more contextual. I’m not going to introduce them in detail today. Their bios are on the sciline.org website, but I will note here that we will hear first from Dr. Eliza Kinsey from Columbia University’s Mailman School of Public Health, who will provide an overview of U.S. food insecurity, what it means, where it is, who it affects most, and something about the impact of COVID-19.

Next, we’ll hear from Dr. Deborah Frank from Boston University’s School of Medicine and Boston Medical Center, who will focus on what we know about the impacts of – the impacts on health, development, behavioral outcomes for children living in food insecure households. And third, we’re going to hear from Mariana Chilton, Dr. Mariana Chilton from Drexel University’s Dornsife School of Public Health, who will speak about the role of nutrition assistance programs like SNAP for addressing not just the need for food, but also the underlying causes of food insecurity and the issues of stigma that are still attached to public assistance programs. So let’s get started. Dr. Kinsey, we’ll start with you.

[0:02:55]

ELIZA KINSEY: Hi. Thank you. Let me just get my slides shared. So thank you all for being here today. Sorry. I’m just getting my computer set up. I’m excited to be sharing this time with my colleagues, Dr. Frank and Dr. Chilton, and to give you an overview of food insecurity in the U.S. today. I want to apologize in advance for my sort of froggy voice. I’m just getting over a cold. Food insecurity is defined as being unable to acquire enough food to meet the needs of all household members for an active and healthy lifestyle, and this can be because of insufficient money or other resources for food. Conversely, you can think of being food secure as including, at a minimum, the ready availability of nutritionally adequate and safe foods for everyone in the household. There are a number of different ways to measure food insecurity. The gold standard for measuring food insecurity is an 18-question USDA screener that’s administered through the Current Population Survey Food Security Supplement.

However, food security is often measured with abbreviated screeners. And for that reason, you may hear us today use other terms like food insufficiency or even hunger. And when you’re reporting on food insecurity rates, it’s always worth asking how food insecurity was measured within that particular community or population. Food insecurity impacts many, many people in this country; 35.2 million people live in food insecure households, and that includes 5.3 million children living in food insecure households.

Food insecurity is a pediatric disease. Households with children are much more likely to be food insecure than adult-only households. Prior to the start of the pandemic, in 2019, the household food insecurity rate was 10.5% and 13.6% among households with children. Since the pandemic started, we’ve seen estimates of food insecurity more than doubling to approximately 22% among all households and 28% among households with children. Food insecurity is just one pathway through which structural racism jeopardizes the health and learning abilities of young children. You can see here in the figure on the right, which depicts very early estimates of food insecurity rates during the pandemic using data from the COVID Impact Survey, that not only was food insecurity higher among households with children, that it disproportionately impacted Black and brown households. And that’s depicted here in the orange and yellow bars on this chart. This emphasizes the fact that house – that food insecurity is not just an issue of health equity, but also one of racial justice.

So in addition to demographic differences in the prevalence of food insecurity in this country, there are also geographic disparities. Rural populations often experience higher rates of food insecurity than people living in metropolitan areas. This is illustrated in this map from the USDA that shows that states with larger rural populations, particularly in the South and some of the Midwest, tend to have food insecurity rates above the national average as compared to states with large urban populations. According to county level data from Feeding America, rural communities make up 63% of counties in the U.S., but they make up 87% of counties with the highest rates of overall food insecurity. Furthermore, 86% of the counties with the highest percentage of children at risk for food insecurity are rural counties. Living in rural areas poses unique challenges for food access. Oftentimes, food stores are really far from where people live, and there isn’t necessarily great transportation infrastructure, especially if households don’t own a vehicle. Then this can be compounded with often higher rates of unemployment and higher rates of poverty. I think it’s important to point out, however, that disparities in food access, often discussed with terms like food deserts or food apartheid, are related but separate concepts that sometimes get conflated with food insecurity.

People can live in an area with high physical access to healthy food retail and still be food insecure if they don’t have the resources to purchase or acquire food. That said, because of legacies of racial segregation and geographic disparities in concentrations of poverty, communities that have disproportionately high rates of food insecurity also often overlap with areas of low food access or with areas of high density of unhealthy food access. We know from prior literature that living close to a grocery store is positively associated with healthy eating habits and with improvements in some health outcomes like healthy weight status, and also that low-income communities and communities of color are disproportionately impacted both by low food access and also by diet related health outcomes with things like obesity and diabetes. So I’m going to transition now a little bit into talking about some programs that are in place to support food insecurity or to improve food insecurity within children. School meals are a vital component of the social safety net that works to reduce food insecurity in this country. In 2019, the National School Lunch Program and School Breakfast Program served approximately 15 million breakfasts and 30 million lunches daily at low or no cost to low-income students. National School Lunch Program participation has been associated with a 14% reduction in food insufficiency.

Similarly, access to the School Breakfast Program has been shown to reduce the risk of marginal food insecurity and the likelihood of skipping breakfast, especially among low-income children. Loss of access to school meals, such as we saw with school closures during the COVID pandemic, puts millions of households at increased risk of food insecurity. To get a handle on the scope of the problem, I worked with several co-authors on a paper last year where we used school closure reports and USDA reports from 2019 state-level free and reduced-price participation in the National School Breakfast Program and the National School Lunch Program to estimate the number of missed breakfasts and lunches per week between March 2 and May 1, 2020.

We estimated with those data that more than one billion meals were not served in school during the initial nine weeks of school closures. And, of course, we know that schools – many schools remained closed for much longer than those first nine weeks. And many of these meals were ultimately replaced through innovative meal delivery programs that were implemented by school districts and states. However, we know from more detailed data in a handful of states, as well as some recent reimbursement numbers that were released by the USDA, that there was still a significant shortfall in the order of 30 to 40% of meals were not replaced, which, of course, has huge implications for the dietary intake and health of school age children. So now I’m going to pass it off to my colleague, Dr. Deborah Frank, to discuss the health implications of food insecurity. Thank you.

[0:10:09]

RICK WEISS: Thank you for an excellent overview there. And I want to move over to Dr. Deborah Frank for our next presentation.

[0:10:34]

DEBORAH FRANK: OK. OK. When you hear these numbers from Dr. Kinsey and Dr. Chilton, your eyes can kind of glaze over. But for health care providers like me and my colleagues, including Dr. Adolphe, who has just taken over the multidisciplinary Grow Clinic that cares for malnourished children served in the city of Boston, these numbers all have names and faces. There’s nothing abstract about it. Everyone is a story and a story that worries us. Pediatricians and health providers in general are in strong – incredibly aware that child policy choices, because it happens so far away, are written on the bodies and brains of our youngest patients. And the younger the child, the more vulnerable they are because they are in the critical period of brain growth when the brain can build new brain at a rate and of a quality that it will never have again. And yet, the poorest families are those with the youngest children. And often because of the lack of child care, the only people who see these children are their families and their health providers, which leaves us with a very special responsibility for making others aware of what’s happening to America’s children.

The impact of food insecurity on child health begins before conception. And the mother’s nutritional status in pregnancy, as she conceives and throughout the pregnancy, has huge impacts on infant outcome, including birth defects like neural tube defects – this one is called spina bifida – and also low birth weight, which is both a major contributant to infant mortality and produces kids who are at a lifelong risk for costly health care needs and special education. Food insecurity during pregnancy is also a marker for jeopardy to the health of the mother. And you know that the United States has a horrifying maternal mortality. There’d be the much greater maternal morbidity – mortality means dead and morbidity means sick. And food insecurity and pregnancy has been tied to high blood pressure, which goes to toxemia, which goes to fetal and maternal death and also to diabetes, which can go on after the pregnancy. Once the baby, the child, is born, there are many postnatal child health effects of food insecurity, and they suffer two to four times as many health problems as other children within the same income group. These include sort of everyday pediatrics like stomach aches, headaches, colds and ear infections, but also much more serious things, higher hospitalization rates.

Children with blood cancers are more likely to die of their cancer if they’re from a food insecure household, even if they’re receiving the same drugs as kids in food secure households – iron deficiency anemia, decreased bone mineral density, greater susceptibility to lead poisoning like in Flint, poor health and asthma. With good care, you can restore children’s ability to fight and resist infection and to grow to near normal levels, although it requires some pretty intensive intervention over – what? – months to a year, but what is – has the more lasting effect is that food insecurity jeopardizes brain health of adults and children. Mothers in food insecure households are more likely to be stressed and depressed and also, as we mentioned, to be sick. If you look at the child from infancy to adolescence, household food insecurity, even at the smallest levels – in my references, there is the USDA 18-item scale and how – what counts as marginal.

And it’s associated with externalizing, which people I would say call acting out behaviors like hyperactivity and aggression, and internalizing behavior disorders like depression and anxiety. Cognitive academic effects are reported and measurable in infants and again in school age, particularly in reading and math. And the concerning thing is that these effects are not only measured while the child is food – in a food insecure family, but can be also detected years later even if the food insecurity has resolved. And that, of course, makes sense because the function and the structure of the brain is impacted by food insecurity.

They’re – like any other poisoning or other serious insult to development, the effects aren’t uniform but depends on how severe the food insecurity is, how long the child was exposured and in what developmental period. And – but it’s important to look for also the long-term effects, which can be found actually in young adulthood, including suicidality, delinquency and substance use disorders. There – we have sort of what we call a biopsychosocial model for this. Physiologically, lack of food of the appropriate quality and quantity makes it – disturbs the body’s manufacture, the brains manufacture, of what are called neurotransmitters, which are chemicals which pass information from nerve to nerve and myelin, which coats the nerves and is like insulation to electrical wires. It permits the rapidity of transfer of information. And both of those, you can measure, are altered by food insecurity. There’s also, of course, economic stress, which has a direct effect on development and behavior and on food insecurity and parental distress, which also influences food insecurity and development and behavior. So we have a vicious cycle of both biologic and environmental issues. And the one we can, with political will – could instantly be fixed is food insecurity.

Dr. Kinsey mentioned structural racism. That is clearly a structural factor, but you can remedy food insecurity while you’re still worrying about what you’re going to do about structural racism. It’s something that could be actually fixed quite quickly if our country chose to do so. There are a lot of references, more than you really want, probably. And these are websites that you might find useful. And this is the research organization that I will – am part of and Dr. Chilton was part of, which has probably more information than you can use on all kinds of hardship – it’s affecting only young children – but particularly food insecurity, housing insecurity and energy insecurity. Has – so thank you for your attention. And I will pass it on to Dr. Chilton who will tell us how to fix it.

[0:19:12]

RICK WEISS: Great. Thank you, Dr. Frank, for a fantastic primer. And I’ll remind reporters that the slides will be available on the SciLine website after the media briefing with video and with a transcript to follow soon after. So we’ll move on now to Dr. Mariana Chilton.

[0:19:31]

MARIANA CHILTON: Hi, everybody. Thank you so much for your – for tuning in. And I can’t think of better people to follow than Dr. Kinsey and Dr. Frank. And just to reiterate what Dr. Frank said, there are a number of pediatricians and public health researchers as a part of the Children’s HealthWatch Research Network, so please do check out the website for Children’s HealthWatch. And much of what I’m going to tell you about today about solutions is based on research that we’ve done together through Children’s HealthWatch, which is a multistate study that looks at the impact on – of public policy on the health and well-being of young children. I’m the director of the Center for Hunger-Free Communities at Drexel University School of Public Health in Philadelphia, the lands of the Lenni – on the lands of the Lenni Lenape. The work at our center is focused on empirical evidence and on the science and also based on our partnerships and on our research alongside of people who have experienced hunger and poverty firsthand. I primarily work with Black and brown women, or Black and Latina women in Philadelphia and also across the country.

I’ve also worked with indigenous communities in my previous career. So one thing that you’ll notice that I focus in on is making sure that we are understanding that people who have experienced hunger and poverty firsthand are actually the true experts on hunger and poverty. And if you wanted to get in touch with me to talk about the research, I’m happy to do that. But I can also connect you with people who have experienced it firsthand. So I was so glad that Dr. Kinsey talked about school breakfast and school lunch and that there are so many ways to be solving food insecurity and hunger, and we can do it actually quite quickly. I want to focus in on two of the major nutrition assistance programs that really have a major impact on food insecurity, and that is SNAP – that was – that used to be called Food Stamps – and WIC. So SNAP stands for Supplemental Nutrition Assistance Program. And we know – and it helps people to pay for groceries. It comes on an electronic benefits transfer card like a credit card, and people can only use it to purchase food. They can’t purchase tobacco or alcohol, and they cannot purchase diapers. But they can provide – they can purchase groceries. But they can’t buy hot things. Anyway, it’s not that complicated. It’s really important for people to be able to purchase food that way. And we know through our research that it improves child health. It prevents and reduces food insecurity. And it also stimulates the economy.

WIC is a special nutrition program for pregnant and nursing mothers and very young children under the age of 5. As Dr. Frank made so explicitly clear that during pregnancy and early childhood, having access to good nutrition is so important for health and well-being. And you all should know that WIC is an incredibly popular and important public health program. Almost 50% of the newborns in America are participating in the WIC program. So it’s incredible reach of public health, but it should also tell you how prevalent poverty is in this country. But it’s also important to remember that public assistance programs that are not – that – can actually help – like, the broad array of public assistance helps people address food insecurity. So you have to think way beyond food.

That’s why I put up the energy assistance program called LIHEAP up here because we know through our research at Children’s HealthWatch that energy assistance protects against food insecurity and it promotes child health, and housing subsidies have even helped to improve birth weight or underweight in young children, as Dr. Frank made very clear that weight is extremely important in early childhood. But if you’re thinking about public assistance, you must also remember to pay attention to issues of work and to wages. If you understand how work operates in this country, a lot of low-income workers are – have seasonal jobs, have part-time jobs or participate in the gig economy. They’re far more likely to be food insecure. And that means that if there are job supports, such as paid sick leave and health insurance, those job supports actually can reduce food insecurity. Wages are extremely important. So we know that states that have lower minimum wage have higher rates of food insecurity. And if I think about it, who has – who are the most low-wage workers in this country? Women of color.

And I want to bring us back to the issues of systemic racism and structural racism. Racism and gender discrimination are the drivers of food insecurity in our society. And this is why we also have to focus on – anything that is focused on improving racial and ethnic and gender equity is going to improve food insecurity. Lastly, I just wanted to put up respect for nature. As we’re in a climate catastrophe that is only worsening, any kind of program or policy that helps to promote sustainability, promote our respect for nature, our respect for food, water and air, will help to prevent food insecurity in the future. So the policy solutions on the horizon, there’s a lot of exciting things happening that you ought to be covering and with the Biden administration. Currently, the USDA Food and Nutrition Services Program, FNS, they are working on reconfiguring the SNAP calculation. This is based on something called the Thrifty Food Plan. Please pay attention. That’s happening. And actually, I have a brief that we’re releasing today that’s based on the experiences and wisdom of people who have participated in SNAP and their recommendations for improving the SNAP program.

Thrifty Food Plan is central to that, so I’m happy to connect you to people who know it firsthand. Paying attention to what’s called Pandemic EBT, this is a way of what – Dr. Kinsey was talking about this – how many missed meals, how many children were not being able to access food. Through the Pandemic EBT program, families that have children participating in the reduced – in reduced or low-cost meal plans or free meal plans were able to get extra money on an EBT card to be able to purchase food. So it’s like an extension or an improvement on the SNAP program and connects the School Breakfast and School Lunch. If you pay attention to the American Families Plan, expansion of universal school meals is on the table. Please try to connect with families that might be impacted. Also guaranteed income, the new child tax credits should be made permanent in our – there is an incredible movement right now in the Biden and Harris administration to work on that. Remembering that racism and gender discrimination are a root cause of food insecurity, anything that improves racial equity, such as reparations for slavery, anything that helps to create a better floor for income such as universal basic income is being – is very popularized right now, thinking about universal health care, minimum wage increases, and also thinking about indigenous sovereignty, less policing in our communities, immigration reform, all of those things that help to promote equity will improve food security.

Finally, thinking about the climate catastrophe upon us, not only is that going to affect our food and water universally across the planet, but it can actually contribute to societal breakdown. A part of societal breakdown is increased or exacerbated discrimination. So pay attention to the climate catastrophe and how that might address food insecurity or deal with it or, you know, be impacted by it. Finally, it’s important to remember that in your own reporting, the way that you talk about people who are poor, talk about the people who are participating in the SNAP program or WIC and School Breakfast and School Lunch can actually contribute to stigma. And a lot of the problems that we have in our country, the lack of political will, has to do with the way that we stigmatize people who are poor. And it also has to do with the way that we misunderstand what food insecurity is really about. Yes, food insecurity is all about – is about food, but it’s about much more than food. So think beyond food. Try to avoid the conceptual confusion. Think beyond food. Notice that the solutions, I did not talk about charity. The solutions to food insecurity are policy based, and I can talk more about that in the question and answer. Try to avoid phrases such as the needy and the hungry or things that portray people who are experiencing hunger and poverty as passive. They’re actually actively engaged in their own communities, have a lot of wisdom to share.

And remember to include the policy context. So that is why you should do more of talking to people with lived experience. Report beyond food. Remember to report – if you’re focusing on food insecurity and hunger, focus on the policy solutions, SNAP, WIC and other supports. Talk about wages. Talk to those elected officials and always, always make sure that poverty – that you remember that poverty is not happening in a vacuum. Poverty is created. Hunger is manmade. So always make sure that you’re juxtaposing rates of food insecurity and hunger along with issues of wealth and wealth inequality. I have a lot of resources in my slides. And I have a final slide that helps you to see racial and ethnic and gender disparities, and I encourage you to engage with my slides and the slides of everyone else. And I’m happy to do a question and answer. Thanks for listening.

[0:29:15]

RICK WEISS: Great. Thank you very much, Dr. Chilton. And I really appreciate your emphasis towards the end of your presentation on some practical tips for reporters as they cover this beat. And it’s actually – typically, the first question I like to ask as moderator before we get into the Q&A from attendees – and I’m going to go around the horn once to do that right now with each of our speakers, to ask you each, you know, what is it, from your vantage point looking at the journalism that’s done on food insecurity and hunger in this country – what are things that you see that either you’re impressed by and proud of our journalists doing or some things, some pitfalls that you’ve seen that you think reporters should be more careful to avoid as they do this reporting going forward? And so I will start with you, Dr. Kinsey, for any observations you might have along those lines.

[0:30:08]

ELIZA KINSEY: Thank you. Yeah. I really appreciated Dr. Chilton’s sort of final take-home messages around things to avoid and things to promote. So I want to amplify some of those by saying that I’ve been really impressed by just the amount of coverage that I’ve seen in the last year in the media on food insecurity and drawing attention to how much of a problem it has become during the pandemic. But food insecurity has been a problem in this country for a really long time, and it’s actually been a relatively intractable problem since we started measuring it in the late ’90s. The rates of food insecurity have sort of stayed at – pretty consistent without budging until now where we’re seeing this really big increase. And I think that something that needs to happen is much more attention to the structural costs. And so Dr. Chilton talked about racism, gender discrimination, imbalances in power, poverty, low wages, and I think more focus on how food insecurity can be changed through attention to those structural causes is needed in the media.

[0:31:16]

RICK WEISS: Thank you. Dr. Frank, anything to add on what you’re seeing in the journalism on this topic?

[0:31:21]

DEBORAH FRANK: Yeah. I think people have done a great job of covering how overwhelmed the charitable food network is and the heroic efforts of schools to feed kids. But as, you know, doctor – I agree with Dr. Kinsey and Dr. Chilton that you have to look upstream. And from my perspective, you also have to look downstream, that people are not paying a lot of attention to the so-what of food insecurity, which is – and there’s a lot of data also on elderly and adults and health care costs in adults around food insecurity. The so-what is that this isn’t just unfortunate, unjust, very sad. It’s very costly now and in the long term. And the other thing is that I think remember that it’s a childhood illness and that 1 in 4 children in America have an immigrant parent. And they are particularly impacted by this because of both de facto and de jure barriers to their families accessing what families need.

[0:32:36]

RICK WEISS: Great. And Dr. Chilton, anything you want to add to your initial remarks in this area?

[0:32:44]

MARIANA CHILTON: One thing that I would love to add is that I’m glad that hunger and food insecurity is getting covered, but I think that a lot of times journalists could ask deeper questions that get at the root causes of the structural racism. And also what Debbie – Dr. Frank is talking about in terms of the so-what, the health impacts, the cost to our society, the cost – it’s a loss of brain trust. The longer we allow children to be food insecure, we are disinvesting and destroying the brain trust of America. So anything that you can do to ask deeper questions to our elected officials and to leaders in the various agencies, the United States Department of Agriculture, Department of Education, Department of Health, to really put people on the spot because it’s the policymakers and as well as our society that helps to generate poverty and food insecurity. We’re causing this illness, this widespread illness. So I think trying to reduce the conceptual confusion and really getting – not taking the surface level answer, getting deeper to the root cause would be great and avoiding the sensationalism of the long lines at the food pantries and food banks. I would really appreciate it (laughter) to stop covering that. That’s the wrong issue. It’s not really the focus. Get to the underneath.

[0:34:07]

RICK WEISS: …Makes for some of the best and easiest images, of course, long lines of cars at food banks, but maybe too easy. Thank you all for that. I have a question here from Jenifer Joy Madden. She’s a reporter with durablehuman.com, asking what are some reasons why there may be food insecurity in some houses and not others, even in the same income level? Dr. Frank?

[0:34:39]

DEBORAH FRANK: Yeah. Remember that food is the most fungible part of a low-income person’s budget. I have a colleague whose motto is rent eats first. And parents know that they have to divert – the only part of their budget which they have control over at all is how much they spend on food. And when they’re afraid the utilities are going to be turned off where children freeze to death before they starve to death or they’re afraid the family is going to be evicted and every penny goes to the rent or the utilities and that family is food insecure, families, as Dr. Chilton told you, who have a floor under some of those other basic needs, like housing and energy, are much less likely to be food insecure because they don’t have to divert their entire food budget to those needs. Also, it’s highly regional. Food stamps is not adjusted for regional costs. And so the same amount of money that, you know, may go pretty far in – I don’t know – Nebraska, goes nowhere at all in Washington, D.C., but it’s the same amount of money set at the same level, for example. So there are many forces impinging on families of which food insecurity is a really important sign and symptom.

[0:36:07]

RICK WEISS: Interesting. I did not know that the rates of reimbursement or provision were not adjusted for living costs in different cities. Dr. Chilton, do you have something to add to that?

[0:36:19]

MARIANA CHILTON: I just wanted to add in that it’s important to pay attention – we haven’t talked about it enough yet – to the experiences with disabilities. And I would say mental health issues are extremely significant and important. So you can have families that may be struggling from mental and behavioral health challenges and may be receiving the same amount of money. But it’s extremely difficult to be functioning, to keep a job, to hold down a job as well as people with physical disabilities, that the types of supports that we have for families across America are just not enough to help people to flourish. We need to focus more on flourishing. So if you look at the research, and you can just do a quick google on disabilities and food insecurity, you’ll find that actually it’s almost 40% of those who are food insecure have some type of disability, mental or physical.

[0:37:14]

RICK WEISS: Great. I have a question here from Sabrina Wilson at WVUE-TV in New Orleans. This might be for you, Dr. Kinsey. I think it plays off some of the data you talked about. Is there data yet showing by what percentage food insecurity in children worsened during the pandemic? I guess there’s a few different ways to cut the data on that, but what’s the best way to talk about what happened during the pandemic with food insecurity?

[0:37:41]

ELIZA KINSEY: So I think what we’re seeing is that food insecurity in households with children has more than doubled. I don’t – I’m not aware of numbers specifically for childhood insecurity. Perhaps Dr. Frank or Dr. Chilton could answer that. One of the challenges, and I sort of alluded to this a bit in the beginning of my presentation, is that food insecurity is measured in a variety of different ways. And so being able to say how much food insecurity has grown or changed during the pandemic is a little bit complicated by whether or not people have an apples-to-apples comparison of pre-pandemic rates and rates during the pandemic. And in many of the surveys that have been deployed during the pandemic, they’ve used more abbreviated food insecurity screeners, and so we don’t necessarily have a great comparison of one to the other. But I do think we can confidently say that food insecurity in households with children has grown tremendously. The estimates suggest more than doubling.

[0:38:35]

RICK WEISS: Great. Dr. Frank? I’m sorry. You’re on mute, Dr. Frank.

[0:38:46]

DEBORAH FRANK: Oh, these machines. The – OK. In Children’s HealthWatch – and if you go on the website, you’ll find it – we are doing pre/post-COVID surveys of families with very young children who are coming to health care settings. And we’ve not only found this, you know, if we talk about the household level, the same everybody else has found with the same disparities, although our participants are disproportionately people of color. But we’ve also found that it’s very hard to get parents to agree to acknowledge child food insecurity. But even so, we found that it went from – the amount that was acknowledged went from 2% to 7% in the year following COVID saying the child had missed meals, didn’t get enough to eat.

We know that the threshold for making kids sick and impairing their education is what the government calls marginal food insecurity and we call the hunger vital sign, which you can measure with just two questions. And there’s reams of stuff about that on our website, which tells you about the whole household and doesn’t measure severity that is really clear about yes-no. It’s used now in all pediatric offices.

[0:40:07]

RICK WEISS: I’m going to remind reporters at this point that you can hover over the Q&A icon to submit your questions. And I have a question here about the practice of addressing unpaid lunch debts in some school districts, which is sometimes in the news I’ve seen called lunch shaming because it can draw attention to children whose parents have fallen behind on their lunch debts. The question is, what is known about how these kinds of stigmatizing actions affect children? Dr. Chilton? Yeah, you’ve mentioned the programs themselves. Have you seen some evidence on that?

[0:40:46]

MARIANA CHILTON: Actually, I’m not sure that there’s – I’m not sure of research. I can look into that and maybe send it on to you all later on to see if I can find some empirical evidence. But what we know through anecdotal evidence is this deep stigma that happens to children who have been called out by professionals in the lunchroom, stamped on their hands that says I need lunch money, or having to wear a little bracelet or even letters that have gone home to parents. This was happening before COVID. The lunch shaming issues are really clearly a deeply rooted problem that we have in our society. And actually, there was a legislation that was passed in New Mexico a few years ago that actually tried to put a clamp on the lunch shaming issue. And so there has been some effort to reduce that. I think the best way to reduce the lunch shaming is to make sure that school meals are universal. And that’s why you really should pay attention to the American Families Plan that is being considered now by the Biden-Harris administration.

That will – that works – that’s trying to expand what’s called community eligibility, which looks at the – or recognizes that counties and school districts that are in very low-income areas, that there should be no questions asked about whether children should be eligible or not, or that they should be income eligible for school meals, that all children in those school districts should have access to free breakfast and free lunch without any questions asked, no pay, no extra types of foods that you can purchase, et cetera. So I think that that’s the most important thing is we should just make free meals for everyone. And there’s a wonderful book by Janet Poppendieck called – I think it’s called “Free Food for All.” But Janet Poppendieck has a good book on the policies associated with school breakfast and school lunch. Thank you for the question. It’s very important.

[0:42:52]

RICK WEISS: Dr. Frank, want to add to that?

[0:42:55]

DEBORAH FRANK: Yeah. I think you should go and talk to school personnel because right now there is universal free meals, and it is such a relief. They are not trying to have to process all this paperwork and ask embarrassing questions and, you know, dither about, you know, this kid was eligible last month or now is he newly eligible because dad lost his job? So in terms of making the life of school personnel more efficient and more able to be focused on education, universal school meals would be a huge benefit, not just to the child who’s getting the meal but to the system.

[0:43:39]

RICK WEISS: Right. So we have a question related to that. We’ll see if there’s more to say on that. This is from Christopher Walljasper at Reuters, noting that Representative Ilhan Omar and Senator Bernie Sanders have recently proposed legislation making universal school meal programs permanent. Do these programs equal more kids eating or are there are other barriers that would not be fixed by this proposal? What are the challenges to adopting these measures? Are schools, for example, prepared to do so?

[0:44:15]

DEBORAH FRANK: Well, schools prepare meals often for many more children than there are on free and reduced because lots of kids buy lunch…

[0:44:23]

RICK WEISS: Sure.

[0:44:23]

DEBORAH FRANK: …Depending on what school you’re in. So yeah. I think with adequate funding – and schools can certainly prepare enough meals. You have to be culturally sensitive depending on the community you’re serving. You don’t serve pork to a Jewish community if you want the kids to eat it, and you have to be able to be flexible about things like kids with food allergies. But in general, I think that the schools have shown they’re up to the challenge and even up to the challenge of doing it not in their own physical plant, which is huge.

[0:45:05]

RICK WEISS: And Dr. Chilton?

[0:45:07]

MARIANA CHILTON: Yes. One of the things that Dr. Kinsey talked about was that children who receive school breakfast are more likely to stay in school, and it actually improves their school performance also – and so does school lunch. So school meals, it’s a win all around. The – schools are totally prepared to provide enough of the meals, culturally appropriate, nutritious, et cetera. And the improvements that through the Healthy Hunger-Free Kids Act during the Obama administration massively improved the quality of nutrition in our school meals, and we saw improvements in children’s health. So it improves child health. It improves school performance. It’s more – and access to these meals will help children to stay in school and get a better education, so it’s a great investment, as I would say, in the brain trust of America.

[0:46:05]

RICK WEISS: Question here from Aubri Juhasz from New Orleans Public Radio. My question has to do with the policy aspect of individuals’ ability to access federal benefits. Louisiana was the only state that required families to register for P-EBT benefits due to a student privacy law that was already on the books. They ultimately created a temporary waiver to get benefits to families automatically, but it happened months later. Should legislators attempt to prioritize access to meals above all else? (Laughter) Dr. Frank says yes. Is that just your personal research area bias or do we have some priorities here that make sense?

[0:46:53]

DEBORAH FRANK: I haven’t done this work, and maybe Dr. Kinsey knows someone who has. But the states varied massively in the efficiency with which they rolled out P-EBT, and Massachusetts was top (laughter). So I think that would be a very reasonable research question, if someone hasn’t already done it. I don’t know if Dr. Chilton has done it. But it – what you’re describing is a barrier that’s supposed to be protective of children, but it’s actually hurtful.

[0:47:24]

RICK WEISS: Dr. Kinsey?

[0:47:24]

MARIANA CHILTON: If I could add…

[0:47:25]

RICK WEISS: Oh, OK. Dr. Chilton?

[0:47:27]

MARIANA CHILTON: I will add that there actually has been research done on this, that the variability in policy – in access to SNAP benefits or to currently to SNAP EBT there is some new research coming out on that and also making it very difficult to – different ways of getting access to free and reduced-cost lunch. So the actual state policies are extremely important. And what we should do across the board, blanket policies, is to not have states to apply for particular waivers to do this thing and that thing. The way that the U.S. government handled the rollout of these extra supports, extra supports in the SNAP program or the Pandemic EBT, they handled it in a very scattershot way. They made different states apply for it, and some states did better than others. You don’t – and to rely on state administrators to figure this all out and to do a variety of things related to waivers, it – all it does is it exacerbates the problem. And it also hides variability. So the fact that things were happening in Louisiana that we – I didn’t know about what this reporter is talking about. But I also know that in the state of Pennsylvania, it took them way too long to figure out how to get more benefits to families. Even though the federal government was at the ready to get these supports out to families, states were a part of the holdup. So we really need to be paying more attention to that, and I think it’s a great question and something that you ought to be talking to legislators about.

[0:48:56]

RICK WEISS: Dr. Kinsey, did you have something to add there?

[0:48:58]

ELIZA KINSEY: Yeah. I can just add and say that I haven’t been working on this research myself, but some of my colleagues at NOPREN, which is the CDC’s Nutrition and Obesity Policy Research and Evaluation Network, have been doing some examination of Pandemic EBT rollout in different states. And that would be a good place to look for resources on that – on this question.

[0:49:19]

RICK WEISS: Fantastic. A question here about whether there’s evidence that food insecurity challenges follow, in a sense, children into adulthood. That is, is a child who experiences food insecurity in their parents’ or guardians’ household more likely to also experience it once they’re on their own as an adult? Dr. Frank?

[0:49:41]

DEBORAH FRANK: I think that data does exist. But the point is, what’s the mechanism? And the mechanism is that their educational achievement is maybe truncated, and their behavioral-emotional development may not be adaptive. Remember, I showed you on that slide that young adults and older adolescents who grew up in food insecure households, even though they might not still be food insecure, have higher rates of suicidality, substance use, even trouble with the law. So there’s social transmission, I think would be the way to put it.

[0:50:27]

RICK WEISS: Yeah. Interesting. I have a question I want to throw out to the three of you and see what your thoughts are, given the context you’ve been providing that food insecurity is about so much more than food. I remember reading as we were preparing for this briefing that the initial food stamp program that FDR actually put together was actually not aimed so much at alleviating hunger but was considered a farm support program. Now that the SNAP program and others really are more focused on dealing with hunger itself, but you’re telling me that it’s about a lot more than just food, are the current programs adequately focused on, you know, the real best target for dealing with food insecurity? Or are there changes to the way these programs are administered or the authorities that they have that might make them more effective? Wonder if anyone is willing to jump on that? Dr. Frank?

[0:51:28]

DEBORAH FRANK: There are two sets of issues here that you’re talking about. And there is, in fact, an alliance between farmers and food stamp advocates. It’s the only reason we have a farm bill at all. And every – there’s – like I said, Dr. Kinsey and Dr. Chilton, it’s like every dollar spent on SNAP generates about $1.75 in economic activity either on farms or in grocery stores. So not only does it feed people, but it’s an economic engine, particularly because it’s what’s called countercyclical, i.e., access goes up when incomes go down, which is why it’s been so important. So the other question is, a lot – you have to look at a program and say, some programs, including traditionally SNAP, although that also varies state to state, are designed to minimize who gets access and by design – all kinds of paperwork and bureaucratic and unanswered phones, you name it. Not – and others are designed and working hard to be streamlined and effective. And so it’s not just are the benefits there, as Dr. Chilton was telling you, but are the states A) interested and B) empowered to go after them? One of the things I learned working on the Massachusetts rollout is it’s not just a matter of let my computer talk to your computer and it’s done. It was unbelievably time consuming and complex to link school meal data to SNAP data, but they did it. So I don’t think it can be done with a magic wand, but it can be done with dedicated, skilled people.

[0:53:14]

RICK WEISS: It’s a really interesting point about – and reflects something I think about a lot of American psychology, about the discomfort of a free lunch, you know, literally or figuratively, and making it more difficult. Dr. Chilton?

[0:53:28]

MARIANA CHILTON: Yeah. Thank you so much for those comments. I think there are two major things that could be done right away. And the first one is to improve the SNAP benefit calculation, and then the USDA is working on that. But we – and I’m just putting a link in the chat that has a link to a policy brief that was developed by SNAP recipients themselves about ways that SNAP doesn’t – ways that SNAP helps but also doesn’t help, and how to improve SNAP. The other issue is much deeper. We have all of – what’s called – you have to be means tested. You have to see – people have to see whether you’re worthy or not of getting help, and that’s sort of the American way. But I think that’s outdated. And if we really want to address food insecurity and hunger, then we have to look at all of the public assistance programs and maybe start thinking about things such as universal basic income where everyone has – is guaranteed a basic income floor rather than having to show up to a different office to – with a pay stub to demonstrate that they’re worthy, etc. All it does is create more stigma. We have some publications on that with some of the SNAP participants in the American Journal of Public Health, and I put that in the chat. I also have a report on universal basic income and how it could reduce food insecurity very significantly. So it’s time to rethink the entire way that we provide public supports. A lot of people talk about it as a safety net. A lot of people I’m familiar with that participate in the safety net don’t refer to it as a net. They refer to it either as a floor or sometimes as a chain. And that’s – it’s not to throw it away, but to think more deeply about what are we really trying to accomplish. If we can focus on health and well-being and flourishing, that’s the way that we can develop programs and policies that truly promote health and well-being.

[0:55:25]

RICK WEISS: Great points. And I want to note to attendees that all the great resources that are showing up in the chat here, we will make sure that they end up on the SciLine website with these other resources as well, so you’ll be able to refer to them there. We’re just about at the end of our hour, so I do want to go once around the horn here and ask each of you for sort of a take-home point of all that we’ve heard today. It’s a really rich discussion and, as predicted, about a lot more than food and I think is going to change some reporters’ heads about how they’re going to cover this topic. But let me just go around and ask each of you for a final take-home point, something you might have said already and want to reemphasize or something new based on what you’ve heard today to make sure that reporters have a slam dunk idea from each of you to walk away with. And Dr. Kinsey, I’ll start with you.

[0:56:15]

ELIZA KINSEY: Sure. So I showed a slide with a map of the U.S. showing food insecurity rates and some disparities across the country, but I want to really emphasize the fact that food insecurity within children is an issue in every community in this country and that it’s important that we really focus on just how widespread it is and how many children it’s impacting.

[0:56:35]

RICK WEISS: Thank you. And Dr. Frank?

[0:56:40]

DEBORAH FRANK: I guess the sort of take-home is that food is medicine, and we know how to distribute the medicine if we want to for a healthy America.

[0:56:55]

RICK WEISS: Spoken like a physician. Dr. Chilton?

[0:56:59]

MARIANA CHILTON: The last thing that I would add is that if you want to focus on child hunger, you cannot leave the parents out. Don’t be a part of the problem in your reporting. Think about it. Not only it’s a family issue, it’s a community issue. It’s a nationwide issue. So don’t just focus on the kids. Focus on the full spectrum of what food insecurity is really about. And the way to do that is to focus beyond food. Think beyond food.

[0:57:29]

RICK WEISS: I want to thank all three of our panelists today, Dr. Kinsey, Dr. Frank, Dr. Chilton, for a really, I think, mind-expanding view of what food insecurity is and how reporters should be thinking about it. I want to remind reporters that you should check out our website, sciline.org. We encourage you to follow us on Twitter @realsciline. And as you log off today, you will be prompted to take a very short three-question survey. It’ll just take you a half minute. It’s so helpful and important for us for you to take those few seconds to answer. We really are grateful for that feedback. And with that, I’m going to bring this media briefing to a close. Thank you all, and we’ll see you at the next SciLine media briefing.