Policy Corner: The $2.4 Billion Cost of Hunger

by Emily Cavanaugh

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.

Friedman Hosts the 2018 Global Food+ Symposium

by Sam Jones

The second annual Global Food+ Symposium was hosted at Tufts University’s Friedman School this year. Innovative research being conducted at Tufts, MIT, Boston University, and Harvard University in the realm of the global food system was presented in speed-dating style, with each speaker giving only a seven-minute talk. Only some of the takeaways are reported here; the entire event can be viewed online.

February 16, 2018 marked the second annual Global Food+ Symposium, hosted by Tufts University at the Friedman School of Nutrition Science and Policy. This year, 23 researchers from Boston University, MIT, Harvard, and Tufts shared the findings of their work in seven-minute presentations on topics ranging from microbiology to nutrition to theology. I attended the conference in its entirety from 12:30 to 4:30 on a Friday afternoon because I wanted to learn about what other researching in our consortium of schools are investigating to gain insight into what the non-Friedman community has to say about the global food system.

Throughout the afternoon, speakers presented fascinating research that touched every corner of the food system. Several presenters from Harvard and MIT discussed how water affects our food system, covering everything from breeding crops to use less water, to developing more adaptable water conserving technologies, and the ramifications of developing a water market in which price reflects scarcity. These speakers together illustrated that whether in the Zambezi River Basin or in Melbourne, Australia, water use and availability affects our food system, but there are steps we can take right now to plan for uncertainty in the face of climate change.

Nutrition was, of course, the subject of several of the presentations. Tufts professor Will Masters discussed his findings on the nutritional quality of baby food. Spoiler alert: the global baby food supply is not actually that nutritious. Alison Brown, a post-doctoral fellow at Tufts presented the research from her dissertation comparing the diet quality and risk of hypertension in foreign-born non-Hispanic blacks to those of U.S.-born blacks. Her findings suggest that the former are better-off than the latter. While useful for developing culturally-appropriate nutrition strategies, it does not delve into the root causes of these differences. A more causal-based study would be useful if the intention were to narrow the gap in diet quality and health between these groups.

Most of the presenters at the symposium used or researched cutting-edge technology to answer some of the most vexing problems in our global food system. Karthish Manthiram from MIT, for example, presented his research on how electricity derived from solar panels can be used to create fertilizer. His research found that by using electric voltage in place of high temperatures, a low-footprint nitrogen fertilizer can be created and used by small-scale farmers in even the remotest parts of Africa.

Angela Rigden, a post-doctoral fellow at Harvard University, presented exciting research derived from new satellite data. These data showed that vapor pressure and root zone soil moisture actually explain significantly more variability in crop yields than does temperature alone. Both Jenny Aker from Tufts and Alicia Harley from Harvard separately explored the effects of having access to technology for poor farmers in Africa and India, respectively. They found that even where a technology exists, the targeted problems may not be solved in exactly the way they were intended. For example, Alicia Harley’s research found that poorer rice farmers were not adopting a system of rice intensification (SRI) that used less water because such a practice required control over one’s water source—a luxury most poor farmers do not have. As Jenny Aker put it, one specific technology is “not going to be a silver bullet.”

Water, technology, health, and sustainability were the overarching themes that wove the presentations together. But one researcher stood alone both in his discipline and in his ability to wow an audience of entirely dissimilar mindsets. Dan McKanan, a senior lecturer in Divinity at Harvard University, revealed that the foundations of organic agriculture, organic certification, WWOOFing, biodynamic agriculture, community supported agriculture, and the environmentalist movement all sprung out of a religion called Anthroposophy. In his words, this was a religion that acted as an antidote to the ideological monoculture system—an antidote to the “monocultures of the mind.”

What the innovative research presented at the Global Food+ Symposium made me realize is that there probably will never be a “silver bullet” that can solve the issues of water scarcity, food insecurity, malnutrition, or climate change. But the research that is being done in these interdisciplinary and diverse fields is worth pursuing, whether it aims to solve a big problem in a small place or a small problem on a global scale.

Sam Jones is a first-year AFE student with a passion for sharing others’ stories. She is currently an intern at Culture Magazine nd hopes to pursue a career in sustainable agricultural development and food journalism.

UN ECOSOC Recap: Building a Sustainable Future

by Laura Barley

In January, second year AFE student Laura Barley served as a student representative to the United Nations Economic and Social Council (ECOSOC) in New York City. Empowered youth from across the globe gathered with governmental officials to share ideas about how to achieve the UN’s 17 Sustainable Development Goals. Here, she recounts her experience and shares some of the key takeaways from the event.

Image source: Author

Image source: Author

For two days at the end of January, I was given the opportunity to travel alongside four fellow Tufts student representatives to the ECOSOC Youth Forum at the United Nations Headquarters in New York. The forum was a whirlwind of speeches, brainstorming sessions, and long-winded discourse from youth representatives and official ministries from all over the world—all putting their heads together to decide how to best empower the future.

ECOSOC, abbreviated from the UN Economic and Social Council, regularly holds these types of events to integrate policy frameworks that support the Sustainable Development Goals from the ground up. For those unfamiliar with the SDGs, they were created by the UN in 2015 as a comprehensive platform of 17 goals that cover the world’s most pressing issues: gender equality, hunger and malnutrition, and climate change mitigation, among many others.

By popular consensus, the SDGs are seen as a much-needed improvement from the UN’s previous set of Millennium Development Goals, which many viewed as too vague and intangible. Instead the SDGs work to define timely, measurable goals that nations can properly mobilize—for instance, reducing current levels of food waste by half, or completely eradicating poverty for people living on less than $1.90 a day.

Fostering the notion that young people have exceptional power to drive social change, the Youth Forum focused specifically on six SDGs that dealt with clean water and sanitation, affordable and clean energy, sustainable cities and communities, sustainable consumption and production, life on land, and technological innovation, and how to empower youth to achieving these goals.

The structure of the forum allowed participants to choose only one SDG-focused brainstorming session, and as the pious AFE student that I am, I naturally gravitated towards the session on SDG 12: Sustainable Consumption and Production. Voices from Great Britain, Nepal, and Saudi Arabia all echoed sentiments familiar to the halls of Jaharis—we’re consuming too much and too quickly for our planet to withstand. We ought to know better by now, but we’re not living up to our own standards as we should be. And under the framework of youth empowerment, the subtext of these truisms begged the question: how can we raise our children to be more mindful than we’ve been?

The voices from developed nations, including my own American perspective, maintained that serious gaps in our educational institutions preclude most youth from even realizing that their choices have an impact on the natural environment. Exposure to nature, agriculture, and nutrition have become secondary and tertiary priorities in most public school systems, which ultimately neglects the chance to positively influence the consumers that all children will become.

So, when it came time to distill our ideas into concrete policy recommendations, we converged on a few points central to the evolution of education. We recommended increasing diverse and equitable educational experiences across all types of school systems, emphasizing focus on transforming the mindsets of youth from those of a consumer towards those of a producer. In this sense, sustainable development means an expanded awareness of the relationship between consumption and production, and that even the simplest of our everyday choices has the power to influence how the world’s natural resources are used.

Image source: Author

Image source: Author

Ultimately, the participants’ recommendations will be compiled into a broader report on youth engagement published by the United Nations, reflecting official policy goals of the signatory countries to the SDGs. And though I gleaned constructive insight into the annals of UN procedure—how they gather information, how they form their policy stances—I found that the hallway conservations I had with my peers were far more valuable. These events function to tap into the infinite potential of minds with vision and hope, and the sum of our parts are starting to become an incredibly powerful whole. Earnestly, I hope to see the Tufts community continue to engage with the Sustainable Development Goals at this level and beyond.

Laura Barley is a second-year Agriculture, Food, and Environment master’s student ceaselessly curious about the complexity that global food systems has to offer. She’s always happy to indulge conversation at laurabarley88@gmail.com.

Gut Microbiota and the Developing Child

by Ayten Salahi

Undernutrition poses a formidable threat to the health and life trajectory of children around the world. A new study examines the role of gut microbiota in modulating nutritional status and early life development, and sheds light on bacterial transplants as a potential new method to tackle this longstanding challenge.

The human gut microbiome is the bacterial ecosystem that lives predominantly in the digestive tract and plays a significant role in our immune response, neurological networks, and both our mental and physical development throughout life. The delicate balance of ‘good’ and ‘bad’ gut bacteria – or gut maturity – partially determines a developing child’s ability to absorb critical nutrients through food. Without that ability during early life, or without medical interventions to restore that ability, children are likely to manifest long-term health consequences associated with childhood undernourishment, including physical stunting, immune dysfunction, and neurodevelopmental issues. Childhood undernourishment has also been linked to permanent impairments to health and human capital, that impact both extant and future generations.

The ‘solution’ to childhood undernutrition is multivariate. As scientific understanding of microbiota continues to evolve, researchers and healthcare practitioners have begun to shift their focus towards examining how the microenvironments of our gut bacteria impact our macroenvironments, and whether these microenvironments could signal potential new treatment targets to alleviate the global burden of childhood undernutrition.

Bacterial transplants have been identified as one potential treatment. A study from Blanton et al. examined whether developmental outcomes could be inherited through microbiota – specifically, through fecal transplants. They tested what would happen if germ-free mice were transplanted with the gut bacteria of both ‘healthy’ and  ‘severely stunted’ infants and children, all of which were fed a traditional Malawian diet of cornmeal, peanuts, and kidney beans. The results showed that when germ-free mice were transplanted with fecal transplants from severely undernourished children, the mice manifested stunted growth, impaired bone morphology, and metabolic abnormalities in the muscle, liver, brain, and immune system. This study therefore suggests that gut bacteria play a role in the transference of developmental outcomes.

Findings from the same study also suggest that microbiota transplants from healthy donors could potentially prevent growth impairments and undernourished health outcomes in recipient animals, depending on the age of the donor and the type of bacteria. When researchers co-housed mice that had just received microbiota from either 6-month-old healthy donors or severely undernourished donors, microbiota from the healthy donor group overpowered and displaced the microbiota from the undernourished donor group, and prevented developmental impairments in both groups.  More research is needed to confer these findings in humans, but the results of this study present the interesting possibility that gut immaturity can be prevented and repaired through transplantation of microbiota from healthy donors. Future research must also be conducted to examine whether bacterial transplants play a role in preventing long-term mental, physical, and socioeconomic consequences of early life undernourishment, or constitute any reduction to the global burden of childhood undernutrition.

Study of microbiota in the developing child offers a compelling new lens with which to examine health inequity at the microscopic scale, with macroscopic implications for therapeutic interventions in community health. Adequate nutrition is the cornerstone of human development, and a growing body of evidence suggests that gut microbiota play an important role in promoting early life nutritional status. The potential therapeutic use of bacterial transplants could have significant implications for global nutrition programs seeking to identify new levers to improve childhood nutrition, particularly in resource-poor settings. However, gut microbiota therapeutics constitute only a small and largely theoretical part of the much bigger and more complex picture that is global nutrition. Pervasive issues around sanitation, hygiene practices, and access to potable water and nutritious food continue to constitute some of the greatest challenges to global health worldwide.

Ayten Salahi is a first-year FPAN MS and RD candidate, and is dedicated to the future of policy, programming, and clinical practice in sustainable diets. Ayten came to Friedman after working as a molecular and clinical researcher in neuropharmacology and diabetes management for nearly 8 years.