As COVID-19 cases reached daily record levels, many families across the United States weighed the risks of celebrating the holiday season with loved ones. Millions faced an additional worry: Would there be any food on the table?
Before the words COVID-19, coronavirus and pandemic became commonplace, nearly 35 million Americans — 10.5% of all U.S. households — experienced food insecurity at some point throughout the year. Defined by the U.S. Department of Agriculture (USDA) as limited access to adequate food due to a lack of money and other resources, food insecurity can cause immediate and long-lasting damage.
Food assistance programs have played an important role before and during the COVID-19 pandemic but must be expanded to truly combat food insecurity among U.S. children and families.
Impact of food insecurity on child health
The AAP policy statement Promoting Food Security for All Children (https://pediatrics.aappublications.org/content/136/5/e1431) recognizes the critical role adequate access to food plays in child health. The policy states that children who live in food-insecure households “are likely to be sick more often, recover from illness more slowly, and be hospitalized more frequently.”
The list of health conditions and behaviors associated with food insecurity in childhood include asthma, developmental delays, behavioral problems, obesity and poor growth. Children experiencing food insecurity are at higher risk for developing hyperactivity, aggression, anxiety, depression, learning disabilities and frequent hospitalizations that limit their ability to thrive in society than children who have adequate access to food.
While these medical problems can be identified, diagnosed, managed and sometimes treated individually, health care providers must understand the role that food insecurity plays in the development and prognosis of these conditions.
Growing number of food-insecure households
Children do not exist in a vacuum. They are taken care of by adults, most of whom battle spending trade-offs like paying rent, putting food on the table, paying for a needed medication or keeping the electricity on. The COVID-19 pandemic has compounded this economic uncertainty.
The Pew Research Center found that approximately one-quarter of U.S. adults surveyed reported that they or someone in their household was laid off or lost their job because of the coronavirus outbreak (https://pewrsr.ch/3mXUBJ5). A study from the Food Research and Action Center found that 21% of those who lost their jobs reported not having enough to eat (https://bit.ly/37GgOoJ). And researchers at the Northwestern Institute for Policy Research estimate that food insecurity has more than doubled as a result of the economic crisis brought on by the COVID-19 pandemic, impacting up to 23% of households during 2020 (https://bit.ly/37MeXPd).
At Feeding South Florida, the largest food bank in Florida, demand for food increased 600% between March and May 2020.
As health care providers who work with children and families, we see a crisis that threatens to drastically alter the long-term health status of children unfolding before our eyes. According to the Brookings Institution, 13.9 million children were food insecure in June 2020 (https://brook.gs/3gpscsM), and Feeding America estimated that 17 million children would experience food insecurity by the end of 2020 (https://bit.ly/36V9zKu).
Simply put, this country is failing at a basic level to keep our children safe and healthy.
Untapped resource
There is, however, a solution that has not yet met its full potential — the government-sponsored Supplemental Nutrition Assistance Program (SNAP).
SNAP, formerly known as food stamps, offers benefits that are broadly available to households with low incomes and fills a gap for families struggling to put enough food on the table. In April 2020, the most recent month of data provided by the USDA, 42.9 million people were enrolled in SNAP, an increase of 15.8% from one month earlier. This number likely increased as the financial instability surrounding the pandemic continued.
Two-thirds of SNAP benefits go to households with children, ensuring access to food for over 20 million children, according to the Center on Budget and Policy Priorities (https://bit.ly/3mSMuxm). This means that SNAP directly mitigates worsening food insecurity for U.S. children and serves as a safety net for families facing financial burdens as a result of an unexpected change in income.
The average SNAP benefit per person is around $125 per month, which amounts to only $1.39 per meal. Congress created the Pandemic-Electronic Benefit Transfer (P-EBT) program, a supplemental benefit for households with children who lose access to free or reduced-price meals due to school closures. P-EBT recently was extended until September 2021.
While these changes meet an immediate need, permanent expansion of these programs is necessary to ensure children and adolescents have access to the adequate nutrition they require to grow and develop normally.
We, as a community of health care providers, have the individual duty to assess the psychosocial aspects of our patients’ care and screen for food insecurity at every visit. We also must continue to advocate for programs that mitigate negative health impacts of financial challenges, both acute and chronic. We must support expansions of these beneficial programs to fight food insecurity and provide families with children access without fear of negative consequences if they apply.
As we reflect on the traditional holiday food and drink that we may have overconsumed, we cannot forget that families with children continue go to bed hungry, unsure if and when they will eat again.
Benoit is a third-year medical student at the University of Miami Miller School of Medicine. Dr. Leeman is a third-year pediatric resident at the University of Miami/Holtz Children’s Hospital Pediatric Residency Program and the program’s liaison to the AAP. Dr. Maurer is a member of the AAP Florida Chapter’s Advocacy Subcommittee and School Health Committee and chairs the Diversity and Inclusion Committee.
