Hunger Does Discriminate: Addressing Structural Racism and Economic Inequality in Food Insecurity Research

On April 10, 1967, Fannie Lou Hamer, Marian Wright, and other Black community leaders testified before the US Senate about the crisis of hunger in the Mississippi Delta. At Wright’s urging, Senator Robert F. Kennedy traveled to the Delta the following day to “look into the deadened eyes of hungry children with bloated bellies” (https://bit.ly/2Y56BhN). The images that followed shocked the nation; many struggled to believe that such conditions could exist alongside such enormous wealth. More than 50 years later, during the COVID-19 pandemic, dramatic images of hunger remain: cars line up for miles outside food pantries as farmers destroy thousands of pounds of fresh food. Why does food insecurity persist? Hamer, Wright, and countless others with lived experiences of racism and economic exploitation knew the answer long before most were ready to listen: structural inequality, and its transmission across generations, lies at the root of food insecurity. Effective and sustainable solutions must acknowledge and address these fundamental causes.

In this issue of AJPH, Larson et al. (p. 1422) examine food insecurity and its association with diet quality, home food availability, and health risk behaviors among emerging adults (18–26 years) in Minneapolis–St. Paul, Minnesota. Their longitudinal study builds on research documenting the high prevalence of food insecurity among college students and points to an even greater risk among emerging adults who do not attend postsecondary school. Their findings are particularly relevant given the economic precarity of our times: workers aged 25 to 37 years without a bachelor’s degree earn less than their counterparts in the previous four generations (https://pewrsr.ch/2YIk7ab), and the COVID-19 pandemic is poised to exacerbate these inequities. The study also confirmed particularly high levels of food insecurity among those who identified as Black/African American or American Indian/Alaska Native or who belong to multiple or other races/ethnicities. Although Larson et al. thoroughly describe these stark socioeconomic, racial, and ethnic inequities, we can do more to highlight their root causes.

REDEFINING THE PROBLEM

Public health research on food insecurity typically aims to identify proximal causes, characterize high-risk populations, enumerate health consequences, and evaluate interventions that increase food access through charitable (e.g., food pantries) and federal (e.g., Supplemental Nutrition Assistance Program; SNAP) assistance programs. This research is needed to inform programs and policies that meet the immediate needs of food-insecure households. However, until we define structural inequality as the problem, we will never move beyond superficial solutions. A full treatment of food insecurity’s root causes will remain outside the scope of many studies. This is understandable. But it does not prevent us from naming the problem, thinking more holistically about proposed solutions, and building broader research agendas that strive for structural change.

Racism, poverty, and food insecurity are increasingly recognized as sources of toxic stress, which can significantly damage health across the life course.¹ The Center for Hunger-Free Communities and their participatory action project, Witnesses to Hunger, have been instrumental in documenting how food insecurity, poverty, and trauma are passed down through generations and highlighting the near impossibility of breaking these links through individual action alone.² They have located food insecurity’s root causes in numerous nonfood policies, including unaffordable housing, child care, and health care; lack of paid family and sick leave; and nonlivable wages.² The finding of Larson et al.—that 38.5% of emerging adults with children were food insecure, compared with 21.6% of those without children—underscores the need for solutions that disrupt intergenerational cycles. Recent work also illustrates that Black and Latinx mothers who experience racial discrimination are more likely to live in food-insecure households.³ Heightened risk may function through multiple pathways, including increased psychological stress, anxiety, and depression as well as reduced self-esteem,⁴ all of which may impede one’s ability to identify adaptive coping strategies needed to mitigate food insecurity.

Virtually no research has examined how structural racism—“the processes of racism that are embedded in laws, policies, and practices of society and its institutions”^4(p107)—directly affects food insecurity. Consider, for example, racially discriminatory policing, sentencing, and incarceration. Laws and policies such as the 1996 welfare reform legislation, which included a lifetime ban on SNAP benefits for people convicted of felony drug offenses, almost certainly have a disproportionate impact on communities of color, and Black communities in particular. Although nearly all states rescinded complete lifetime bans, 25 maintain modified bans (e.g., terminating benefits for parole violations, requiring drug testing) that act as barriers to SNAP participation (https://bit.ly/3d43c7f). Discriminatory policing is not limited to adults. Black K through 12 students are more than three times more likely to be suspended or expelled than are White students,⁵ which may significantly limit access to the National School Lunch and School Breakfast Programs, the nation’s key tools in the fight against child food insecurity. Rigorous research examining how specific manifestations of institutional racism affect food insecurity should be prioritized.

WHERE DO WE GO FROM HERE?

Reframing food insecurity research to center structural inequality is no small task. There are several places where we can begin.

Adopt Antioppressive Frameworks

It is incumbent on food insecurity researchers to acknowledge how systems of oppression and racism pattern population health. We must consider how our own identities, experiences, and varying degrees of privilege and power shape the questions we ask and the ways we answer them. Elevating the voices of those directly affected by food insecurity is critical. We can do that by using participatory research methods, generating practice-based evidence, and recognizing that the most innovative solutions are often developed by affected communities themselves. Fannie Lou Hamer, although best known for her voting rights activism, was a pioneer of the food justice movement. Her Freedom Farm Cooperative holistically addressed food insecurity, housing, land ownership, and education for families across Sunflower County, Mississippi.⁶ This history and the work it inspired in communities across the nation offer many valuable lessons.

Apply Trauma-Informed Interventions

Concerns about adequate nutrition dominate public health approaches to reducing food insecurity. Although nutrition is critical, the adversity and trauma experienced by many who are food insecure must also be addressed. Trauma-informed approaches—which recognize the far-reaching impacts of trauma; integrate key principles of safety, trustworthiness, peer support, collaboration, and empowerment; and incorporate resilience-building strategies—offer a more holistic model for addressing food insecurity. One successful example is the Building Wealth and Health Network, a trauma-informed intervention born of the Witnesses to Hunger project, which improved food insecurity among families with young children.⁷ Such interventions should be implemented across diverse settings, with the goal of determining the most effective strategies for scalability and sustainability.

Recognize the Need for Health in All Policies

Food- and nutrition-specific policies are urgently needed to address the growing crisis of food insecurity amid the COVID-19 pandemic, including immediate increases to SNAP benefits that are maintained for the duration of economic recovery. But, in the longer term, we must look toward a health in all policies approach, which recognizes that many of the fundamental causes of health inequities lie in sectors outside public health, including housing, education, employment, and criminal justice. Researchers can examine nonhealth determinants of food insecurity, intentionally choose measures that are policy relevant, communicate our results to state and local government agencies, form partnerships to conduct food insecurity–specific health impact assessments, and advocate policies in all sectors that promote health equity.

As a first step, we must acknowledge that hunger does discriminate.