Individuals and families may live in neighborhoods where food is available, but that does not imply that the food provides sufficient nutrition for a healthy lifestyle. Unlike grocery stores, which provide a large variety of fruits and vegetables, convenient corner stores and quick marts in poor neighborhoods stock fat-filled and sugary snacks that provide empty calories and little nutrition.

Food insecurity leads to poor health, placing enormous social and financial burdens on public health and welfare systems, which can't keep up with demand. Educating students throughout their elementary, middle school and high school years about the benefits of a healthy diet can mitigate some of the damage done by a poor diet, leading to improved quality of life, better job opportunities, higher school and work attendance and reduced reliance on government programs.

 
Nutrition and Health

Like hunger, poor and inadequate nutrition has led to a health crisis in the U.S. Poor nutrition also has far-reaching economic, social and political impacts.

According to the Centers for Disease Control and Prevention (CDC):

• 20% of young people aged 2 to 19 years and 42% of adults are obese,having abnormal or excessive fat accumulation that presents a risk to health putting them at risk for heart disease, type 2 diabetesa disease that occurs when blood sugar is too high for the body to process and some cancers
• two of the leading causes of heart disease and strokeoccurs when the blood supply to part of the brain is blocked or reduced are high blood pressure and high blood cholesterolthe condition of having too much fat in one's blood
• unhealthy diet is responsible for up to 45% of all cardiometabolic disease deaths (CMD)a group of common but often preventable conditions including heart attack, stroke, diabetes, insulin resistance and non-alcoholic fatty liver disease
• consuming too much sodiumhelps maintain a balance of body fluids and keep muscles and nerves running smoothly but most Americans eat too much of it can increase blood pressure and the risk of heart disease and stroke
• current sodium guidelines recommend getting less than 2,300 milligramsone thousandth of a gram a day, but the average American consumes more than 3,400 milligrams per day
• more than 70% of the sodium that Americans eat comes from packaged, processed, store-bought and restaurant foods
• people who are overweight or obese are at increased risk of type 2 diabetes because they are less able to use the insulina hormone produced in the pancreas that regulates the amount of glucose in the blood they manufacture
• 96 million, more than 1 in 3 American adults, are prediabetic,a condition, that without intervention, is likely to become diabetes and more than 8 in 10 of them don't know they have this condition
• the number of adults with diagnosed diabetes has nearly doubled in the last 2 decades as the U.S. population has increased, aged and become more overweight
• consuming sugar-sweetened beverages and highly processed food often leads to weight gain, obesity and other chronic conditions that put people at higher risk of at least 13 types of cancer, including uterine, breast cancer in postmenopausal women and colorectal cancer
• the risk of colorectal cancer is also associated with eating red and processed meat.^[3],[4]

Health costs related to poor eating and nutritional habits cost millions of dollars annually:

• annual diet-related CMD costs were $50.4 billion for 18.2% of the total population
• 84.3% of the cost, $42.6 billion, is to pay for acute medical carecare in which a patient is treated for a brief but severe episode of illness, for conditions that are the result of disease or trauma and during recovery from surgery^[4]
• two-thirds of Medicaid beneficiaries are overweight or obese, 28% have hypertension, and 26% report being in poor health
• 2020 costs due to treatment and lost productivity were estimated at $238.7 billion for diabetes, $302.3 billion for cancer, $519.9 for cardiovascular disease and $805.2 billion for obesity
• the economic cost of obesity, heart disease, type 2 diabetes and nutrition-related cancers totaled $16 trillion between 2011-2020.^[5]

To reduce the probability of nutrition-related illnesses the CDC recommends:

• a healthy diet, physical activity and sleep to prevent obesity
• eating foods low in saturated fatsa type of fat containing a high proportion of fatty acid molecules without double bonds and high in fiberthe indigestible parts or compounds of plants, which pass relatively unchanged through our stomach and intestines
• increasing access to low-sodium foods.^[3]

The Healthy Eating Index (HEI), modified several times since 1995, is a measure of diet quality used to assess how well particular foods align with dietary recommendations published in the Dietary Guidelines for Americans (Dietary Guidelines), which are used by health and nutrition professionals to help individuals and families eat nutritious foods.^[1]

The HEI, developed by USDA Food and Nutrition Services, Center for Nutrition Policy and Promotion, Health and Human Services and National Cancer Institute is used to assess the dietary quality of those two years and older. A new set of guidelines, Healthy Eating Index-Toddlers-2020 was developed to assess the diets of very young children 12 through 23 months.^[1]

The HEI uses a scoring system ranging from 0 to 100, with a score of 100 indicating that foods best meet dietary recommendations. As of 2020, the HEI score for those ages 2 and older was 58 out of 100 and the average HEI-Toddlers-2020 score for ages 12 through 23 months was 63 out of 100, indicating that U.S. diets do not meet current national recommendations for good nutrition.^[1]

Researchers found that even when those with poor diets were provided with easily accessible, higher quality and nutritious foods, they didn't usually modify poor eating and food purchashing behaviors and nutritional inequality was reduced by only 9%. The remaining 91% difference was due to food demand and existing purchasing and eating practices.^[2]

Poor nutrient soil, grain processing that removes nutrients and fertilizers that contain dangerous heavy metalsmetals that bind to parts of cells that prevent organs from working properly reduce crop nutrition. Mineral and vitamin concentration in local food crops, usually consumed by poor populations, can be increased by using different biofortificationprocess of increasing the micronutrient content of a food crop through selective breeding, genetic modification, or the use of enriched fertilizers techniques.^[7] Some of these agriculture methods are now being utilized.

Food waste is also an international problem contributing to poor nutrition. A 2021 United Nations global initiative, to halve food loss and waste by 2030 in 50 countries, will identify methods of decreasing food waste using data collection, improved farming technology, public and private partnerships and consumer education.^[8]

Sources:

 
Food Deserts

• an area that has either a poverty rate greater than or equal to 20% or a median family income not exceeding 80% of the median family income in urban areas, or 80% of the statewide median family income in non-urban areas
• in urban areas, at least 500 people or 33% of the population must live more than 1 mile from the nearest large grocery store
• In rural areas, at least 500 people or 33% of the population must live more than 10 miles from the nearest large grocery store.^[6]

In the 2008 Food, Conservation and Energy Act (2008 Farm Act), Congress directed the USDA to assess the extent of areas in the U.S. where people have limited access to a variety of healthy and affordable food. The outcome was Access to Affordable and Nutritious Food: Measuring and Understanding Food Deserts and Their Consequences report.^[2],[3]

The report asked three important questions:

• What are affordable and nutritious food?
• What is the impact of not having access to nutritious food?
• Do individuals or areas lack access?^[3]

• are more likely to be found in high poverty and high percentage of minority areas
• can also be found in urban and rural areas where vehicle and public transportation are inadequate
• are less prevalent in the Northeastern U.S. than in other regions of the country
• are more likely to be located in areas with few food retailers
• are less likely to be found in rural areas experiencing population growth
• populations with low access to stores are likely to be found in the Southwest, Midwest, Northwest, and Florida
• populations with lower access to vehicles are more common in the Northeast and Southeast.^[2],[5]

The causes of nutritional inequality resulting from food deserts are based on several facts:

• households in the upper 25% of income buy groceries that are 0.56 standard deviationsa measure of how dispersed the data is in relation to the average more healthful than those in the bottom 25% of income, as measured by the Healthy Eating Index, the standard measure of dietary quality
• stores in low-income neighborhoods offer fewer healthy groceries than those in high-income neighborhoods
• low-income neighborhoods have more drug and convenience stores as well as fewer large supermarkets, which offer wider variety of healthy options
• lack of access to full-service grocery stores and easy access to convenience foods is likely linked to obesity and other diet-related diseases.^[3],[4]

A 2020 study of Tucson found that independent food stores were found in neighborhoods with high population densities and in central Tucson, food was accessible for a substantial part of the population due to Asian, Mediterranean, African and Hispanic food markets.^[7] These small stores tended to be clustered close to each other.

Sources:

 
Hunger in America

Engel's law, posed more than 150 years ago by statistician Ernst Engel, states that households spend more money on food as incomes rise but a smaller share of overall income. Poor households spend less money on food than higher income households, but the amount accounts for more of their total income. During the last 25 years, the poorest 20% of U.S. households spent between 28.8% and 42.6% of their annual before-tax income on food, compared with 6.5% to 9.2% spent by the richest 20% of U.S. households.^[1]

For poorer households, however, financial security is more unpredictable and inconsistent. They are far more financially sensitive to increasing food prices, overall cost-of-living and availability of local, state and federal food assistance programs.^[1]

According to the Federal Reserve Board Black families' median wealth, $24,100, is less than 15% that of white families, $188,200. The median wealth of Latino families is about 20%, $36,100, of that of white families.^[3]

A 2021 National Women's Law Center report found that among full-time, year-round workers, Native American women are typically paid only 60 cents for every dollar paid to white, non-Hispanic men. The annual difference is $24,656.^[4]

In the U.S. hunger most affects children, rural communities, senior citizens, active and retired military veterans, African Americans, Latinos, Native Americans and Asian Americans.^[2] The effects of hunger depend on age, location, job status, housing status, household size, familial responsibilities and other factors.

Hungry children often exhibit poor academic performance, increased risk to anemia,a condition characterized by an absence of healthy red blood cells or hemoglobin to carry oxygen to body tissues asthmaa respiratory condition that causes breathing difficulties and other health problems and growth issues that affect thinking, learning and behavior.^[5] These can have devastating and life-long effects on a child's educational success, ability to find reliabile employment later in life and to extracate themselves from the environment that caused the hunger.

Those living in rural communities often do not have access to public transportation and may live far from the nearest grocery stores. Unemployment in many rural communities is high and jobs, when available, tend to be part-time, low-wage opportunities.^[6]

Between November and April, 90% of American and Canadian leafy greensinclude kale, microgreens, collard greens, spinach, cabbage, beet greens, water cress, romaine lettuce, Swiss chard, arugula, endive, bok choy and turnip greens and other vegetables come from the Yuma area.^[7] Despite the abundance of food produced in that area, 80% of that county's population qualifies for federal food assistance, 14.6% living in the county are food insecure and nearly $17 million are needed to meet their basic food needs.^[8]

Senior citizens suffer from many of the same hunger factors as other populations. But more than other group, they tend to be socially isolated or find themselves as the primary caretakers of grandchildren.^[9] According to the 2022 American Community Survey, 6,928,281 grandparents live with their own grandchildren under 18 years of age, with 32.4% responsible for caring for those grandchildren.^[10] This creates additional financial burdens on hungry older adults.

In 2020, 24% of active duty service members were food insecure. Ironically, some military families don't qualify for federal food assistance because military housing allowances are considered income. Low pay and frequent relocation also create difficulty for partners seeking secure and steady jobs that pay a liveable wage.^[11]

In communities of color, hunger is a product of discrimination, racism, low wages, language barriers, immigration status issues and stereotyping.^{[12],[13],[14],[15]}

Of western states, which include Arizona, California, Colorado, Idaho, New Mexico, Nevada, Oregon, Texas, Utah and Washington, Arizona ranks third in food insecurity at 11.1%. Within large cities in those states, including Albuquerque, Austin, Colorado Springs, Denver, El Paso, Las Vegas, Phoenix, Portland, Salt Lake City, San Antonio, San Diego and Tucson, Tucson ranks second in food insecurity, at 12.6%, behind Colorado Springs. In Pima County, 10% of the white populiation is food insecure, but 18% of the Hispanic and Latin community is food insecure.^[16]

Sources:

 
Food Security and Education

Nutrition education is related to better health, improved financial security and a higher quality of life in both food secure and food insecure environments. Many individuals with regular access to nutritious food already know that fruits, vegetables, nuts and whole grains are linked to reduced risk of cardiovascular disease, that diets high in saturated fat, trans fat and refined sugars are linked with higher risk of diabetes and cardiovascular disease and that sugar-sweetened beverages increase the risk of obesity, diabetes and cardiovascular disease.^[1]

Life-long nutrition education is more effective than short-term programs. Food nutrition labels, removal of unhealthy foods from school and work environments, calorie information in fast food outlets, food literacy programs and public service ads can be used to educate consumers.^[13]

U.S. studies have shown that greater availability and lower priced food from fast food restaurants are related to poorer diet. Other studies demonstrated that, instead of opening new supermarkets, promoting healthy food options in corner convenience stores in underserved areas increased the sales of fruits and vegetables and improved the diets of vulnerable populations.^[1]

Food consumption data demonstrates that increasing healthy food supplies, healthier eating and a healthier lifestyle do not necessarily show an immediate benefit of eliminating food deserts. Unhealthy food supplies in a community usually lead to a lower demand for good food and less incentive for healthy food suppliers to locate in that community. This leads to a vicious circle of poor nutrition choices supporting poor food supplies.^[12]

• mobility counseling and a Section 8 public housing voucher that could only be used in census tracts with low poverty rates
• a Section 8 voucher that could be used in the traditional way, without any geographic restriction
• no new assistance.^[1],[2]

Learning and developing long-term healthy eating habits among children, parents, and in schools, is needed for better nutrition to be normalized and accepted.^[12]

Education efforts in poor international communities are also possible. The goals of Food for Education (FFE) programs are to increase school enrollment and attendance and reduce dropout rates while educating students about nutrition. These programs differ among countries but most provide free school meals, food rations and groceries for families of children in elementary schools, or cash incentives for students' participation in food and nutrition eduction programs.^[5]

Adequate learning resources must be provided for these programs to succeed. An FFE program in Bangladesh improved poor student school enrollment, especially for girls, but exposed an important nutritional education program issue. Bangladesh failed to invest in school resources needed to support high student enrollment in this program, resulting in overcrowding and reduced educational achievement.^[6]

In 2018 McGovern-Dole began a five-year, $36 million project in Sri Lanka with Save the Children. The program supports nutrition education, child development and food security. Its objective is to reduce hunger and improve literacy and primary education, especially for young girls. The program provides school meals, teacher training, and related support, to maintain school enrollment and academic performance. It also educated students, parents and staff about sanitation and provided simple recipes that enabled caregivers to cook nutritional, well balanced meals.^[3]

When Sri Lankan schools closed during the pandemic the program shifted its efforts to providing take-home meals that fed more than 460,000 citizens. When they reopened meals were distributed to students in their schools.^[3]

The U.S. Department of Agriculture provides many nutrition resources in English and Spanish to educate the public about nutrition:

• MyPlate helps shoppers in any community locate farmers' markets, SNAP EBT savings options, healthy shopping tips, meal planning options and explanations of retail and unit food prices^[7]
• Small Changes Matter describes how to reduce sugar, saturated fat, salt and sodium consumption^[8]
• Life Stages provides nutrition information for pregnant women, infants, toddlers, preschoolers, teens, young adults, adults, older adults and families^[9]
• Partner Resources includes healthy recipes and cooking videos^[10]
• Dietary Guidelines for Americans 2020-2025 provides descriptions on using U.S. Department of Agriculture nutrition-related resources.^[11]

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Observations and Conclusions

• Poor nutrition leads to chronic diseases, disability and early death, reducing the quality of life of individuals and families.
• Poor health stresses social, economic and political institutions, including education and employment opportunities and health system resources.
• Families and individuals need access to healthy food where they live and work.
• When nutrition education programs are provided with sufficient resources, they can offer short-term and long=term benefits to students and families, improving quality of life.
• Access to nutrition, dietary and health guidelines needs to be available to everyone in grocery stores and local, corner markets.

 
Resources

Denise Meeks, dmeeks@arizona.edu / tucsonkosmicgirl@gmail.com