COVID-19 and food insecurity in the U.S.

A new paper published on the preprint server medRxiv* in May 2020 reports that the measures taken to block the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)  such as social distancing and lockdown are associated with widespread effects on food security in the US state of Vermont.

The global COVID-19 pandemic has resulted in many countries and states declaring lockdown and movement restrictions to prevent the spread of the virus. This has caused severe economic slowdowns and interrupted food supply chains over a large part of the world.

Los Angeles, CA / USA - 03.13.2020: empty shelves at grocery store in Los Angeles. Image Credit: BrittanyNY / Shutterstock
Los Angeles, CA / USA - 03.13.2020: empty shelves at grocery store in Los Angeles. Image Credit: BrittanyNY / Shutterstock

Food insecurity

Food insecurity is defined as “the lack of consistent physical, social, and economic access to adequate and nutritious food that meets dietary needs and food preferences.” It is one of the inevitable consequences of a sharp and sudden lockdown, as was enforced after the rapid spread of the COVID-19 pandemic to almost all the countries of the world.

It is estimated that in 2018, about 11% of families in the US had food insecurity at some point. About 4% had low food security, characterized by interruption of normal eating patterns and reduced food intake.

Food insecurity has many undesirable consequences, including high blood pressure, diabetes, ischemic heart disease, depression, and other mental disorders. The risk of death due to all causes is also greater. People with food insecurity also have markedly higher healthcare needs and costs.

Factors Which Cause Food Insecurity

Food insecurity is closely associated with national and household economic wellbeing. The rate of food insecurity in a region mirrors the unemployment, poverty, and food prices. Given the increase in unemployment in the US since March 2020, food insecurity is bound to rise, based on the events of the economic downturn in 2007-2008.

Food insecurity is not merely a lack of money to buy food in the current situation. Instead, it is the result of many factors such as unavailability of food, inaccessibility of food locations, reduced utilization, and fluctuating conditions.

Short-term unavailability of food has hit the US due to panic buying, which emptied the shelves. However, with the near-complete cutting of the transport chain, food availability is likely to be compromised.

Meanwhile, as the cost of food rises and the infrastructural foundation breaks down, food accessibility also wanes. This involves changes in the way food assistance is distributed, the availability of public transport, and product shortages in some areas. Market reports also suggest that food buying behavior has also changed, pointing to reduced utilization patterns.

How Was the Study Carried Out?

The current study is aimed at addressing the literature gap in documented changes in food insecurity as a result of the pandemic. The researchers collected data from a statewide survey, selecting the mostly rural US state of Vermont for their study. They discuss the findings in terms of difficulties in gaining access to food, coping with these challenges, food assistance program utilization, as well as the implications of food insecurity for public and individual health.

The survey was designed with the help of important state-level organizations and from literature reviews. After a small pilot study, the survey was put online between March 29 to April 12, 2020. A convenience sample was used, with the participants recruited via a variety of methods such as paid advertising, community partner listservs, and advertising via the press, radio, and television.

The US Department of Agriculture form titled “Household Food Security Survey Module: Six-Item Short Form” was used to decide the food security status of the household, in two periods. The first was the year before the outbreak, the other after it, based on the start date set as March 8, 2020 (the date of the first positive test in Vermont). Low and very low food security levels are combined as food insecurity.

How Has Food Security Changed in Vermont?

There were about 3,200 respondents who were eligible for the study. Most respondents were whites, rural, and had a household income below $75,000. They were classified into three categories:

  • Those with food security – either continuously, or who shifted into this category before COVID-19 – about 2,800
  • Those with consistent food insecurity – both before and after the start of COVID-19 – about 470
  • Those with new food insecurity – were food secure before but not after COVID-19 – about 260

The prevalence of food insecurity went up by 33% over this period (from a year before the outbreak), from about 18% to 24%.

About 65% of the food insecurity group was consistently insecure, while about 36% were newly insecure. In the former, 58% of households were eating differently and much less than before (very low food security) since COVID-19, and 42% had low security. Among the newly insecure, 33% had very low, and 67% low, food security.

Factors which increased the odds for food insecurity include job loss (odds are 3.4 times higher), temporary furlough (2.73), fewer hours (2 times), living in a household with children (1.8 times), and being a woman (1.5 times more likely than men). The odds were only half as high in more affluent households, or for people with college degrees.

What Were the Main Challenges to Food Accessibility?

The participants named multiple obstacles to accessing food during COVID-19, both physical and economic. These were more likely in food-insecure households, especially in those who were consistently food insecure. These challenges included unaffordability of food, inaccessibility of food pantries, and ignorance of sources of help or information about food sources.

Food insecure households were much more likely to feel worried about many food access situations and COVID-19. Here again, consistently, food insecure households were much more likely than newly food insecure households to be anxious about all food access situations except that food would become unsafe.

How did People Cope with Food Insecurity?

Coping strategies were more commonly found in food-insecure households. Among these, the consistently food insecure households were more likely to borrow funds, make use of a food pantry, or use government assistance programs like the Supplemental Nutrition Assistance Program (SNAP).

Two-thirds of the households with food insecurity said they were already eating less than usual, to stretch their food longer.

All food insecure households said they would use the same plans going forward, too, while the pandemic lasts.

What Help Did People Want?

Food insecure households were much more likely to appreciate any plan that would improve food access physically or economically. Consistently insecure households were more likely to find benefit in measures like public transit, extra money to spend, extra benefits in food assistance programs, information about and help with making use of such programs, and with the costs of food delivery.

Implications of Food Insecurity

The study shows that all aspects of food security, from physical and economic access to stability, were threatened, which could have significant adverse effects on health. Job loss is linked to food insecurity, indicating a profound and acute population impact.

With Vermont unemployment rates paralleling those of the US as a whole, the Vermont food security situation probably mirrors the American phenomenon as a whole. Apart from the economic difficulty, physical barriers have arisen due to the lack of public transport and the inability to pay for fuel or other means of transport in this rural state.

Again, rural areas present fewer opportunities to benefit from food pantries and other food assistance programs. Where these exist, illness of a volunteer or the need for social distancing may cause massive problems.

Food insecurity negatively affects not just dietary quality but can cause anxiety among adults and children due to the perceived threat that food supplies will run out. Inadequate food intake may impair immune function.

Screening and Food Assistance

Relatively simple measures can reduce food insecurity, such as screening programs and food assistance programs. While requiring capital investment, these can reduce adverse impacts on pediatric health over the long term by cutting short the period of food insecurity and preventing the need for higher spending on health care due to food insecurity.

Screening can be rapidly carried out in the clinic as well as the community level, using the Hunger Vital Sign tool. This is already in extensive use and can be introduced as standard care throughout the pandemic.

Food insecure households could be referred to food distribution resources, or government agencies such as those which handle unemployment benefits could help make sure such families receive the help they need. More fixed and mobile food pantries, or more prescriptions for fruits and vegetables, which benefits food security and overall health, would be helpful.

However, the findings also show that many households that experience food insecurity still do not make use of food assistance programs, perhaps due to shame or from ingrained habits of seeing such government programs as a choice of desperation.

This is especially true of people in non-urban areas who typically rely on family and friends in such situations. When this is not possible due to social distancing, such households are at risk of inadequate nutrition, indicating the need to understand and deal with such attitudes.

Looking Ahead

This is among the earliest studies on how COVID-19 and public health interventions affect food security. The convenience sample was chosen in the interest of rapid completion in the early stages of the pandemic to allow the evolution of these conditions to be assessed over the long term. Also, at the time of the study, many unemployment payments and stimulus checks had not yet reached the beneficiaries, and the effects of these interventions are not clear. Future studies will analyze such aspects as well as the impact of further interventions.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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