Hungry for Change: Food Insecurity During the COVID-19 Pandemic

The COVID-19 pandemic has upended our everyday lives and transformed how we work, socialize with others, and share meals with friends and family. One of the most notable impacts of the pandemic has been food insecurity and eating behaviors. The COVID-19 pandemic has exacerbated food insecurity for low-income individuals and changed eating behaviors for many Americans of different socioeconomic levels. Because these changes have harmful health implications, action must be taken at both the individual and governmental/policy levels to mitigate food insecurity and the disruptive effect of pandemic-related guidelines on our eating behaviors.

Food security means that individuals have access to a sufficient amount of nutritious food. Households may access food in many ways, such as growing, buying, and bartering. Gifts, food, and financial assistance are additional sources. Food access is ensured when households have enough resources, like land, money, or social connections, to obtain nutritious foods in adequate amounts. The COVID-19 pandemic has increased the number of individuals experiencing food insecurity in the US. By the end of April 2020, more than 20% of households in the US were food insecure, compared to 11.1% in 2018. In addition, between 35–40% of American households with children under 18 were food insecure in April 2020, compared to 14.7% in 2018 (1). Multiple indicators have also demonstrated that the pandemic is causing food insecurity: industries that rely on imports and export are struggling, food supplies are hard to get locally, and economic activities are disrupted (2).

Additionally, some groups will be more at risk than others for the food insecurity impact of a pandemic. The most at-risk populations in most emergencies are those that are already struggling with hunger, health, and poverty, including low-income households and communities of color in America (2,3). These populations are at greater risk of hunger and malnutrition due to food access issues mediated by income, food environments, where they live, and employment status. Specifically, low-income families and individuals are already forced to make dangerous trade-offs between survival needs, including food, healthcare, education, housing, and other essentials. The COVID-19 pandemic has furthered financial stress due to job loss or reduced working hours, increasing the number of trade-offs low-income families must make for items such as food (4). As a result, the COVID-19 pandemic has exacerbated food insecurity among the most vulnerable Americans.

Food insecurity worsened by the pandemic has led to changes in eating behaviors, disproportionately affecting low-income, minority communities (5). Among low-income households, food access issues have led to decreased consumption of sufficient amounts of food. The COVID Impact Survey and The Hamilton Project/Future of the Middle-Class Initiative Survey of Mothers with Young Children found that 17.4% of mothers reported that the children in their household were not eating enough because they could not afford enough food (1). Other sources have found that in families with food insecurity, parents will often skip meals to ensure greater portion sizes for their children. Families who are food insecure are also more likely to purchase cheaper junk foods over more expensive nutritious foods (6).

Higher-income, white communities have also experienced changes in eating behaviors due to the pandemic, though to a lesser extent than low-income communities (7,8). In fact, one study of employed, white women found no change in the intake of animal protein, fruits, and veggies due to reduced financial access and availability. However, this demographic has experienced eating behavior changes regarding other food groups, including increased consumption of sweet and salty snacks, red and processed meats, and refined grains (8).

Americans overall, in both low and high-income groups, have experienced pandemic-driven eating behavior changes due to social distance guidelines. These changes include shifting to online grocery shopping, buying shelf-stable foods more often, cooking at home more often, and decreasing indoor restaurant dining (9).

Eating behavior changes and food insecurity have health implications for both low and high-income individuals. Changes in eating behavior involving increased consumption of sweet and salty foods are linked to weight gain in the short term and a greater risk of chronic diseases like diabetes and high blood pressure in the long term. In particular, limited access to nutritious food can lead to nutritional deficiencies. Iron and vitamin D deficiency are already common, and underconsumption of foods rich in these nutrients can result in iron deficiency, iron deficiency anemia, and longer-term problems with bone health. Food insecurity also worsens existing diseases and is a predictor of malnourishment, obesity, and other nutrition-related diseases. These morbidities contribute to a greater risk of chronic and infectious diseases, such as COVID-19, and create costly burdens on both health care consumers and systems (5). Food insecurity also has negative psychological consequences. The uncertainty of one’s next meal, poor sleep, and other biobehavioral effects of malnourishment can take a toll on one’s mental health (1). The psychological stress of food insecurity activates the body’s stress response, leading to inflammation, possibly increasing an individual’s risk for numerous chronic diseases.

Given the significant negative impacts of pandemic-driven food insecurity on eating behaviors and poor health outcomes, it is important to address this issue at both the government/policy and individual levels. Programs currently exist to support families struggling with food insecurity; however, they are not sufficient. Recent research has found that while programs like the Supplemental Nutrition Assistance Program (SNAP) make food more affordable, the cost of food in states like Connecticut was 40–50% higher than these benefits in 2015. This emphasizes how policies fall short in providing access to basic nutrition needs to low-income communities that are disproportionately affected by rising food costs. New policies need to be implemented in tandem with community-based organizations that work to boost economic opportunities and access to food (10).

Another food insecurity report stresses the importance of municipal authorities in ensuring food security in emergencies such as a pandemic. The success of municipal authorities in this regard depends on three important factors: the degree to which the public is informed about the necessity of household and community preparedness, the capacity of public and private agencies to organize and provide basic services and needed assistance under stressful circumstances, and the degree to which mass confusion, civil disorder, and conflicts over resources disrupt response efforts. Municipal authorities must work together with the national government and the private sector to secure essential food in consecutive periods of 6–12 weeks when normal supplies may be disrupted, and to ensure that the population has food access, particularly the most vulnerable individuals (2).

Further insight into interventions was gathered from an interview with Dr. Lauren Fiechtner, the Director of Nutrition at MassGeneral Hospital for Children in the Division of Gastroenterology and Nutrition. Dr. Fiechtner is the Senior Health and Research Advisor for the Greater Boston Food Bank. Dr. Fiechtner recommended continuing to prioritize funding for expanded food and financial assistance such as WIC, SNAP, P-EBT, universal school meals, and unemployment benefits. Previous research has also recommended that to increase food security, economic security, and economic growth, the national government should increase the generosity of food security programs immediately and sustain the benefit for enough time to ensure families are well-positioned after the pandemic. In particular, the government should increase maximum SNAP benefits by at least 15% and double the minimum benefit (1). This policy has now been adopted by the Biden Administration but can be expanded to support additional populations of vulnerable individuals.

Dr. Fiechtner also discussed ways that individuals could take action at the local level to alleviate food insecurity. The food banks and their network of food pantries have served an increased number of people during this time. These individuals are disproportionately affected by diabetes, hypertension, and obesity, morbidities that predispose them to severe illnesses such as COVID-19. Therefore, such pantry systems statewide are important in both emergency and non-emergency contexts because they fill a need for food access, particularly for vulnerable individuals. Because of the central role of food pantries and food banks in addressing food insecurity, Dr. Fiechtner emphasized the importance of volunteering at food pantries as a way to increase food access at the individual level. She stressed other forms of volunteering such as donating funds and food to food pantries and food banks and showing compassion towards communities that are experiencing food insecurity, all approaches that can help destigmatize food insecurity.

The impact of food access and economic stability on the physical and mental health care of vulnerable communities is clear. As a physician-led advocacy group, we aim to promote more interventions that improve the well-being of our community in challenging times.

For Boston-area residents:

  1. Volunteer at and donate to Greater Boston Food Bank
  2. Assist with meal preparation, service, and clean-up at St. Francis House, the largest day shelter in MA

For everyone:

  1. List of resources for those who may be experiencing food insecurity during the pandemic
  2. Find a food bank near you. Search their website for opportunities to donate and volunteer.

Sources:

  1. https://www.brookings.edu/blog/up-front/2020/05/06/the-covid-19-crisis-has-already-left-too-many-children-hungry-in-america/
  2. https://www.paho.org/disasters/index.php?option=com_docman&view=download&category_slug=tools&alias=533-pandinflu-leadershipduring-tool-7&Itemid=1179&lang=en
  3. https://www.feedingamerica.org/sites/default/files/2021-03/National%20Projections%20Brief_3.9.2021_0.pdf
  4. https://frac.org/wp-content/uploads/2021-Spring-ResearchWire.pdf#page=2?eType=EmailBlastContent&eId=41e09328-2d2e-4b11-803e-6fd105cc9652
  5. https://tcf.org/content/commentary/covid-19-lays-bare-vulnerabilities-u-s-food-security/?agreed=1
  6. Dr. Lauren Fiechtner’s interview conducted on March 19, 2021.
  7. https://foodinsight.org/wp-content/uploads/2020/06/IFIC-Food-and-Health-Survey-2020.pdf
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697798/#B14-nutrients-12-03468
  9. https://foodinsight.org/consumer-surveys-covid-19s-impact/
  10. https://ctmirror.org/2020/07/06/study-highlights-worsening-disparities-amid-covid-19-pandemic/

Authors: Emily Lin and Darshana Banka

Edited by: Dr. Daniel Kamin, Dr. Elana Pearl Ben-Joseph, and Dr. Lauren Fiechtner

The COVID-19 Action Coalition (COVAC) is a Massachusetts-based physician-led, grassroots non-profit that advocates for evidence-based public health practices. Darshana Banka is the COVAC Medium Team Lead and a current Junior studying at Wesleyan University. Emily Lin is the COVAC Medium Team Content Writer and a current Junior studying at Boston University. Dr. Daniel Kamin is the COVAC Physician Medium Advisor. Dr. Elana Pearl Ben-Joseph is the COVAC Executive Director of Communications. The views expressed in this article are the authors’ own and do not reflect the official opinions of the institutions at which they work and study.

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