Health Care Foundation of Greater Kansas City Cost of
Food Insecurity
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What is food insecurity?
The United States Department of Agriculture (USDA) defines food insecurity as a state in which “either due to lack of money or other resources, constant access to sufficient food is limited at times during the year.”
Low food security and very low food security represent the different severity levels of food insecurity.
  • Low food security: Indications of poor quality, desirability of diet or variety. Marginal or no indication of reduced diet or food intake (Coleman-Jensen et al., 2017).
  • Very low food security: Reports of multiple indications of reduced food intake and disrupted eating patterns (Coleman-Jensen et al., 2017).
What is food security?
Both high food security and marginal food security are classified as food security.
  • High food security: No indications of problems or limitations with food sufficiency or shortage of food in the house were reported (Coleman-Jensen et al., 2017).
  • Marginal food security: One or two indications of anxiety over problems or limitations with food sufficiency or shortage of food in the house were reported indications. Marginal or no sign of changes in food intake or diet (Coleman-Jensen et al., 2017).
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How is food insecurity identified?
The USDA's food security statistics are based on a national food security survey conducted as an annual supplement to the monthly Current Population Survey (CPS). In the survey, individuals and households are assessed to determine their social and economic status, uncertain or limited access to sufficient food, and if and how often they skipped a meal. If at times during the year normal eating patterns are affected or the household member’s average food intake is reduced because the household lacks resources and money needed for food, the household is considered to be food insecure. (Coleman-Jensen et al., 2017).
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How is food insecurity associated with chronic diseases?
Several findings from different studies suggest there is an association between household food insecurity and chronic diseases. Particularly, evidence for the association of type 2 diabetes and obesity with food insecurity has been well documented, with strong consensus in the scientific and research community. Depression has also been linked to food insecurity, but to avoid overstating the impact, we have not included costs stemming from depression. The hypothesis behind this association is that household food insecurity increases dependence on highly palatable, inexpensive foods that are energy-dense. Additionally, it is possible that obesity and type 2 diabetes are perpetuated by the cyclical nature of having sufficient food at the beginning of the month and not having enough at the end of the month when funds run out. This can lead to weight gain and, therefore, result in chronic diseases. Children living in food insecure households may also be more likely to develop chronic diseases due to a frequent, prolonged activation of the stress response at critical junctures in their life (Laraia, 2013).
How is direct cost estimated?
The subpopulation of food-insecure individuals who suffer from diabetes and obesity is calculated using data from peer-reviewed journals. We estimate that, among food insecure individuals, 52% suffer from obesity (Silverman et al., 2015) and 45% suffer from diabetes (Seligman et al., 2002). We accounted for an overlap between obesity and diabetes, i.e. 30% of individuals who are obese are also diabetic. Annual treatment cost of obesity and diabetes is used for the subpopulations of food-insecure individuals suffering from these chronic diseases to estimate the burden from direct cost. It includes primary care physician (PCP) visits, emergency department visits, hospitalization, and medication costs.
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What is absenteeism?
Absenteeism is defined as the number of days of work missed by employees due to food insecurity. It is the time lost when they are away from work either because they are sick, experiencing symptoms of associated chronic disease, have a doctor’s appointment, or just did not show up to work. It is expressed as number of days lost/person/year.
What is presenteeism?
Presenteeism is defined as time lost when employees are at work and are not able to function at full capacity due to food insecurity. When at work they are not as productive because they cannot focus, cannot accomplish their daily tasks, or they take longer than usual to complete assigned tasks. It is expressed as number of days lost/person/year.
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How is indirect cost estimated?
The subpopulation of food-insecure individuals who suffer from diabetes and obesity is calculated using data from peer-reviewed journals. We estimate that among food insecure individuals 52% suffer from obesity (Silverman et al., 2015) and 45% suffer from diabetes (Seligman et al., 2002). We accounted for an overlap between obesity and diabetes, i.e. 30% of individuals who are obese are also diabetic. In the subpopulation of people suffering from obesity and diabetes, we used the number of absenteeism days and presenteeism days directly attributed to each diseases to calculate total lost time to the workforce, or lost productive time (LPT).
  • The data was obtained from case control studies where obese, food insecure individuals were compared to obese, food secure individuals. The additional LPT days experienced by obese, food insecure individuals is a result of food insecurity. In our calculator, we use the additional LPT days to calculate indirect cost resulting from obesity and food insecurity. The same approach was used for LPT in diabetic, food insecure individuals.
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What is educational burden?
Educators such as teachers and principals frequently observe when students come to school hungry and further note that students who are hungry do not interact or engage positively with their teachers and classmates, cannot focus on their schoolwork, and suffer from a lack of energy. This can have serious effects on their future, including an inability to become engaged, productive citizens in adulthood.
Educator's perspective about the Impact of hunger on students at school
Impact on education % Educators reporting Bibliography
Inability to concentrate 88% Hunger in our schools.
No kid hungry.
2015
Lack of energy or motivation 87%
Poor academic performance 84%
Tiredness 82%
Behavioral problems 65%
Students feeling sick 53%
Almost 14 million children under the age of 18 live in a household where there is uncertain or limited availability of safe or nutritionally sufficient foods. Recent studies have shown that school students coming from food insecure households identified as “at risk” of hunger have an increased likelihood of experiencing diminished psychosocial function participating in psychological counseling. These students were also more likely to be late to school or absent from school, and marginally more likely to have repeated a grade or to have received special education services (Alaimo et al., 2001).
What is economic burden of school absenteeism?
The U.S. Department of Education calculates a “revenue limit” for each student in a public school. School districts receive that money with respect to student-based attendance. This attendance-based funding system penalizes absenteeism and may result in reduced funding in subsequent years. When a student misses 10% or more of the 180-day school year, they are considered chronically absent (Faryon et al., 2011). This funding system penalizes absenteeism and may result in reduced funding in subsequent years. For every single day a student misses, we estimate schools in Kansas and Missouri are burdened with a $38 deficit in their expected funding.
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What is medically appropriate food assistance?
Food insecurity is associated with negative chronic health outcomes. One study, in particular, showed that providing medically appropriate food assistance to food-insecure individuals might enhance health outcomes. In the study, a community-based medically appropriate food support intervention for individuals living with type 2 diabetes and/or HIV, offered meals and snacks designed to meet nutritional guidelines for a healthy diet and contained 100% of daily energy requirements. Study results showed increases in the number of people with diabetes who achieved optimal blood sugar control, and decreases in hospitalizations or emergency department visits. Participants with diabetes also consumed less sugar and lost weight. (Palar et al., 2017; Kurtzman et al., 2017).
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What is the Expanded Food and Nutrition Education Program (EFNEP)?
Since 1969, the Expanded Food and Nutrition Education Program (EFNEP) has successfully focused on important societal concerns by influencing the nutrition and physical activity practices of low-income households, specifically ones with young children. From a community-based, relationship-driven, hands-on educational approach, EFNEP has directly impacted economic, obesity, and food insecurity challenges that impede the welfare and health of the country. (National Institute of Food and Agriculture, 2017).
Research findings support EFNEP’s cost-effectiveness, ability to improve food security status and promote behavior changes that can improve poor health outcomes, dietary intake, and further improve food security status. Participation in EFNEP has displayed a measured improvement in food security status (Farrell, 2014).
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What is Supplemental Nutrition Assistance Program (SNAP)?
The Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program) is the largest food assistance program in the United States. SNAP provides nutrition assistance to millions of eligible, low-income families and individuals and provides economic benefits to communities. Participants can obtain benefits and purchase food in approved retail food outlets distributed through an Electronic Benefit Transfer (EBT) card. The rate at which a household will receive the benefit is determined by family size and income level. The number of people in USA who received the benefit in 2015 totals around 45 million individuals served per month, with an annual benefit distribution of about $68.3 billion. (Gundersen, 2012; Mykerezi et al., 2010; Food and Nutrition Services, 2017; Center on Budget and Policy Priorities, 2016).
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What is Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)?
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) offers federal grants to states to provide health care referrals, supplemental foods, and nutrition awareness for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age 5 who are identified to be at nutritional risk (Food and Nutrition Services, 2017).
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What is bundle of safety net programs (TANF, SSI, EITC, SNAP, and Medicaid)?
The bundle of safety net programs is the structure of benefits from five major safety net programs – Temporary Assistance for Needy Families (TANF), Supplemental Security Income (SSI), federal and state Earned Income Tax Credits (EITC), food assistance through the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program), and Medicaid. The safety net program focuses on single parent families with income that is below 300% of the poverty line. The findings show that food benefits or $1000 in cash received reduces low food security. The results also suggest, and highlight, the significance of using a full range of safety net programs (Schmidt et al., 2013).
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Reference: 1. Craig Gundersen. Addressing U.S. Food Insecurity. Con Agra Foods Foundation. 2012 2. Alisha Coleman-Jensen, Christian Gregory, and Matthew Rabbitt . United States Department of Agriculture Economic Research Services.. USDA. 2017 3. Barbara A. Laraia. Food Insecurity and Chronic Disease. Reviews from ASN EB 2012 Symposia. Adv Nutr March 2013 Adv Nutr vol. 4: 203-212, 2013 4. Hunger in our schools. No kid hungry. 2015 5. Katherine Alaimo, Christine M. Olson, and Edward A. Frongillo.Food Insufficiency and American School-Aged Children’s Cognitive, Academic, and Psychosocial Development. PEDIATRICS Vol. 108 No. 1 July 2001 6. Joanne Faryon and Kevin Crowe.Chronically Absent Students Cost County Schools Millions. Watchdog Institute. KPBS. 2011 7. Kartika Palar & Tessa Napoles & Lee L. Hufstedler & Hilary Seligman & Fredrick M. Hecht & Kimberly Madsen & Mark Ryle & Simon Pitchford & Edward A. Frongillo & Sheri D. Weiser. Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health. J Urban Health 8. DOI 10.1007/s11524-016-0129-7.2017 9. National Institute of Food and Agriculture. United States Department of Agriculture. 2017 10. Jamie A. Farrell. e Impact Of Nutrition Education On Food Security Status And Food-related Behaviors. University of Massachuse s Amherst. 2014 11. Craig Gundersen. Addressing U.S. Food Insecurity. Con Agra Foods Foundation. 12. Elton Mykerezi Bradford Mills. The Impact of Food Stamp Program Participation on Household Food Insecurity. Am J Agric Econ (2010) 92 (5): 1379-1391. 13. Food and nutrition services. United States Department of Agriculture. 2017 14. Lucie Schmidt, Lara Shore-Sheppard, and Tara Watson. The Effect of Safety Net Programs on Food Insecurity. JOLE,. 2013. 15. Center on budget and policy priorities. Policy basics introduction to the supplemental nutrition assistance program snap. 2016.
What is presenteeism?
Presenteeism is defined as time lost when employees are at work and are not able to function at full capacity due to food insecurity. When at work they are not as productive because they cannot focus, cannot accomplish their daily tasks, or they take longer than usual to complete assigned tasks. It is expressed as number of days lost/person/year.
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