Institute Insights: September 2017


Ending hunger is a matter of political will. Photo: Bread for the World

From the Director

If you don’t teach classes, and you don’t have children or grandchildren heading back to school, September might not seem much different from August. But the start of the academic year also seems to signal government agencies and organizations, large and small, that it’s time to release their reports. At Bread for the World Institute, we read quite a few reports no matter what month it is — but there seems to be a noticeable uptick in September.

Some reports focus on the recent past, since fall is as early as most statistics covering the previous calendar year can be gathered and verified. Others focus on themes, events, commissions, hearings … Most include data. Lots of data. Charts, graphs, rankings, descriptions of methodology, critiques of other reports’ methodology… 

Is ending hunger mainly a matter of reports and quantitative analysis? No — it’s a matter of political will. Hunger will end when enough people with enough power, influence, and persistence decide to end it. But quantitative information is proving more important than some anti-hunger advocates may have thought in the past. The personal stories of what works to reduce hunger, and the qualitative evaluations of policies and their impact, are still very important. But we’ve come to realize that if you think something is important, you keep track of it using all available tools.

The Millennium Development Goals (MDGs) proved that setting goals and measuring progress toward them (and even some friendly competition on occasion) had an impact. Hopefully the same will be true of our current set of goals, the Sustainable Development Goals (SDGs). The detailed discussions of SDG “indicators” that will track progress in valid ways are a positive sign.

In this issue of Institute Insights, we alert you to reports that amplify the message of several past Hunger Reports (the 2015, 2016, and 2017 editions, on gender and hunger, health and hunger, and fragility and hunger, respectively) and reflect on missing data and its implications. Happy Reading!  

Asma Lateef is director of Bread for the World Institute

Asma Lateef is director of Bread for the World Institute.

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Joseph Terranova for Bread for the World.

Is Hunger or Poverty Worse for Your Health?

By Cynthia Woodside

Would you rather be poor or hungry? Maybe you’d choose hungry, because hunger could be more episodic? And being poor may be more chronic? Well, it turns out that if you want to lead a long, healthy life, it is better to live in poverty than to be food insecure.

A new report from the Economic Research Service (ERS) of the U.S. Department of Agriculture found that, “Food insecurity status is more strongly predictive of chronic illness in some cases even than income. Income is significantly associated with just 3 of 10 chronic diseases examined in the report, while food insecurity is associated with all 10.” The 10 diseases are hypertension, coronary heart disease, hepatitis, stroke, cancer, asthma, diabetes, arthritis, chronic obstructive pulmonary disease (COPD) and kidney disease. The only three diseases that are significantly associated with income are hepatitis, arthritis, and COPD.

Much of the previous research on the link between hunger and health has focused on children, but the ERS report examines the link between Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. Bread for the World Institute’s 2016 Hunger Report, The Nourishing Effect, looks at both children and adults. However, the ERS report also looks at health outcomes over the full range of four possible levels of food security – high, marginal, low, and very low, not only the differences between food-secure (high and marginal) and food-insecure (low and very low) adults. The report uses five years of data (2011-2015) from the National Health Interview Survey from the National Center for Health Statistics in the Centers for Disease Control and Prevention (CDC). It covers adults age 19-64 in households with incomes below 200 percent of the federal poverty line (the 200 percent cutoff is at approximately $24,000 for a single adult or $50,000 for a family of four). 

Adults who are food secure are defined as having access at all times to the kinds and quantities of food needed to enjoy an active, healthy life. Those who are food insecure are defined as having difficulty consistently obtaining adequate food because of limited economic resources.

The report confirms that food security status is strongly related to the likelihood of chronic disease in general, to the number of chronic conditions reported, and to self-health assessments. Adults in households with high food security only have a 37.4 percent probability of having one of the 10 chronic diseases; those in marginal food security households have a 43.2 percent probability; the probability increases to 46.9 percent for those in low security households; and for those in very low food security households, the probability is 52.7 percent.

The sad reality is that adults in very low food security households are more likely than not to have one or more chronic diseases — their odds are better than getting heads if they flip a coin. The even sadder reality is that the majority of poor health outcomes correlated with food insecurity are preventable — all that is needed is a sufficient amount of nutritious food.   

Overall, adults with very low food security are 40 percent more likely to have a chronic illness than adults in households with high food security. On average, the number of chronic conditions for adults in households with low food security is 18 percent higher than those in high food-security households. Marginal food security is also a problem, even though people with marginal food security are considered “food secure” when it comes to labeling people as food secure or food insecure. Adults in these households were 9 percentage points less likely to report excellent health than those in households with high food security. Remember, none of the people in the study, including those with high food security, were wealthy — 200 percent of the poverty level is what many economists consider the minimum needed to afford basic living expenses.

As The Nourishing Effect and other reports have documented, adults struggling with food insecurity and chronic health conditions are often more susceptible to thoughts of suicide and to substance abuse, and are less likely to be able to maintain employment. This, of course, makes it less likely that they can afford the high cost of medical treatment for their conditions. With or without treatment, the CDC reports, chronic diseases caused 70 percent of all U.S. deaths in 2014.

The costs of food insecurity and chronic conditions are not only high for individuals and their families — they are also high for the U.S. healthcare system and U.S. business. The CDC estimates that in 2010, chronic health problems accounted for more than 86 percent of the nation’s $2.7 trillion in annual spending on medical care. Businesses’ average lost productivity costs for cardiovascular disease alone in 2012-2013 were $126 billion. The study cited in the Institute’s 2016 Hunger Report: Nourishing Effect estimated the cost of food insecurity to the U.S. healthcare system at a conservative $160 billion in 2014.  

The Sustainable Development Goals (SDGs), which the United States endorsed in September 2015, offer ways to respond to the correlation between hunger and health, and the correlations among poverty, jobs, inequality, and education. The goals provide a roadmap for integrating work on multiple intersecting issues and making progress on all of them simultaneously. In fact, the SDGs are a not-to-be missed opportunity — not only to end hunger by 2030 and improve health, but to address other issues facing our people and our planet.

Cynthia Woodside is senior domestic policy advisor with Bread for the World Institute.

Food insecurity status is more strongly predictive of chronic illness than income.

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Hungry Americans are more likely to become sick — and, of course, less likely to be able to pay for health care. Photo: Bread for the World

Why Building Affordable and Accessible Health Care Matters for Hungry Americans

By Bridgette Leathers

On July 26, 2017, the Council for Affordable Health Coverage (CAHC) hosted an event titled Health Rx: Building Affordability & Access. The topic was the pressing issue of rising healthcare costs and what can be done to moderate these increases. The audience heard from a handful of members of Congress from both sides of the aisle as well as several health professionals.

This event took place during a month of recurring congressional attacks on healthcare coverage, prompting us to focus on the Sustainable Development Goals, which the United States adopted two years ago. The third goal is good health and well-being. To achieve it, we must ensure access to safe medicines and affordable health care for everyone. The only way to do this is to reach the people with the least access to medicine and affordable health care. Although the percentage of uninsured persons in the United States is at an all-time low, the country still has 28.6 million uninsured individuals and healthcare costs remain on the rise. Considering the complementary relationship of health and hunger, we expect that these higher costs will have a disproportionate impact on food insecure communities.

The biggest concerns in the national healthcare discussion about rising healthcare costs have been improving the quality of care that patients receive, and ensuring that there are enough well-qualified physicians and enough physicians, especially in rural communities. However, there is one group that has been consistently left out of the conversation — those who are food insecure. While rising healthcare costs impact everyone, they affect individuals who experience hunger in a different and more profound way. Too often, mothers must choose between buying medicine to treat a sick child or putting dinner on the table. There are substantial numbers of U.S. citizens who must choose between not getting health care and not getting groceries — a “choice” that most voices that we hear, most healthcare stakeholders, are completely unfamiliar with.

Throughout the discussion, all members of Congress spoke about the need for better care with less strain on patients. Consider vulnerable populations, many of whom live in rural areas with the least access to healthcare. Representative Tim Murphy (R-PA) shed new light on the subject when he informed the audience that in half of all rural American counties, there are no psychiatrists or psychologists. This is especially compelling because 2.8 million households facing hunger are in rural communities, and 86 percent of counties with the highest child hunger rates are in rural areas. The lifestyle “choices” that food insecurity forces many families into, such as purchasing cheaper food with less nutritional value or purchasing food in damaged packages for less cost, all lead to negative health outcomes, particularly for mental health.

The U.S. healthcare system must increase access and affordability because there is an entire population disproportionately at risk of falling ill or dying. While it is commendable that people in Congress are speaking about these issues, action must be taken to respond to them. In order to do its part to end hunger moving forward, Congress can ensure that people who are food insecure receive subsidies for health care; provide incentives for physicians to have at least some of their training in a rural or other under-served area; and allocate additional funding to rural states and areas with persistent and/or concentrated poverty to reach food-insecure families.  

In a country where each person is supposed to have equal opportunity, it is our government’s responsibility to construct a system that makes this possible. 

Bridgette Leathers was a summer 2017 intern at the Alliance to End Hunger and Bread for the World Institute.

Hungry Americans are more likely to become sick — and, of course, less likely to be able to pay for health care.

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Getting to zero hunger means investing in communities that are most vulnerable to experiencing food insecurity. Photo: Laura Pohl / Bread for the World

Ending U.S. Hunger: The Quest to Find Missing Data

By Marlysa D. Gamblin

We can all agree that in order to solve a problem, we must first understand the full scope of the issue. How many people is the problem affecting? What are the trends — e.g., is it increasing, and how quickly? What programs or policies help to address this problem? What factors seem to exacerbate the problem? These questions are as applicable to the problem of U.S. hunger and poverty as to any other.  

Bread for the World Institute’s 2015 Hunger Report, When Women Flourish … We Can End Hunger, found that 80 percent of hunger and poverty-related data on women does not exist. It made the case that the world cannot get to zero hunger without first identifying data that can help strengthen policy and program efforts, especially among populations where food-insecurity rates are quite high.

We can certainly use this truth and apply it in domestic terms with our goal to end U.S. hunger and poverty by 2030. As described in Ending U.S. Hunger and Poverty by Focusing on Communities Where It is Most Likely, getting to zero hunger means investing in communities that are most vulnerable to experiencing food insecurity. Ironically, however, I have found that these are the groups that have the least amount of consistent and aggregate data.

My portfolio of research and analysis at Bread for the World Institute includes six population groups — female-headed households, Native Americans, African Americans, Latinos, returning citizens/people who were previously incarcerated, and undocumented immigrants. These communities experience hunger and poverty at far higher levels than an average U.S. household – anywhere from two to six times as high.

Every September, the U.S. Census Bureau and the U.S. Department of Agriculture (USDA) release new data on hunger and poverty. But even with the general rigor and consistency of this data, we still have data gaps. Neither report releases data on households with returning citizens or undocumented immigrants. USDA also does not disaggregate the food insecurity data of female-headed households of color, even though we know from the U.S. Census that poverty rates among Native American, Latina, and African American female-headed households are often three times the rate of the nation as a whole. On top of that, we can expect even higher hunger and poverty rates among female-headed households of color that also have the added pressure of a family member who is undocumented or has a criminal record. But, yet again, the specific data is missing for households with members who are undocumented or have a criminal record.

These are just a few examples of gaps in the data — there are more of them. Consequently, we are forced to estimate these rates, when this data should instead be uniformly collected, analyzed, and released by federal agencies. Perhaps it is not considered important — just as, in many countries, the  statistics on violence against women are not considered important.

It is my hope that both USDA and the Census Bureau begin to collect the data  on people returning to the community and undocumented immigrants,  if they do not already, and that the data gaps are filled and publicly released.  Stronger data means stronger analysis, which means stronger policies to end hunger — and stronger U.S. communities.  

Marlysa D. Gamblin is domestic advisor for policy and programs, specific populations at Bread for the World Institute.  

We still have data gaps.

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•	Humanitarian crises have increased in number and severity due to conflict, extreme weather events, and other disruptions. In turn, international food assistance expenditures have grown in scale and coverage.

New Report by World Food Program Connects Hunger and Conflict

By Faustine Wabwire

20 million people across four countries are at risk of famine — Yemen, Somalia, northeastern Nigeria, and the world’s newest country — South Sudan. Conflict in all four countries, compounded by drought in the case of Somalia, has created a humanitarian crisis the world has not seen since World War II. Humanitarian assistance is further complicated by ongoing insecurity and violence perpetrated by armed militia.

Today, we know that children, men, and women living in fragile situations such as these are most at risk of being left behind. Addressing conflict is not simple, but it is  necessary to make our world safer and promote shared prosperity. Bread for the World Institute’s 2017 Hunger Report, Fragile Environments, Resilient Communities, notes that increasingly complex conflict points to the need for smarter approaches to make humanitarian interventions such as food assistance effective and tenable.

More evidence of the need to find better approaches to conflict is everywhere for world leaders to see — and to take action. The World Food Program just released a new report, World Food Assistance 2017: Taking Stock and Looking Ahead.  

The report highlights sobering findings: 

  • About 40 percent of total humanitarian spending is on food assistance.
  • Humanitarian crises have increased in number and severity due to conflict, extreme weather events, and other disruptions. In turn, international food assistance expenditures have grown in scale and coverage.
  • For example, food assistance expenditures by WFP from 2009 to 2016 increased from $2.2 billion to $5.3 billion — more than doubling.
  • Poor access to people in need raised food assistance costs by $997 million in the 20 countries facing the most severe food crises around the world.
  • High levels of instability in most of the 80 countries in which WFP operates raised costs by $2.24 billion.
  • Low levels of performance of food systems in many of these countries raised costs by $439 million.
  • Together, these challenges raised costs by $3.45 billion. This amount would have more than filled the $3.16 billion funding gap between WFP’s assessed needs and funding actually received in 2015.

The complexity of the current crisis also points to a very important but often overlooked issue: humanitarian assistance alone won’t end the suffering, nor can it stabilize affected communities. While immediate humanitarian assistance is critical to save lives in the short term, diplomatic efforts, peace-building, and long-term investments in countries’ own efforts to rebuild through agriculture and nutrition, education, health care are the building blocks of sustainable peace. These investments yield dividends in lowering the need for and cost of repeated, costly humanitarian interventions.

The current crises point to the need for leadership at all levels — the global, regional, national, and local. We cannot wait for the situation to deteriorate further before we take action. We need only look to the last time famine was declared — in Somalia in 2011 — to see why. Global inertia cost 130.000 lives — because half of the 260,000 people who starved to death were already dead by the time famine was officially declared, and they were dead before any meaningful global response was mobilized.

We should not repeat mistakes of the past.

Specific criteria must be met before famine is declared. It’s a matter of what percentage of children have acute malnutrition, how many “extra” people are dying over what would be expected, and so forth. Thanks to the intense response mounted by the humanitarian community, the famine declaration made in two counties of South Sudan in February 2017 has been lifted. At this writing in late August 2017, Somalia, Yemen, and northeast Nigeria have averted famine. 

This does not mean that the situation has improved by any noticeable amount. People are still in dire situations; humanitarian, diplomatic and long-term interventions are still critically important.

Three out of the four countries (with the exception of Yemen) are now entering the lean season, the time of year when the previous season’s harvest has run out and food stocks are at their lowest. Also, the rains are making access by land difficult,  even impossible in some cases. Air transportation is sometimes possible, but it can cost up to seven times as much. In Yemen, the severe food crisis is the consequence of armed conflict devastating the country.

All may seem quite hopeless, but as a global community, we know what to do — and 194 countries have committed to doing it. In 2015, the comprehensive, ambitious global Sustainable Development Goals (SDGS) framework was adopted. This historic framework — intended to address the world’s most pressing problems in a more integrated way — applies to all countries and rallies all people to “leave no one behind.”

Just a year later, the first-ever World Humanitarian Summit sparked a major review of the way financing for emergencies is delivered and highlighted the need for more long-term development investments.

To achieve the SDGs — at the very least, to prevent future near-famine emergencies — the global community, world leaders and each country itself, must confront the political drivers of vulnerability and hunger. Increased investments in agricultural systems and in better nutrition at an early age are essential to strengthening the local human and institutional capacity that can promote stability, build peaceful institutions, and lead to shared prosperity.

Faustine Wabwire is senior international policy advisor with Bread for the World Institute.

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