By V. Faye Jones, MD
Imagine walking to your neighborhood store and being unable to purchase fresh vegetables and fruits for your family because you are worried the amount you pay for this “luxury” could provide two to three meals. Imagine you have no food in your home to feed your child and wishing the weekend would be over so your children could go back to school and have a hot meal. Imagine simply not knowing where or when you would be able to provide a healthy meal for your child.
Unfortunately, these scenarios play out over and over in families’ lives throughout our communities. Food insecurity, defined as “limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire these foods in socially acceptable ways,” affected one in six children (18 percent) under age 18 in the United States in 2015. The rates are even higher for children in Kentucky (22 percent) and Jefferson County (18.6 percent).
The American Academy of Pediatrics (AAP) reviewed research on the consequences of food insecurity in children in the policy statement “Promoting food security for all children.” The authors determined that the health and socioeconomic effects of food insecurity are complex and may be long-lasting, affecting both the child and the parent. For the parent, the additional stress associated with the inability to consistently provide needed nourishment for their child may lead to internalizing symptoms, in turn affecting parenting skills.
The report indicated that:
- Parents of children with food insecurity are more likely to report their child has poorer health or problems with behavior or development.
- Children with food insecurity are at higher risk of hospitalization and developing chronic diseases such as asthma, anemia, malnutrition and obesity.
- Food insecure children are at higher risk of depression, anxiety, inattention and hyperactivity, which may impact school readiness.
- Children who have experienced food insecurity, particularly early in life, may display developmental problems and have lower cognitive skills.
- Adolescents are at increased risk for dysthymia, suicidal ideation and substance disorders.
Clearly, social determinants, the conditions in which individuals are born and live that are shaped by financial and other resources, can explain a number of health disparities among populations. An obvious social determinant is economics. Children living in households with incomes below the poverty level (family income for a family of four is $24,300) are twice as likely to have food insecurity compared to all households. Food insecurity also is three times more prevalent in households headed by a single woman and twice as likely in households headed by a Black or Hispanic guardian.
As a pediatrician, preventing children’s health problems is my goal. If prevention fails, however, we can effect change by identifying issues and using innovative strategies that focus on social determinants of health to correct the situation. Families can quickly be identified for risk of food insecurity with the following two questions 83 percent of the time.
- Within the past 12 months, we worried whether our food would run out before we got money to buy more. (Yes/No)
- Within the past 12 months, the food we bought didn’t last and we didn’t have money to get more. (Yes/No)
If parents respond positively to either of these questions, they should be directed to community and government resources for support. It is important for pediatricians and their office staff to be knowledgeable of community resources, such as Dare to Care and its “Cooking Matters” program, and to encourage patients and parents to utilize government resources including the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC). The simple act of directing families to the support they need in this area may substantially alter a child’s life course toward one of health, happiness and academic success.
In addition, I believe physicians have a responsibility to advocate for funding of food assistance programs at all levels of government and to support research in the relationship of food insecurity, stress and other adverse outcomes in children, as well as other health inequities associated with social determinants.
-V. Faye Jones, MD, PhD, is assistant vice president for Health Affairs – Diversity Initiatives at the University of Louisville.