FFPAC Nutrition Policy Update

Friedman Policy Corner: The $2.4 Billion Cost of Hunger

In February of this year, the Greater Boston Food Bank released a report on the hidden costs of hunger and food insecurity in Massachusetts. For the Policy Corner this month, Emily Cavanaugh reports on what the report’s findings mean for public health policy in the Commonwealth.

The Greater Boston Food Bank recently partnered with Children’s Health Watch on a report, released this February, documenting the hidden costs of food insecurity in the state of Massachusetts.  This first-of-its-kind study was commissioned as part of the mission of Children’s Health Watch to “inform public policies and practices that give all children equal opportunities for healthy, successful lives”. Children’s Health Watch is headquartered at Boston Medical Center, where the health effects of hunger can be seen firsthand.

The report states that these health effects cost the commonwealth a whopping $2.4 billion in 2016. High cholesterol, anxiety and depression, asthma, and diabetes were just a few of the conditions the study related to hunger. Indirect costs incurred by anxiety, behavioral problems, inattention or ADHD by food insecure children were also captured. Lastly, the study sought to account for work absence and lack of productivity caused by the related health conditions.

Costs of various diseases and poor health outcomes caused by hunger, as estimated by the study. (Image: MACostOfHunger.org)
Costs of various diseases and poor health outcomes caused by hunger, as estimated by the study. (Image: MACostOfHunger.org)

Though it’s difficult to prove certain causality by these methods, the study concluded that “as with the relationships between smoking tobacco and lung, throat and mouth cancers, the evidence of relationships between food insecurity and these health outcomes is so strong … that we believe we are justified in acting on strong evidence even if it is not absolutely conclusive and unassailable.” The combination of poverty and food insecurity contribute to poor health and educational issues and create a feedback loop, reinforcing the poverty that is the root cause of hunger.  While this study didn’t address racial disparities in food insecurity, a 2017 pamphlet from bread.org states that people of color in Massachusetts are 3 times more likely to face poverty and hunger, and in 2016, Children’s Health Watch reported significantly higher rates of hunger among immigrant families.  Intervening to address food insecurity can help to breaking that poverty-health-education feedback loop, enabling wellness and opportunity for all the Commonwealth’s residents.

Having established that hunger is a public health issue, how do we address it? The study makes recommendations in 3 main areas – healthcare practices, policy at the federal and local level, and academia. In the healthcare industry, we can consistently screen for hunger and intervene as necessary, pointing patients and parents to resources like SNAP and food banks.  GBFB has partnered with nine medical providers in the state, including three in Boston to implement the Hunger Vital Sign two-question that screening tool for food insecurity. As healthcare providers see the evidence of hunger during doctor’s visits, they are uniquely positioned to connect families in need with the available resources. Therefore partnerships between doctors and hospitals, foods banks, and other assistance programs could be very effective.

On a national policy level, the upcoming Farm Bill could contain changes to nutrition assistance programs, and the study recommends that lawmakers be pressured not to reduce SNAP funding. Reduction in funding could lead to reduction in the number of families served or amount of food dollars granted to each family, further reducing support that is already sometimes inadequate.

At the state level, lawmakers can mandate “breakfast after the bell” programs, especially in low-income communities. Several communities, from Boston to Worcester to Chicopee have implemented breakfast after the bell and have seen increases in attendance, and decreases in tardiness and nurse visits. The state could also increase funding for WIC and the Massachusetts Emergency Food Assistance Program. The CDC has acknowledged the link between nutrition, health, and academic performance, meaning hunger can limit the academic potential of children and should be addressed to provide more equality in our school systems. Access should be improved to state and federal assistance programs, first by creating a common application for MassHealth, SNAP, and WIC benefits. Filling out one set of forms to access multiple benefits would increase participation, particularly for those who are on the edge of qualifying for assistance.

We can all contact our representatives at the state and local level to bring these causes to their attention. You can find your legislator here, or contact legislators serving on specific committees such as public health or education. Contact your city or town officials to inquire about school food programs. Call a SNAP outreach partner organization and help residents enroll in SNAP programs.

Lastly, in academia, we can undertake research that supports these policy recommendations and sheds light on the causes and effects of hunger in our community.  Research regarding vulnerable populations can help target nutrition assistance where it is needed most. Though interventional studies are challenging to carry out, they provide strong evidence for effective solutions. A stronger causal link between hunger and health outcomes would strengthen the argument that food insecurity is a public health issue that needs to be prioritized in policy making.  Lastly, a review of costs to implement some of the recommended programs, compared to the annual $2.4 billion cost of adverse outcomes could make a compelling, black and white case for addressing hunger as a public health issue.


Emily Cavanaugh is a professional in the medical diagnostics industry with a Bachelor’s degree in biology and a persistent passion for nutrition.  After years of reading Marion Nestle books and following FFPAC on twitter, she decided to get involved by writing a Policy Corner article. She is also an enthusiastic home cook, bread baker, and gym goer.

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