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Food Accessibility, Insecurity and Health Outcomes

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Go to food and nutrition insecurity scientific resources

Go to food accessibility and insecurity as an SDOH

Go to NIMHD food accessibility/insecurity resources

Having access to nutritious food is a basic human need.

  • Food security means having access to enough food for an active, healthy life.
  • Nutrition security means consistent access, availability, and affordability of foods and beverages that promote well-being, prevent disease, and, if needed, treat disease.

On the other hand, food and nutrition insecurity is an individual-, household-, and neighborhood-level economic and social condition describing limited or uncertain access to adequate and affordable nutritious foods and is a major public health concern.

research on food insecurity

Food insecurity and the lack of access to affordable nutritious food are associated with increased risk for multiple chronic health conditions such as diabetes , obesity, heart disease, mental health disorders and other chronic diseases . In 2020, almost 15% of U.S. households were considered food insecure at some point in time, meaning not all household members were able to access enough food to support active, healthy lifestyles. In nearly half of these households, children were also food insecure ( see chart above ), which has implications for human development and school experience . Food insecurity disproportionately affects persons from racial and ethnic minority and socioeconomically disadvantaged populations:

  • 20% of Black/African American households were food insecure at some point in 2021 , as were 16% of Hispanic/Latino households when compared to 7% of White households.
  • Food insecurity for U.S. Hispanic/Latino adults differs by origin. Current national data is not available but from 2011-2014 food insecurity was highest among those identifying from Puerto Rico (25.3%), followed by Mexico (20.8%) Central and South America (20.7%) and Cuba (12.1%).
  • In the past 20 years, American Indian/Alaskan Native (AI/AN) households have also been at least twice as likely to have experienced food insecurity when compared with White households, often exceeding rates of 25% across different regions and AI/AN communities.
  • Native Hawaiian and Pacific Islander (NHPI) adults also experience a high food insecurity prevalence (20.5%) and had significantly higher odds of experiencing low and very low food security compared with White households.
  • While national data on specific Asian American national origin populations is not readily available, among Asian Americans living in California from 2001-2012 , food insecurity was highest among Vietnamese households (16.4%), followed by Filipino (8.3%), Chinese (7.6%), Korean (6.7%), South Asian (3.14%), and Japanese households (2.3%), highlighting considerable variation across Asian American communities.
  • Food insecurity is inextricably linked to poverty , with 35.3 % of households with incomes below the federal poverty line being food insecure.
  • Although the graph below on national trends in food insecurity does not capture the full impact of the COVID-19 pandemic, food insecurity is likely to increase, and racial and ethnic disparities in food insecurity experiences could worsen.

Healthy food accessibility and insecurity is a social determinant of health.

Food and nutrition insecurity are predominantly influenced by the local environment, including surrounding neighborhood infrastructure, accessibility, and affordability barriers. Access to grocery stores that carry healthy food options (such as fresh fruit, vegetables, low-fat fish and poultry) are not located equitably across residential and regional areas in the United States.

Areas that lack access to affordable, healthy foods are known as food deserts . Food deserts are:

  • Found in urban or suburban neighborhoods that lack grocery stores (supermarkets or small grocery stores) that offer healthy food options.
  • Found in rural areas and neighborhoods where the nearest grocery stores are too far away to be convenient or accessible.
  • More prevalent in neighborhoods that are comprised of a majority of racial or ethnic minority residents or in rural AI/AN communities.
  • More likely found in areas with a higher percentage of residents experiencing poverty , regardless of urban or rural designation.

Urban, suburban, and rural areas can also be overwhelmed with stores that sell unhealthy calorie-dense and inexpensive junk foods, including soda, snacks, and other high sugar foods. This is known as a food swamp . Food swamps:

  • Reduce access to nutritional foods and provide easier access to unhealthy foods .
  • Are a predictor of obesity , particularly in communities where residents have limited access to their own or public transportation and experience the greatest income inequality.

Reducing food and nutrition insecurity in the U.S. will require a multifaceted approach that considers, among other possibilities:

  • Strategies that engage communities in local health programs; for example, recruiting community partners to assist in addressing gaps between food access and intake .
  • Interventions that utilize federal food and nutritional supplemental programs, including the Supplemental Nutrition Assistance Program ( SNAP ) and the Special Supplemental Nutritional Program for Women, Infants, and Children ( WIC ).
  • Leveraging local and federal policies targeting food insecurity; for example, retail store interventions , where healthy food placement, promotion and price influence healthier choices; sweetened beverage taxes to reduce the purchase appeal to consumers; and junk food taxes balanced with removal of taxes on water and fruits and vegetables.

NIMHD is studying and addressing issues related to food and nutrition insecurity through a variety of initiatives:

NIH Publication

Research Opportunities to Address Nutrition Insecurity and Disparities Coauthored by Shannon N. Zenk, Lawrence A. Tabak and Eliseo J. Pérez-Stable, JAMA 2022

NIMHD Events on Food Insecurity

Food Insecurity, Neighborhood Food Environment, and Nutrition Health Disparities: State of the Science NIMHD co-sponsored this September 2021 workshop led by the NIH Office of Nutrition Research and its Nutrition and Health Disparities Implementation Working Group

NIMHD Hosts Senior Research Investigators to Present on Food Insecurity and Related Topics:

NIMHD co-sponsored the November 2020 virtual workshop NIH Rural Health Seminar: Challenges in the Era of COVID-19 . This workshop focused on long-standing health disparities and social inequities experienced by rural populations, and featured experts on food insecurity, including:

  • Dr. Brenda Eskenazi , Professor in Maternal and Child Health and Epidemiology, Brian and Jennifer Maxwell Endowed Chair in Public Health and Director of the Center for Environmental Research and Children’s Health, University of California, Berkeley, who spoke on the topic of COVID-19 and the impact on health of Californian farmworkers .
  • Dr. Alice Ammerman , Mildred Kaufman Distinguished Professor of Nutrition, Director, Center for Health Promotion and Disease Prevention, University of North Carolina, who spoke on interventions to address job loss and food security in rural communities during COVID .

NIMHD Content on Food Insecurity

Nimhd science visioning and research strategies.

As part of the Scientific Visioning Research Process , NIMHD developed a set of 30 strategies to transform minority health and health disparities research . Several of these strategies focus on issues related to food security and accessibility, including:

  • Assessing how environment and neighborhood structures such as areas where people have limited access to a variety of healthy and affordable foods (or food deserts) influence health behaviors.
  • Promoting multi-sectoral interventions that address the structural drivers of food deserts.
  • Promoting interventions that address the social determinants of health within health care systems, including food insecurity.

Publications

Food Insecurity and Obesity: Research Gaps, Opportunities, and Challenges Dr. Derrick Tabor, NIMHD Program Officer, co-authored “Food insecurity and obesity: research gaps, opportunities” in Translational Behavioral Medicine . This review highlights NIH funding for grants related to food insecurity and obesity, identifies research gaps, and presents upcoming research opportunities to better understand the health impact of food insecurity.

NIMHD Research Framework

Native Hawaiian Health Adaptation The NIMHD Research Framework was adapted by Keawe’aimoku Kaholokula, Ph.D., University of Hawai’i at Mānoa, to reflect social and cultural influences of Native Hawaiian health . Ka Mālama Nohona (nurturing environments) to support Native Hawaiian health include strategic goals of food sovereignty and security to promote a strong foundation for healthy living.

NIMHD Articles

NIMHD Research Features

  • The Navajo Nation Junk Food Tax and the Path to Food Sovereignty
  • Fighting Cancer—and Reducing Disparities—Through Food Policy
  • Fresh Food for the Osage Nation: Researchers and a Native Community Work Toward Improved Food Resources and Food Sovereignty

NIMHD Insights Blog

  • Amplifying the Voice of Native Hawaiian and Pacific Islander Communities Amid the COVID-19 Crisis by Joseph Keawe‘aimoku Kaholokula, Ph.D.
  • Racism and the Health of Every American by NIMHD Director Eliseo J. Pérez-Stable, M.D.
  • The Future of Minority Health and Health Disparities Research by Tany Agurs-Collins, Ph.D., R.D., and Susan Persky, Ph.D.
  • Addressing Social Needs and Structural Inequities to Reduce Health Disparities: A Call to Action for Asian American and Pacific Islander Heritage Month by Marshall H. Chin, M.D., M.P.H.
  • “Insights” on Simulation Modeling and Systems Science, New Research Funding Opportunity by Xinzhi Zhang, M.D., Ph.D.

NIMHD Funding Resources and Opportunities

Funding opportunity announcements (foas).

NIMHD supports many FOAs that include topics related to food security as an area of research interest:

  • Request for Information: Food Is Medicine Research Opportunities
  • Notice of Special Interest: Stimulating Research to Understand and Address Hunger, Food and Nutrition Insecurity
  • Community Level Interventions to Improve Minority Health and Reduce Health Disparities (R01 Clinical Trial Optional)
  • Addressing Health Disparities Among Immigrant Populations through Effective Interventions (R01 Clinical Trial Optional)
  • Health Services Research on Minority Health and Health Disparities (R01 Clinical Trial Optional)
  • Long-Term Effects of Disasters on Health Care Systems Serving population experiencing health disparities (R01 Clinical Trial Optional)
  • Please see our list of Active NIMHD Funding Opportunities for more.

NIMHD-Supported Research Projects

See a list of active NIMHD-supported research projects studying food security and related topics .

NIMHD-Supported, NIH-Wide Initiatives

The PhenX Toolkit provides recommended and established data collection protocols for conducting biomedical research. There are PhenX protocols available for assessing and understanding food insecurity and food swamps .

The Strategic Plan for NIH Nutrition Research is the first NIH-wide strategic plan for nutrition research that highlights crosscutting, innovative opportunities to advance nutrition research from basic science to experimental design to research training. The plan emphasizes the need for studies on minority health and nutrition-related health disparities research.

Additional Resources and Data

The Centers for Disease Control’s Healthier Food Environments: Improving Access to Healthier Foods discusses CDC efforts to improve food access within the community.

The United States Department of Agriculture has two databases that compile national data on food accessibility:

  • The Food Access Research Atlas provides food access data for populations within census tracts and mapped overviews of food access for low-income communities.
  • The Food Environment Atlas assembles statistics on food environment indicators to stimulate research on the determinants of food choice and diet quality.

The Healthy People initiative provides 10-year, measurable public health objectives and useful tools to help track progress. The Healthy People 2030 includes food insecurity as a social determinant of health.

Page updated April 26, 2023

Page updated February 24, 2023

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Food Insecurity

Economic Stability

About This Literature Summary

This summary of the literature on Food Insecurity as a social determinant of health is a narrowly defined examination that is not intended to be exhaustive and may not address all dimensions of the issue. Please note: The terminology used in each summary is consistent with the respective references. For additional information on cross-cutting topics, please see the Access to Foods that Support Healthy Dietary Patterns literature summary.

Related Objectives (4)

Here's a snapshot of the objectives related to topics covered in this literature summary. Browse all objectives .

  • Reduce household food insecurity and hunger  — NWS‑01
  • Eliminate very low food security in children — NWS‑02
  • Increase fruit consumption by people aged 2 years and over — NWS‑06
  • Increase vegetable consumption by people aged 2 years and older — NWS‑07

Related Evidence-Based Resources (1)

Here's a snapshot of the evidence-based resources related to topics covered in this literature summary. Browse all evidence-based resources .

  • The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States

Literature Summary

Food insecurity is defined as a household-level economic and social condition of limited or uncertain access to adequate food. 1  In 2020, 13.8 million households were food insecure at some time during the year. 2 Food insecurity does not necessarily cause hunger, i but hunger is a possible outcome of food insecurity. 3

The United States Department of Agriculture (USDA) divides food insecurity into the following 2 categories: 1

  • Low food security : “Reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake.”
  • Very low food security : “Reports of multiple indications of disrupted eating patterns and reduced food intake.”

Food insecurity may be long term or temporary. 4 , 5 , 6  It may be influenced by a number of factors, including income, employment, race/ethnicity, and disability. The risk for food insecurity increases when money to buy food is limited or not available. 7 , 8 , 9 , 10 , 11  In 2020, 28.6 percent of low-income households were food insecure, compared to the national average of 10.5 percent. 2  Unemployment can also negatively affect a household’s food security status. 10  High unemployment rates among low-income populations make it more difficult to meet basic household food needs. 10  In addition, children with unemployed parents have higher rates of food insecurity than children with employed parents. 12  Disabled adults may be at a higher risk for food insecurity due to limited employment opportunities and health care-related expenses that reduce the income available to buy food. 13 , 14  Racial and ethnic disparities exist related to food insecurity. In 2020, Black non-Hispanic households were over 2 times more likely to be food insecure than the national average (21.7 percent versus 10.5 percent, respectively). Among Hispanic households, the prevalence of food insecurity was 17.2 percent compared to the national average of 10.5 percent. 2 Potential factors influencing these disparities may include neighborhood conditions, physical access to food, and lack of transportation.

Neighborhood conditions may affect physical access to food. 15  For example, people living in some urban areas, rural areas, and low-income neighborhoods may have limited access to full-service supermarkets or grocery stores. 16  Predominantly Black and Hispanic neighborhoods may have fewer full-service supermarkets than predominantly White and non-Hispanic neighborhoods. 17  Convenience stores may have higher food prices, lower-quality foods, and less variety of foods than supermarkets or grocery stores. 16 , 18  Access to healthy foods is also affected by lack of transportation and long distances between residences and supermarkets or grocery stores. 16

Residents are at risk for food insecurity in neighborhoods where transportation options are limited, the travel distance to stores is greater, and there are fewer supermarkets. 16  Lack of access to public transportation or a personal vehicle limits access to food. 16  Groups who may lack transportation to healthy food sources include those with chronic diseases or disabilities, residents of rural areas, and some racial/ethnicity groups. 15 , 16 , 19  A study in Detroit found that people living in low-income, predominantly Black neighborhoods travel an average of 1.1 miles farther to the closest supermarket than people living in low-income predominantly White neighborhoods. 20

Adults who are food insecure may be at an increased risk for a variety of negative health outcomes and health disparities. For example, a study found that food-insecure adults may be at an increased risk for obesity. 21  Another study found higher rates of chronic disease in low-income, food-insecure adults between the ages of 18 years and 65 years. 22  Food-insecure children may also be at an increased risk for a variety of negative health outcomes, including obesity. 23 , 24 , 25 They also face a higher risk of developmental problems compared with food-secure children. 12 , 25 , 26  In addition, reduced frequency, quality, variety, and quantity of consumed foods may have a negative effect on children’s mental health. 27

Food assistance programs, such as the National School Lunch Program (NSLP); the Women, Infants, and Children (WIC) program; and the Supplemental Nutrition Assistance Program (SNAP), address barriers to accessing healthy food. 28 , 29 , 30 , 31 Studies show these programs may reduce food insecurity. 29 , 30 , 31  More research is needed to understand food insecurity and its influence on health outcomes and disparities. Future studies should consider characteristics of communities and households that influence food insecurity. 32  This additional evidence will facilitate public health efforts to address food insecurity as a social determinant of health.

i  The term hunger refers to a potential consequence of food insecurity. Hunger is discomfort, illness, weakness, or pain caused by prolonged, involuntary lack of food.

U.S. Department of Agriculture, Economic Research Service. (n.d.). Definitions of food security . Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/

U.S. Department of Agriculture, Economic Research Service. (n.d.). Key statistics & graphics. Retrieved March 10, 2022, from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/key-statistics-graphics.aspx

Carlson, S. J., Andrews, M. S., & Bickel, G. W. (1999). Measuring food insecurity and hunger in the United States: Development of a national benchmark measure and prevalence estimates. Journal of Nutrition, 129 (2S Suppl), 510S–516S. doi:  10.1093/jn/129.2.510S

Jones, A. D., Ngure, F. M., Pelto, G., & Young, S. L. (2013). What are we assessing when we measure food security? A compendium and review of current metrics. Advances in Nutrition, 4(5), 481–505.

Food and Agriculture Organization. (2008). An introduction to the basic concepts of food security . Food Security Information for Action Practical Guides. EC–FAO Food Security Programme.

Nord, M., Andrews, M., & Winicki, J. (2002). Frequency and duration of food insecurity and hunger in U.S. households. Journal of Nutrition Education and Behavior, 34 (4), 194–201.

Sharkey, J. R., Johnson, C. M., & Dean, W. R. (2011). Relationship of household food insecurity to health-related quality of life in a large sample of rural and urban women. Women & Health, 51 (5), 442–460.

Seefeldt, K. S., & Castelli, T. (2009). Low-income women’s experiences with food programs, food spending, and food-related hardships (no. 57) . USDA Economic Research Service. https://naldc.nal.usda.gov/download/35894/PDF

Nord, M., Andrews, M., & Carlson, S. (2007). Measuring food security in the United States: household food security in the United States, 2001. Economic Research Report (29).

Nord, M. (2007). Characteristics of low-income households with very low food security: An analysis of the USDA GPRA food security indicator. USDA-ERS Economic Information Bulletin (25).

Klesges, L. M., Pahor, M., Shorr, R. I., Wan, J. Y., Williamson, J. D., & Guralnik, J. M. (2001). Financial difficulty in acquiring food among elderly disabled women: Results from the Women’s Health and Aging Study. American Journal of Public Health, 91 (1), 68.

Nord, M. (2009). Food insecurity in households with children: Prevalence, severity, and household characteristics. USDA-ERS Economic Information Bulletin (56).

Coleman-Jensen, A., & Nord, M. (2013). Food insecurity among households with working-age adults with disabilities. USDA-ERS Economic Research Report (144).

Huang, J., Guo, B., & Kim, Y. (2010). Food insecurity and disability: Do economic resources matter? Social Science Research, 39 (1), 111–124.

Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health, 95 (4), 660–667.

Ploeg, M. V., Breneman, V., Farrigan, T., Hamrick, K., Hopkins, D., Kaufman, P., Lin, B.-H., Nord, M., Smith, T. A., Williams, R., Kinnison, K., Olander, C., Singh, A., & Tuckermanty, E. (n.d.). Access to affordable and nutritious food-measuring and understanding food deserts and their consequences: Report to congress. Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=42729

Powell, L. M., Slater, S., Mirtcheva, D., Bao, Y., & Chaloupka, F. J. (2007). Food store availability and neighborhood characteristics in the United States. Preventive Medicine, 44 (3), 189–195.

Crockett, E. G., Clancy, K. L., & Bowering, J. (1992). Comparing the cost of a thrifty food plan market basket in three areas of New York State. Journal of Nutrition Education, 24 (1), 71S–78S.

Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010). Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition, 140 (2), 304–310.

Zenk, S. N., Schulz, A. J., Israel, B. A., James, S. A., Bao, S., & Wilson, M. L. (2005). Neighborhood racial composition, neighborhood poverty, and the spatial accessibility of supermarkets in metropolitan Detroit. American Journal of Public Health , 95(4), 660–667.

Hernandez, D. C., Reesor, L. M., & Murillo, R. (2017). Food insecurity and adult overweight/obesity: Gender and race/ethnic disparities. Appetite, 117, 373–378.

Gregory, C. A., & Coleman-Jensen, A. (n.d.). Food insecurity, chronic disease, and health among working-age adults . Retrieved March 10, 2022, from http://www.ers.usda.gov/publications/pub-details/?pubid=84466

Gundersen, C., & Kreider, B. (2009). Bounding the effects of food insecurity on children’s health outcomes. Journal of Health Economics , 28 (5), 971–983.

Metallinos-Katsaras, E., Must, A., & Gorman, K. (2012). A longitudinal study of food insecurity on obesity in preschool children. Journal of the Academy of Nutrition and Dietetics, 112 (12), 1949–1958.

Cook, J. T., & Frank, D. A. (2008). Food security, poverty, and human development in the United States. Annals of the New York Academy of Sciences, 1136 (1), 193–209.

Cook, J. T. (2013, April). Impacts of child food insecurity and hunger on health and development in children: Implications of measurement approach. In Paper commissioned for the Workshop on Research Gaps and Opportunities on the Causes and Consequences of Child Hunger.

Burke, M. P., Martini, L. H., Çayır, E., Hartline-Grafton, H. L., & Meade, R. L. (2016). Severity of household food insecurity is positively associated with mental disorders among children and adolescents in the United States. Journal of Nutrition , 146(10), 2019–2026.

Bhattarai, G. R., Duffy, P. A., & Raymond, J. (2005). Use of food pantries and food stamps in low‐income households in the United States. Journal of Consumer Affairs , 39(2), 276–298.

Huang, J., & Barnidge, E. (2016). Low-income children's participation in the National School Lunch Program and household food insufficiency. Social Science & Medicine, 150 , 8–14.

Kreider, B., Pepper, J. V., & Roy, M. (2016). Identifying the effects of WIC on food insecurity among infants and children. Southern Economic Journal, 82 (4), 1106–1122.

Ratcliffe, C., McKernan, S. M., & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity? American Journal of Agricultural Economics, 93 (4), 1082–1098.

Larson, N. I., & Story, M. T. (2011). Food insecurity and weight status among U.S. children and families: A review of the literature. American Journal of Preventive Medicine, 40 (2), 166–173.

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Millions of american families struggle to get food on the table, report finds.

Maria Godoy at NPR headquarters in Washington, D.C., May 22, 2018. (photo by Allison Shelley) (Square)

Maria Godoy

research on food insecurity

The increase in food insecurity in 2022 reverses a decade-long decline in the number of U.S. households experiencing hunger. Justin Sullivan/Getty Images hide caption

The increase in food insecurity in 2022 reverses a decade-long decline in the number of U.S. households experiencing hunger.

Just putting three meals a day on the table was a struggle for millions of people in the U.S. last year. That's the sobering conclusion of a new report from the U.S. Department of Agriculture, which found hunger in the U.S. rose sharply in 2022.

The report found that 44.2 million people lived in households that had difficulty getting enough food to feed everyone in 2022, up from 33.8 million people the year prior. Those families include more than 13 million children experiencing food insecurity, a jump of nearly 45 percent from 2021.

"These numbers are more than statistics. They paint a picture of just how many Americans faced the heartbreaking challenge last year of struggling to meet a basic need for themselves and their children," U.S. Secretary of Agriculture Tom Vilsack said in a statement.

The findings reverse a decade-long decline in hunger and food insecurity in the U.S. And they reflect the loss of several pandemic-era measures designed to strengthen the social safety net, says Elaine Waxman , a senior fellow at the Urban Institute who studies food insecurity and federal nutrition programs.

" A lot of the programs that had buffered people's experience during the pandemic were retired or rolled back in some way ," Waxman says.

Pandemic food assistance that held back hunger comes to an end

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Pandemic food assistance that held back hunger comes to an end.

Those programs included an expanded child tax credit that gave families with children extra money, temporarily increased benefits from the Supplemental Nutrition Assistance Program, or SNAP – formerly known as food stamps – and free school meals for every child.

At the same time, food prices and housing costs have shot up, says Kelly Horton , chief program officer at the Food Research and Action Center. And she points out an increasing number of Americans are working in unstable gig-economy jobs, like delivering groceries, driving for ride-share services or completing tasks on demand.

" So all of these things converging...we have a lot of people who are living on the edge," Horton says.

In its report, the USDA found that nearly 7 million households were so financially squeezed last year that they had to skip meals at times because there wasn't enough food to go around. Almost all of these households said they couldn't afford to eat balanced meals. In some 381,000 households with children, kids also experienced the pangs of hunger – skipping meals or going the whole day without eating. Waxman notes this could have significant health consequences, especially for kids.

"In particular, we worry about that for children because their trajectory now influences what happens to them later," says Waxman. She notes research has found children who experience food insecurity are more likely to experience worse health outcomes down the road, including cognitive or developmental delays and higher rates of hospitalization.

Overall, households with children and those of color experienced food insecurity at significantly higher rates than the national average. The rates of hunger for Black and Latino households were both more than double the rates for white households.

Congress tackles food stamp changes in the farm bill

Congress tackles food stamp changes in the farm bill

Food access advocates say the findings underscore the importance of protecting social safety-net programs. Right now, there's particular concern when it comes to the fate of the food assistance program known as WIC , which serves pregnant mothers and young children up to age 5.

Since the pandemic-era increases to SNAP benefits ended, more families have been turning to WIC for help with food, says Nell Menefee-Libey , public policy manager at the National WIC Association.

" We know that more families are turning to the program and find themselves needing support from WIC who may previously have not been using WIC services," Menefee-Libey says.

But some lawmakers have proposed funding cuts to WIC benefits, even as the program needs additional funding to serve the increased number of families that are seeking assistance, says Horton of FRAC.

"So there could be a case where WIC runs out of money if Congress does not give them additional funds," Horton says.

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Hidden Food Insecurity: The Adolescents Who Aren’t Getting Enough to Eat

Adolescents often miss out on the benefits of food programs that tend to target adults and younger kids.

Lindsay Smith Rogers

In 2022, 17 million U.S. households faced  food insecurity , meaning that they were unable to acquire sufficient food for everyone in the home. Several federal programs provide resources to bridge the gap, yet they often miss a key group: youth ages 14–18, who need more calories than younger kids.

In this Q&A, adapted from the  March 6 episode of  Public Health On Call , adolescent health researcher  Kristin Mmari , DrPH, MA, talks about the long-term impacts being hungry can have on young people and why most programs aimed at relieving food insecurity don’t help this age group. Mmari, an associate professor in  Population, Family and Reproductive Health , also rebuts false claims that nutrition assistance programs contribute to childhood obesity.

What exactly is food insecurity?

Food insecurity is when a person lacks access to nutritious food for normal growth and development. This may be caused by either unavailability of food or a lack of resources to obtain food.

There are different levels of food insecurity, from moderate to more severe food insecurity. When someone is severely food insecure, that means that they have maybe not eaten for the whole day. They’re hungry. But even those with moderate food insecurity may have to sacrifice some things to get food, and they may also not be getting the most nutritious foods. As you know, highly processed foods are usually cheaper.

How common is this in the US?

It’s very common in low-income households. It hasn’t been researched as much among adolescents compared to adults or children. Estimates are that it’s very high, but it’s also hidden. When I first looked into this about four or five years ago, it was largely unknown among adolescents.

But when we started interviewing adolescents in Baltimore, it was very common. In fact, just in our small sample, 53% were food insecure. And a third of those were severely food insecure. It’s something adolescents don’t like to discuss; many adolescents said that admitting that they’re hungry or food insecure is almost the worst thing that they can admit.

What age range do you use to define adolescence?

Adolescence is typically 10–19-year-olds, as defined by the World Health Organization. In our study, we looked at 14–18-year-olds. Other studies have looked at the full range, but we’ve found that among children that have food insecurity issues, the older an adolescent is, the more likely they are to be food insecure.

Why does food insecurity uniquely impact adolescents?

It hits adolescents differently because they’re in a critical period of development where they’re actively growing, their brains are expanding, their metabolic rates are increasing—all kinds of changes are happening to their bodies. And it’s at this moment when they have a need for more calories.

This isn’t often considered in terms of the whole food insecurity issue. When we talk about food assistance programs, we typically think of families with younger children. A lot of food pantries are geared to them. But we don’t associate adolescents with food insecurity.

There’s been some recent research linking food insecurity to a number of behavioral problems and problems with learning and academic achievement. If you can imagine adolescents in school who don’t have their caloric requirements met, you can imagine that their learning is going to be affected. A wide variety of other health outcomes are impacted as well.

Can you talk about some of those other health outcomes?

Some studies have linked adolescent food insecurity with cognitive issues, obesity, diabetes, and other outcomes like substance use and even sexual risk behaviors. For the study we did a few years ago, we conducted focus groups with adolescents. One of the things that was so heartbreaking to hear was that in all six of the Baltimore neighborhoods where we did these focus groups, girls described having to engage in transactional sex to get money to pay for food. It was very common.

Boys, meanwhile, would engage in basically “anything,” as they said. If you think of the “squeegee kids” [who wash windshields at intersections for money]—a lot of them mentioned doing that to get money for food. They said that was easier than going to places like food pantries, where they were often judged and people didn’t seem to want them there.

What about federal programs, like SNAP benefits? Why are adolescents falling through the gaps?

There are a number of reasons. For one, we have to look at how the SNAP [Supplemental Nutrition Assistance Program] benefits are calculated. SNAP benefits are tied to the USDA’s Thrifty Food Plan , which accounts for what would be a nutritious meal at a minimum price for four individuals in a family: a man and a woman, ages 20–60, a child ages 6–8, and another child ages 9–11. That calculation doesn’t include adolescents over that age who need more calories.

The other thing is that the benefits go to the head of the household. And in many low-income households, while adolescents aren’t called the head of the household, they are actually the ones responsible for many of the family's food needs. Many adolescents we spoke to were having to shop for food, yet they don’t have the benefits that come with SNAP debit cards. It’s rare that the household head gives them the cards to purchase food. They have the responsibility without these benefits, essentially.

You did this study of groups within Baltimore. Tell us a little bit more about what you found.

Just recently, during the COVID pandemic, we conducted a study to look at the impact of three different types of federal food assistance programs during the pandemic. We worked with the Mayor’s Office of Employment Development and Support Services in Baltimore City to recruit 284 adolescents. 

In a nutshell, we found that for adolescents, there really was no association between these additional benefits offered during the pandemic and food insecurity. 

In another part of the study, we asked adolescents themselves what they think they need to be able to deal with food insecurity. I think the most common answer was that they felt SNAP benefits need to increase. Many of the adolescents also felt that they should be given the benefits directly. We talked with policymakers, and they didn’t feel that that would go over well because we often think of adolescents as not being the most responsible. That’s the typical stereotype. But in fact, like I said before, these are adolescents who are often, in many ways, the most responsible in their households for getting food. So I think there is kind of that misconception out there.

I read that legislators across the U.S. are cutting these food programs. One of them cited childhood obesity as a reason to not give people access to programs that might help alleviate food insecurity. What do you have to say about that?

There is actually a link between food insecurity and obesity, and I think there needs to be more research to look at that. We all know that healthy food is much more expensive, especially in low-income neighborhoods. It’s no wonder that if the only choices are highly processed foods, there may be an obesity link. If anything, that exemplifies the problem even more.

What opportunities are there for solutions?

One of my colleagues, Kaitlyn Harper , has been working with young people in Baltimore on this issue and has implemented an online food pantry where adolescents can purchase foods. Another thing we’re thinking of trying is going through Instacart, where we can load up like a card, almost like a SNAP benefit card, and adolescents can choose and purchase foods that way. We’d like to do a study to see if adolescents purchase healthy food. What do they purchase? How often do they use it? And ultimately, does it reduce food insecurity? 

But there’s more than that. The neighborhood where you live makes a big difference in terms of accessing food. I’m also really interested in community gardening and urban farming and the relationship of where those places are in relation to where adolescents live. There are a number of ideas to be examined. And young people are the ones who are the most informative because they know what works best for them, so we need to listen to them to learn which approaches work.

Lindsay Smith Rogers, MA, is the producer of the Public Health On Call podcast , an editor for Expert Insights , and the director of content strategy for the Johns Hopkins Bloomberg School of Public Health. 

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  • Published: 08 August 2022

Systematic evidence and gap map of research linking food security and nutrition to mental health

  • Thalia M. Sparling   ORCID: orcid.org/0000-0002-8071-3232 1 ,
  • Megan Deeney   ORCID: orcid.org/0000-0002-4817-1170 1 ,
  • Bryan Cheng 2 ,
  • Xuerui Han 2 ,
  • Chiara Lier   ORCID: orcid.org/0000-0003-0868-1384 2 ,
  • Zhuozhi Lin 3 ,
  • Claudia Offner 1 ,
  • Marianne V. Santoso 4 ,
  • Erin Pfeiffer 5 ,
  • Jillian A. Emerson 6 ,
  • Florence Mariamu Amadi 7 ,
  • Khadija Mitu 8 ,
  • Camila Corvalan 9 ,
  • Helen Verdeli 2 ,
  • Ricardo Araya 10 &
  • Suneetha Kadiyala   ORCID: orcid.org/0000-0002-9101-1471 1  

Nature Communications volume  13 , Article number:  4608 ( 2022 ) Cite this article

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  • Epidemiology
  • Risk factors

Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research.

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Introduction

Food security and nutrition (FSN) are key components of global health and development. Internationally, healthy diets are increasingly reported to be out of reach 1 and unaffordable 2 for people of lower socioeconomic status, leading to undernutrition (e.g., wasting, underweight, micronutrient deficiency, growth faltering) in low- and middle-income countries (LMIC) and nutrition-related chronic diseases (NRCD) in both LMIC and high-income countries (HIC) 3 . Despite progress in reducing overall hunger and food insecurity (especially in Asia and Africa), one in ten people were exposed to severe levels of food insecurity in 2019, with areas or populations experiencing much higher prevalence 4 . However, in most regions, improvements in food security have slowed (including West Asia and North Africa) or reversed (including Latin America and the Caribbean) in recent years 5 . Linear growth measures are slow to reduce in line with global development goals 6 , and one in every three people are overweight or have obesity 7 .

Mental health has also been identified as a major cause of disability 8 , although efforts to address global mental health burdens in low-resource settings is not commensurate with the magnitude of that burden 9 . Depressive disorders alone are thought to be the single-most contributor to health loss globally (7.5% of all Years Lived with Disability—YLD) 10 . Anxiety and stress, which along with depression are the common mental health disorders, are also leading causes of disability 11 . Despite improvements in measuring global mental health burdens, estimating the true burden remains a serious challenge. Transcultural identification and underreporting (especially due to stigma and differing social constructs) hinder the ability to make accurate global estimates 12 .

Each of these fields has evolved in the last several decades. Both have shifted from clinical and continuum of care frameworks to include influential factors of wider environments and contexts, leading to an understanding of complex and systems-driven aetiologies 12 . Furthermore, the connections between FSN and mental health have been increasingly investigated. Food insecurity has been shown to lead to poor mental health in many contexts 13 , 14 . There is mixed or poor quality evidence linking distinct nutrients to mental health 15 , 16 , 17 . Dietary patterns and diet quality have been shown to be related to depression and in some instances anxiety, although heterogeneity of different measures and indices hampers the inferences we can make 18 , 19 , 20 , 21 . The association between BMI and mental health has perhaps been the longest-standing topic of inquiry, although this literature is dominated by research carried out in HIC settings 22 , 23 . Poor mental health of parents, particularly mothers, has been associated with low dietary diversity, lack of micronutrients, anthropometric outcomes, and other illness and care measures of their children in several settings 23 , 24 , 25 , 26 , 27 , but not in others 28 , 29 . Mental health, for instance depression, has also been shown as a factor influencing nutritional risk and malnutrition (the nutritional aspects of frailty) in older adults 30 , 31 . Each of these investigations are further nuanced by their varying populations of interest and settings.

Systematic reviews on these topics are often (by nature) narrow in scope–usually in specific populations, using a particular subset of FSN and mental health indicators. Primary studies are often post-hoc or ad-hoc analyses derived from observational studies where FSN and mental health relationships are not primary outcomes. This limits the breadth and quality of the available evidence. Taking stock of the literature across interrelated aspects of FSN and mental health overall will allow for better identification and use of the strongest available evidence and more systematic efforts to research these intersections. It will also offer the possibility of creating an empirical framework that can guide hypothesis testing and causal identification going forward.

We aimed to systematically identify and map analytical studies associating FSN with mental health resulting in an interactive Evidence and Gap Map (EGM) that can offer both broad and granular views of this diverse body of literature. Our objectives were to describe the nature and range of evidence on (a) a wide range of constructs of food security and nutrition (food security, nutritional risk, diets, nutrient intakes, nutrient biomarkers, infant and young child feeding [IYCF], birth outcomes, and anthropometry), (b) linked to all types of common mental health problems (depression, anxiety, stress, and mental wellbeing), (c) across most healthy populations, settings, and study designs.

Search and screening results

The study selection process is shown in the PRISMA Flowchart (Fig.  1 ). A search of three databases retrieved 40,192 results total, 30,896 of which remained after removing duplicates and were screened on title and abstract. Of these, 3771 were included for full-text review. Most articles excluded at this stage were excluded on FSN measurement, in populations with underlying health conditions, were not analytical, or were non-systematic reviews, theses, comments, or abstracts. Finally, 1945 studies met the inclusion criteria and were mapped, as shown in the HTML map linked to this article . The cells in the EGM are segmented into population groups: children (green), pregnant women and mothers (blue), adults (yellow), and mid- to later-life populations (red). Summary statistics presented here forth are not additive to the total number of reports included, as many studies included multiple measures, populations, and settings. A simplified heat map of FSN and mental health studies is shown in Fig.  2 .

figure 1

Number of identified studies from search at each stage of screening.

figure 2

Rows are measures of mental health, columns are measures of food security and nutrition.

Food security and nutrition measures

Proportionally, the FSN measures in studies by group were comprised of: anthropometry (40%), diets (24%), nutrient intakes (14%), birth outcomes (13%), food scarcity (12%), nutrient biomarkers (10%), and IYCF indicators (6%).

Overall, BMI was the main indicator in 703, or 36% of all mapped studies, and was measured in almost 90% of studies including anthropometry. Studies measuring dietary patterns and quality (16%) and specific food groups (12%) were both prevalent. Of the studies measuring nutrient intake – via foods or supplements (14%), most were about macronutrients ( n  = 152/273), of which 94/152 were about polyunsaturated fatty acids (PUFA). The second largest group was vitamin intake ( n  = 110/273 studies). Of 110 studies on vitamins, various B vitamins (65%), calcium (40%), and vitamin C (29%) were most common. Of all nutrient intake studies, 87 measured supplement intake. Studies on nutrition-related birth outcomes ( n  = 245) primarily measured birth weight (84%). The majority of studies on food scarcity ( n  = 230) measured food security (71%) via many different indices. The most popular was the United States Department of Agriculture (USDA) scale used in national surveys in the US or adapted to other countries such as Canada or Korea ( n  = 70 including all versions). A small number of studies measured food scarcity through famine exposure ( n  = 9), and nutritional risk was mostly assessed in older populations ( n  = 70). Of the nutrient biomarkers in studies ( n  = 202), about half were on vitamins (55%), particularly for vitamin D (66%), folate (25%), and vitamin B12 (20%). Breastfeeding (including initiation, duration, or exclusivity) was the main FSN measure for nearly all IYCF studies ( n  = 114/124). A count of studies in each category is listed in Supplementary results  1 .

Mental health measures

Depression was by far the most common mental health measure, assessed in 61% of included studies. Hybrid domains of mental health—defined as capturing more than one aspect of mental health (e.g., a combination of depression and anxiety, a clinical interview for all common mental disorders)—were assessed in 26% of studies. Stress (12%), mental well-being (12%), and anxiety (10%) linked to FSN were the least studied.

Most studies (82%) used screening questionnaires to ascertain mental health status. Mental well-being and stress have no clinical diagnosis, so almost all of these were based on established indicators via questionnaires. For depression screening, the Center for Epidemiological Studies-Depression scale (CES-D) was the most common tool ( n  = 332), followed by the Edinburgh Postpartum Depression Scale (EPDS) ( n  = 183), the Geriatric Depression Scale ( n  = 105) and the Patient Health Questionnaire (PHQ) ( n  = 104). For hybrid domains, the Global Health Questionnaire (GHQ) was the most used screening tool ( n  = 76), as well as the Child Behavior Checklist (CBC) for measuring mental health in children ( n  = 41), the Hopkins Symptom Checklist (HSCL) ( n  = 36) and the Depression and Anxiety and Stress Scale (DASS) ( n  = 33). The State-Trait Anxiety Inventory (STAI) was by far the most common screening tool for anxiety ( n  = 64), and the Perceived Stress Scale (PSS) and Kessler Stress Inventory (KSI) were the most common stress measures used ( n  = 84 and n  = 46, respectively). For mental wellbeing ( n  = 229), 83 used the Short Form-36 questions, (also known as the Rand questionnaire). Many of these tools have been translated, adapted, and validated for cross-cultural use in LMIC contexts, and some tools have been developed specifically for these settings rather than adapted.

Clinical and diagnostic interviews were carried out in 9% of all studies, almost all of which (96%) were on depression or a general psychological or psychiatric interview which is used to diagnose multiple common mental health problems (hybrid domains). Some studies used a self-reported diagnosis, prescription medication as a proxy for diagnosis or medical records (8% of all studies). Only 14 studies investigated mental health using qualitative or mixed methods. There were 89 reviews or meta-analyses on depression, 58 on hybrid domains, 14 on anxiety, eight on stress, and three on mental wellbeing.

Relationships between FSN and mental health

The number of studies in each FSN and MH category and the proportion investigating linkages between them are presented in the Sankey diagram in Fig.  3 . The largest groups of BMI studies within anthropometry (90%) and overall (36%) were those examining BMI with: depression ( n  = 401, 21%), hybrid mental health measures ( n  = 192, 10%) and mental wellbeing ( n  = 109, 6%). The second largest intersection was diets (food groups, patterns, quality) with: depression ( n  = 278; 14%), hybrid mental health measures ( n  = 121, 6%) and mental wellbeing ( n  = 69, 4%).

figure 3

Categories of FSN measures on the left are linked to corresponding groups of MH measures listed on the right, with the width of the bands indicating the proportional number of studies connecting the groups.

Despite anthropometry and depression being the largest category, measures other than BMI and mental health besides depression were far less researched. Although there are some studies on child stunting, wasting, and underweight related to depression ( n  = 45 with depression, n  = 23 with hybrid domains), studies reporting relationships with other common mental health disorders such as anxiety and stress were few ( n  = 5).

Although studies measuring nutrient intake were the third largest FSN group, 75% of these were analyzed for their relationship to depression, and an additional 18% to hybrid domains. Most of these studies linked macronutrients and vitamins to depression ( n  = 117 and n  = 77, respectively), while few studies linked to anxiety, stress, or mental well-being ( n  = 56 altogether). Eighty-nine studies linked PUFA intake to depression or hybrid domains, and 32 studies to vitamin D intake and depression. There was almost an identical distribution for nutrient biomarkers, where proportionally almost all studies on biomarkers were linked to depression and hybrid measures. Vitamin D ( n  = 66) was the most common biomarker linked to depression.

Almost 50% of studies about birth outcomes ( n  = 245 total) were about birth weight with depression, and an additional 35% with hybrid domains. Many studies measured multiple nutrition-related birth outcomes (31%) such as birth length and head circumference, however only 28/245 of these included mental health measures other than depression. Only 10 of these studies investigated foetal growth restriction in relationship with mental well-being or stress, for example.

Food scarcity was linked to depression in many studies as well, especially in the studies examining nutritional risk in the elderly ( n  = 56/70). Food security was often studied in relationship to depression ( n  = 72/163), however as food security is also associated with worry, stress, and anxiety, other measures of mental health were relatively more common in the studies than in other groups of FSN (40% measured hybrid domains, 19% measured stress, 9% measured anxiety and 9% measured wellbeing).

Breastfeeding and depression were examined in 91 studies. There were especially few studies on any IYCF measure with anxiety ( n  = 28), stress ( n  = 11), and mental well-being ( n  = 4). Child diets and complementary feeding was linked to depression or hybrid domains in six out of eight child diet studies. For instance, only three studies compared any measure of mental health with child dietary diversity.

Study methods

Hypothesis testing.

We included studies that hypothesized the relationship between FSN and mental health in either direction: with FSN constructs as the ‘exposure’ or independent factor and mental health as the ‘outcome’ or dependent factor and vice versa (shown in each iteration, segmented proportionally by study design, in Fig.  4 ). Most studies ( n  = 1291, 66%) hypothesized FSN constructs as the exposure or equivalent, including cross-sectional studies. Almost 28% of these studies were about BMI associated with depression or hybrid domains of mental health outcomes. Another 25% were about diets related to depression or hybrid domains of mental health.

figure 4

The top panel is the number of studies with food security and nutrition (FSN) as the hypothesized exposure and mental health as the studied outcome.  The middle panel is the number of studies with mental health as the exposure and FSN as the outcome, and the bottom panel is the number of studies where both hypotheses were investigated.

Mental health was treated as the exposure in 31% of studies ( n  = 600). Of these studies, 39% investigated mental health related to BMI as an outcome, of which 121 studied depression as an exposure, 69 studied hybrid domains of mental health, 60 studied stress, 27 studied anxiety, and 9 studied mental wellbeing. Birth outcomes were the second-largest group of mental health exposure studies, where 119/147 were about birth weight. Where IYCF was the outcome ( n  = 75), almost all were about breastfeeding ( n  = 67). There were relatively fewer studies on diets, nutrient intakes, and biomarkers than in either the EGM overall or where mental health was the outcome.

In a small number of studies ( n  = 54), investigators tested the hypothesis for relationships in both directions over time. For instance in a longitudinal cohort where dietary patterns could be isolated as an exposure among people who develop mental health problems, or alternatively within the same study population, those whose dietary patterns change over time linked to preceding mental health problems. Most of these studies investigated BMI and mental health ( n  = 31/54). These characteristics can be selected through the filter function on the interactive EGM.

Study design

The majority of studies were observational (83%), with 46% cross-sectional and 37% longitudinal (Supplementary results  2 ). An additional 3% of studies were case-control design. There were 142 systematic reviews, of which 48 offered a meta-analysis. Experimental studies were not common —only 65 Randomized Controlled Trials (RCTs) were identified, along with 20 quasi-experimental studies (12 of which used Mendelian Randomization or genetic instrumental variable methods). Only ten qualitative studies were identified, and 4 mixed methods studies, despite explicitly including qualitative eligibility and coding parameters.

Cross-sectional studies followed a similar pattern to the EGM as a whole on mental health measures, although regarding FSN there were proportionally more studies on food scarcity and BMI and fewer on birth outcomes and IYCF. There were proportionally more longitudinal studies on birth outcomes (double across all but one mental health category) and more IYCF studies, and less on nutrient intake, nutrient biomarkers, and food scarcity, although mental health measures were similar proportionally to the full EGM.

Systematic reviews and meta-analyses on diets linked to depression or hybrid domains were most common (reviews without meta-analysis = 28; reviews with meta-analysis = 9, meta-analysis without review = 4), and nutrient intakes with depression or hybrid domains were the second most common (systematic reviews = 42; 15 of these with meta-analyses). Almost all (14/15) meta-analyses on nutrient intakes were about supplements. There were 18 reviews on BMI and depression or hybrid domains (seven of these with meta-analysis), while nine others focused on child growth measures. There were 22 systematic reviews on mental health related to birth outcomes, 17 of which were about mental health of mothers and birth outcomes of their offspring. Of all 69 meta-analyses, 59 of them focused on depression or hybrid domains.

Most experimental studies were RCTs of nutrient intake exposures and mental health outcomes ( n  = 46/65 experimental studies), namely depression ( n  = 26) and hybrid domains ( n  = 16). Half of experimental studies included anxiety, stress, or mental well-being. Nutrient intakes were primarily measuring supplement intake ( n  = 38/47), especially those on B vitamins, Vitamin D, Zinc, and fatty acids. Sixteen RCTs exposed people to fatty acids, and 12 to Vitamin D. Several studies also exposed people to Vitamins A, C, or E and magnesium or manganese minerals. The second most common type of RCTs were those randomizing people to diets and measuring various measures of mental health (six on depression, 10 on hybrid domains, three on anxiety, seven on well-being, but none on stress). Sixteen studies intervened on: Mediterranean diet pattern ( n  = 4), low fat or low-calorie diet ( n  = 4), the DASH diet, high-protein diet, healthy diet, or fish/animal source foods ( n  = 2 each), low glycaemic diet, high protein diet and vegetarian diet ( n  = 1 each). Only three studies had mental health interventions with FSN outcomes: two on stress reduction interventions and BMI or food intake, and one on antenatal depression interventions and birthweight/child growth.

The geographic distribution of studies by country, defined by where the participants were located, is shown through a choropleth map in Fig.  5 . The most saturation (number of studies) was in the United States, Australia, and the United Kingdom, 521 studies came from across Europe, 418 from Asia, and 81 from Africa. Central and South America were represented in fewer studies ( n  = 18 and n  = 67 respectively). Overall, 23% ( n  = 446) were set in low- and middle-income countries (LMIC). Eight percent ( n  = 160) were ‘global’ studies, such as those in five or more nations across regions, or those using global datasets, such as the Gallup poll or World Bank data.

figure 5

The bar plot on the left shows the number of studies by region and political category, and the map on the right shows number of studies by country.

Heat maps segregated into HIC and LMIC evidence is provided in Supplementary results  3 . Overall, there were proportionally more studies on nutrient intakes in HIC (15% vs. 9% of FSN measures), and proportionally more studies on food scarcity in LMIC (18% vs. 10%).

For instance, there were proportionally more studies of BMI in HIC (95% of 611 studies) compared to LMIC (72% of 172 studies). In LMIC studies, there were more studies on relative height (20% vs. 1%) and relative weight (11% vs. 2%) in children. For mental health measurement, 82% of studies using validated diagnostic tools were from HIC. Studies including measures of anxiety, stress, and mental well-being were more common in HIC than LMIC (13% vs. 7% for mental well-being).

Almost all reviews and meta-analyses were global in nature. Eighty percent of experimental studies and 90% of quasi-experimental studies came from HIC. Populations of interest in studies from HIC were proportionally more focused on general or representative adult populations (52% vs. 42% in LMIC studies). LMIC studies shift focus to women (particularly pregnant women and mothers—35% of LMIC studies vs. 26% HIC studies), although only slightly more on children (39% of LMIC studies vs. 35% HIC studies). Studies on mid-to-later-life populations were similar in both HIC and LMIC contexts (21%).

Populations

The EGM linked to this paper is segmented in each cell by broad population categories. We also offer a more granular classification of populations of children, women, men, and pregnant women and mothers (available as filters). Figure  6 shows a bubble diagram proportional to the population groups of included studies. Almost half of studies in the EGM were conducted in general or representative adult populations (49%). Studies including only mid- to later-life populations (usually 60 or 65 years of age and older) made up 21% of the EGM. Of the studies that included children of any age ( n  = 695), 433 included children under 5 years, 221 included children 5 to 12 years old, and 248 focused on adolescents 13 to 18 years old. Children under 5 were not commonly assessed on their mental health status ( n  = 106 vs. 423 studies of under-five measurements of FSN) as these measures are difficult to obtain and not reliable in very young children. Pregnant, perinatal women, mothers, and fathers were studied in 28% of all studies. Far more studies in pregnant women and mothers measured mental health as the exposure than FSN (26% vs. 8%). Pregnant and postpartum women were assessed more on their mental health status (9% pregnant and 5% postpartum) than on their FSN status (3% pregnant and 1% postpartum). Studies with women-only populations (not including perinatal women or mothers) made up an additional 8% ( n  = 158). Studies focusing only on men were fewer ( n  = 42, 2%).

figure 6

Bubbles are proportional to the frequency of analyses based on each population group. Bubbles for ‘Children’ ( n  = 257), ‘Adolescents’ ( n  = 214), ‘Pregnant Women and Mothers’ ( n  = 149), ‘Adults’ ( n  = 735) and ‘Mid Later Life populations’ ( n  = 408) refer to studies in which the relationship between FSN and mental health is examined within the same study population group. The bubble for ‘Cross-cutting populations’ shows studies in which the FSN measure in one group is hypothesized to affect the mental health of another group or vice versa, this includes interactions between households, parents, and/or children.

Some studies measured FSN in one group (e.g., children) and mental health in another (e.g., parents) (Fig.  7 ) . Amongst these ( n  = 484), the mental health of pregnant women and parents and the FSN of their children through adolescence has been studied the most: 355 total studies, 329 on FSN of children under five years, 44 on FSN of children 5–12, and 17 on FSN of adolescents. Fathers, however, are only included in eight of these studies. Mental health of pregnant women and mothers has mostly been hypothesized as the exposure for FSN outcomes in children ( n  = 314), though far fewer considered an association whereby FSN in children is the exposure and mental health of pregnant women and parents is the outcome ( n  = 54). The association between food security measured in the household with mental health in individuals was reported in 107 studies, most of which were in general adult populations ( n  = 51) and pregnant women and mothers ( n  = 38).

figure 7

The size of the bubbles and width of the links between them is scaled according to the number of studies and frequency of hypothesized relationships in the literature. The direction of the arrows indicates the hypothesized direction of effect according to the studies, a double arrow in opposite directions shows that both directions have been hypothesised in different studies.

Time trends

Our analysis shows clearly that the overarching body of literature linking FSN to mental health has steadily grown since 2000 (Fig.  8 ). As we concluded our search half-way through 2020, the number of these studies is likely to increase annually, marking a continued interest in this cross-section of fields.

figure 8

The plotted line shows the increase in studies from 2000 until 2020.  The search concluded half-way through 2020, which accounts for the drop off in this year.

Evidence is steadily growing about links between many of the FSN and mental health constructs measured by included studies, and the EGM makes this clear. Studies on depression and studies on BMI dominated the map overall. Anxiety, stress and mental wellbeing, and IYCF were the least represented in the literature. Given that food insecurity, inaccessibility of healthy, diverse diets, and poor clinical nutrition are all likely to exacerbate worry and stress, the dearth of studies linking FSN to dimensions of anxiety, stress, and well-being, rather than depression alone, is notable. There may be strong evidence on how food security, certain nutrients (e.g., Vitamin D), dietary patterns, and BMI are associated with depression. On the other hand, evidence seems sparse on the relationships between other nutrients (e.g., selenium, antioxidants), IYCF practices, or child growth related to mental health, or vice versa.

Regarding study design, experimental studies were mostly about nutrient intakes; very few intervened on other FSN measures or mental health interventions with FSN outcomes. Overall, experimental, quasi-experimental studies, and systematic reviews with meta-analyses were far less common than the plethora of cross-sectional and cohort studies. Only 34% of systematic reviews were accompanied by a meta-analysis. There was much less qualitative or mixed methods evidence.

Geographically, studies with paticipants from the United States, Australia, and United Kingdom dominated the evidence. Although almost a quarter of studies were carried out in LMIC, 77 of these 446 were conducted in China and 75 in Iran, with few in Arab countries or Latin America. The studies with participants from Africa ( n  = 81) were mostly carried out in three countries (South Africa, Ghana, and Ethiopia). Three-quarters of studies carried out in South America were from Brazil. Of the LMIC countries represented in the EGM, evidence is largely based in industrialised countries, which suggests that the LMIC literature does not capture the diversity of less industrialized, poorer, or more rural countries. It is an especially important gap, given that food insecurity and undernutrition are the highest in the countries least represented by the literature base.

Most studies that measured FSN in one population group and MH in another were about mothers’ mental health and their children’s nutrition or growth status. Very rarely were FSN indicators in children investigated for their effect on parents’ mental health. Fewer studies still focus on fathers or parents together. As studies among women in LMICs can sometimes focus on reproduction, and without sufficient attention to other aspects of womens health, we highlight the lack of studies from LMICs that examine mental health impact on women’s nutritional status and vice versa.

Despite studies showing that FSN and mental health are related in many ways, there are still large gaps across the EGM of studies investigating causal mechanisms of these relationships. There were many studies showing relationships between FSN and mental health, but less with the combined design, contextual factors, and analysis to provide information most needed to design effective programs and policies. For example, there were few qualitative studies identified, even though the ethnographic lens of lived experience can provide important insights into why and how mental health is related to FSN, without relying on nosological distinctions that may be less important in certain contexts. Some of the qualitative studies raised interesting findings, for example the mental health toll from weighing trade-offs in types of food purchases (e.g., healthier options versus volume or calories) 32 , how rising food prices affect not just food security and nutrition, but contribute to multi-fold mental health consequences from constraining cultural practices like funerals and other ceremonies 33 , and the varied role of social support related food insecurity: in some contexts social connectedness increased shame and stigma, whereas in others it helped buffer the negative effects of food insecurity through shared resources 34 .

That said, there is scope to further investigate the shared and underlying determinants of FSN and mental health. From the existing literature, these include poverty (although interestingly poverty alone does not account for these burdens 35 ), lack of women’s agency, other health conditions, environment, and climate change, as well as conditions of violence, conflict, instability, and social strife 36 , 37 , 38 , 39 . Most of these factors have been identified through the respective bodies of literature on each, but some new work on the topic has tried to understand common determinants and mechanisms between FSN and mental health through innovative theoretical framing, study design, and more advanced statistical models 28 , 40 . Recent interventions that at the least measure and at the most include programmatic components of both FSN and mental health have begun to give insight into some of these mechanisms as well 41 .

Through this systematic synthesis and mapping, we were able to combine various intersections of measures, populations, study types, and cross-cultural settings into an interactive resource. This is the first paper to systematize the body of evidence linking FSN to mental health. The EGM can be used in various ways by selecting and describing the nature and extent of literature on this topic.

We employed rigorous, expert-led screening and coding processes, including a search strategy designed by an information specialist using an index list of known literature. We followed state-of-the-art guidance on creating EGMs, which stop short of offering a synthesis effects observed but do include interactive filters to sort evidence according to study characteristics. Conducting a meaningful and feasible quality assessment of almost 2000 studies or pool results was beyond the scope of this EGM.

We also created parameters that limited our analysis in certain ways. We searched only papers published from 2000, did not search non-English repositories or include grey literature, and our chosen databases may not have been as likely to include qualitative reports, all which may have introduced some bias. That said, we are confident that collectively, the large number of studies identified and included serve as a basis from which to draw conclusions about trends, gaps, and characteristics of the available evidence on FSN and mental health.

The most important exclusion criteria were for studies in populations with underlying health problems, such as diabetes, cardiovascular disease, HIV, tuberculosis, or hospitalized patients, as well as niche characteristics (e.g., female endurance athletes or male textile factory workers). Although there is literature relevant for these populations, we aimed to identify evidence that minimized the confounding nature of other health conditions or characteristics. We also excluded FSN measures that were not direct measures of food security, intake, or nutrition status, such as eating behaviours, stimulant foods, or breastfeeding intentions.

In line with current trends to measure mental health globally through a symptom-based framework rather than a diagnostic criterion (which can bias and confound locally appropriate constructs of mental health) 42 , 43 , 44 , we included mental well-being and mental health quality of life measures. We also included qualitative literature on the topic, which might not fit within the traditional depression, anxiety, and stress groupings. For instance, a systematic review of qualitative literature about depression experience globally found that DSM model and standard instruments derived from the DSM fall short of capturing the experience of depression worldwide or regionally. Specifically, half of the 15 features of depression identified in non-western populations were not captured in current diagnostic tools 42 . However, measures of mental well-being were often difficult to disentangle from general happiness, life satisfaction, or other physical health quality of life measures. Many were mixed across these domains. We thus relied on expert guidance from Teachers College Global Mental Health Lab, who assessed each measure identified across all categories for eligibility and classified them.

We propose that this EGM is a tool to navigate a diverse literature base that will be primarily driven by the interests and expertise of the user. It can identify key gaps in the literature and thus direct novel efforts in research. This might include planning new primary studies or synthesis of existing primary research. When interpreting cells with fewer studies, it is important to carefully examine the quality of those studies and the clinical or practical relevance of research efforts to fill the gaps. Some research may be less strategic from a policy and planning perspective, for instance conducting new studies on IYCF related to anxiety and stress may have more application than new studies on minerals related to mental wellbeing, both of which appear as gaps on the EGM.

Furthermore, a cluster of studies in a cell (particularly certain study types—such as RCTs and reviews—commonly deemed further up on the hierarchy of evidence) still might prove worthy of further investigation. For instance, the most common subject of studies in the EGM is adiposity and depression, and there are several large, rigorous reviews with meta-analyses included on this topic. However, there is no pooled analysis of this relationship in low-income settings, where the observed effects may be quite different. This example highlights that the EGM as a whole can bring focus to understudied regions or populations: if used to highlight broad contextual factors, this might spur research that changes the conclusions we draw from either combining all available evidence (which may not all act in the same direction) or making assumptions based on the most prevalent literature (e.g., from high-income settings).

The overarching goal of building the EGM was to lay the groundwork for an evidence-based, empirical framework highlighting linkages that are known and hypothesized between FSN and mental health. This would entail selecting and synthesizing the strongest evidence within each cell, insofar as combining certain groups of studies is appropriate. This will serve to direct and support future inquiries into these relationships, as well as systematize our knowledge on the topic (Supplementary discussion  1 , Box 1). Furthermore, a new understanding of and emphasis on these relationships can become part of advocacy, programs, strategic planning, and policy to support progress towards health goals such as the SDGs and others.

Through a systematic literature search, we comprehensively identified analytical studies investigating relationships between a broad array of FSN and mental health constructs. We mapped 1945 eligible studies onto an interactive EGM which can provide visualization of this diverse field of literature. The EGM overall allows readers to step back and take stock of the body of literature, as well as dive into specific intersections of food security, nutritional risk, diets, nutrients, nutrition-related birth outcomes, IYCF indicators, and anthropometry with depression, anxiety, stress, and mental wellbeing. The EGM also allows for narrowing of each intersection through an extensive list of filters that can be combined in various ways to select characteristics of interest.

The analysis and map highlight thematic trends (such as the proliferation of evidence linking BMI and depression) as well as gaps (stress and mental well-being related to nutrients or child diets). It also shows the nature of the literature—an increasing number of studies on the topic that are dominated by observational designs in high-income countries. Studies from Central and South America, Arab nations, and Africa are less prevalent, as well as studies using qualitative, mixed, quasi-experimental and experimental methods. Many different populations are investigated through this wide array of studies, although studies comparing associations between populations are dominated by mothers and their children.

We imagine that this analysis and EGM will serve as a basis for future inquiry, whether it be original research, evidence synthesis, and analysis, funding priorities, or the development of synergistic and integrated public health programmes and policies.

This systematic Evidence and Gap Map, including accompanying analysis, relied on publicly accessible documents as evidence, without including personal, sensitive, or confidential information from participants, thus complying with current ethical standards.

Search strategy

Following PRISMA guidelines, we conducted a systematic search of three published literature databases: Web of Science, CAB Global Health, and PsychInfo, searching from January 1 2000 until July 28, 2020. We chose the year 2000 as a cut-off as preliminary searches revealed diminishing returns in the eligibility and relevance of previous studies in this area. Broadly, the search was operationalized by including synonyms for mental health, stress, distress, anxiety, depression, or mood disorders, and synonyms for food security, micronutrients, diet, nutrition, or anthropometry, as well as all kinds of study designs. Results from the searches were deduplicated and loaded into EPPI Reviewer 4 and web-based software. All analysis and graphics were produced in Excel version 16 or the web-based Flourish Studio. The full search strategy, designed by an information specialist, is specified in Supplementary methods  1 . The screening and coding guidelines are listed in Supplementary methods  2a–d .

Eligibility—Inclusion

We included only papers published in peer-reviewed journals and in English, from 2000 until July 28, 2020, that presented empirical links between measures of food security and nutrition and mental health in human populations from anywhere in the world. We only included analytical research (studies associating mental health to FSN), excluding descriptive or prevalence studies. We included population-based quantitative and qualitative studies of any design. We included systematic reviews based on their eligibility criteria; to be included, at least one study in the review had to fit our overall eligibility criteria.

We included any quantitative indicator for: food scarcity (including food security, exposure to famine or hunger, and nutritional risk [usually in the elderly]); diets (specific food groups and dietary patterns or quality); nutrient intake (including vitamins, minerals, macronutrients, polyphenols/antioxidants via food intake or supplements); nutrient biomarkers (vitamins, minerals, macronutrients, and polyphenols/antioxidants measured through blood, urine, fat); Infant and Young Child Feeding (standard WHO indicators as well as breastfeeding initiation, duration or exclusivity); nutrition-related birth outcomes (e.g., birth weight, birth length, intrauterine growth restriction [IUGR] or small-for-gestational age [SGA], head circumference); and nutrition-related anthropometry (e.g., BMI, body composition, body ratios, relative weight, relative height). We used ‘relative weight’ as an umbrella group for wasting and weight-for-height z-scores (WHZ) and ‘relative height’ as a group including stunting, height-for-age z-score (HAZ), growth faltering, and other height measures of child growth. We also included studies that measured these elements of food security and nutrition through qualitative methods.

For mental health, we included studies that measured common mental disorders (CMDs) under the International Classification of Diseases version 10 (ICD-10), as well as general distress and mental well-being in order to capture transcultural and qualitative literature on the intersections of mental health and FSN. We used the following broad categories: depression; hybrid domains; anxiety; stress; and mental wellbeing (e.g., mental health-related quality of life). These could be assessed through qualitative interviews, screening questionnaires, self-report of diagnosis, prescription medication (as a proxy for diagnosis), or clinical and/or diagnostic interviews. The list of eligible screening measures was assessed and categorized by the mental health specialists at the Global Mental Health Lab.

Eligibility—Exclusion

We did not include grey literature in our search. Studies in populations with comorbid health conditions, such as hypertension, diabetes, HIV, or surgical patients were excluded as both the nutritional and mental health correlates of these populations is likely to be unique. We also excluded studies in populations where all participants were already identified as overweight or having obesity, low birth weight, or having mental illness. We excluded case reports ( n  < 10), theoretical or simulation-based modelling, studies in solely clinical setting, non-systematic reviews, theses, commentaries, and abstracts.

On FSN, we excluded studies on: dietary practices and attitudes without intake measures (e.g., eating family dinners, dieting); amino acids, hormones, single, specialized or stimulant foods (e.g., arginine, seaweed, walnuts only, coffee, caffeine, alcohol); proprietary or specialized supplement or food formulas; attitudes or preferences related to infant and young child care; preterm birth (as often an outcome of non-nutritional factors); and weight change, loss or trajectories. A full list of included and excluded measures with examples and justification are included in Supplementary methods  3a, b .

On mental health, we excluded mental illnesses other than CMDs (e.g., compulsive disorders, trauma-related stress disorders, phobic anxiety disorders, and developmental disorders). Measures that had no experiential component were excluded. Measures of cortisol were excluded as this hormone fluctuates for various reasons besides experience of stress (e.g., early in the morning, during birth, during exercise), as well as stressful event inventories or circumstances without ascertainment of perceived impact. General happiness or satisfaction measures were excluded as they are not direct measures of mental health, rather an indication of heightened risks or protective factors. We also excluded general health-related quality of life focusing only on physical health without mental health components separated. Lastly, we excluded studies where common mental illness could not be disentangled from other mental illness such as psychosis, bipolar disorder, substance use, eating disorders, or other mental health problems.

Some of our FSN or mental health measures (especially BMI) were included as covariables in studies for which they were not the main outcome or exposure of interest. Studies that did not report results directly linking FSN to mental health were therefore excluded.

Screening and study selection

A team of screeners were trained and double-screened reports on title and abstract until 85% agreement rate was reached, whereafter 85% of reports were single-screened and at least 15% (sometimes more with sensitivity checking) were double-screened by a senior researcher. Patterns and disagreements were discussed and additional written guidance offered. Eligible reports based on title and abstract were reviewed in full text. We undertook a similar training process, whereby once agreement rates were reached, screeners were allowed to single screen. A third of records were double screened to ensure good sensitivity. In addition to this, several iterations of backchecking and targeted searches were re-screened throughout the process.

Data coding and analysis

Data was classified through a mix of a priori and iterative coding strategies. Fields that were decided a priori (e.g., groups of FSN and mental health measures, countries, study designs, etc.) served to identify both trends and gaps. Iterative coding included the specific measures within FSN and mental health groups. For example, although we had pre-identified a list of common and validated measures of anxiety or depression, or food security, there were many more measures that emerged beyond initial lists. These were grouped into a code if more than one study employed the measure. We used a coding form built in EPPI Reviewer to extract data on eligible reports. Only analytical comparisons and their characteristics were considered for data extraction.

We extracted information on publication year, country (or countries) and regions, study design, hypothesized direction of association between FSN and mental health (exposure-outcome relationship) and specific categories of measures and indicators, study population characteristics and sample size, and whether the analysis was adjusted or not (with at least two covariables). For the hypothesized relationship, we coded based on the authors’ stated aims and methods even for cross-sectional and qualitative studies. The ‘adult’ population category included any age range over 18, whereas studies with populations limited to older people (usually 60 or 65+ years old) were coded with ‘mid- to later-life populations only’.

Data extraction was carried out by single coding of included studies with a full review of all data extraction forms by a second researcher and targeted sensitivity checks. Given the breadth of evidence included and the aims of an evidence and gap map, quality appraisal of individual studies was not feasible or meaningful at this stage.

>All studies that met the inclusion criteria were mapped into an EGM using standard methods 45 . The EGM framework consists of columns of categories and sub-categories of FSN constructs, and rows of mental health constructs as well as measurement categories. These rows and columns are collapsed (as the map opens) and then expanded to see all sub-categories. The cells can be segmented into four groups indicated by different colours. The bubbles scale proportionally to the number of studies in the group. The user can scroll over a cell to see a summary of studies or click on the cell to see a classified bibliography of selected studies. There is also a list of filters (codes), which can be used to select studies with specific characteristics for which data was extracted. A full coding structure is provided in Supplementary results  1 .

Reporting summary

Further information on research design is available in the  Nature Research Reporting Summary linked to this article.

Data availability

All scientific reports included in the Evidence and Gap Map were identified via Web of Science, PsychInfo, and CAB Abstracts Global Health repositories. The dataset (essentially included studies) generated during the current study are available within the HTML Evidence and Gap Map, and analysed within the manuscript and supplementary files. The full database (including initial search results and screening codes) can be accessed upon reasonable request from the corresponding author, as this is contained within EPPI Reviewer software which requires a user account.

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Acknowledgements

We thank the IMMANA team for their ideas, logistical and dissemination support, especially Sylvia Levy for supporting the ANH Academy Mental Health Working Group. Maria Palar, Lambert Felix, Venus Mahmoodi, Vildana Hodzic, Pema Payang, Srishti Sardana, Elliot Golden, and Justine Wright each contributed to the screening and coding of articles and we wholeheartedly thank them for their contributions. Herbert Aimiani and Nadine Seward also contributed to the ANH Academy Working Group on Mental Health which produced this work. Funding for this study was provided by the Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA) Programme, funded by FCDO and the Bill and Melinda Gates Foundation, which specifically funded the time of TS, MD, CO, and SK. We received in-kind support from the Global Mental Health Lab at Teachers College, Columbia University.

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TS conceived of the EGM and led the review, along with support from the ANH Academy Mental Health Working Group, consisting of TS, BC, MD, MS, EP, JE, FMA, KM, CC, HV, RA, and SK. TS, MD, and BC oversaw the methods and training for study identification. Screening and coding of studies was carried out by MD, TS, XH, CL, ZL, CO, and BC. TS drafted the manuscript, map, and figures, supported by CO and MD. The manuscript was reviewed by all authors, with further editing and revision support from CO, MD, BC, and SK.

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Sparling, T.M., Deeney, M., Cheng, B. et al. Systematic evidence and gap map of research linking food security and nutrition to mental health. Nat Commun 13 , 4608 (2022). https://doi.org/10.1038/s41467-022-32116-3

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Received : 28 September 2021

Accepted : 18 July 2022

Published : 08 August 2022

DOI : https://doi.org/10.1038/s41467-022-32116-3

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Food insecurity and food deserts in the US: A research roundup and explainer

The food landscape in the U.S. has changed since the first White House Conference on Food, Nutrition, and Health was held 53 years ago. We summarize several studies that show the link between food insecurity and health and include resources for journalists.

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by Naseem S. Miller, The Journalist's Resource September 27, 2022

This <a target="_blank" href="https://journalistsresource.org/home/food-insecurity-health/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

On Sept. 28, the White House is hosted a conference on hunger, nutrition and health — the second conference of its kind in five decades — and introduced a 40-page national strategy as a roadmap toward the goal of ending hunger and increasing healthy eating by 2030.

Among the drivers of the national strategy are food insecurity, which affects millions of Americans, and the increasing rates of diet-related diseases like obesity and diabetes.

The national strategy is built on five pillars: improving access to affordable food; prioritizing the role of nutrition and food security in overall health; empowering consumers to make healthy food choices; making it easier for people to be more physically active; and enhancing food and nutrition research.

“Lack of access to healthy, safe, and affordable food, and to safe outdoor spaces, contributes to hunger, diet-related diseases, and health disparities,” according to the conference ’s website. “The COVID-19 pandemic has exacerbated these challenges further.”

It’s been more than 50 years since the White House has held such a conference.

The first and only White House Conference on Food, Nutrition, and Health was held in 1969 during the Nixon administration and it led to the launch of programs like the Supplemental Nutrition Assistance Program — or SNAP — the Special Supplemental Nutrition Program for Women, Infants, and Children — known as WIC — and changes to food labels.

When the first conference was held, one of the main concerns was that families and children were not getting enough calories. In the 1930s, 1940s and 1950s conditions like rickets and night blindness were common as a result of vitamin deficiencies, explained Dr. Dariush Mozaffarian , a renowned expert on food systems and cardiologist, in a Sept. 22 video conversation about the White House conference, hosted by “ Conversations on Health Care ,” which regularly features discussions on health policy and innovation with industry experts.

“We have addressed those, but what we have now is kind of a mess of a situation where more Americans are sick than healthy from diet-related diseases like obesity, diabetes and hypertension,” said Mozaffarian, Jean Mayer Professor at the Tufts Friedman School of Nutrition Science and Policy. “And at the same time, we have people who are food insecure.”

Mozaffarian is one of the co-chairs of an initiative that has been informing the White House conference on hunger and has produced a report with 30 policy recommendations. They include strengthening the existing federal nutrition programs such as WIC, accelerating access to “ Food Is Medicine ” services to prevent and treat diet-related diseases and establishing a new structure and authority within the federal government to coordinate various hunger, nutrition and health efforts across agencies.

Meanwhile, the COVID-19 pandemic has not only disrupted access to food for some, including children who relied on school lunches, it also has highlighted the link between diet-related diseases such as obesity and worse outcomes from a COVID-19 infection. Although average income and employment numbers have improved since 2020, “some U.S. households continue to face difficulties obtaining adequate food, particularly in the face of increasing food prices,” according to a report from the U.S. Department of Agriculture .

Nearly 30% of the world population — or 2.3 billion people — were food insecure in 2021, according to the United Nation’s report on the state of food security and nutrition, published in July 2022. That’s 350 million more people compared to before the COVID-19 pandemic began.

In the U.S., 10.2% of households were food insecure in 2021, which was not significantly different from 10.5% in 2020, according to the latest USDA data . The latest U.S. Census Bureau Household Pulse Survey , conducted between July and August 2022, shows that 11.5% of households reported sometimes or often not having enough to eat during the prior 7 days.

research on food insecurity

Food insecurity

The USDA defines food security as “access by all people at all times to enough food for an active, healthy life.”

Food insecurity occurs when people have limited or uncertain access to healthy, affordable food because of a lack of money and other resources, according to the USDA . Food insecurity may be influenced by factors such as income, employment, race and ethnicity, and disability.

Food insecurity is considered one of the social determinants of health . It has been associated with higher rates of obesity, chronic diseases and developmental problems in children. Food insecurity can also affect mental health, studies show .

“Although having a chronic physical and/or mental health condition can be a precursor to food insecurity, research also shows that food insecurity itself causes considerable stress and anxiety, which can exacerbate pre-existing mental illnesses,” according to a June 2022 study from the United Kingdom, published in BJPsych Advances.

research on food insecurity

Food insecurity disproportionately impacts communities of color, people living in rural areas, people with disabilities, older adults, LGBTQ+ individuals, military families and veterans, said the U.S. Health and Human Services Assistant Secretary for Health Admiral Rachel L. Levine in a public video conference on Friday, Sept. 23, previewing the upcoming White House conference on hunger.

“No one should wonder where their next meal is coming from, or if they will have a safe opportunity to be physically active,” she said.

In 2006, the USDA introduced new terminology to describe American households’ access to food, ranging from “high” and “marginal” to “low” and “very low” food security. The low and very low food security levels are also described as “food insecurity.”

Food security levels are typically measured at the household level. The USDA monitors levels of food insecurity through an annual survey of U.S. households.

The agency’s 2021 survey , which included 30,343 households, finds 10.2%, or 13.5 million, U.S. households were food insecure and had difficulty at some points during the year providing enough food for everyone in the household due to lack of resources. The rate was 10.5% in 2020 and 2019 . In total, 33.8 million people lived in food-insecure households in 2021 . The reports also provide state-by-state data.

Rates of food insecurity were higher among certain groups , including single women with children, Black and Hispanic individuals, and households with income below the federal poverty line, which was $27,479 annually for a family of four in 2021.

Food security levels also vary by state, ranging from a low of 5.4% in New Hampshire to a high of 15.3% in Mississippi, according to the 2021 USDA report .

In the U.S., food assistance programs such as SNAP, WIC and the National School Lunch Program may help reduce food insecurity, according to the U.S. Department of Health and Human Services.

The U.S. rate of food insecurity is comparable to rates in other developed nations, although it is higher than some, including France, Germany, Austria and the United Kingdom, according to an analysis of 2019 data by Our World in Data , an organization that published research and data about world’s largest problems. Some of the highest rates of food insecurity are seen in parts of Africa, South America and the Middle East.

research on food insecurity

Food deserts

The term “food desert” was coined in the early 1990s by the Scottish Nutrition Task Force. Food deserts are defined as geographic areas where there’s a dearth of supermarkets, food retailers or other sources of healthy and affordable food. In many instances, these areas are low-income communities .

In its Food Access Research Atlas , the USDA maps food access indicators — mainly distance from supermarkets — in relation to poverty. Distance to food stores is measured in half-mile and 1-mile increments in urban areas and 10- and 20-mile increments in rural areas. For instance, a low income, low access area is where at least 500 people, or 33% of the population, lives more than one mile in an urban area or more than 10 miles in a rural area from the nearest supermarket, supercenter or large grocery store, according to the agency.

The agency also has a Food Environment Atlas , which examines how factors such as store or restaurant proximity, food prices, food and nutrition assistance programs, and community characteristics interact to influence food choices and diet quality. 

Lack of access to healthy food options is associated with poorer health outcomes, studies have shown.

“A consequence of poor supermarket access is that residents have increased exposure to energy-dense food (’empty calorie’ food) readily available at convenience stores and fast-food restaurants,” according to the 2010 study “ Disparities and Access to Healthy Food in the United States: A Review of Food Deserts Literature .” “It is documented that a diet filled with processed foods, frequently containing high contents of fat, sugar and sodium, often leading to poorer health outcomes compared to a diet high in complex carbohydrates and fiber,” the authors write.

Maintaining a healthy diet may be difficult for low-income people for several reasons. They may not be able to afford healthier options or lack transportation to a supermarket outside of their neighborhood.

“I think there are some people that make it seem like poor people are ignorant” about what healthy food choices are, said Dan Glickman, the former Secretary of Agriculture, in the video conversation including Mozaffarian and hosted by “ Conversations on Health Care .” “And that’s just not true at all. There are certainly economic disincentives for them to be able to purchase, in many cases, fresh produce in the same capacities for the higher-income people.”

There have been efforts to bring healthy food options to underserved areas.

In 2010, former First Lady Michelle Obama’s “Let’s Move!” campaign announced the goal of eradicating food deserts by 2017, according to “ Food Deserts: Myth or Reality? ” published in the Annual Review of Resource Economics in October 2021. In 2011, the Healthy Food Financing Initiative (HFFI) was established at the Department of the Treasury and HHS. The 2014 Farm Bill – or the Agricultural Act of 2014 — officially established HFFI at the USDA. The program provides grants to community organizations to build or renovate grocery and retail food stores in underserved communities.

To be sure, bringing a supermarket to a low-income neighborhood isn’t going to quickly solve health problems like obesity, according to “ The Changing Landscape of Food Deserts ,” a report by the United Nations System Standing Committee on Nutrition released in June 2020. “However that new supermarket will probably have an impact on community health and well-being, including economic benefits,” the authors write .

About 10% of 65,000 U.S. census tracts are identified as food deserts by the USDA , affecting 13.5 million households.

Below, we have gathered several studies that examine the relationship between food insecurity and health. The list is followed by reporting resources for journalists. We will update this piece as new research and information becomes available.

research on food insecurity

Research roundup

The effect of food access on type 2 diabetes control in patients of a new orleans, louisiana, clinic jasmine a. delk; et al. journal of the american pharmacists association, september 2022..

The authors reviewed the records of 109 patients at a diabetes management clinic in New Orleans, Louisiana, and find that reduced proximity to grocery stores offering fresh foods may negatively affect patients’ ability to control their type 2 diabetes. The patients’ mean age was 54 years and 92% were Black. Six percent of the patients identified as “other or multiple races or ethnicities,” 1% were Native American/Pacific Islander and 1% were Asian. There were no white patients in the study group.

The study finds 79% of patients whose diabetes was uncontrolled — their blood glucose levels were above glycemic control standards — lived in food deserts.

“The results of this small, retrospective study serve as a beneficial starting point in raising awareness for the socioeconomic phenomena of food deserts and how these environments influence chronic disease state management,” the authors write.

Social Determinants of Health in Total Hip Arthroplasty: Are They Associated With Costs, Lengths of Stay, and Patient Reported Outcomes? Ronald E. Delanois; et al. The Journal of Arthroplasty, July 2022.

The authors examine data from 136 Medicare patients at the Rubin Institute for Advanced Orthopedics at the Sinai Hospital of Baltimore, part of the Lifebridge Health network, who had an outpatient total hip replacement surgery between 2018 and 2019 to look for associations between social determinants of health — such as living in a food desert and having access to housing and transportation — and patient outcomes, including the costs of care during the 30 days after the procedure. The cost of care was defined as all costs of care after discharge, including physician payments. The mean age of the patients was 73 years and 60% were female. About 35% of the patients were “nonwhite,” and 40% of all patients reported living alone.

The authors find that the costs of care in the 30 days after the procedure were, on average, $53,600 more for people who lived in food deserts compared with those who didn’t live in a food desert. Other factors associated with increased costs included poor access to transportation and appropriate housing, and minority status, the authors find.

“As more [patients with total hip replacements] transition to the outpatient setting, social factors should play an increasing role in patient selection,” the authors write.

Disparities in Access to Food and Chronic Obstructive Pulmonary Disease (COPD)-Related Outcomes: A Cross-Sectional Analysis Eric Moughames; et al. BMC Pulmonary Medicine, April 2021.

The study links data collected from the SubPopulations and InteRmediate Outcome Measures in COPD Study between 2010 and 2015, and the 2019 food desert data using USDA’s Food Access Research Atlas. Of the 2,713 patients in the dataset, 22% lived in food deserts. Those living in food deserts were more likely to be “nonwhite” and more likely to have a lower income than those who didn’t live in food deserts, according to the study.

The authors find living in a food desert area was associated with worse chronic obstructive pulmonary disease, or COPD, outcomes. They also find limited food access is detrimental in both low- and high-income neighborhoods. The connections between low food access and COPD outcomes were stronger in urban areas compared with rural areas.

“The results further suggest that the impact of low food access may be greatest in urban areas,” they write. “Our results could be explained by the ubiquitous prevalence of unhealthy options (e.g., corner stores, fast food chains, etc.) in cities compared with rural areas, and in this type of urban setting, people will be more inclined to go to a fast food restaurant or corner store that is much closer and cheaper rather than walking farther away to a healthy food source.”

Related study : “ Evaluating the Association Between Food Insecurity and Risk of Nephrolithiasis: An Analysis of the National Health and Nutrition Examination Survey ,” by Benjamin W. Green; et al., published in the World Journal of Urology in September 2022, finds a relationship between food security and developing kidney stones, with greater severity of food insecurity associated with increased risk of developing kidney stones.

Food Deserts and Cardiovascular Health among Young Adults Alexander Testa, Dylan B. Jackson, Daniel C. Semenza and Michael G. Vaughn. Public Health Nutrition, July 2020.

The authors analyze data from Wave I (1993–1994) and Wave IV (2008) surveys from the National Longitudinal Study of Adolescent to Adult Health , including 8,896 study participants between 24 and 36 years old. They find living in a food desert was associated with poorer cardiovascular health. They also find living in a food desert has the strongest association with greater cigarette use.

“One possibility is that engagement in worse health behaviors via living in a food desert may be a partial function of the composition of the type of retail outlets in the area,” the authors write. “For instance, food deserts tend to have a larger composition of unhealthy retailers that sell cigarettes and advertise the sale of tobacco products on store fronts (such as convenience stores or neighborhood bodegas), which may translate into poorer health behaviors.)”

Related study : “ Association Between Living in Food Deserts and Cardiovascular Risk ,” by Heval M. Kelli; et al., published in Circulation Cardiovascular Quality and Outcomes in September 2017, finds that among 1,421 people living in the Atlanta metropolitan area, those living in food deserts had higher prevalence of high blood pressure, smoking, obesity and 10-year risk for cardiovascular disease.

Food Insecurity and Loneliness Amongst Older Urban Subsidised Housing Residents: The Importance of Social Connectedness Judith G. Gonyea, Arden E. O’Donnell, Alexandra Curley and Vy Trieu. Health and Social Care in the Community, September 2022.

The authors use survey data from in-person interviews in English or Spanish with 216 adults ranging in age from 55 to 90 years and living in a subsidized housing community in a neighborhood of a U.S. northeastern city. Half of the participants were Black and 45% were Latino.

Researchers find that 34% survey respondents reported being food insecure, which is higher than the 10% average for the older adults in the U.S. About 34% of the respondents also reported being lonely, which is higher than the 19% to 29% average for older adults nationally.

“The present study offers evidence of the interrelatedness of food insecurity, loneliness, poor health and food access challenges for the understudied population of lower-income older adults living in subsidized housing communities,” the authors write. “Importantly, the current study underscores the need to investigate the role of social and emotional factors that may heighten the risk of individuals experiencing food insecurity in later life.”

research on food insecurity

More studies of note

  • “ The 1969 White House Conference on Food, Nutrition and Health: 50 Years Later ,” by Eileen Kennedy and Johanna Dwyer, published in Current Developments in Nutrition in June 2020, provides a historical overview of the first conference and the programs that were developed as a result. “Necessary ingredients such as policy-relevant science, leadership, advocacy, and the science and art of politics must be blended together to make nutrition policies that truly advance the public’s health and well-being,” the authors write.
  • “ Association of Socioeconomic and Geographic Factors With Diet Quality in US Adults ,” by Marjorie L. McCullough; et al., published in JAMA Network Open in June 2022, examines data from 155,331 adults participating in a nationwide U.S. cohort study. The researchers find that Black individuals, low-income white individuals, those with low levels of education (high school or lower), and people living in rural areas or food deserts, were more likely to have overall poor diet quality. “All dietary components, but especially sugar-sweetened beverages and processed meats, contributed to the disparities observed,” the authors write. “Higher income and education had protective associations against poor diet quality, but these associations were not the same across all racial and ethnic groups.”
  • “ Measuring the Food Environment and Its Effects on Obesity in the United States: A Systematic Review of Methods and Results ,” by Ryan J. Gamba, Joseph Schuchter, Candace Rutt and Edmund Y. W. Seto, published in Journal of Community Health in October 2014, examines 51 peer-reviewed studies that analyzed the relationship between obesity and the number, type and location of food outlets such as supermarkets, convenience stores and fast-food restaurants. It finds that 80% of the studies found at least one significant association between the food environment and obesity. “Although the methods and results of individual studies were inconsistent, as a whole this body of research suggests that food environments are associated with obesity,” the authors write.
  • “ Food Insecurity Among People With Cancer: Nutritional Needs as an Essential Component of Care ,” a commentary by Margaret Raber; et al., published in the Journal of the National Cancer Institute in September 2022, notes that 17% to 55% of the cancer patients in the U.S. are food insecure. The commentary “explores the issue of food insecurity in the context of cancer care, explores current mitigation efforts, and offers a call to action to create a path for food insecurity mitigation in the context of cancer.”
  • “ Food insecurity Among African Americans in the United States: A Scoping Review ,” by Elizabeth Dennard; et al., published in PLOS One in September 2022, aims to identify risk factors associated with food insecurity and how food insecurity is measured across studies that focus on African Americans. In their conclusion, the authors write, “underrepresented risk factors to consider for future research include factors linked to health disparities among African American adults: lifetime racial discrimination, neighborhood grocery store availability, neighborhood safety from violence, income insecurity, and the impact of COVID-19 on employment.”
  • “ The Economics of Food Insecurity in the United States, ” by Craig Gundersen, Brent Kreider and John Pepper, published in Autumn 2011 in Applied Economic Perspectives and Policy, provides an in-depth review of food insecurity, including the nuanced relationship between income and food security and the impact of food assistance programs on food insecurity.
  • “ Food Insecurity and Severe Mental Illness: Understanding the Hidden Problem and How to Ask About Food Access During Routine Healthcare ,” by Jo Smith; et al., published in BJPsych Advances in June 2022, provides an overview of the relationship between food insecurity and mental illness, and its impact on people with severe mental illnesses such as schizophrenia and bipolar disorder. “Psychiatrists need to routinely assess and monitor food insecurity in people with [severe mental illness],” the authors write.
  • “ Changes in Food Environment Patterns in the Metropolitan Area of the Valley of Mexico, 2010–2020 ,” by Ana Luisa Reyes-Puente; et al., published in the International Journal of Environmental Research and Public Health in July 2022, looks at “food swamps,” which are areas where residents have easy access to high-calorie food, so much that the supply overshadows healthy food options. “The proliferation of food swamps is a feature of food environments in the global south. Unlike food deserts in the global north, where solving physical access to healthier food suffices to regulate its effect on malnutrition, in food swamps in the global south, solutions must be geared towards solving physical access as well as the social preferences of the population for certain types of food,” the authors write.
  • “ A Descriptive Analysis of Food Pantries in Twelve American States: Hours of Operation, Faith-Based Affiliation, and Location ,” published in BMC Public Health in March 2022, provides an overview of food banks and finds that in the 12 states studied, “approximately three quarters of food pantries are located in urban areas, and almost two thirds were considered to have a faith affiliation, which were also more common in urban versus rural areas.”
  • “ Mobile Pantries Can Serve the Most Food Insecure Populations ” by Lily K. Villa; et al, published in Health Equity in January 2022, uses data from an Arizona food pantry called the Phoenix Rescue Mission and finds “people aged 60-80 years and immigrant people of color are more likely to use both mobile and brick-and-mortar pantries.” The mobile pantries in this study are an extension of the brick-and-mortar food pantry operation and are vans that can change locations to meet the residents’ needs. The authors write: “This research suggests that mobile pantries can reach the most food insecure populations and local nonprofits and governments can consider implementing mobile pantries to reach food insecure communities.”
  • “ An Equity-Oriented Systematic Review of Online Grocery Shopping Among Low-Income Populations: Implications for Policy and Research ,” published in Nutrition Reviews in May 2022, examines 16 studies that assessed various aspects of online grocery shopping. It finds low availability of online grocery services in rural communities, high costs, and perceived lack of control over food selection were important barriers to using online grocery services. Meanwhile, factors such as the ability to pay for groceries online with SNAP benefits were motivators. (Related studies: “ Online Pilot Grocery Intervention among Rural and Urban Residents Aimed to Improve Purchasing Habits ,” and “ Availability of Grocery Delivery to Food Deserts in States Participating in the Online Purchase Pilot .”)

More recommended sources

  • “ Conversations on Health Care ” hosts Mark Masselli and Margaret Flinter speak with Dan Glickman, the former Secretary of Agriculture, and Dr. Dariush Mozaffarian, a renowned expert on food systems, about the White House Conference on Hunger, Nutrition, and Health, on Sept. 22, 2022. The program features in-depth discussions on health policy and innovation with industry newsmakers.
  • “ The White House Conference on Hunger, Nutrition and Health is an opportunity for transformational change ,” by Dariush Mozaffarian; et al., published in Nature Food in August 2022, provides historical context and the authors’ hopes for the 2022 White House conference on hunger.
  • “ USDA Food Box Program: Key Information and Opportunities for Better Access to Performance ,” published in September 2021 by the U.S. Government Accountability Office, evaluated the Food Box Program, which was implemented by the USDA in May 2020 in response to the COVID-19 pandemic. The program paid contractors to buy food from producers and deliver it to organizations like food banks, according to GAO.
  • “ Position of the Academy of Nutrition and Dietetics: Food Insecurity in the United States ,” by David H. Holben and Michelle Berger Marshall, published in the Journal of the Academy of Nutrition and Dietetics in October 2022, states, “systematic and sustained action is needed to achieve food and nutrition security in the United States.” It adds: “To build and sustain solutions to achieve food security and promote health, [registered dietitian nutritionists (RDNs), and nutrition and dietetics technicians, registered (NDTRs)] should engage in outreach efforts to forge partnerships among clinicians, charitable food providers, community partners, food processors, food retailers, other stakeholders, and people living with food insecurity.”

Resources for journalists

  • You can sign up here to watch the White House conference, which will be livestreamed on Sept. 28, 2022 at 9 a.m. EST.
  • “ Food Security in the U.S. ” is the USDA’s main online source for data and information on the topic. It also has a helpful “ Media Resources ” page, which includes tips for interpreting food security statistics.
  • You can use the USDA’s Food Access Research Atlas to find food access indicators for low-income areas using different measures of supermarket accessibility at the census tract level. A census tract is a small, relatively permanent subdivision of a county that usually contains between 1,000 and 8,000 people but generally averages around 4,000 people. You can also find state-by-state estimates of the size of low-income populations who have low access to nutritious food here .
  • The USDA’s Food Environment Atlas provides maps and data on restaurant proximity, food prices, food and nutrition assistance programs and community characteristics. One of the Atlas’ goals is “to provide a spatial overview of a community’s ability to access healthy food and its success in doing so.”
  • The USDA’s Food and Nutrition Service has data and reports on child nutrition and programs, including SNAP and WIC.
  • You can find the USDA’s annual reports on household food security, dating back to 1995, here .
  • Our World in Data has several charts that compare countries’ levels of hunger and undernourishment.
  • The Center for Science in the Public Interest is an independent, science-based consumer advocacy organization and a food and health watchdog.
  • Feeding America is a nationwide hunger-relief organization with a network of 200 food banks and 60,000 food pantries and meal programs.

About The Author

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Naseem S. Miller

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Diane whitmore schanzenbach.

Diane Whitmore Schanzenbach

IPR Director Diane Whitmore Schanzenbach is an economist who studies policies aimed at improving the lives of children in poverty, including education, health, and income support policies. Her recent work has focused on tracing the impact of major public policies such as the Food Stamp Program and early childhood education on children’s long-term outcomes.

Research Roundup

The impact of snap emergency allotments on snap benefits and food insufficiency.

January 2023

Since April 2020, states have been able to award Emergency Allotment, or EA, payments to SNAP recipients to supplement the formula-based SNAP benefits that they otherwise would have received. Nationwide, EA payments will be eliminated after the February 2023 payment, and SNAP benefits will revert for each family to the value that the SNAP benefit formula allocates. This rapid research  report  by IPR Director and economist Diane Whitmore Schanzenbach estimates the amount and impact of EA benefits. 

The Link Between Water and Food Insecurity

In a new study, IPR researchers show that avoiding tap water can increase an individual's chances of experiencing food insecurity. Asher Rosinger of Penn State University, IPR research associate Hilary Bethancourt, and IPR anthropologist Sera Young find that avoiding tap water is associated with a 20% to 30% increased likelihood of experiencing food insecurity in the United States.

App Explores Seven Key Economic Indicators

December 2020

IPR researchers have created a new application for tracking seven economic indicators data across the nation and state by state. Users can find data from April 23 onward from the U.S.  Census Bureau Household Pulse Survey on unemployment, children's schooling, housing, finances, mental health, and food insecurity for American households. Read the summary or the accompanying report .

Visualizing Food Insecurity

IPR researchers have created a new tool for visualizing food insecurity data across the nation. Users can find data from April 23 onward from the U.S.  Census Bureau Household Pulse Survey on weekly rates of food insecurity for respondents with and without children, which can also be sorted by race and ethnicity for selected states. The complete report can be read  here .

Racial Disparities in Food Insecurity Persist

In another report based on Census Household Pulse Survey data, IPR director and economist Diane Whitmore Schanzenbach and research analyst Abigail Pitts look at recent trends in food insecurity in the wake of the COVID-19 pandemic. They find that food insecurity rates and related measures of food hardship are elevated for all groups, and there is some evidence they have improved in recent weeks among White households. Overall, Black and Hispanic households with children are much more likely to experience food hardships than are White households with children. 

Food Insecurity Remains Elevated Across All 50 States

In a  report , Schanzenbach and Pitts estimate current rates of food insecurity and the extent to which food insecurity rates have increased in national data, as well as by state. They find that food insecurity has doubled overall, and tripled among households with children, and that twenty-three percent of households overall experienced food insecurity in the first 3 waves of the Census’s Household Pulse Survey ( CHHPS), which was collected from April 23–May 19.

Food Insecurity in the Census Household Pulse Survey Data Tables

In a report , Schanzenbach and Pitts estimate rates of food insecurity from the Census Household Pulse Survey (CHHPS) that, depending on the approach taken to map food insufficiency onto food insecurity, range in the first week of data collection from 23%–31% for respondents overall and 28%–37% among respondents with children. The estimates of food insecurity from the CHHPS are very similar to those found in the  COVID Impact Survey  (COVID Impact) and indicate that food insecurity rates have at least doubled from their previous levels. 

Food Insecurity Remains at Persistently High Levels in May

This  report  from IPR economist Diane Whitmore Schanzenbach and research analyst Abigail Pitts shows that food insecurity remained persistently high in May. Their previous report from earlier in May revealed that food insecurity tripled for families with children during the COVID-19 pandemic. Using data from the COVID Impact Survey, they find that nearly half of those surveyed with children said they were worried about food running out before they had money to buy more. The state of Louisiana had the highest estimated rate of food insecurity, with more than 1 in 3 respondents reporting being food insecure, and it was highest in the Birmingham, Columbus (Ohio), Chicago, and Phoenix metro areas.

Food Insecurity Triples for Families with Children During COVID-19 Pandemic

New evidence is emerging from surveys since the COVID-19 pandemic began that document dramatic increases in food insecurity as well as very low food security—a more severe condition in which there have been substantial disruptions or reductions in food intake—among   adults ,   children ,  and other   vulnerable populations .  In their first full  report  and  appendix , IPR Director and economist  Diane Whitmore Schanzenbach and research analyst Abigail Pitts  take several approaches to contextualizing current levels of food insecurity in the United States, using data from the COVID Impact Survey.

The Changing Safety Net for Children

December 2018

A new rule by the current White House administration has tighten regulations for those who receive food stamps and work, which could cut  benefits for tens of thousands of people.  IPR economist Diane Whitmore Schanzenbach finds that 80% of safety net spending has shifted to households with earnings—where people work—than to the poorest households without earnings. She notes that moving to work-contingent assistance is problematic for people in these households who rely on SNAP benefits. 

SNAP’s Short- and Long-Term Benefits

January 2017

The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is the fundamental safety net for American families, lifting 5 million people out of poverty in 2014 (the most recent data available). With more and more families receiving benefits from programs like SNAP, IPR economist Diane Whitmore Schanzenbach is examining the program’s short- and long-term effects. She finds that SNAP improves birth outcomes and long-term health for recipients, and leads to better economic outcomes for women

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  • Introduction
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National Health and Aging Trends Study participants were included if they lived in community settings at baseline, had at least 2 outcome measures over the study duration, and did not have dementia (probable dementia) or mild cognitive impairment (possible dementia) at baseline.

a Data were missing for 1 patient.

eMethods. Adjustment Variables

eFigure. A Directed Acyclic Graph to Determine Potential Confounders

eTable 1. Sensitivity Analysis: Conditional Associations Between Food Insecurity With Cognitive Function, National Health and Aging Trends Study, 2013-2019 (n = 3014)

eTable 2. Sensitivity Analysis: Marginal Associations Between Food Insecurity With Cognitive Function, National Health and Aging Trends Study, 2013-2020 (n = 3015)

eTable 3. Sensitivity Analysis: Marginal Associations Between Food Insecurity With Cognitive Function, National Health and Aging Trends Study, 2013-2019 (n = 3015)

eReferences

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Kim B , Samuel LJ , Thorpe RJ , Crews DC , Szanton SL. Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older. JAMA Netw Open. 2023;6(3):e234674. doi:10.1001/jamanetworkopen.2023.4674

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Food Insecurity and Cognitive Trajectories in Community-Dwelling Medicare Beneficiaries 65 Years and Older

  • 1 School of Nursing, Johns Hopkins University, Baltimore, Maryland
  • 2 Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 3 Division of Nephrology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Question   Is food insecurity associated with faster cognitive declines among community-dwelling older adults?

Findings   In this cohort study using data from 3037 community-dwelling Medicare beneficiaries 65 years and older, food insecurity reported in late life was associated with a faster decline in executive function.

Meaning   These findings suggest that older adults who report food insecurity may be at higher risk of accelerated decline in executive function; intervention studies are needed to determine whether food assistance programs addressing food insecurity can prevent and/or delay executive function decline among older adults.

Importance   Food insecurity has a known association with prevalent impaired cognition. However, it is unknown whether food insecurity has a longitudinal association with cognitive decline among older adults.

Objective   To determine whether food insecurity is associated with a faster decline in cognitive function among community-dwelling older adults.

Design, Setting, and Participants   This retrospective cohort study used data from a nationally representative sample of Medicare beneficiaries 65 years and older recruited for the National Health and Aging Trends Study (NHATS). Community-dwelling NHATS participants were followed up for a maximum of 7 years (mean [SD] follow-up duration, 5.4 [1.1] years). Data were collected from January 1, 2012, to December 31, 2020, and analyzed from December 23, 2021, to December 6, 2022.

Exposures   Self-reported food insecurity assessed from 2012 to 2019.

Main Outcomes and Measures   Primary outcomes were immediate memory, delayed memory, and executive function collected from 2013 to 2020. Immediate and delayed recall were assessed by a 10-item word-list memory task (range, 0-10, with higher scores indicating more words recalled). Executive function was measured by the clock drawing test (range, 0-5, with higher scores indicating more accurate depiction of a clock). Each year’s cognitive functions were linked to the prior year’s food insecurity data. Linear mixed-effects models with random slopes and intercepts were used to examine the association between food insecurity and cognitive decline. Analytic weights in each year were applied to represent community-dwelling Medicare beneficiaries 65 years and older in 2011.

Results   Of 3037 participants, a weighted 57.8% (raw count, 1345) were younger than 75 years, 56.2% (raw count, 1777) were women, and most (84.9% [raw count, 2268]) were White. Over 7 years, 417 (weighted proportion, 12.1%) experienced food insecurity at least once. Food insecurity was associated with a faster decline in executive function in a fully adjusted model: the mean difference of annual change in executive function score between people exposed to and not exposed to food insecurity was −0.04 (95% CI, −0.09 to −0.003) points. However, food insecurity was not associated with changes in immediate and delayed memory (0.01 [95% CI, −0.05 to 0.08] and −0.01 [95% CI, −0.08 to 0.06], respectively).

Conclusions and Relevance   Among community-dwelling older adults, food insecurity was prevalent and associated with a decline in executive function. Interventions and policies aiming to increase healthy food access or reduce food insecurity should be assessed for their impact on older adults’ cognitive outcome.

Food insecurity is defined as uncertain access to or inability to acquire nutritionally adequate foods in socially acceptable ways. 1 An estimated 5.2 million older US residents (6.8% of adults older than 60 years) experienced food insecurity in 2020. 2 Some groups of older adults are disproportionately affected. 2 , 3 For instance, in 2020, 26.5% of older adults with incomes below the poverty threshold and 19.1% of self-identified Black older adults were food insecure, while only 2.9% of older adults with incomes above 200% of the federal poverty line and 5.2% of White older adults were food insecure. 2 The number of US adults 60 years and older experiencing food insecurity has more than doubled since 2007. 2 , 4

Food insecurity adversely affects mental and physical health, including cognitive performance. 5 - 9 Because poor cognitive performance can impair quality of life and functional independence in late life, identifying modifiable factors that influence cognitive decline, like food insecurity, has caught the attention of many health researchers and policy makers. 10 - 12 Food insecurity could be targeted to prevent or delay cognitive decline, 8 , 12 , 13 but associations between food insecurity and cognitive function are underexamined. Determining whether food insecurity is associated with cognitive decline could advance understanding of the role of interventions and policies addressing food insecurity.

Extant literature cannot fully explain the longitudinal impact of food insecurity on cognitive function in older adults due to the nature of a cross-sectional study 13 , 14 or a regional cohort study. 15 Important gaps in this topic area remain. First, food insecurity status likely changes, and it is important to understand the total exposure of food insecurity over time to better estimate the health effect. However, no longitudinal study assessed food insecurity status over time. Second, cognitive trajectories should be followed up more than twice to describe the shape and to distinguish true decline from measurement error. 16 Third, to our knowledge, no longitudinal study has used data from a nationally representative sample of US older adults, which can limit generalizability of findings.

Accordingly, we undertook a longitudinal analysis to examine the association between time-variant measures of food insecurity with changes in cognitive function among a nationally representative sample of US adults 65 years and older. We hypothesized that food insecurity would be associated with a faster rate of cognitive decline among older adults.

This retrospective cohort study used the existing data set of the National Health and Aging Trends Study (NHATS), a nationally representative cohort of US Medicare beneficiaries 65 years and older. NHATS began participant recruitment in 2011 and replenished in 2015. We used data from the 2011 cohort, and its response rate at initial recruitment was 71%. 17 Enrolled participants underwent detailed in-person interviews annually, except the 2020 interview conducted by telephone due to the COVID-19 pandemic. We linked each year’s cognitive function assessment to the 1-year prior food insecurity measurement to ensure that the exposure preceded the outcome. 16 Food insecurity was first assessed in 2012; therefore, we used food insecurity data collected from January 1, 2012, to December 31, 2019, and cognitive function data collected from January 1, 2013, to December 31, 2020. All participants provided informed consent for their participation. These analyses were regarded as exempt by the Johns Hopkins School of Medicine Institutional Review Board because only publicly available data were used. This cohort study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.

Of the 8245 individuals enrolled in 2011, 5799 (70.3%) completed the 2013 interview. Of those, we included only community-dwelling individuals (n = 4508), because the food insecurity measure has not been validated among older adults living in residential care, and institutionalized older adults may have qualitatively different experiences of food insecurity. Of those, participants with dementia (n = 245) or mild cognitive impairment (n = 348) at baseline and having only 1 valid cognitive assessment data over the study period (n = 877) were excluded, leaving an analytic sample size of 3037 participants ( Figure ).

The primary outcomes were executive function, immediate memory, and delayed memory scores. Executive function was assessed by the clock drawing test. 18 Participants were instructed to draw a clock with a specific time and were scored on a scale from 0 (not recognizable as a clock) to 5 (an accurate depiction of a clock) by trained coders. 19 The interview was administered by telephone in 2020. Previous research 20 showed that there were no significant differences in mean cognitive scores by test administration mode (telephone vs in person). Memory was assessed by performance on word list memory and recall tests. 21 Immediate and delayed recall scores were constructed by the total number of words correctly recalled at a given time (immediately and after 5 minutes, respectively), ranging from 0 to 10, where higher scores indicated more words recalled. 19 The memory recall tests have been validated in telephone interviews. 22

Food insecurity was measured based on the following 5 items 23 : (1) going without groceries due to limited ability or social support, (2) going without hot meals related to functional limitation or no help, (3) going without eating because of inability to feed oneself or no available support, (4) skipping meals due to insufficient food or money, and (5) days of skipped meals. Participants were classified as food insecure if the summed score was 1 or greater than 1. 23 This measure is more holistic than other food insecurity measures that focus on only financial constraints because it incorporates risk factors for food insecurity among older adults such as social isolation and reduced mobility in addition to financial strain. 23

Potential confounders in these analyses were educational level, sex, self-reported race and ethnicity (American Indian or Alaska Native, Asian, Black, Hispanic, Native Hawaiian or other Pacific Islander, and White), age, depression (measured by the Patient Health Questionnaire), 24 functional disability, 25 and social isolation scores 26 at baseline. Race and ethnicity data were included in this model because racial and ethnic minority groups were more likely to experience food insecurity as well as have worse cognitive health. We additionally adjusted for marital status, income, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and rural or urban residence as time-varying covariates. Income was reported in 2011, 2013, 2015, 2017, and 2019. Marital status and BMI were measured between 2012 and 2019, and residential areas were extracted from 2012 to 2018 data (eMethods in Supplement 1 ). Year since study enrollment was also included in these analyses as a time metric.

Data were analyzed from December 23, 2021, to December 6, 2022. In NHATS, income data were missing for 31% of participants in 2011, 25% in 2015, and 13% in 2019. NHATS imputed income based on reported bracketed income value, sources of income, their amounts, and other auxiliary variables such as home ownership and labor force status using a hot-deck procedure. 27 Based on a missing-at-random assumption, we replaced the missing values with the imputed income. All other variables were missing at less than 5%. Baseline characteristics were compared between individuals who were food insecure at least once and those who were never food insecure during the study period using Pearson χ 2 statistics with corrected SE based on sampling design. We used mixed-effects linear models to assess the association of food insecurity with change in cognitive function. Both outcomes and exposure were treated as time-varying variables. One-year time-lagged analyses linked each year’s outcomes to prior exposure data to diminish the possibility of reciprocal causation. 16 A model for each cognitive function measure included terms for food insecurity, time (years since baseline), and their interaction. There were no nonlinear time trends in cognitive function over the study period. The hypothesis was tested using the interaction term between food insecurity and time, which describes differences in the yearly change in cognitive function comparing participants with vs without food insecurity. All models adjusted for age, sex, race and ethnicity, educational level, depression, functional disability, and social isolation at baseline, which were known to be associated with food insecurity 9 , 23 and cognitive function. 28 - 30 We additionally adjusted for income, marital status, BMI, and residential area over the study period (eFigure in Supplement 1 ). Adjusted models included statistically significant interactions with time for race and ethnicity, educational level, and age at baseline to account for differential decline in cognitive function scores over time depending on the baseline characteristics. Intercepts and slopes of cognitive trajectory were allowed to vary for each individual as random effects. We applied analytic weights each year to account for complex sampling design and nonresponse, allowing us to generalize the findings to the 2011 Medicare population 65 years and older. To account for potential differences in measurement modality during the pandemic, we conducted a sensitivity analysis to see whether the estimates were changed when data collected in 2020 were excluded. We also performed other sensitivity analyses using marginal structural models with stabilized inverse propensity weights for better adjustment of potential time-varying confounders. 31 Statistical significance was presumed at 2-sided P < .05. Analyses were performed with Stata, version 16.1 (StataCorp LLC) using a module for survey data analyses with multilevel mixed-effects generalized linear models.

The analytic sample consisted of 3037 participants; 1345 (weighted proportion, 57.8%) were younger than 75 years, 1777 (weighted proportion, 56.2%) were women, and 1260 (weighted proportion, 43.8%) were men. A total of 568 participants (7.3%) were Black, 128 (5.1%) were Hispanic, 2268 (84.2%) were White, and 53 (2.5%) were of other race or ethnicity (American Indian or Alaska Native, Asian, and Native Hawaiian or other Pacific Islander). The mean (SD) duration of follow-up was 5.4 (1.1) years, with a maximum duration of 7 years. The baseline weighted prevalence of food insecurity was 2.5% (raw count, 81 participants). Over 7 years, 12.1% of the participants experienced food insecurity at least once (raw count, 417 participants). Participants who experienced any food insecurity over the study interval were more likely to be older, female, part of racial and ethnic minority groups, not living with a partner, and obese and to have lower income, lower educational attainment, depressive symptoms, social isolation, and disability compared with their peers without any food insecurity ( Table 1 ).

Food insecurity was not associated with baseline cognitive function scores or changes in immediate or delayed recall but was associated with a faster decline in executive function ( Table 2 ). Over time, immediate and delayed recall scores but not executive function scores significantly declined when adjusting for all covariates: immediate and delayed recall scores decreased by −0.09 (95% CI, −0.12 to −0.06) points and −0.05 (95% CI, −0.10 to −0.003) points each year, respectively. The annual change of cognitive function measures was faster among participants experiencing food insecurity compared with those not experiencing food insecurity. Among older adults with food insecurity, the mean decline in executive function scores each year was −0.04 (95% CI, −0.09 to −0.003) points faster than those without food insecurity in an adjusted model. The differences in mean changes comparing participants with vs without food insecurity were 0.01 (95% CI, −0.05 to 0.08) points per year for immediate memory and −0.01 (95% CI, −0.08 to 0.06) points per year for delayed memory, but they were not statistically significant in adjusted models ( P = .73 and P = .78, respectively). Our sensitivity analysis revealed that the direction and magnitude of the coefficient for food insecurity × time interaction in the executive function model was similar but not statistically significant when using a shorter follow-up period (2013-2019) (eTable 1 in Supplement 1 ). The findings from marginal structural models were consistent with the results from the mixed-effects models (eTables 2 and 3 in Supplement 1 ).

This cohort study found that food insecurity was associated with a faster decline in executive function among a nationally representative sample of community-dwelling older adults, but not with faster declines in immediate or delayed memory function. Both food insecurity and cognitive function data were assessed longitudinally to incorporate changes in food insecurity and cognitive performance.

This study expands the literature by testing our hypothesis among a nationally representative sample of US older adults. In a regional study, 15 over a 2-year follow-up, baseline food insecurity in late life was associated with declines in executive function but not memory among 597 Puerto Rican participants aged 45 to 75 years. The association may be explained by 4 pathways: allostatic load, unhealthy eating patterns, poor disease management, or a lack of cognitive reserve. First, food insecurity indicating financial strain is associated with higher levels of stress. 9 , 32 , 33 Chronic and repeated exposure to psychosocial stress can lead to dysregulation in inflammatory, cardiovascular, and metabolic systems, and the pathophysiological allostatic states consequently result in cognitive decline as well as other chronic diseases related to cognitive declines such as hypertension and diabetes. 34 - 38 In particular, exposure to stress can affect the prefrontal cortex region of the brain and the affected brain region may disrupt cognitive processes and executive function. 39 Furthermore, food insecurity is associated with decreased consumption of vegetables and fruit, which may slow decline in cognitive function. 40 - 42 Individuals with food insecurity are more likely to have low diabetes medication adherence; uncontrolled diabetes is associated with a faster decline in cognitive function. 43 , 44 Additionally, food insecurity is associated with less moderate to vigorous physical activity. 45 Physical activity is an important indicator of cognitive reserve referring to resilience against changes in brain structure. 46 Participants with food insecurity may be more susceptible to cognitive decline and showed a faster decline in executive function in the present study.

We observed a decline of 0.28 points in executive function measured by the clock drawing test over the study period among individuals with reported food insecurity compared with those without food insecurity. The cutoff score of the test to detect dementia is 1 on a 5-point scale (1.5 SDs below the mean). 47 , 48 The effect of the association between food insecurity and executive function is small, but subtle decline can indicate preclinical dementia 49 and further cognitive decline in multiple domains. 50 The clock drawing test is a useful tool to detect dementia early and monitor cognitive change over time, 51 and it may be more relevant to primary care settings than a specialized care context. 52 The association between food insecurity and executive function should be paid attention, since food insecurity disproportionally affects racial and ethnic minority and low-income populations, and the disparity is preventable.

Interestingly, this study found that immediate and delayed memory scores but not executive function scores significantly declined with time, and food insecurity was associated with a faster decline in executive function but not memory scores. This finding may suggest that age-related cognitive declines and food insecurity–related cognitive declines may have different effects across cognitive domains. A meta-analysis 53 suggested that psychosocial stress, a major pathway of food insecurity to cognitive decline, may have no or little association with episodic memory but have an association with executive function. Food insecurity may have associations with executive function than episodic memory. Accelerated declines in executive function associated with food insecurity, not a part of normal cognitive aging, are especially concerning. This is because executive function encompasses a wide range of cognitive processes that allow people to engage in independent and purposive behaviors. 54 , 55 Compared with memory, executive function was a stronger factor associated with physical functioning. 56 Additionally, the higher health care expenditures, even at the early stage of cognitive decline, were largely attributed to executive dysfunction. 57 Alternatively, it is possible that we found the association of food insecurity with executive function declines because the measure used in this study captures food insecurity due to limited physical functioning, which is associated with executive function. However, we controlled for baseline physical functioning to minimize the confounding bias.

The association between food insecurity and change in executive function was absent after excluding 2020 data in sensitivity analyses. This may be due to duration of follow-up, enlarged disparities in cognition by food insecurity status during the COVID-19, or a different survey administration mode. First, change in cognitive performance measures among community-dwelling older adults without dementia can be slow. Follow-up of participants is required for a long enough period to detect the small change over time. Adding 1 more year of data might allow us to detect the significant change. Alternatively, difference in cognition by food insecurity status could be larger in 2020, the last year cognitive data were collected during the pandemic. During the pandemic, restricted social interaction, higher unemployment rate leading to lower income, higher stress, less cognitive activities, and limited opportunity for physical activities might have indirectly or directly affected cognitive aging. Individuals with food insecurity were likely to have fewer resources to compensate the challenges so that they were exposed to greater risk of cognitive declines. Additionally, different results after excluding 2020 cognition data might be related to altered survey administration mode, but differences in cognitive performance by survey modalities are very small, 20 , 58 especially for individuals without cognitive impairment.

This study estimated that baseline prevalence of food insecurity was 2.5% among community-dwelling Medicare beneficiaries 65 years and older. The estimate was smaller than that from another report. 2 In 2020, prevalence of food insecurity was 6.8% and prevalence of very low food security was 2.6% among participants 60 years and older in the Current Population Survey, which is a nationally representative survey. 2 The difference in the estimates can be explained by different measures of food insecurity. The food insecurity measure used in our study captured actual experiences while another food insecurity measure, the US Household Food Security Survey Module applied in the Current Population Survey, assessed both worry and actual food insecurity experiences. Another difference in the measures is that we asked about food insecurity experiences in relation not only to financial strain but also lack of social support and physical function, while the latter instrument focused on food insecurity due to financial constraint. This may suggest that the food insecurity measure used in our study captures more severe cases of food insecurity (very low food security). More severe food insecurity may induce even higher levels of stress and adverse health impacts. 59

This study has several limitations. Due to the nature of observational studies, we cannot establish the causality between food insecurity and cognitive decline. Considerable missing income data were imputed to minimize risk of bias such as selection bias, but this may result in another bias if the missing-at-random assumption is violated. Additionally, we did not correct P values for fitting multiple models; thus, the findings on statistical significance should be interpreted with caution.

The findings of this cohort study suggest that food insecurity in late life was associated with accelerated declines in executive function that is necessary for daily activities. Clinicians should be aware that older adults reporting food insecurity are at higher risk of faster cognitive decline that can be an early mark of cognitive impairment. The adverse effects of food insecurity on cognitive health call for interventions and policies incorporating a variety of approaches such as addressing food quality, food preferences, transportation, food preparation, and food purchase to eliminate food insecurity. Other interventions to delay or prevent cognitive decline such as exercise, stress management, or social groups can be considered for people reporting food insecurity or those at higher risk of food insecurity.

Accepted for Publication: February 8, 2023.

Published: March 24, 2023. doi:10.1001/jamanetworkopen.2023.4674

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Kim B et al. JAMA Network Open .

Corresponding Author: Boeun Kim, PhD, MPH, RN, School of Nursing, Johns Hopkins University, 525 N Wolfe St, Room 307, Baltimore, MD 21205 ( [email protected] ).

Author Contributions: Dr Kim had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Kim, Samuel, Szanton.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kim, Thorpe.

Critical revision of the manuscript for important intellectual content: Kim, Samuel, Crews, Szanton.

Statistical analysis: Kim, Samuel.

Obtained funding: Szanton.

Administrative, technical, or material support: Samuel.

Supervision: Samuel, Szanton.

Conflict of Interest Disclosures: Dr Samuel reported receiving grant funding from the National Institute of Aging (NIA) during the conduct of the study. Dr Crews reported receiving grant funding from Baxter International Inc and Somatus Medical, Inc, serving on the Patient and Physician Advisory Board Steering Committee for Disparities in Chronic Kidney Disease Project for Bayer AG, and lecture honorarium from Maze Therapeutics outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grants DP1AG069874 (Dr Kim), K01AG054751 (Dr Samuel), and P30AG059298 (Dr Thorpe) from the NIA. The National Health and Aging Trends Study was supported by grant U01AG32947 from the NIA.

Role of the Funder/Sponsor: The NIA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

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Authentic Engagement, Real Impact: Using a Community First Approach to Address Food Insecurity

research on food insecurity

Blakely Amati, MD, FAAP

March 20, 2024

Imagine this: a young mother with newborn twins, facing the impossible choice of feeding herself enough healthy food to produce breast milk or feeding her older children. This heartbreaking reality highlights the difficult decisions parents experiencing food insecurity face. As pediatricians, we witness firsthand the devastating impact of limited access to healthy food on children. But we also see the incredible strength and resilience of families like the one just mentioned. 

Food insecurity isn't just about a lack of food; it's about systems of injustice that create barriers to accessing nutritious options. To truly address this issue, we need to move beyond mere food distribution and work toward food equity . Achieving food equity means “every person has ready and affordable access to healthy, sustainable, nutritious, high-quality, and culturally appropriate food.” Food equity acknowledges that the same efforts won’t work in all settings and that closing gaps will require co-creating solutions within our communities, empowering individuals to use identified resources, and advocating for sustainable, systemic change. 

Community partnerships are the cornerstone of this approach. In Greenville, South Carolina, where I live and work, I partnered with Mill Village Ministries , a local nonprofit social justice enterprise, to bring the FoodShare model (a bi-weekly fresh produce box program valued at $30, available for purchase for $5 SNAP benefits with a SC Healthy Bucks program match or $20 cash) to multiple neighborhoods and clinics in 2017. Each box contains applicable recipes and pairs with a “Fresh Out of the Box” Facebook Live event consisting of cooking demonstrations and nutrition education to equip clients with the knowledge and skills to prepare healthy meals. 

“Seeing her thrive after connecting her to resources is a powerful reminder of the positive impact we can have through collaboration.” 

Authentic engagement – meaning listening to community members, fostering trust, preserving dignity, power-sharing and using an asset-based approach – is key. I am a member of the Greenville Food Security Coalition , organized by LiveWell Greenville , which exemplifies this by incorporating a resident advisory board made up of individuals with diverse backgrounds who have the shared lived experience of food insecurity. By centering their voices and reimbursing them for their time, the coalition ensures solutions are relevant and impactful to those affected. For example, this group brought forward significant transportation concerns, which led to the development of FoodRx, a USDA grant-funded produce prescription program, which allows for home delivery of food boxes using DoorDash or Meals on Wheels volunteers. In response to the 2022 formula shortage and limited WIC appointments post-pandemic, my clinic partnered with the Food Security Coalition to launch a formula bank in collaboration with a local food bank, a local food recovery group, Sam’s Club, DHEC, and a SC Medicaid Managed Care Organization. 

My experience with the mother and her twins reinforces the importance of a holistic approach. This mother was referred to our Children’s Hospital food resource navigator who provided her tailored resources: the FoodRx program, the formula bank, convenient food pantries, SC Thrive (to reapply to SNAP due to changes in financial status and follow-up on her existing WIC application), utility and rental assistance, and our Children’s Hospital diaper bank. During the one-month follow-up call, the mother shared that she was so grateful for the fresh produce delivered to her home, and that she was able to keep producing breast milk and feed her family healthy meals. The formula bank provided a month of formula, which bridged her to approval of her WIC and SNAP benefits. Addressing her immediate needs for food, formula, diapers, and financial assistance allowed her to focus on her children, as well as her health. Seeing her thrive after connecting her to resources is a powerful reminder of the positive impact we can have through collaboration. 

So, what does your community need? How can we, as individuals and organizations, do better? During the 2023 AAP Community Pediatrics Training Initiative: Building Effective Ambassadors Community of Practice to Address Food Insecurity (sponsored by Share Our Strength ), we discussed ways we can move beyond charity and develop authentic partnerships. We talked about how to amplify community voices and co-create solutions that not only provide food but empower families and build a just and equitable food system for all. 

Here are some ways you can get involved: 

  • Help create/support/advocate for local food economies.
  • Invest in your community financially or by volunteering your time and skills.
  • Learn your local history of redlining, structural racism, and food apartheid.
  • Advocate for policies that promote food access, affordability, and food sovereignty.
  • Support businesses and initiatives that prioritize local, sustainable agriculture.
  • Start a conversation around food justice and food equity. 

Remember, each community is unique with varied challenges but also incredible assets. Let's build communities across the United States where food is not just sustenance, but a source of strength and connection. 

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author

Blakely Amati, MD, FAAP, is a member of the Community Pediatrics Training Initiative, the Council on Community Pediatrics, and the Section of Oral Health. She is an Assistant Professor of Pediatrics at the University of South Carolina School of Medicine Greenville and Medical Director of the Prisma Health Bradshaw Institute for Community Child Health and Advocacy.  She is the SC lead for the Carolinas Collaborative and a SCAAP board member.   

research on food insecurity

Science our best bet to fight and beat food insecurity

I n July this year, India halted the export of basmati rice to prevent domestic shortages, triggering global spikes in prices. Argentina’s worst drought in 60 years cost the agricultural sector $20 billion. And the war between Ukraine and Russia has led to major disruptions of grain exports. 

With changing weather patterns, increased climatic shocks and rising inflation, the confluence of the food and climate crises demands global action. 

This is why now, more than ever, it is critical that global leaders invest in the tools and technologies needed to make the agriculture sector more resilient and foods more nutritious. 

Earlier this week, Prime Minister Rishi Sunak paved the way by announcing a new partnership , at the UK hosted Global Food Security Summit, to drive cutting-edge research on innovations like flood-tolerant ‘scuba’ rice and disease-resistant wheat. 

To back this up, at next month’s Dubai based COP meeting, the global food emergency will be a major part of the world’s climate agenda. 

Unpredictable and extreme weather patterns are destroying crops and damaging the livelihoods of smallholder farmers and other food producers around the world. 

Global agricultural productivity has declined by nearly 21 percent in the past 60 years due in large part to our climate breakdown and its associated social and economic impacts. Some 780 million people around the world are affected by hunger, a number that will grow millions larger with every degree the world heats. And experts say that by 2050, food production will have to increase 60 per cent to meet growing populations.

Lower-income countries are particularly susceptible to climate change – like Pakistan, which saw a third of its land submerged during devastating floods just over a year ago. Around the world, climate extremes and food insecurity are fueling migration, both within borders and between countries.

But decades-long efforts in agricultural innovation have yielded critical tools and technology. From biofortified sweet potatoes to techniques for better managing soil, water, livestock, and fishstock, there are real examples that when fully realized strengthen food security and reward farmers. 

By increasing investment in research and development, world leaders can foster and scale these groundbreaking solutions to transform food systems and turn the tide on what has become the largest hunger crisis in modern history. 

As the world’s largest publicly funded agricultural research network, the Consultative Group on International Agricultural Research (CGIAR) is uniquely positioned to address these compounding challenges.

Over the past five decades, this unique organization has delivered some of the most important tools to improve agricultural productivity and transform the way we use our land and water. 

Nobel Laureate Dr Norman Borlaug and Professor M.S. Swaminathan, for example, led the creation of a high-yielding rice variety that drove vital increases in food production in the second half of the 20 th century – averting a global famine and saving a billion lives.

That research sparked further advances. 

The development of hardier and more nutritious crop varieties, for instance, has reduced infant mortality by 30 percent across the developing world, preventing between three and six million deaths each year. For the 500 million smallholder farmers who produce a third of the world’s food while facing severe droughts, flooding, and other erratic weather, producing more climate-resilient crops can now protect growth and economic yields. 

Other new projects are gathering critical data to inform food production, like a regional evapotranspiration network that measures real-time water loss data to foster smarter water management in some of the world’s most arid countries across the Middle East and North Africa. 

Scientists are even working on ways to sequester more carbon in land used for agriculture, aiming to provide smallholder farmers with supplemental income by removing the gas from the atmosphere. 

The myriad challenges facing our increasingly scorching world underscore that funding groundbreaking research is a key component to building food security. This week the UK government stepped up, and at COP28 next month other governments will match their commitments. 

A comprehensive new case for $4 billion in investments in CGIAR science explains just how much of a difference more money will make; helping to develop and scale cutting-edge innovations so that they can be readily available to food producers around the world. 

The world has revolutionized the way we produce food before. Today, we must transform our food, land and water systems in the context of a climate crisis to deliver a more secure, sustainable and resilient future. 

This year’s emergencies were not anomalies – they reflect a new normal. Science is our best bet to not just fight back against food insecurity, but to beat it.

Dr Ismahane Elouafi, Incoming Executive Managing Director, CGIAR 

Protect yourself and your family by learning more about Global Health Security .

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USDA Announces Up to $12 Million in Grant Funding Available to Promote U.S. Agricultural Products and Address Food Insecurity in Underserved Communities

Public affairs.

WASHINGTON, March 21, 2024 -- The U.S. Department of Agriculture (USDA) today announced up to $12 million in funding available to strengthen and explore new market opportunities for U.S. agricultural products and increase access to locally grown food in communities experiencing food insecurity. The funding is available through three grant programs administered by the Agricultural Marketing Service (AMS): the Acer Access and Development Program, the Federal State Marketing Improvement Program, and the Micro-Grants for Food Security Program.

“Each of these grant programs focus on a different area of the food system, but all work to support USDA’s goals to create new market opportunities that bring equity and financial stability to small farms and that rural and historically underserved communities have access to fresh, locally grown foods,” said USDA Under Secretary for Marketing and Regulatory Programs Jenny Lester Moffitt. “The projects funded through these programs will improve the nation’s food system by developing new products, supporting small-scale producers and improving healthy food access in food insecure communities.”

Acer Access and Development Program

This year, up to $6 million is available through the Acer Access and Development Program for projects that expand consumer awareness of the maple syrup industry and provide valuable resources to maple syrup producers. The program promotes the domestic maple syrup industry by funding research and education projects related to maple syrup production, natural resource sustainability in the maple syrup industry, and the marketing of maple syrup and maple-sap products. Acer funding is authorized by the 2018 Farm Bill and funded through annual appropriations.

Examples of projects previously awarded grants funds through the Acer Access and Development Program include:

  • Stockton University used Acer Access and Development Program funding to help increase maple syrup production in New Jersey and the larger Mid-Atlantic region through the use of novel technology, landowner engagement, and sustainable forest management. The project fostered a new consumer base for maple products in a region where pure maple products are not embedded in the culture of the community.
  • A West Virginia University Research Corp project used Acer Access and Development Program funding to assemble a team of experts in forest management, forest operations, forest pathology, landowner assistance, and maple syrup operations to create an integrated program designed to promote maple syrup production by educating forest landowners, foresters, and loggers on the nuances of southern sugarbush management. The program helped increase maple syrup production by increasing the number of maple trees tapped as landowners learn about these opportunities.

Federal State Marketing Improvement Program

Through the Federal State Marketing Improvement Program, up to $1 million in grant funding is available to support projects that explore new market opportunities for U.S. food and agricultural products and to encourage research and innovation aimed at improving marketing system efficiency and performance. The program supports state departments of agriculture, state agricultural experiment stations, and other appropriate state agencies. FSMIP is authorized by the Agricultural Marketing Act of 1946 and funded by annual appropriations.

One successful project that recently received funding through the Federal State Marketing Improvement program was managed by the University of Kentucky. The university received the grant to identify best practices in sustaining financially profitable relationships between local producers and restaurants. The project focused on developing strategies for verifying local purchasing, evaluating different systems for verifying businesses’ level of local sourcing, and gauging consumer willingness to pay for locally produced foods. By understanding the strategies of consumer engagement and local product incentivization and verification, the project developed best practices that state departments of agriculture are using to improve local-sourcing programs. These outcomes improve economic opportunities for farmers and extended rural economies.

Micro-Grants for Food Security Program

Additionally, up to $5 million is available through the Micro-Grants for Food Security Program to agricultural agencies in eligible states and territories to increase the quantity and quality of locally grown food in food insecure communities through small-scale gardening, herding, and livestock operations. The program focuses on food insecure communities in areas of the U.S. that have significant levels of food insecurity and import a significant quantity of foods. The agricultural agencies or departments competitively distribute the funds through subawards to eligible entities. The Micro-Grants for Food Security Program is authorized through the 2018 Farm Bill and funded by annual appropriations.

Through a subaward from the Alaska Department of Natural Resources, a family in Alaska recently received funding through the Micro-Grants for Food Security Program to increase food availability in their local community. The funding enabled the family to freeze dry Alaskan fruits and vegetables and purchase a high tunnel and freeze drier. As a result, they increased their gardening space and now provide biweekly food deliveries to families, supplying 18 people in their area.

Application Information

A Request for Applications (RFAs) for each program is available on the program webpages listed below. Applications must be submitted electronically through www.grants.gov  by 11:59 p.m. ET on the date listed in the respective RFAs. Grant applications submitted after the due date will not be considered unless the applicant provides documentation of an extenuating circumstance that prevented their timely submission of the grant application. More information is available in the AMS Late and Non-Responsive Application Policy .

AMS encourages applications for initiatives that benefit smaller farms and ranches, new and beginning farmers and ranchers, underserved producers, veteran producers, low-income, and minority individuals, and underserved communities. For projects intending to serve these entities, applicants should engage and involve those beneficiaries when developing projects and applications.

USDA touches the lives of all Americans each day in so many positive ways. In the Biden-Harris Administration, USDA is transforming America’s food system with a greater focus on more resilient local and regional food production, fairer markets for all producers, ensuring access to safe, healthy and nutritious food in all communities, building new markets and streams of income for farmers and producers using climate smart food and forestry practices, making historic investments in infrastructure and clean energy capabilities in rural America, and committing to equity across the Department by removing systemic barriers and building a workforce more representative of America. To learn more, visit www.usda.gov .

Get the latest Agricultural Marketing Service news at www.ams.usda.gov/news or follow us on Twitter @USDA_AMS. You can also read about us on the USDA blog.

USDA is an equal opportunity provider, employer, and lender  

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Lehigh University leadership identified the pantry as a key aspect of the “A Lehigh for Everyone” initiative.

Lehigh Opens Two New Food Pantries for Students in Need

The food pantries are located in Johnson Hall on the Asa Packer Campus and Iacocca Hall on the Mountaintop Campus.

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Christa Neu

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Food insecurity happens when people can’t access the food they need to live their fullest lives. It is a nationwide issue that also impacts members of our student body.

“There are many causes of food insecurity,” says Donald Outing , vice president for equity and community. “But one thing is clear: we can do something about it for members of our Lehigh community.”

In the summer of 2022, Lehigh’s Health & Wellness Center staff wanted to bring a wellness component to the center. After assisting students experiencing food insecurity for some time, they sought to provide a space that students could visit, stocked with resources such as health-related items and snacks. They established what would become the food pantry that year and have since been working to expand it.

To expand the pantry, the Office of Diversity, Inclusion and Equity applied for funding through Swipe Out Hunger . They were awarded $7,000 as foundational funding for the food pantry. University leadership identified the pantry as a key aspect of the “A Lehigh for Everyone” initiative and helped to further fund the project, with the goal of fostering a more equitable Lehigh.

Through partnerships with Swipe Out Hunger, a national nonprofit committed to ending college student hunger and Sodexo, Lehigh is able to centralize its support of a university-wide food bank pilot program by tapping existing resources identified to support work in the wellness/diversity, equity and inclusion support realm. While specifically put in place for the Lehigh community and primarily for students in need, no Lehigh individual who shows up will be turned away.

Located on the third floor lobby of Johnson Hall and on Mountaintop in the College of Education graduate student lounge on the first floor of Iacocca Hall, these university pantries and student resource centers will provide Lehigh community members with a variety of healthy and convenient foods, including snack options, small grab-and-go meals and/or health-related products. Gluten-free, nut-free and vegan options are available.

“Students will be able to find items at both pantries such as fresh fruit, salad kits & vegetables, tuna, mac and cheese, soups, oatmeal, a variety of granola bars, crackers, trail mix and cereal,” says Yen DeBellis , director of Health Advancement & Prevention Strategies (HAPS) and assistant director of the Health & Wellness Center. “In addition, at Johnson Hall, students will also have access to health items such as hygiene, sexual health and menstrual products, COVID tests, pregnancy tests, first aid kits, Tylenol, Ibuprofen and so much more.” All items are free for undergraduate and graduate students.

Pantry hours are as follows: Johnson Hall Food Pantry: Monday-Friday 8 a.m. to 4:30 p.m.; Iacocca Hall Food Pantry: Open 24 hours, seven days a week. Students can use their ID cards to gain access to the pantries themselves and the items they offer.

Story by Amy Bilello

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Exploration of Food Security Challenges towards More Sustainable Food Production: A Systematic Literature Review of the Major Drivers and Policies

Sabreen wahbeh.

1 Faculty of Business, University of Wollongong in Dubai, Dubai 20183, United Arab Emirates

Foivos Anastasiadis

2 Department of Agribusiness and Supply Chain Management, Agricultural University of Athens, 11855 Athens, Greece

Balan Sundarakani

Ioannis manikas, associated data.

Not applicable.

Food security is a central priority for international policy as one of the world’s most significantly urgent targets to achieve. It is considered one of the most pressing issues in many countries, the degree of food security representing the level of self-sufficiency and well-being of citizens. In particular, in the current COVID-19 pandemic era, it has more than ever become a mission-critical goal. In this research, we report on the food security drivers and the current state of recommended policies addressing chronic food insecurity aimed at ensuring the sustainability of future food production. Mapping the determinants of food security contributes to a better understanding of the issue and aids in the development of appropriate food security policies and strategies to enhance the sustainability of food production in all facets; namely environmental, social, and economic. Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) data screening and selection guidelines and standards, we carried out a comprehensive, reliable, systematic, and rigorous review of research from the last ten years in order to identify the most frequently mentioned drivers and policies of food security in the literature available in two databases: Scopus and Web of Science (WOS). The number of extracted articles was 141 papers in total. An analysis revealed 34 drivers of food security and 17 most recommended policies for the mitigation of food insecurity. The existence of food loss and waste (FLW) policies was the primary driver of food security, followed by food security policies (FSP) in their different forms. However, FSP were the most recommended policies, followed by FLW policies. The identified food security drivers and recommended policies should be used by policy-makers to improve food security, thus contributing to sustainable food production. Our research findings, reflected in the latest version of the Global Food Security Index (GFSI), resulted in more tangible policy implications, suggesting the addition of two dimensions regarding food security. We also identified elements not listed under the GFSI that could be considered in its future revision, including environmental policies/indicators, consumer representation, and traceability throughout the entire supply chain. Overall, it can be concluded that food security is a complicated and multi-faceted issue that cannot be restricted to a single variable, necessitating the deeper integration of various multi-disciplinary interventions.

1. Introduction

Food security (FS) is “a situation that exists when all people, at all times, have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” [ 1 ] p.3. It is a significant priority for international policy [ 2 ], and has been perceived as being among the key challenges worldwide [ 3 ] as it represents a country’s degree of self-sufficiency and the well-being of its citizens [ 4 ]. Securing a nation’s self-sufficiency has become a top priority in the context of the current COVID-19 global epidemic era, even more so than earlier [ 5 ]. Economic expansion, rising incomes, urbanization, and growing population are driving up the demand for food, as people adopt more diverse and resource-intensive dietary habits [ 2 , 6 ]. The world’s current population is steadily increasing, placing significant pressure on the available natural resources to feed the growing population [ 7 , 8 , 9 ]; however, this dramatic growth in the global population is anticipated mainly in developing countries, which already suffer from devastating hunger and food insecurity [ 7 ]. One of the biggest obstacles to ensuring global food security is the need to roughly double food production within the coming few decades, particularly in the context of the developing world’s rapidly increasing demand [ 10 , 11 ]. The natural resources such as land, water, energy, and other resources used in food production are all subject to increasing competition [ 12 , 13 ]. Climate change poses difficulties for agricultural production [ 14 ], mainly in developing nations, while some existing farming practices harm the environment and contribute significantly to greenhouse gas emissions (GHG) [ 15 , 16 ]. There is a real danger that less developed countries may be forced to reverse direction. The FAO’s statistics on world hunger in 2009 showed a dramatic rise to 1.023 billion people, demonstrating precisely such a situation. When commodity prices fell the following year, this number dropped to 925 million, which was still more prominent than in 2007 (i.e., before the price spike) [ 17 ]. According to recent data published by the Global Hunger Index, the number of malnourished people grew from 785 million in 2015 to 822 million in 2018. Moreover, 43 out of 117 countries reported extreme hunger [ 18 ]. Approximately 20% of developing countries lack the resources and physical access necessary to provide their citizens with the most basic food. Children in developing countries face vitamin and nutritional deficiencies and being underweight, which puts them at risk for various sicknesses due to food insecurity [ 12 ]. National and global imbalances brought on by food insecurity are expected to worsen human suffering and make it harder for people to survive [ 12 ]. Despite the efforts of multiple global organizations such as the FAO and the UN, the problem of food insecurity is worsening [ 19 ], which means that more effective and sustainable solutions must be provided to ensure the alleviation of food insecurity and the sustainability of food production. Hence, policy-makers must understand that in a world that is becoming more globalized, food insecurity in one region could have significant political, economic, and environmental impacts elsewhere [ 2 ].

Throughout the twentieth century, policy-makers used the concept of food security as a key notion in formulating food-related policies [ 17 ]. Lang and Barling [ 17 ] have proposed two main schools of thought on food security: the first focused on increased production as the primary solution to under-consumption and hunger, while the second is a newer one that is more socially and environmentally conscious and accepts the need to address a wide range of issues, not just production. The former is primarily concerned with agriculture, while the latter is concerned with food systems. One approach to solve the food security challenge is to intensify agricultural production in ways that impose much less environmental stress and do not jeopardize our long-term ability to continue producing food [ 2 ]. The above sustainable intensification strategy comprises a policy agenda for several governments worldwide, but has also drawn criticism for being overly production-focused or incoherent [ 2 ]. The central mission of the twenty-first century is to establish a sustainable food system, which calls for a more concrete policy framework than that which is currently in place [ 17 ]. This mission has been disrupted by competing solutions for policy focus and policies that have, so far, failed to incorporate the complex array of evidence from social, environmental, and economic components into such an integrated and comprehensive policy response [ 17 ]. Millions of people are being pushed into a cycle of food insecurity and poverty due to climate change; however, we can combat both food insecurity and climate change by implementing climate-friendly agricultural production methods [ 12 ]. Tsolakis and Srai [ 20 ] have stated that any comprehensive food security policy should entail multi-dimensional policies considering aspects such as resilience, trade, self-sufficiency, food waste, and sustainability. As it is traditionally understood, food security concerns individuals, while ecological and environmental concepts operate locally and at supra-national, regional, and international levels [ 1 ]. According to Guiné, Pato [ 21 ], the four pillars of food security—availability, access, utilization, and stability—should be reconsidered to include additional factors such as climate change. Clapp, Moseley [ 22 ] has also stressed that it is time to officially update the existing food security definition to involve two further dimensions—sustainability and agency—containing broader dynamics that have an impact on hunger and malnutrition [ 23 ]. Sustainability relates to the long-term ability of food systems to ensure food and nutrition security in a way that does not jeopardize the economic, social, and environmental foundations that generate food and nutrition security for upcoming generations [ 22 , 23 ]. Agency represents the ability of people or groups to decide what they consume, what they produce, and how they produce, process, and distribute their food within food systems, as well as their capacity to participate in processes that shape the food system’s policies and governance [ 22 , 23 ]. Instead of dismissing food security as being insufficient, Clapp, Moseley [ 22 ] has contended that the inclusion of two extra dimensions—agency and sustainability—into food security policy and assessment frameworks will help to guarantee that every human has access to food, not just now but also in the future. Sustainability can be viewed as a pre-requisite for long-term food security [ 1 ]. Environmental aspects—particularly climate and the availability of natural resources—are pre-requisite for food availability and biodiversity protection [ 24 ]. The availability of food for everybody depends on economic and social sustainability. Food utilization, too, is influenced by social sustainability. The three components of sustainability—social, economic, and environmental—ensure the continuity of the three food security dimensions and the food system stability on which they rely. As confirmation of the vital relationship between food security and sustainability, “The International Food Policy Research Institute” has launched a 2020 Vision of Food Security to achieve food security, stating that “a world where every person has economic and physical access to sufficient food to sustain a healthy and productive life, where malnutrition is absent, and where food originates from efficient, effective, and low-cost food and agricultural systems that are compatible with sustainable use and management of natural resources” [ 12 ] (p357). Many policies, priorities, technologies, and long-term solutions must be developed and implemented worldwide to achieve the 2020 food security vision [ 10 , 11 , 12 ]. However, there is a scarcity of systematic studies analyzing the food security drivers and the recommended policies to improve food security.

Following a review of the academic literature, we discovered a scarcity of research that systemically summarizes the major drivers of food security, outlines the recommended policies to improve food security, ensures the sustainability of future food production, and provides policy recommendations to enhance food security based on a country’s context. In response to this gap in the literature, we carried out a comprehensive, reliable, systematic, and rigorous review of previous research from the last ten years in order to identify the most frequently mentioned drivers/policies in the scanned literature. The rationale behind this study is to identify and list food security drivers and the current state of recommended policies that address chronic food insecurity to ensure the sustainability of future food production, utilizing a systematic literature review (SLR) methodology. Moreover, we hope to identify drivers/policies in order to aid policy-makers in selecting the most appropriate policies based on each nation’s context (e.g., agricultural production, natural resource availability, climate, political stability, and so on). Most importantly, policy-makers can use the identified drivers of food security and the recommended policies in the literature to customize appropriate policies that ensure the sustainability of future food production and, hence, ensure food sustainability for future generations. Based on the evidence reported in the literature, the identified food security drivers and recommended policies will aid the policy- and decision-makers of various countries in sustainably improving the food security situation. The need to identify the main drivers of food security arises from the notable increase in households and individuals suffering from food shortages and insecurity globally [ 25 ]. Finally, the findings of this research will be used to inform the GFSI developers in order to include more comprehensive indicators expected to contribute to the sustainability of future food production.

2. Materials and Methods

This research aims to report on food security drivers and the current state of recommended policies that address chronic food insecurity in order to ensure the sustainability of future food production through the use of a systematic literature review (SLR) methodology. We highlight existing food security drivers and outline recommended policies to alleviate food insecurity following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) data screening and selection guidelines [ 26 ]. The extraction process was meticulously documented in order to ensure the transparency and replicability of this systematic literature review [ 27 ]. A panel of researchers was formed, following the systematic review guidelines [ 26 ], to define the research field and questions, select keywords and the intended databases, and develop the sets of inclusion and exclusion criteria.

The research began by formulating the research questions to guide this systematic review based on identified gaps in the literature, guiding us in an attempt to answer the following research questions:

  • Q1. What are the main drivers of food security?
  • Q2. What are the main recommended policies to alleviate food insecurity?

By answering these questions, this paper provides a reference that policy-makers and practitioners can use to identify the main drivers of food security and the recommended policies in the literature in order to customize and choose appropriate policies that ensure the sustainability of future food production. The identified food security drivers and recommended policies are expected to aid policy- and decision-makers in improving the state of FS. This study also provides a roadmap for future research based on the evidence reported in the literature.

A specific research criterion was used to ensure that the research sources selected were sufficient and comprehensive enough to capture all of the significant and salient points to adequately answer the research questions [ 26 ]. To this end, we provide a critical review of the existing literature that has been published in two databases—Scopus and Web of Science (WOS)—between 2010 and 15 March 2021, to answer the abovementioned research questions. The time limit was set to cover the period following the global financial crisis of 2008/2009 and its effect on rising food prices, increased unemployment rates, and increasing food insecurity worldwide [ 28 , 29 , 30 ]. This period allows for consideration of policies designed to ensure global food security following the food shortage crisis. The use of Scopus and Web of Science (WOS) databases helped us to include most potential published works in a broad scope of journals, thereby limiting the risks of bias and possible exclusions associated with the use of fewer journals.

We employed a set of identified keywords, which are summarized in detail in Table 1 . A critical analysis was conducted regarding the most relevant concepts that are available in the literature and which affect each of the four dimensions of FS: Food availability, food access, food utilization, and food stability. For instance, the research string “Agrifood supply chain” OR “Agri food supply chain” OR “Agri-food supply chain” was added as a secondary search string, because food availability is highly dependent on the food supply chain and how well its activities are managed. The food supply chain is exposed to many factors that can negatively impact the country’s food security level, such as severe weather conditions [ 31 , 32 ]. Therefore, it is critical to consider some characteristics of the food supply chain, such as biophysical and organoleptic features, shelf life, transport conditions, production time, and storage, to efficiently and effectively manage it [ 33 ]. Effective supply chain management is seen as a significant contributor to gaining and enhancing industrial competitive advantage and efficiency at the company level, possibly impacting food security positively [ 34 ]. “MENA Region” OR “Middle East and North Africa” OR “Middle East” OR “North Africa” research string was added due to the severity of food insecurity there and to ensure the inclusion of papers that address the problem in these countries and propose strategies to overcome food insecurity. According to the GFSI data [ 25 ], MENA region countries are experiencing a decline in food security; moreover, the number of households and individuals suffering from food shortages and insecurity is dramatically increasing.

Primary and secondary search strings used in this research.

The research string “Sustainable supply chain” OR “Resilient supply chain” was added due to much research that stressed the impact of designing a proper supply chain structure due to its significant impact on the future improvement of its performance [ 33 ]. The central mission of the twenty-first century is to establish a sustainable food system, which calls for a more concrete policy framework than what is currently in place [ 17 ]. Sustainability can be viewed as a prerequisite for long-term food security [ 1 ]. The environment, particularly climate and the availability of natural resources, is a prerequisite for food availability and biodiversity protection [ 24 ]. The availability of food for everybody depends on economic and social sustainability. Food utilization, too, is influenced by social sustainability. The three components of sustainability—social, economic, and environmental—assure the continuity of the three food security dimensions and the food system stability on which they rely. Moreover, food security is increasingly considered a prerequisite for long-term sustainability [ 1 ]. Adopting a “sustainable production and consumption approach throughout the global food supply chain” is a solution that will help reduce the amount of food waste along the food supply chain [ 35 , 36 ]. Cooper and Ellram [ 37 ] argued that building a resilient supply chain has many advantages such as decreasing inventory time, which will lead to cost and time savings, increasing the availability of goods, reducing the order cycle time, improving customer service and satisfaction, and gaining a competitive advantage. Stone and Rahimifard [ 38 ] stressed the importance of having a resilient agricultural food supply chain to achieve food security due to the incremental increase in volatility across the supply chain.

The research string “Food Safety” OR “Food diversity” OR “Food quality” OR “Food standards” OR “Micronutrient availability” was added due to one of the food security dimensions: utilization, which is concerned with all aspects of food safety, and nutrition quality [ 39 ]. According to FAO (2019), the utilization dimension should assess food diversity, food safety, food standards, and micronutrient availability. It is inadequate to provide enough food to someone unable to benefit from it because they are constantly sick due to a lack of sanitary conditions. It indicates that in the country, individuals are taking advantage of the food they receive or have access to, with extra emphasis on the dietary quality that contains nutritious ingredients such as vitamins (vitamin-A) and minerals (Iron, Zinc, Iodine) [ 40 ]. According to the World Health Organization, people diagnosed with malnutrition usually suffer from micronutrient deficiencies, protein deficiency, obesity, or undernutrition. The lack of micro-ingredients can increase the risk of developing severe chronic and infectious diseases for people in general and children in particular (toddlers 9–24 months). These diseases have an irreversible negative impact on people’s health, which enhances the persistence of poverty and food insecurity. It is critical to invest in the health and nutrition elements on a global scale by ensuring safe drinking water, immunization, enhancing sewage discharge, improving public health services, and reducing poverty levels [ 41 ].

The research string “Agricultural infrastructure” OR “Agricultural production volatility” OR “Vulnerability assessment” was chosen because much research has emphasized the importance of investing in a strong agricultural infrastructure to improve food security levels, especially in light of current challenges such as climate change, increased urbanization, water scarcity, and the shift away from using cropland for non-agricultural activities [ 7 , 8 , 41 ]. Food security is vulnerable to severe weather conditions, whereas harsh weather conditions may adversely impact the food supply chain in weak areas [ 31 , 32 ]. Therefore, it is critical to assess the vulnerability level of each country to protect the food supply chain. The use of the “Food loss” OR “Food waste” OR “Food waste and loss” research string was due to the general agreement among researchers on the importance of reducing food waste to improve food security [ 35 , 42 , 43 ]. According to the Food and Agriculture Organization (2013), around one-third of the food produced globally (1.3 billion tons) is wasted or lost. Most wasted food is either fresh and perishable or leftovers from eating and cooking [ 36 , 42 ]. Basher, Raboy [ 43 ] argued that eliminating just one-fourth of the food waste would be enough to feed all the currently undernourished people. One of the Sustainable Development Goals established by the United Nations, “SDG 12.3 Food Waste Index” stresses that decreasing the amount of food loss and waste will help reduce hunger levels, promote sustainable production and consumption, and enhance food security [ 44 ].

The use of “Policy description” OR “Policy assessment” OR “Policy recommendation” OR “Policymaking” OR “Policy-making” OR “Policy making” research string was due to the impact of adequate and proper policy formulation on food security ( Table 1 ). Establishing effective and efficient food policies that ensure that each individual has an optimal level of food security is critical in every country because it directly enhances the country’s competitive advantage and efficiency [ 34 , 45 ]. Timmer [ 46 ] emphasized that designing the proper set of policies to end hunger based on each country’s context is challenging and requires collaborative participation from multiple stakeholders. Murti Mulyo Aji [ 34 ] stressed the role of the government’s policies in developing a collaborative supply chain that creates value throughout the supply chain by improving information, logistics, and relationship management. Effective and efficient supply chain management significantly impacts managing long-term partnerships and corporations among a wide range of firms that vary in size and sectors (public or private). This collaboration will enhance prediction of changes in customer demands in domestic and international markets. If previous policies were insufficient to ensure that country’s true competitive advantage, it could cause market distortion [ 34 , 47 ]. Countries are encouraged to gradually reduce the adoption of inequitable trade policies to focus on enhancing their true competitive advantage, demonstrating fair competition, and increasing economic efficiency, particularly in the spirit of trade liberalization [ 34 ].

The selection of research sources was accomplished in March 2021, and the search for keywords was enabled for titles, abstracts, and full texts in both electronic search engines (i.e., Scopus and WOS). Several keywords were identified to retrieve the available literature, and search strings consisted of primary and secondary keywords. The primary search string used was as follows: “food security” OR “food insecurity” OR “food availability” OR “food affordability” OR “food access” OR “food utilization” OR “food stability”. The reason behind including these multiple strings was to cover the maximum number of articles that handle the topic of food security or any of its four dimensions.

Specific exclusion and inclusion criteria were applied in order to develop high-quality evidence [ 26 ]. A reasonable number of articles were limited for deep analysis by following the specific exclusion and inclusion criteria to control the quality of the review in the food security field, as detailed in Table 2 above. Only peer-reviewed journal articles were included within the time frame (2010–15 March 2021) and only those written in English. Furthermore, due to this study’s nature and to ensure consistency with the topic area, the most common and effective approach for examining drivers and recommended policies were limited to the business, management, accounting, and agricultural fields [ 48 ]. We have used the “business, management and accounting” research field in the Scopus database to ensure that all the included articles were business-related. Then, we restricted the research field to” Economics, business, and agriculture Economics” in the WoS database to ensure the inclusion of agriculture-related papers and maximize the inclusion of a diverse range of articles. Another round of retrieval was applied using a set of secondary keywords in order to narrow down the search to specific areas of food security. For this purpose, the primary keywords were escorted each time with “AND” and other secondary keywords, as listed in Table 2 .

Inclusion and exclusion criteria.

The initial search using the primary keywords (“food security” OR “food insecurity” OR “food availability” OR “food affordability” OR “food access” OR “food utilization” OR “food stability”) revealed a total of 113,709 documents (Scopus, n = 63,860; WOS, n = 49,849). Strict selection criteria were applied to the first search pool in order to maintain transparency and guarantee the selection of relevant material that answers the research questions. To ensure academic rigor, the search was restricted to including only peer-reviewed publications [ 49 ] (Scopus, n = 47,673; WOS, n = 40,305). The research was then restricted by publication date to between 2010 and 15 March 2021 (Scopus, n = 34,789; WOS, n = 31,278). Only journal articles published in English were selected (Scopus, n = 33,292; WOS, n = 30,313). Then, advanced research was conducted by combining the primary keywords with one of the secondary keywords. The results and the number of articles identified in each search step are detailed in Figure 1 . After removing duplicate articles from each database, a total of 281 journal articles (Scopus, n = 140; WOS, n = 141) were revealed. After combining both databases, 248 journal articles were obtained. These collected 248 journal articles were scanned by reading their abstracts in order to check their applicability to answering the research questions. At this point, 107 articles were excluded as they were considered irrelevant and outside the scope of the research. Finally, the total number of extracted articles was 141, as can be seen in Figure 1 . Data extraction and analysis were performed by a single reviewer (SW), and all extracted data and revealed results were double-checked by three researchers (FA, IM, and BS) to enhance the research and reduce bias in study selection. A complete description of the validity threats (Construct, Internal, External, and Conclusion Validity) following the validation process of Zhou, Jin [ 50 ] is provided in detail in Table 3 .

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Research protocol following the PRISMA guidelines.

A reporting of validity threats in this systematic literature review.

Among the selected 141 articles, 28 (19.86%) were published in the Journal of Cleaner Production , 20 (14.18%) were published in Food Policy , and 5 (3.55%) were published in Quality-Access to Success . The rest of the journal names are visualized in Figure 2 .

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The most popular journals publishing the 141 included articles. Others denotes journals that were cited once or twice.

After the 141 articles have been extracted, they were analyzed and summarized individually by listing all the discussed food security drivers, as well as the recommended policies for the improvement of food security and sustainable food production. Then, we synthesized the extracted information from all sources in order to identify the gaps, list the similarities between all the resources, and extract significant insights regarding the main drivers of food security and the recommended policies [ 26 ].

3.1. The Major Drivers of Food Security

Analysis of the retrieved literature revealed 34 different drivers of food security, as visualized in Figure 3 . Detailed information, along with a full citation list for all the drivers, is provided in Appendix A .

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Summary of the major drivers of food security.

Most papers discussed food loss and waste (FLW) and emphasized its impact on food security [ 6 , 19 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 ]. Around one-third of the food produced globally (1.3 million tons) is wasted or lost [ 96 ]. Basher, Raboy [ 43 ] has argued that, if we could save just one-fourth of the wasted food, it would be enough to feed all the world’s undernourished people, contributing positively to FS. The previous finding supports our research findings that FLW is the primary driver of FS. To reduce FLW, Halloran, Clement [ 6 ] has argued that effective communication, more efficient food packaging, and a better consumer understanding of food packaging could lead to solutions. To decrease food loss, Garcia-Herrero, Hoehn [ 62 ] has suggested improving food labelling, enhancing consumer planning, and developing technological advances in packaging and shelf life for perishable products. Morone, Falcone [ 83 ] has suggested the repetition of large-scale research to help define a set of policies encouraging the transition to a new model for consumption that promotes sustainably procured food and dramatically reduces the amount of waste (more details are provided in Section 3.2 ).

Additionally, several authors have considered food security policy (FSP) as a driver of food security in its different forms [ 56 , 63 , 65 , 69 , 70 , 74 , 79 , 85 , 94 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 ]. The primary goal of establishing food security policies that consider the factors influencing individuals and groups is to reduce poverty and eliminate hunger. One example is safety-net programs or public food assistance programs (FAPs). The main goal of providing safety-net programs is to increase food consumption among poor people and improve food security [ 102 ].

Many papers have discussed the importance of technological advancement as an enabler of food security [ 56 , 57 , 58 , 63 , 69 , 71 , 74 , 77 , 85 , 90 , 94 , 95 , 109 , 116 , 119 , 120 , 121 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 , 138 , 139 , 140 , 141 ]. The use of technology to promote behavioral changes has increasingly become a vital instrument to reduce food waste and indirectly improve food security [ 130 ]. Mobile applications offer households helpful guidance on increasing shelf life and experimenting with dishes using leftovers [ 58 ]. Shukla, Singh [ 130 ] has elaborated that, at present, farmers have access to mobile applications that provide them with reasonably and timely priced information.

Some authors have discussed sustainable agricultural development and practices as enablers of food security [ 56 , 57 , 59 , 64 , 71 , 73 , 94 , 97 , 105 , 109 , 111 , 119 , 120 , 121 , 124 , 130 , 132 , 134 , 136 , 137 , 139 , 142 , 143 , 144 , 145 , 146 , 147 ]. Some authors have discussed local production enhancement as a driver of food security to enhance the self-reliance of countries [ 57 , 69 , 85 , 87 , 89 , 94 , 98 , 103 , 105 , 109 , 112 , 117 , 120 , 134 , 137 , 144 , 148 , 149 ]. For example, Ahmed, Begum [ 98 ] has emphasized how, following the GCC ban, Qatar took several successful steps to foster local production, support domestic businesses, and promote the consumption of locally produced food by its citizens. Some authors have argued that building the capacities of small farmers is essential to achieving FS. Education policies are critical for educating farmers, building their capacities, and increasing their human capital; moreover, educational programs should also include food preparation and health education programs in order to ensure the safety of consumed food [ 101 ].

The government’s role in managing a country’s agriculture can also be seen as a driver of food security [ 67 , 75 , 84 , 86 , 100 , 109 , 116 , 117 , 119 , 121 , 137 , 138 , 147 , 150 , 151 , 152 ], as it is responsible for various aspects such as designing, testing, and implementing the right policies to ensure the welfare of its citizens, while providing the necessary assistance to small-scale farmers and ensuring their safety and security in all aspects of life. Governments in developing nations must focus on R&D, agriculture infrastructure (e.g., technologies for irrigation and soil preservation), expansion services, early warning systems, or subsidized farm income in order to alter the production function of the population [ 101 ].

Many authors have discussed the importance of food safety policies as an enabler of food security [ 61 , 64 , 69 , 103 , 105 , 111 , 112 , 129 , 149 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ]. Food safety policies include food and water safety at several points throughout the supply chain where food-borne diseases might develop [ 69 ]. Environmental policies are also seen as a fundamental enabler of food security [ 59 , 73 , 121 , 124 , 130 , 135 , 139 , 147 , 159 , 160 , 161 , 162 , 163 ]. Regardless of the various approaches discussed by the authors, they all agreed that environmental protection would help to ensure food availability for current and future generations. According to some authors, trade policies [ 69 , 94 , 95 , 103 , 111 , 112 , 114 , 123 , 129 , 141 , 146 , 161 , 164 ] and import policies [ 69 , 95 , 100 , 103 , 120 , 124 , 126 , 129 , 146 ] are enablers of food security. Regulating international trade can help to ensure food security. Lowering trade barriers, for example, has been proposed as a way to mitigate the adverse effects of market regulation caused by climate change [ 141 ].

Many authors have recognized policies that promote consumer education on sustainable consumption and increase consumer awareness and knowledge of the environmental impact of their purchases as a driver of food security [ 52 , 60 , 67 , 69 , 86 , 133 , 144 , 151 , 163 , 165 , 166 , 167 ]. Others have stressed proper communication among all stakeholders as a driver of food security [ 6 , 56 , 68 , 69 , 84 , 92 , 129 , 130 , 156 , 157 , 168 ]. Some authors have considered risk management as an enabler of food security [ 94 , 117 , 118 , 137 , 138 , 139 , 145 , 154 , 155 , 157 ]. For example, the aims of building a disaster risk reduction framework in the Pacific include boosting resilience, protecting investments (e.g., in infrastructure, operations, and FS), and decreasing poverty and hunger [ 169 ].

Some authors have proposed the effective gleaning process as a driver of food security [ 70 , 72 , 74 , 80 , 84 , 92 , 142 , 170 ]. Gleaning is the collection of the remaining crops in agricultural fields after their commercial harvest, or just in crop fields where their harvest is not cost-effective. Some old cultures have fostered gleaning as an early form of social assistance [ 80 ]. Some authors have considered the management of government food reserves to be a food security driver [ 64 , 104 , 112 , 117 , 118 , 124 , 136 ]. Despite the high cost of storing food, any country must maintain adequate food reserves to serve the country in case of a crisis scenario [ 171 ]. Some authors have considered integrative policies (i.e., food–water–energy, food–energy, or water–food) as a driver of food security due to their impact on environmental improvement through natural resource handling efficiency [ 56 , 73 , 133 , 139 , 172 , 173 ]. Some authors have considered establishing dietary standard policies as an enabler of food security [ 69 , 151 , 163 , 174 ]. The government should impose policies on healthy food consumption to prevent obesity, such as prohibiting trans-fats. Moreover, they should restrict trans-fat usage in food outlets, establish institutional food standards, implement menu labelling regulations for chain restaurants, and ensure that disadvantaged people have better access to healthy meals [ 151 ].

Authors have highlighted various additional arguments or policies that are considered drivers for FS such as establishing public programs to influence diets in a healthy manner, reducing yield volatility [ 85 , 94 , 105 , 119 , 124 , 126 , 175 ], the country’s natural resources [ 85 , 105 , 119 , 124 , 137 , 145 , 162 , 163 , 176 ], geopolitical and political stability [ 69 , 98 , 104 , 117 , 123 , 124 , 142 ], agricultural infrastructure [ 64 , 114 , 116 , 118 , 142 , 146 , 175 ], food distribution infrastructure [ 71 , 75 , 76 , 112 , 177 , 178 ], economic integration [ 109 , 112 , 123 , 179 , 180 ], collaboration among all supply chain stakeholders [ 75 , 130 , 134 , 157 ], proper measurement of food security dimensions [ 123 , 181 , 182 , 183 ], urban agriculture policies [ 56 , 147 , 148 ], adjustments in dietary structure [ 59 , 86 , 163 ], establishing employment programs for poor household representatives [ 110 , 152 ], customer engagement in designing public policies [ 158 ], and trust in public institutions [ 166 ].

3.2. The Recommended Policies to Alleviate the Food Insecurity

Analysis of the 141 retrieved papers revealed 17 major recommended policies, as visualized in Figure 4 . We also determined sub-policies under each category which were grouped based on common characteristics, relevance, and how they were categorized in the papers. The complete list of sub-policy categories and related references is provided in Appendix B .

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The main 17 recommended policies and statistics.

Most authors recommended establishing FSP, in general, as a primary solution for food insecurity in developing and developed countries [ 56 , 57 , 63 , 64 , 65 , 69 , 81 , 85 , 87 , 89 , 91 , 94 , 97 , 98 , 99 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 126 , 127 , 130 , 131 , 133 , 134 , 137 , 142 , 144 , 145 , 148 , 149 , 151 , 152 , 175 , 177 , 180 , 182 , 184 , 185 ]. Many authors have suggested food consumption policies that offer safety-net programs or public food assistance programs (FAPs) such as food price subsidies, cash-based programs, structural pricing adjustments, or micro-credits as enablers of FS. The main goal of providing safety-net programs is to increase food consumption among poor people and improve food security [ 102 ]. Given the solid bidirectional causal link between poverty and malnutrition, FAPs have been recognized as critical components of the overall poverty reduction strategy. Food aid policies and initiatives can fill the gaps left by the for-profit food system and the informal (non-profit) social safety nets, ensuring food security for disadvantaged individuals, families, and communities [ 108 ]. Several authors have recommended establishing policies to enhance the performance and asset bases of small-scale farmers, such as loans, subsidies, access to information, and knowledge-sharing, to address food insecurity. Governments should adopt direct interventions such as structural price adjustments and targeted food subsidies to enhance the food access of farmers by lowering market prices and stabilizing consumption during high food price inflation [ 116 ]. Others have recommended establishing government input subsidy programs (input subsidy policies) that provide farmers with subsidies for investment into high-yielding technology (e.g., automation, fertilizers, high-yield seed). They all claimed this as an effective policy instrument for agricultural development, but each focused on a different mechanism. Shukla, Singh [ 130 ], for example, has discussed public distribution programs; Sinyolo [ 131 ] has emphasized policies aimed at increasing the amount of land planted with enhanced maize varieties among smallholder farmers; Wiebelt, Breisinger [ 124 ] has suggested investments in water-saving technologies, while Tokhayeva, Almukhambetova [ 137 ] have proposed the development of an agricultural innovation system. Others have recommended rural development policies to reduce yield volatility and improve the agricultural infrastructure (e.g., irrigation and water-saving technologies). Governments in developing nations must focus on R&D, agricultural infrastructure (technologies for irrigation and soil preservation), expansion services, and early warning systems [ 101 ]. Technological advancement, in general, is seen as a vital element in reducing yield volatility [ 85 ]. Capacity-building policies (e.g., educational, training, and technical support) have received considerable attention in the literature as a fundamental component of urban farming initiatives, and as attempts to promote self-reliance and networking. Capacity building in many areas connected to urban agriculture is essential for equipping residents with knowledge and expertise [ 148 ]. To enhance FS, some researchers have suggested policies supporting locally produced food, diversified agricultural production policies, policies that impact farm-level commodity pricing, food stock policies, establishing policies to increase the income of farmers, buffer stock policies, and resource allocation policies (for a complete list of references, see Appendix B ).

Many authors have proposed different policy recommendations to reduce food waste and, thus, food insecurity [ 6 , 19 , 51 , 52 , 56 , 57 , 58 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 91 , 92 , 93 , 94 , 103 , 130 , 138 , 144 , 150 , 160 , 167 , 168 , 170 , 177 ]. Many have agreed on the importance of policies that promote information and education campaigns that spread awareness at household and public levels by improving meal planning and management in consumers. However, each author suggested a different approach. For example, Schanes, Dobernig [ 58 ] have discussed face-to-face door-stepping campaigns (online and in traditional newspaper leaflets), word-of-mouth, and television shows or movies. However, Septianto, Kemper [ 66 ] have highlighted the importance of social marketing campaign design and framing (having vs. not having) in conveying the intended message to consumers. Tucho and Okoth [ 73 ] have asserted the advantages of producing bio-wastes and bio-fertilizers from food waste and human excreta (in a food–energy–sanitation nexus approach), and also advocated for educating families on how to do so at the household level. Xu, Zhang [ 86 ] has argued that governments should help society to develop a logical perspective on food consumption and aggressively promote the habit of eating simple meals, particularly in social catering. Von Kameke and Fischer [ 52 ] and Zorpas, Lasaridi [ 60 ] have emphasized the importance of teaching customers about efficient meal planning to reduce food waste. Von Kameke and Fischer [ 52 ] have proposed using the Nudging tool rather than campaigning. Xu, Zhang [ 86 ] have suggested initiating suitable policy instruments to nudge individuals to adopt sustainable consumption habits, with important implications for decreasing food waste and increasing food security in China. Smart (innovative) food packaging and labelling policies have received significant attention in the literature, as they are critical in reducing food waste and, thus, improving FS. The nature, size, and labelling of the packaging impact the lifetime of the food. Smart packaging innovations and new technologies are steadily penetrating markets, thus increasing the shelf-life of foods through enhanced protection, communication, convenience, and control [ 58 ].

Food banks, food sharing, and food rescue policies have also received significant attention in the global literature, as they help reduce food waste and improve FS. Food banking is a critical long-term rescue policy for re-distributing surplus food to those in need and reducing poverty and food insecurity [ 80 , 92 ]. Several authors have recommended positive sanctions such as financial rewards, tax credits, federal and state funding, vouchers, or reduced taxes to decrease food waste and improve FS. Positive sanctions consist mainly of financial incentives to encourage restaurants and grocery retailers to donate their leftover food [ 60 ]. Addressing liability concerns might be one incentive, as the research participants have highlighted this as a universal barrier and that this issue, in particular, must be handled [ 51 ]. Negative sanction policies have received considerable attention in the literature as a tool for reducing food waste and improving FS. These include fines and fees imposed on companies and individuals accountable for food waste [ 58 ]. Taxes and fines are a potential way to manage and motivate restaurants and retailers to donate their leftover food to charities and community centers [ 65 ].

The establishment of policies that regulate the sharing of information and knowledge among supply chain stakeholders has received some attention in the literature in terms of reducing food waste and improving food security. Comprehensive food waste legislation has been discussed as a potential enabler of food security. A possible regulatory tool would be to revise and remove unnecessary food safety requirements that result in excessive food waste levels [ 58 ]. According to Halloran, Clement [ 6 ], food waste increased due to European food safety regulations and standardization. Food waste recycling policies have been used as a method to reduce food waste. Food waste can be utilized for value generation at any point of the food supply chain process through efficient techniques, then reincorporated into the cycle [ 77 ]. Food waste has a long history as a source of ecologically friendly animal feed [ 61 ].

A few authors have highlighted the impact of technological advancement (e.g., mobile applications) as a strategy to reduce food waste. Some authors have proposed implementing gleaning operation policies that provide tax incentives and government assistance to gleaners in order to decrease food waste. Some authors have proposed implementing peak storage reduction policies, such as stock-holding incentives. Nudging tools (which nudge people toward forming sustainable consumption behaviors) have been mentioned by a few authors.

Food safety policies received significant attention in the retrieved literature [ 61 , 64 , 69 , 70 , 103 , 105 , 111 , 112 , 120 , 125 , 129 , 130 , 137 , 138 , 149 , 153 , 154 , 155 , 156 , 157 , 158 , 159 ]; however, they have been discussed in various different forms. Few authors have discussed food quality and food hygiene compliance certifications. Compliance with sanitary standards is required to maintain the best practices for preventing food-borne diseases and food security threats [ 155 ]. Other authors have discussed the importance of food safety standards. Meanwhile, few authors have emphasized the importance of food safety throughout the supply chain, but each proposed a different strategy to achieve it. For example, some authors have suggested using an effective IT system [ 130 ], RFID [ 138 ], or developing food safety training policies [ 155 ].

Many authors have advocated for the implementation of trade policies to address food insecurity in developing and developed countries [ 94 , 95 , 101 , 103 , 111 , 112 , 119 , 123 , 129 , 136 , 141 , 146 , 148 , 149 , 152 , 157 , 161 , 164 , 178 , 180 ], but in different contexts. For example, some have suggested establishing infrastructure development policies that target agricultural logistic infrastructure, or improving the speed and quality of shipping logistics. In contrast, some authors have agreed on the importance of state trading and private trade-supporting policies. Others have suggested the removal of tariff and non-tariff barriers, while a few authors recommended reliable marine connection and transportation logistics policies.

Environmental policies are a fundamental enabler of food security [ 59 , 73 , 94 , 120 , 121 , 124 , 130 , 135 , 139 , 141 , 145 , 147 , 159 , 160 , 161 , 162 , 163 , 166 ]. However, authors have focused on many different aspects of these policies. Some authors, for example, have emphasized the importance of establishing policies to mitigate the effects of climate change. Others were too specific, suggesting greenhouse gas reduction policies, and proposed penalizing non-compliance. Due to the strong links between climate change, poverty, and food insecurity, some authors have proposed establishing coordinating policies among the three. Other authors have stressed the consideration of policies that encourage the optimization of fertilizer use.

Many authors have considered food import policies as a solution to food insecurity [ 94 , 95 , 100 , 103 , 104 , 105 , 109 , 112 , 116 , 117 , 119 , 120 , 124 , 126 , 134 , 146 ]; however, most authors provided different opinions regarding the most effective policy to implement. For example, some authors have stressed the importance of policies that provide direct government financial assistance to local agriculture, or the importance of policies that sustain local agricultural product prices compared to imported products. Some have recommended providing temporary tax benefits for agricultural investment, while others recommended import ban (substitution) policies. A few authors have recommended direct budget subsidies, subsidized loan interest rates, and strategies for the diversification of imported food origin.

Many authors have discussed the importance of establishing a common agricultural policy (CAP) to address sustainable agriculture [ 56 , 57 , 64 , 89 , 109 , 111 , 118 , 119 , 132 , 142 , 143 , 149 , 161 , 172 , 184 , 186 ]. Others have stressed the importance of food surplus policies in enhancing a country’s food security status [ 51 , 58 , 70 , 72 , 75 , 76 , 79 , 82 , 84 , 90 , 91 ]. Some authors have suggested strategies to regulate a company’s liability regarding the donation of surplus food. A few authors have proposed food policies that subsidize the purchase of surplus food—also known as “ugly food”—by controlling for prices and surplus item characteristics. Some authors have suggested establishing food loss policies. However, few authors have specified the need for policies promoting food loss quantification.

Many authors have discussed the policies that promote traceability across the whole supply chain as an enabler for food security [ 56 , 69 , 103 , 128 , 129 , 130 , 137 , 138 , 168 , 178 ]. However, the different authors discussed different technologies such as investment into information technology such as RFID, effective IT systems, ICT systems, and blockchain technology. Government policies should promote investments into traceability systems that focus on rapid withdrawal in unsafe food scenarios such as product recall regulations, fines imposed on hazardous product distributors, and food-borne food risk monitoring [ 129 ]. Many authors have discussed various risk management strategies to improve a country’s food security [ 94 , 117 , 118 , 137 , 138 , 139 , 145 , 154 , 155 , 157 ]. However, each considered a different approach to overcome the risk. Specifically, they have discussed food scandal policies, the COVID-19 pandemic, programmed risk identification, proactive policy measures to handle flood crises, early warning systems for natural disasters, or risk management throughout the food supply chain. Some authors have highlighted water quality policies such as efficient water-use policies, improving water resources policies, using water-efficient crops, investments into water-saving technologies, and food and water safety throughout the supply chain.

Some authors have discussed the management of government food reserves as an enabler of food security [ 64 , 104 , 112 , 117 , 118 , 124 , 136 ], and others have discussed integrative and coherent policies between food, water, and energy (as a nexus) [ 56 , 73 , 133 , 139 , 172 , 173 ]. Meanwhile, other authors have discussed policies that promote consumer education on sustainable consumption, improving consumer status awareness and knowledge regarding the ecological impact of their purchases [ 60 , 69 , 133 , 144 , 163 , 165 ]. Few authors have addressed the importance of dietary standard policies [ 69 , 151 , 163 , 174 ], urban agriculture policies [ 56 , 147 , 148 ], and food-aid policies [ 118 , 150 ].

Some policies were suggested in one paper only such as devising the right population policy in China [ 85 ], flexible retail modernization policies [ 158 ], policies that facilitate short-term migration [ 187 ], policies to stimulate equitable economic growth through manufacturing and services [ 95 ], and sound research governance policies [ 140 ].

4. Discussion

In this section, we discuss the polices and drivers in the greater areas, then compare them based on specific contexts. This approach serves to provide better understanding, thus informing decision-makers about the importance of choosing the right policies through considering many food security dimensions. By looking deeply at the extracted food security drivers and policies and the way in which they can be applied to each country’s context, we take an example from the MENA region. The MENA region includes a diverse range of nations, including low-income and less-developed (e.g., Sudan, Syria, and Yemen), low–middle-income (e.g., Algeria, Egypt, Iran, Morocco, and Tunisia), upper middle-income (e.g., Jordan, Lebanon, and Libya), and high-income (e.g., the UAE, Qatar, Oman, Bahrain, Israel, Kuwait, and Saudi Arabia) countries [ 126 ]. As food availability is a serious problem in the MENA region low-income countries (Syria and Yemen), due to war and violent conflicts [ 188 ], policies aimed at increasing food availability continue to pique the interest of policy-makers. In these countries, where citizens are incapable of fulfilling their basic food needs [ 189 ], the existence of food security policies in different forms is crucial for achieving food security [ 53 , 97 , 98 , 124 , 184 ], more than FLW policies. Policy-makers should focus on ensuring the availability of either locally produced or imported food, which requires appropriate trade policies to deal with food shortages and improve the availability dimension in these countries. Trade policies should focus on creating infrastructure development policies that target agricultural logistic infrastructure, improve the speed and quality of shipping logistics, and establish reliable marine connections and transportation logistics policies that remove tariff and non-tariff barriers.

Policy-makers should establish import policies that sustain local agricultural product prices compared to imported products, provide direct government financial assistance to local agriculture, and provide temporary tax benefits for agricultural investment.

Additionally, the governments should improve food access in the MENA region low-income countries by reducing or stabilizing consumer and producer food prices. To enhance food access, FSPs (e.g., education policies in general and capacity-building policies) may help to improve individual human capital. Governments also must provide supplemental feeding programs, typically targeting vulnerable groups in need of special diets, such as pregnant women and children [ 101 ].

Moreover, the government should improve credit access through the following means: policies that enhance the performance and asset base of small-scale farmers; the existence of policies that impact farm-level commodity pricing, thus retaining farmers and increasing local production; the existence of government input subsidy programs for individuals, and the existence of policies supporting locally produced food. These are all possible policies to improve the MENA region FS. Governments and global health organizations should promote food utilization in MENA low-income countries through the development of policies that monitor overall food quality, such as access to clean water and micronutrient fortification, or through individual educational programs on safe food preparation [ 155 ]. Finally, enhancing food quality can optimize the individual nutrient absorption [ 101 ].

In contrast, discussions of food security in the MENA region high-income countries have indicated that food availability, access, and utilization are generally higher and not a problem. However, food stability is low, which requires the attention of policy-makers to improve FS. Food stability impacts the other food security pillars (access, availability, and utilization). Moreover, it requires the economic, political, and social sustainability of food systems, which are vulnerable to environmental conditions, land distribution, available resources, conflicts, and political situations [ 190 ]. Food stability necessitates increased efforts and expenditures to achieve food security in the sustainable development goals, especially in light of increased academic and governmental interest in incorporating sustainability values into policies.

As food waste is prevalent in these countries, FLW policies are more critical than FSP, which is in alignment with our findings regarding food security drivers. FLW makes it difficult for the poor in developing countries to access food by significantly depleting natural resources such as land, water, and fossil fuels while raising the greenhouse gas emissions related to food production [ 115 ]. Addressing food loss and waste in these countries can hugely influence the reduction of wasted food and indirectly enhance food security. The number of food-insecure individuals may be reduced in developing regions by up to 63 million by reducing food loss, which will directly reduce the over-consumption of cultivated areas, water, and greenhouse gas emissions related to food production [ 115 ]. According to Abiad and Meho [ 189 ], food waste produced at the household level differs across MENA-region countries. For example, it ranges from 68 to 150 kg/individual/year in Oman, 62–76 kg/individual/year in Iraq, 194–230 kg/individual/year in Palestine, and 177–400 kg/individual/year in the UAE. It is critical to take more aggressive but scientifically sound initiatives to minimize FLW, which will require the participation of everyone involved in the food supply chain such as policy-makers, food producers and suppliers, and the final consumers [ 191 , 192 ]. Food waste reflects an inefficient usage of valuable agricultural input resources and contributes to unnecessary environmental depletion [ 191 , 193 ]. Furthermore, food loss is widely recognized as a major obstacle to environmental sustainability and food security in developing nations [ 194 ]. Preventing FLW can result in a much more environmentally sustainable agricultural production and consumption process by increasing the efficiency and productivity of resources, especially water, cropland, and nutrients [ 115 , 191 , 192 , 195 ]. Preventing FLW is crucial in areas where water scarcity is a prevalent concern, as irrigated agriculture makes up a sizeable portion of total food production, and yield potential may not be fully achieved under nutrient or water shortages [ 191 , 196 , 197 ]. According to the study of Chen, Chaudhary [ 197 ], food waste per capita in high-income countries is enough to feed one individual a healthy balanced diet for 18 days. Chen, Chaudhary [ 197 ] also found that high-income countries have embedded environmental effects that are ten times greater than those of low-income countries, and they tend to waste six times more food by weight than low-income countries. Consequently, implementing proper FLW policies in high-income countries can help to alleviate the food insecurity problem while maintaining the economic, social, and environmental sustainability of future food production.

Implementing effective food storage techniques and capacities is considered a key component of a comprehensive national food security plan to promote both food utilization and food stability; furthermore, proper food storage at the household level maintains food products for a more prolonged period [ 198 ]. Encouragement of economic integration between MENA region countries is very applicable considering the heterogeneity of these countries. For example, countries with limited arable land and high income, such as the UAE and Saudi Arabia, can invest in countries with a lower middle income, such as Egypt, and use its land to benefit both countries. On the other hand, Boratynska and Huseynov [ 101 ] have proposed food technology innovation as a sustainable driver of food security and a promising solution to the problem of food insecurity in developing countries. Due to the higher food production demand to support the expanding urban population while having limited water and land availability, higher investments in technology and innovation are needed to ensure that food systems are more resilient [ 190 ]. Boratynska and Huseynov [ 101 ] have argued that, in general, using innovative technologies to produce healthy food products is frequently a concern. However, improving the probability that innovative food technology will enable the production of a diverse range of food products with enhanced texture and flavor while also providing a variety of health advantages to the final consumer is essential. Jalava, Guillaume [ 193 ] have argued that, along with reducing FLW, shifting people’s diets from animal- to plant-based foods can help to slow environmental degradation.

The MENA region example described above can be adapted to different regions based on their food security situation, and relevant policies can be devised to improve food security more sustainably.

5. Conclusions

Food security is a complicated and multi-faceted issue that cannot be restricted to a single variable, necessitating the deeper integration of many disciplinary viewpoints. It is essential to admit the complexity of designing the right policy to improve food security that matches each country’s context [ 46 ] while considering the three pillars of sustainability. Furthermore, it is of utmost importance to implement climate-friendly agricultural production methods to combat food insecurity and climate change [ 12 ]. Mapping the determinants of food security contributes to better understanding of the issue and aids in developing appropriate food security policies to enhance environmental, social, and economic sustainability.

This research contributes to the body of knowledge by summarizing the main recommended policies and drivers of food security detailed in 141 research articles, following a systematic literature review methodology. We identified 34 food security drivers and outlined 17 recommended policies to improve food security and contribute to sustainable food production. Regarding the drivers, one of the foremost priorities to drive food security is reducing FLW globally, followed by food security policies, technological advancement, sustainable agricultural development, and so on (see Appendix A ). Regarding the recommended policies, most studies have detailed the contents and impacts of food security policies, food waste policies, food safety policies, trade policies, environmental policies, import policies, the Common Agricultural Policy (CAP), food surplus policies, and so on (see Appendix B ).

5.1. Policy Implications

We assessed the obtained results in comparison to the latest version of the GFSI. Using the GFSI (2021) indicators as a proxy resulted in the identification of gaps and specific policy implications of the results. The idea was to identify which of the policies and drivers have been already implemented and which have not (or, at least, have not been very successfully implemented). We used the GFSI as it is a very well-established benchmarking tool used globally by 113 countries to measure the food security level. We examined the indicators mentioned under each of the four dimensions of food security, and listed associations with the identified policies and drivers found in the literature. Accordingly, we suggest the addition of two dimensions to the current index:

  • Sustainability

The first dimension relates to measuring the sustainability dimensions that each participating country adopts in its food production process. We noticed that many authors stressed the importance of the existence of clear environmental policies that drive long-term food security. However, the current GFSI lacks indicators measuring this dimension. The reviewed literature suggested environmental indicators considering optimized fertilizer use, carbon taxes, aquaculture environment, bio-energy, green and blue infrastructure, gas emissions reduction policies, policies to reduce the impacts of climate change, and heavy metal soil contamination monitoring.

  • Consumer representation

The second dimension is related to consumer voice representation within the GFSI. The reviewed literature suggested implementing policy measures that promote consumer education on sustainable consumption and improve the consumer status, consciousness, and knowledge regarding the ecological impact of their purchases. Any sustainability initiative should be supported and implemented by the final consumer.

Additional gaps in the policies and drivers of food security were identified and allocated under the relevant indicators in the GFSI based on the four dimensions of food security. Under the affordability dimension, we found a lack of policies in the reviewed literature addressing the Inequality-adjusted income index. Regarding the Change in average food costs indicator, we observed that the policies that exist in the literature concern the farmer level only (e.g., policies that impact farm-level commodity pricing and policies supporting locally produced food), and not all of the citizens at the national level. Additionally, policies that promote traceability across the whole supply chain were missing. There were no policies in the reviewed literature under the food quality and safety dimension representing the following: the dietary diversity indicator; micronutrient availability (e.g., dietary availability of vitamin A, iron, and zinc); regulation of the protein quality indicator; the food safety indicator (specifically the two sub-indicators of food safety mechanisms and access to drinking water), and illustration of the national nutrition plan or strategy indicator. Therefore, future research should pay more attention to and emphasize the importance of such policies, particularly in developed countries seeking to improve their food security status and score high on the GFSI.

Moreover, the reviewed literature suggested “developing food safety training policies” to improve food safety and FS; however, no indicators or sub-indicators within the GFSI represent such training policies. The GFSI developers should pay more attention to safety training practices and include them in the index’s future development. Under the availability dimension, the reviewed literature suggested establishing a food loss policy that promotes the quantification of food loss under the food loss indicator. This indicator should be enhanced through well-articulated policies that address the problem of food loss and attempt to mitigate its impact. However, while there were various policies concerning food waste or surplus, there were no indicators within the GFSI that represented food loss. As food loss and waste was identified as the primary driver of food security in this study, we recommend expanding the GFSI to include food loss quantification and reduction policies under the availability dimension. Finally, under the political commitment to adaptation dimension, some policies were identified in the reviewed literature in two sub-indicators: early warning measures/climate-smart agriculture (e.g., proactive policy measures to handle flood crises, programmed risk identification, and early warning systems for natural disasters) and disaster risk management (e.g., food scandals, COVID-19, and risk management throughout the food supply chain). However, under the other two relevant sub-indicators—commitment to managing exposure and national agricultural adaptation policy—there were no identified policies.

5.2. Contributions of the Study

The key contributions of this study to the existing literature are threefold. First, we identified the (34) main food security drivers and the (17) most-recommended policies to improve food security and enhance the future food production sustainability. Several studies have partially covered this area, but none have employed a systematic literature review of 141 papers covering such an scope in this topic. The gravity of food security worldwide is well established; hence the contribution of this work. Second, we provide a reflection of policies/drivers on the latest version of the GFSI, resulting in more tangible policy implications (see Section 5.1 ). Third, through a systematic literature review, we identified elements not listed under the GFSI that could be considered in its future revision. Examples include environmental policies/indicators such as optimized fertilizer use, carbon taxes, aquaculture environment, bio-energy, green and blue infrastructure, gas emission reduction, policies to reduce the impact of climate change, and heavy metal soil contamination monitoring; consumer representation, as the reviewed literature suggested policy measures that promote consumer education on sustainable consumption, as well as improving consumer status, consciousness, and knowledge regarding the ecological impact of their purchases; and traceability throughout the entire supply chain.

5.3. Study Limitations and Future Research

In this study, we identified the major drivers and the recommended policies to improve food security and enhance the future food production sustainability based on the reviewed literature. However, we recommend conducting a Delphi research study in consultation with policy-makers and industry experts. A Delphi study can be used to validate the findings of this systematic literature review based on a specific country’s context. This research was conducted using only 141 articles from two databases; therefore, we suggest replicating this research using different databases, which will allow for the inclusion of more related papers. Moreover, this research included only peer-reviewed articles, which may be considered, based on the guidelines of Keele [ 185 ], as a source of publication bias. Future research may consider including gray literature and conference proceedings. This research did not include the three sustainability pillars within its research string; therefore, we recommend considering the inclusion of the three pillars in future research. Future research should also investigate the use of alternative protein food technology innovation, such as plant-based protein, cultured meat, and insect-based protein, as a sustainable solution to the food security problem. Additionally, understanding the factors influencing acceptance of various technologies by the final consumer is particularly important given some regional characteristics such as harsh arid environments and the scarcity of arable land, freshwater, and natural resources.

Appendix A. Summary Table of Major Drivers of Food Security

Appendix b. summary table of most-recommended policies, funding statement.

This research was funded by the UAE Ministry of Education, Resilient Agrifood Dynamism through evidence-based policies-READY project, grant number 1733833.

Author Contributions

Conceptualization, S.W., F.A., B.S. and I.M.; methodology, S.W., F.A., B.S. and I.M.; validation, S.W., F.A., B.S. and I.M.; formal analysis, S.W.; investigation, S.W., F.A., B.S. and I.M.; resources, I.M. and B.S.; data curation, S.W.; writing—original draft preparation, S.W.; writing—review and editing, F.A.; visualization, S.W.; supervision, F.A., B.S. and I.M.; project administration, B.S. and I.M.; funding acquisition, B.S. and I.M. All authors have read and agreed to the published version of the manuscript.

Data Availability Statement

Conflicts of interest.

The authors declare no conflict of interest.

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The Farm Near AAMU Will Address Food Insecurity and Strengthen Research

AAMU Farm

Alabama A&M and Madison County Commission to Establish Community Farm

Alabama A&M University and the Madison County Commission have signed a five-year agreement to establish a community farm near the AAMU campus. The farm will be used to address food insecurity and strengthen research and local food systems in Madison County.

AAMU and the Madison County Commission have a long history of working together to grow fresh produce for public distribution. This agreement allows the team to expand its operations to meet the increasing food insecurity needs throughout Madison County. The University designated campus property near or adjacent to Meridian Street in Huntsville for the farm. The Madison County Commission, under the leadership of District 6 Commissioner Violet Edwards, will manage daily operations and work closely with campus units like the Alabama Cooperative Extension System (Alabama Extension), to not only establish the farm, but implement its community outreach activities.

“This has been 40 years in the making, and I am excited to see it come to fruition,” said Commissioner Edwards . “It makes sense that the county and the university work together to maximize investments already made and create a mutually beneficial program for the community, the university, and the students, while addressing the lack of fresh, affordable produce in north Huntsville.”

AAMU Vice President of Research and Economic Development, Dr. Majed El-Dweik , added, “AAMU, including Alabama Extension, looks forward to working with Commissioner Edwards to tackle the rising food insecurity issues in this area.” Dweik also serves as interim director for Alabama Extension at AAMU.

According to Hunger Free America, food insecurity in Alabama grew to over 44 percent between 2021 and 2023. This means that nearly 500,000 Alabamians, including children and older adults, experience hunger, and at least 12 percent of residents experience hunger on a regular basis. Initiatives like the Madison County community farm will help to change those odds in Alabama.

For inquiries regarding this initiative, please contact Jason Andra, District 6 harvest manager at (256) 532-1505 or [email protected]. or Dr. Dweik at (256) 372-7010 or [email protected].

IMAGES

  1. First global estimates of food insecurity among households with children

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  2. Introduction to Food Insecurity in Liverpool: Definitions, Impact

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  3. USDA ERS

    research on food insecurity

  4. Food Security in the 21st Century

    research on food insecurity

  5. Infographic: 2020 Global Report on Food Crises

    research on food insecurity

  6. Infographic: 2020 Global Report on Food Crises

    research on food insecurity

COMMENTS

  1. Food Insecurity and Child Development: A State-of-the-Art Review

    Emerging research in food insecurity is exploring other distal factors that impact on the ability of children to reach their full potential. Recent research has explored broader societal issues, such as lack of social cohesion [51,52], racism [53,54], violence , and neighborhood safety , and how these impact food insecurity.

  2. USDA ERS

    USDA monitors the extent and severity of food insecurity in U.S. households through an annual, nationally representative survey sponsored and analyzed by USDA's Economic Research Service (ERS). This report presents statistics from the survey that cover household food security, food expenditures, and use of Federal food and nutrition ...

  3. Food Accessibility, Insecurity and Health Outcomes

    Source: USDA, Economic Research Service, using data from U.S. Department of Commerce, Bureau of the Census. Food insecurity and the lack of access to affordable nutritious food are associated with increased risk for multiple chronic health conditions such as diabetes , obesity, heart disease, mental health disorders and other chronic diseases .

  4. Food Insecurity

    Food insecurity is defined as a household-level economic and social condition of limited or uncertain access to adequate food.1 In 2020, ... barriers to accessing healthy food. 28,29,30,31 Studies show these programs may reduce food insecurity. 29,30,31 More research is needed to understand food insecurity and its influence on health outcomes ...

  5. USDA ERS

    USDA monitors the extent and severity of food insecurity in U.S. households through an annual, nationally representative survey sponsored and analyzed by USDA's Economic Research Service (ERS). This report presents statistics from the survey that cover household food security, food expenditures, and use of Federal nutrition assistance ...

  6. Food Insecurity Research in the United States: Where We Have Been and

    Food insecurity is now recognized as a major health crisis in the United States. This is due to the size of the problem—more than 42 million persons were food insecure in 2015—as well as the multiple negative health outcomes and higher health care costs attributable to food insecurity.

  7. Food Insecurity and Health: Practices and Policies to Address Food

    Food insecurity is a significant public health concern given the high prevalence and negative consequences for nutrition, health, and well-being. In 2018, approximately 11.2 million children lived in food-insecure households. 2 This represents 15.2% of all children. Research shows that certain households with children are more vulnerable to ...

  8. Determinants and Consequences of Food and Nutrition Insecurity in

    Introduction. Food and nutrition insecurity are determinants of health that impact people across the globe. Although food insecurity, defined as the "limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways," [] includes nutritional adequacy in the definition, much of the focus and how ...

  9. Food insecurity has economic root causes

    Yes, in a way. Food insecurity has been linked to low wages, adverse social and economic conditions, limited access to healthy foods, residential segregation, lack of affordable housing and ...

  10. Food Insecurity Trajectories in the US During the First Year of the

    Food insecurity. Three survey items were adapted from the US Department of Agriculture's US Household Food Security Survey (13), designed to assess food insecurity in the previous 12 months. ... For the 3 questions, unsure accounted for 2.6%, 2.1%, and 1.4% of responses, respectively. Given prior research on social desirability bias when ...

  11. Millions of families in the U.S. experience food insecurity, report

    17 million U.S. households were food insecure in 2022. That's 3.5 million more than the prior year. Families with children and people of color experienced higher than average rates of food insecurity.

  12. PDF FOOD SECURITY EVIDENCE REVIEW

    Food insecurity is an economic condition, meaning that it is driven primarily by lack of money ... We think the following conditions have a relationship with food insecurity, but additional research is needed. High healthcare costs (e.g., chronic, pre-existing conditions, reliance on medication) and ...

  13. USDA ERS

    Webinar: USDA, ERS economist Matthew P. Rabbitt provides an overview of USDA's annual report on the prevalence and severity of food insecurity in U.S. households in 2022. This report documents the extent and severity of food insecurity among working-age veterans, ages 18-64, who made up 76 percent of the veteran population in 2019.

  14. PDF Children Living in Households That Experienced Food Insecurity: United

    The percentage of children living in food-insecure households was similar for girls (11.0%) and boys (10.6%). The percentages of children living in households that experienced food insecurity were similar across age groups: 10.9% of those aged 5 and under, 10.3% of those aged 6-11, and 11.2% of those aged 12-17.

  15. Hunger Statistics & Facts

    Hunger and Health. Many individuals experiencing food insecurity are forced to make a difficult choice between food and medical care in order to stretch the monthly budget. For people who have the additional burden of living with diabetes, these tradeoffs can be particularly harmful as one works to manage their disease. Learn More ›.

  16. Food Insecurity And Health Outcomes

    Food Insecurity, Neighborhood Food Environment, and Health Disparities: State of the Science, Research Gaps and Opportunities The American Journal of Clinical Nutrition, Vol. 119, No. 3

  17. Tackling Adolescent Food Insecurity

    This isn't often considered in terms of the whole food insecurity issue. When we talk about food assistance programs, we typically think of families with younger children. A lot of food pantries are geared to them. But we don't associate adolescents with food insecurity. There's been some recent research linking food insecurity to a ...

  18. Systematic evidence and gap map of research linking food ...

    Food insecurity has been shown to lead to poor mental ... Deeney, M., Cheng, B. et al. Systematic evidence and gap map of research linking food security and nutrition to mental health ...

  19. Interventions Addressing Food Insecurity in Health Care Settings: A

    INTRODUCTION. Clear and convincing evidence demonstrates food insecurity (FI)— restricted access to adequate food due to a lack of money or other resources 1 —adversely impacts health and well-being across the life course. 2 - 5 As of 2017, 11.8% of US households reported being food insecure at some point during the year, though rates varied by household demographics. 6 For example, over ...

  20. Food insecurity in the US: An explainer and research roundup

    Food insecurity and food deserts in the US: A research roundup and explainer. The food landscape in the U.S. has changed since the first White House Conference on Food, Nutrition, and Health was held 53 years ago. We summarize several studies that show the link between food insecurity and health and include resources for journalists.

  21. Food Insecurity

    Racial Disparities in Food Insecurity Persist. July 2020. In another report based on Census Household Pulse Survey data, IPR director and economist Diane Whitmore Schanzenbach and research analyst Abigail Pitts look at recent trends in food insecurity in the wake of the COVID-19 pandemic. They find that food insecurity rates and related measures of food hardship are elevated for all groups ...

  22. Food Insecurity and Cognitive Trajectories in Community-Dwelling

    Key Points. Question Is food insecurity associated with faster cognitive declines among community-dwelling older adults?. Findings In this cohort study using data from 3037 community-dwelling Medicare beneficiaries 65 years and older, food insecurity reported in late life was associated with a faster decline in executive function.. Meaning These findings suggest that older adults who report ...

  23. Authentic Engagement, Real Impact: Using a Community First Approach to

    Food insecurity isn't just about a lack of food; it's about systems of injustice that create barriers to accessing nutritious options. To truly address this issue, we need to move beyond mere food distribution and work toward food equity. Achieving food equity means "every person has ready and affordable access to healthy, sustainable ...

  24. Science our best bet to fight and beat food insecurity

    The myriad challenges facing our increasingly scorching world underscore that funding groundbreaking research is a key component to building food security. ... fight back against food insecurity ...

  25. USDA ERS

    Download chart data in Excel format.. Food insecure—At times during the year, these households were uncertain of having or unable to acquire enough food to meet the needs of all their members because they had insufficient money or other resources for food.Food-insecure households include those with low food security and very low food security. 12.8 percent (17.0 million) of U.S. households ...

  26. USDA Announces Up to $12 Million in Grant Funding Available to Promote

    WASHINGTON, March 21, 2024-- The U.S. Department of Agriculture (USDA) today announced up to $12 million in funding available to strengthen and explore new market opportunities for U.S. agricultural products and increase access to locally grown food in communities experiencing food insecurity.The funding is available through three grant programs administered by the Agricultural Marketing ...

  27. Lehigh Opens Two New Food Pantries for Students in Need

    Food insecurity happens when people can't access the food they need to live their fullest lives. It is a nationwide issue that also impacts members of our student body. "There are many causes of food insecurity," says Donald Outing, vice president for equity and community. "But one thing is clear: we can do something about it for ...

  28. Exploration of Food Security Challenges towards More Sustainable Food

    2. Materials and Methods. This research aims to report on food security drivers and the current state of recommended policies that address chronic food insecurity in order to ensure the sustainability of future food production through the use of a systematic literature review (SLR) methodology.

  29. PDF IPC Global Initiative

    Gender lens. Food insecurity has a multidimensional impact on women, as it not only relates to unequal access to, distribution of, consumption of, and control over food, but it also has long-term health and safety risks. UN Women data shows that the escalation in food insecurity has also increased the vulnerability of women to food insecurity.

  30. The Farm Near AAMU Will Address Food Insecurity and Strengthen Research

    The farm will be used to address food insecurity and strengthen research and local food systems in Madison County. AAMU and the Madison County Commission have a long history of working together to grow fresh produce for public distribution. This agreement allows the team to expand its operations to meet the increasing food insecurity needs ...