Hunger and Food Assistance Policy in the United States

Regina Galer-Unti

• Publisher: Routledge
• Year: 2019
• Print ISBN: 9780367275938
• eBook ISBN: 9781000124262
• Edition: 1
• Topic: Betriebswirtschaft
• Subtopic: Business allgemein

Originally published in 1995. This study collects and analyses the results of hunger studies carried out in the United States during the 1980s, whether national, state or local. It also reviews the history and development of food assistance programs and policy. This is an unusual and fascinating study of public health policy which employs meta-analysis to investigate the sociodemographic factors affecting those seeking food assistance and draws recommendations for future studies and to feed into policy decisions.

I

Introduction

In the early 1980s reports of widespread hunger among members of the U.S. population began to appear in the media. Throughout the decade this phenomenon of “hunger in the land of plenty” was continually reported and debated. Hundreds of national, state, and local studies were undertaken by churches, private agencies, and government agencies in an effort to document the existence and extent of hunger in the U.S. The President’s Task Force on Food Assistance studied the problem in 1984, but found no evidence of widespread hunger. In 1985 the Harvard-based Physician Task Force on Hunger in America [Physician Task Force] estimated that 20 million Americans were experiencing hunger while 40 million were at risk of hunger. This lack of agreement with regard to the incidence and prevalence of the problem was argued throughout the 1980s (Brown and Allen 1988). The confusion over the issue is exemplified by statements such as the one in 1988 by then Surgeon General C. Everitt Koop. In his opening letter to The Surgeon General’s Report on Nutrition and Healthy, Koop stated:

“The apparently sizeable numbers of people resorting to the use of soup kitchens and related food facilities, as well as the possible role of poor diet as a contributor to the higher infant mortality rates associated with inadequate income, suggest the need for better monitoring of the nature and extent of the problem and for sustained efforts to correct the underlying causes of diminished health due to inadequate or inappropriate diets.” (United States Department of Health and Human Services [USDHHS], 1988, p. iv)

The Surgeon General’s Report on Nutrition and Health was developed as an authoritative source of information about the relationship between diet and disease and was designed to be used as the basis for U.S. nutrition policy decisions (McGinnis and Nestle 1989). Yet hunger, and its related physiologic and behavioral problems, was not addressed in the report.

Despite the lack of agreement about the nature and extent of the hunger problem, there is agreement in the scientific community that hunger can have particularly detrimental health consequences for the individual. Malnutrition is a serious health threat and this is especially true for vulnerable population segments such as pregnant and lactating women, infants and children, and the elderly (Guthrie 1979; Robinson et al. 1986). Authors of some studies suggested that there had been an increase in indicators of health problems associated with inadequate nutrition during the decade of the 1980s (Physician Task Force 1985; USDHHS 1988). Brown and Allen (1988) reported an association between poor diet and elevated infant mortality rates. Polhamus, Peterson, and Miller (1989) documented poor diet in a low income group of Boston children and a relationship with failure-to-thrive syndrome.

This was not the first time that hunger appeared as a prominent national issue. Hunger and malnutrition became the topics of national security during World War II when a noticeably large number of draftees were rejected because of nutrition-related health disorders (Food Research and Action Center [FRAC] 1984). In 1960, after witnessing hunger in West Virginia, John F. Kennedy made the eradication of hunger one of his campaign promises. His pilot food stamp program became, as a result of the passage of The Food Stamp Act of 1964, a national food assistance program. The purpose of this law, was to aid low income families in improving their diets and overall nutritional status.

In 1968, hunger resurfaced as a national political issue. This time, however, studies were undertaken by various groups to document the existence of this problem. The Citizens’ Board of Inquiry into Hunger and Malnutrition in the United States [Citizens’ Board of Inquiry] documented 256 counties in the U.S. that required emergency food assistance for its low income recipients. As a result of this and other studies, a special Senate committee was formed and a 1969 White House conference was convened. In the early 1970s existing food assistance programs were expanded and new programs initiated. In a 1977 report to the Senate Select Committee on Nutrition and Human Needs, government food assistance programs were heralded as the catalysts for the virtual eradication of hunger in the United States (U.S. Senate 1977).

One of the issues that emerged from the furor over hunger was an expressed need for systematic surveillance and monitoring of the nutritional status of the U.S. population. One resulting effort was the Ten-State Nutrition Survey—the first effort to assess the nutritional status of the U.S. population (USDHHS 1989). Since then, a variety of surveillance data, including that from the National Health and Nutrition Examination Survey [NHANES] series, have been collected (USDHHS 1989). Despite these surveillance efforts and the apparent recurrence of the hunger problem, the National Nutrition Monitoring System [NNMS] has failed to initiate data collection that would not only estimate the number and characteristics of hungry individuals, but would also do so in a timely fashion. In 1990, Public Law 101-445, The National Nutrition Monitoring and Related Research Act, was signed into law. This law mandates the sampling of low income population subsets on a continuous basis. These population subsets will be monitored for food expenditures and participation in food assistance programs. The government will also attempt to measure time periods in which the acquisition of adequate food is impaired due to insufficient monetary resources (U.S. Congress 1990).

The impact of the lack of adequate monitoring and surveillance in the 1980s is evidenced by the paucity of appropriate data with which to examine the hunger issue (Brown 1984). The importance of an accurate database for use in making informed policy decisions is acknowledged by policy planners (Hanft 1981; Bazzoli 1985). Health policy decisions are predicated upon epidemiologic databases (Ibrahim 1985) and policy formulation is hindered if not obstructed by inaccurate or nonexistent data.

The need for an accurate description of populations at risk of hunger is widely recognized by individuals conducting hunger research (Physician Task Force 1985). As noted previously, hundreds of studies were undertaken in an effort to assess the hunger problem in the U.S. Nestle and Guttmacher (1989) chose 25 of the state studies for comparison. The Physician Task Force presented a narrative summation of selected studies in its 1985 report: Hunger in America. Little effort was made, prior to this book, to integrate data from various studies or to merge and analyze data from surveys.

In this investigation, meta-analysis was employed to systematically examine studies in which survey methodology was utilized to study the hunger issue. Data from this analysis were synthesized in order to generate descriptive characteristics and baseline information about hunger survey respondents. Correlational analyses between certain socio-demographic characteristics and self-reported hunger were conducted. Measurement, surveillance, and monitoring techniques for the study of hungry people in the United States were discussed. Meta-analysis as a tool for investigating nonexperimental studies was evaluated. Finally, government food assistance programs during the decade of the 1980s and factors that were found to be critically linked to hunger were discussed.

Statement Of The Problem

Adequate nutrition is a basic component of health. Reports, in the 1980s, indicated that the health of segments of the population of the United States was being compromised due to inadequate dietary intakes (Brown and Allen 1988). Conflicting evidence, however, as to the nature and extent of the problem and a failure by the U.S. government to establish a surveillance and monitoring system to appropriately measure the nutritional status of the nation resulted in a lack of government data to study the problem.

The purposes of this study were to establish consensus data regarding the characteristics of individuals who self-reported hunger, to make suggestions as to how this information can and should be collected in the future, and to discuss the policy implications of the research. This was accomplished through the examination of hunger surveys conducted in the U.S. between 1981 and 1989. During this time frame, a large number of hunger studies were conducted by states, churches, and private agencies. Meta-analysis was employed for the review of these hunger studies.

Meta-analysis is a methodological technique that is achieving importance in the field of health. For the most part, meta-analysis has been used to study the results from experimental research. Recently, however, this technique has gained favor with investigators studying survey research (Hall and Dornan 1990). This study, then, also provided information regarding the use of meta-analysis to study survey methodology.

Research Questions

1. What are the characteristics of individuals who sought emergency food assistance?

a) What are the basic socio-demographic characteristics of individuals who sought emergency food assistance?

b) Do these characteristics vary depending on the type of food assistance facility or the type of survey administered?

2. To what degree are each of the following factors correlated with hunger and are there interactions between some of the factors?

a. Gender/sex

b. Ethnicity

c. Age

d. Marital status

e. Education

f. Employment status

g. Income level

h. Income source

i. Household size

j. Household composition

k. Special dietary needs

l. Food stamp participation

m. Participation in government food assistance programs

n. Participation in government assistance programs

o. Living conditions

p. Geographic location

q. Type of locale

3. What recommendations can be made for future meta-analytic investigations of survey research?

4. What are the policy implications of the research findings?

a) What conclusions about government food assistance policy in the 1980s can be drawn from the results of this study?

b) How can information from this study be used to aid in future policy decisions?

Organization Of The Book

Chapters two through seven are organized in the following manner. The second chapter is a review of the background literature related to the study of hunger in the 1980s. This chapter contains a brief discussion of the physiological effects of insufficient caloric intake and adverse consequences for certain at-risk populations in the United States. An examination of the history of hunger reports and the response of the U.S. citizenry and government is also undertaken in this chapter. The final section in this chapter involves the methods used to monitor hunger in the U.S. and the National Nutrition Monitoring System. Meta-analysis was used to assist in the systematic review of hunger studies conducted in the United States in the 1980s and Chapter Three provides an overview of this method of investigation. From there, an extensive discussion of the data collection and the process used to select the surveys used for statistical analysis is undertaken. Chapter Four contains a discussion of the statistical analyses employed in the study. This chapter contains information about the socio-demographic characteristics of the survey respondents as well as the results of the correlational analyses. Chapter Five is a discussion of the use of meta-analysis in a study of surveys. The focus of Chapter Six is an examination of food assistance policy in the United States. This analysis is drawn from a perspective gained by studying the quantitative and qualitative results of the analysis of the studies. The seventh and final chapter contains conclusions and recommendations for surveillance and monitoring of hunger in the United States, improvement of future hunger surveys, and suggestions for food assistance policy in the U.S.

II

Literature Review

In this chapter, three areas that are integral to a thorough investigation of hunger in the United States are examined. First, the effects of hunger and malnutrition on human beings are discussed. The health consequences of hunger are discussed in terms of specific populations (e.g., pregnant women) that are particularly susceptible to negative health effects of malnutrition. Second, a brief historical recountal of the history of hunger and food assistance in the United States is presented. Finally, the history of hunger surveys, types of hunger surveys conducted in the decade of the 1980s, and the National Nutrition Monitoring System is discussed.

Hunger, Malnutrition, And Human Health

Food is the basic sustenance for human life. In the strictest biochemical sense, food is necessary for three basic functions in the human body: 1) it provides for maintenance of the bodily functions; 2) it provides necessary energy; and 3) it is required for the replacement of tissue (Rolfes, DeBruyne, and Whitney 1990). Food also provides nurture and is a psychological component in human development (Guthrie 1979; Robinson et al. 1986). Many cultural or social customs also place importance on food. When food is unobtainable in adequate amounts or there is an imbalance in the intake of essential nutrients, the health of the individual is threatened.

Hunger and Malnutrition Terminology

In order to discuss hunger and malnutrition, it is necessary to agree on the terminology to be used. For the purposes of this study, the following terms were utilized:

Starvation. Starvation is the condition in which the individual is dying from lack of food (Robinson et al. 1986).

Undernutrition. Undernutrition occurs when an individual consumes an inadequate amount of kilocalories and/or essential nutrients (protein, vitamins, minerals, and water) (Robinson et al. 1986).

Malnutrition. Malnutrition literally means bad or poor nutrition. Malnutrition exists when an individual fails to obtain the essential nutrients in proper quantity or proportions. Malnutrition, therefore, results in impaired health, growth, and/or ph...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Original Title Page
• Original Copyright Page
• Dedication
• Table of Contents
• List of Tables
• Preface
• Original Half Title
• Chapter 1: Introduction
• Chapter 2: Literature Review
• Chapter 3: Method and Procedure
• Chapter 4: Results and Discussion
• Chapter 5: Evaluation of the Methodology
• Chapter 6: Policy Implications
• Chapter 7: Conclusions
• Appendix
• Bibliography
• Index