Issue At A Glance: September 2017 INSTITUTE FOR HEALTH POLICY AND LEADERSHIP

“Low Food Security” and “Very Low Food Security” are two terms that measure

food insecurity.

In a low food-secure family, the quality, variety, or

desirability of diet is reduced but food intake is not

reduced.

In a very low food-secure family, the eating pattern is disrupted and food intake is

reduced.5

Did You Know?

Addressing Hunger in San Bernardino County

Although 11 percent of families are estimated to be food insecure in San Bernardino County, the actual extent of food insecurity is not known as San Bernardino County is a large and diverse region.3 Since food insecurity directly impacts health, making a concerted and targeted effort to decrease food insecurity across the County is important for a healthy community. To do this well, accurate and up-to-date information about food insecure households and the causes and consequences of food insecurity should be collected at the local community level.

What is Food Insecurity? Researchers use food security to measure whether people or households have access to enough healthy and safe foods without having to steal or scavenge for food. When people or households have food insecurity they might not know where their next meal is coming from or cannot get enough nutritious foods for their family to eat. In other words, people suffering from food insecurity often go hungry or must rely on cheaper, less healthy foods for their daily needs.4

Bringing wholeness to individuals and communities, the Institute for Health Policy and Leadership (IHPL) strives to integrate health policy research and education with

leadership development. Our goal is to improve the health of our communities by building on our strong heritage of health promotion and disease prevention.

To learn more, visit us at www.IHPL.llu.edu

Food insecurity affects over 12 percent of families nationwide and about the same percentage of families across California.1,2 In San Bernardino County, 11 percent of families are

estimated to be food insecure.

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP September 2017

Food Insecurity in San Bernardino County San Bernardino County suffers from high rates of poverty, under- and unemployment, disability, and other risk factors for food insecurity. One in five individuals—and one in four children—lives in poverty.18,19 In recent years, the County unemployment rate has been between four and seven percent. Additionally, 7.5 percent of adults report having only part-time employment, 16.5 percent of adults report being disabled, and almost half of County residents do not make enough money to be financially self-sufficient.20-22

From 2014 to 2015, 70 percent of County children were eligible for school meal assistance based on income.19 And from 2011 to 2016, Countywide enrollment in the federal Supplemental Nutrition Assistance Program (SNAP; CalFresh is California’s version) increased from 15 percent to nearly 20 percent.19,23

In San Bernardino County, nearly one-fifth of adults

may not be able to afford enough food at one point or

another in a given year.

According to estimates produced by Feeding America, 221,000 or 11 percent of County residents experience food insecurity, and nearly 120,000 or 20 percent of children experience food insecurity.3,24,25 Although County access to CalFresh is quite good, nearly 20 percent of income-eligible individuals were not participating in CalFresh in 2013, and about the same number of County adults may not be able to afford enough food at one point or another each year.21,27 Furthermore, an additional 26 percent of food-insecure children are likely not income-eligible for federal nutrition assistance.3 Finally, school-based meal programs reach three-fourths of eligible students when school is in session, yet only six percent of school lunch participants are reached during the summer months.27

Why is Food Insecurity Important? Besides hunger, food insecurity is also linked to many health problems, including obesity, high blood pressure, heart disease, diabetes, liver disease, stroke, cancer, asthma, arthritis, lung disease, kidney disease, and depression.5–8 People affected by food insecurity are more likely to:

Ø Eat fewer fruits and vegetables, drink more soda, or eat more fast foods9

Ø Smoke10 Ø Have more stress11,12 Ø Not take their prescription medications12-15 Ø Feel unable to take care of their diabetes16

In 2007, healthcare costs attributed to hunger were about $98.5 billion nationwide—and by 2010 this figure had increased to $130.5 billion.17

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP September 2017

1

Although these statistics paint a broad picture of the problem of food insecurity across the County, it tells an incomplete story of the problem. Dramatic differences between neighborhoods and communities exist but little is known about which communities are most affected by food insecurity.28 Furthermore, from the existing regional data and computer models, only guesses can be made about the causes of food insecurity in these communities. These gaps in our knowledge about our local communities limit the ability of stakeholders from all sectors to coordinate efforts in targeting food insecurity and its underlying causes.

Right now, hundreds of organizations in San Bernardino County distribute food to insecure communities and households. In some communities, local agencies are beginning to coordinate their efforts through written agreements and shared resources with the goal of best serving their local communities.29 Up to now, such activities have been guided by the demand alone, as routine and systematic data collection does not occur at the local community level.30 Consequently, little is known about which neighborhoods are most affected and why. If such an assessment were to be undertaken, the resulting information could guide a targeted and concerted effort to make impactful improvements in these measures. For example, one such needs assessment helped a California community identify targetable barriers to food insecurity, which allowed strategic interventions to be implemented.31

2

Accurate and up-to-date information about food insecure households, risk factors for food insecurity, and health issues resulting from food insecurity, should be collected at the community level. Specifically, stakeholders from different sectors—especially government, health care, academia, for-profit food retail and distribution, and community-based organizations—should come together to study the reach of food insecurity within their local communities. Ideally, this effort would be led by local Healthy Communities programs and would occur every one to two years. Such information should then be shared with and used by existing food distribution agencies in order to coordinate a targeted and concerted countywide effort to eliminate food insecurity. Such information should also be shared with regional and state government representatives in order to guide additional food policies.

A targeted effort to eliminate hunger requires

up-to-date information about where it exists and

what causes it.

Identifying Local Data Gaps in San Bernardino County

Recommendations to Stakeholders

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INSTITUTE FOR HEALTH POLICY AND LEADERSHIP September 2017

References

1. 1. Coleman-Jensen A, Rabbitt MP, Gregory CA, Singh A. Household Food Security in the United States in 2015. United States Department of Agriculture; 2016 Sep. Report No.: 215.

2. 2. Profile of Hunger, Poverty, and Federal Nutrition Programs - California. Food Research and Action Center; 2015 Feb.

3. 3. Gundersen C, Dewey A, Crumbaugh A, Kato M, Engelhard E. Map the Meal Gap 2017: Child Food Insecurity in California by County in 2015. Feeding America; 2017.

4. 4. National Research Council. Measuring Food Insecurity and Hunger: Phase 1 Report. Washington, D.C.: National Academies Press; 2005.

5. 5. Gregory CA, Coleman-Jensen A. Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. United States Department of Agriculture; 2017 Jul. Report No.: ERR-235.

6. 6. Leung CW, Epel ES, Willett WC, Rimm EB, Laraia BA. Household food insecurity is positively associated with depression among low-income supplemental nutrition assistance program participants and income-eligible nonparticipants. J Nutr. 2015;145: 622–627.

7. 7. Smith TM, Colón-Ramos U, Pinard CA, Yaroch AL. Household food insecurity as a determinant of overweight and obesity among low-income Hispanic subgroups: Data from the 2011-2012 California Health Interview Survey. Appetite. 2016;97: 37–42.

8. 8. Berkowitz SA, Berkowitz TSZ, Meigs JB, Wexler DJ. Trends in food insecurity for adults with cardiometabolic disease in the United States: 2005-2012. PLoS One. 2017;12.

9. 9. Becerra MB, Hassija CM, Becerra BJ. Food insecurity is associated with unhealthy dietary practices among US veterans in California. Public Health Nutr. 2016; 1–8.

10. 10. Kim JE, Tsoh JY. Cigarette Smoking Among Socioeconomically Disadvantaged Young Adults in Association With Food Insecurity and Other Factors. Prev Chronic Dis. 2016;13: E08.

11. 11. Allen NL, Becerra BJ, Becerra MB. Associations between food insecurity and the severity of psychological distress among African-Americans. Ethn Health. 2017; 1–10.

12. 12. Becerra BJ, Sis-Medina RC, Reyes A, Becerra MB. Association Between Food Insecurity and Serious Psychological Distress Among Hispanic Adults Living in Poverty. Prev Chronic Dis. 2015;12: E206.

13. 13. Bengle R, Sinnett S, Johnson T, Johnson MA, Brown A, Lee JS. Food insecurity is associated with cost-related medication non-adherence in community-dwelling, low-income older adults in Georgia. J Nutr Elder. 2010;29: 170–191.

14. 14. Herman D, Afulani P, Coleman-Jensen A, Harrison GG. Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample.

15. 15. Knight CK, Probst JC, Liese AD, Sercye E, Jones SJ. Household food insecurity and medication “scrimping” among US adults with diabetes. Prev Med. 2016;83: 41–45.

16. 16. Vijayaraghavan M, Jacobs EA, Seligman H, Fernandez A. The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults. J Health Care Poor Underserved. 2011;22: 1279–1291.

17. 17. Shepard DS, Setren E, Cooper D. Hunger in America: Suffering We All Pay For. Center for American Progress; 2011 Oct.

18. 18. U.S. Census Bureau Quick Facts selected: San Bernardino County, California. In: United States Census Bureau. [cited 16 Aug 2017]. Available: https://www.census.gov/quickfacts/fact/table/sanbernardinocountycalifornia/INC110215

19. 19. 2016 Community Indicators Report. San Bernardino County Board of Supervisors; 2016. 20. 20. Self-Sufficiency Standard Tool for California. In: Insight - Center for Community Economic

Development. 2015. https://insightcced.org/tools-metrics/self-sufficiency-standard-tool-for-california/ 21. 21. AskCHIS 2014. UCLA Center For Health Policy Research; Available: http://ask.chis.ucla.edu 22. 22. EDD. Historical Data for Unemployment Rate and Labor Force (Not Seasonally Adjusted) in San

Bernardino County. In: CA.gov. 2017 [cited 12 Sep 2017]. Available: http://www.labormarketinfo.edd.ca.gov/cgi/databrowsing/localAreaProfileQSMoreResult.asp

23. 23. FRAC. Households Participating in SNAP by County, 2011-2015. In: Food Research and Action Center. 2017 [cited 22 Aug 2017]. Available: http://www.frac.org/snap-county-map/tables/snap-county-tab.html

24. 24. Gundersen C, Dewey A, Crumbaugh A, Kato M, Engelhard E. Map the Meal Gap 2017: Overall Food Insecurity in California by County in 2015. Feeding America; 2017.

25. 25. Children Living in Food Insecure Households. In: Kidsdata.org. 2017 [cited 15 Aug 2017]. Available: http://www.kidsdata.org/topic/764/food-insecurity/

26. 26. Call J, Shimada T. Program Access Index 2014: Measuring CalFresh Utilization by County. California Food Policy Advocates; 2016 Nov. http://cfpa.net/CalFresh/CFPAPublications/PAI-FullReport-2016.pdf

27. 27. CFPA. Nutrition and Food Insecurity Profile - San Bernardino. In: California Food Policy Advocates [Internet]. 7 Jul 2016 [cited 22 Aug 2017]. Available: http://cfpa.net/county-profiles

28. 28. 2017 Community Health Assessment Report. St. Mary Medical Center; 2017. 29. Seeley D. 2017. High Desert Food Collaborative. Personal interview. 30. Kelvin G. 2017. High Desert Food Collaborative. Personal interview. 31. Current and Prospective Scope of Hunger and Food Security in America: A Review of Current Research. Research Triangle Institute International; 2014 Jul.

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Questions? Please contact Helen Jung, DrPH, MPH. Senior Health Policy Analyst at the Institute for Health Policy & Leadership (helenjung@llu.edu)

Special Guest Contributor: Marcus Heisler, MD, IHPL Intern