COMM NUTR FINAL

Background of Food Assistance Programs

1960's-1970's, Poverty and hunger were national priorities Old programs revised, new programs developed -Food Stamp Program expanded -School lunch & breakfast programs enlarged -Senior feeding programs began -WIC for women and young children 1980's, Hunger diminished until 1980's when federal spending for antipoverty programs was reduced

U.S. households with children by food security status of adults and children, 2016

83.5% Food-secure households 16.5% Food-insecure households 8.0% Food-insecure, children

Commodity Supplemental Food Program (CSFP)

Direct food distribution program - distributed monthly -Supplements diet with nutritious USDA commodity foods -Food packages designed to meet nutritional needs of participants Participants -Low-income pregnant and breastfeeding women -Other new mothers up to one year postpartum -Infants and children up to age six -Elderly people at least 60+ Must be determined at nutritional risk by competent health professional at local agency May not participate in WIC and CSFP

Department of Homeland Security (DHS)

Disaster feeding

Ethnic Minorities

Disparity in poverty rate

Poverty Thresholds

Dollar amounts below which a family would be viewed as living in poverty

Community Food Security:Strategies and Activities

Farmer's markets Community-supported agriculture programs (CSA's) Farm-to-cafeteria initiatives SNAP outreach programs - increase participation Community gardens Food recovery and gleaning programs Food-buying cooperatives - pool purchasing resources Directory of supply and demand for community food surplus to connect food surplus sources with food pantries & soup kitchens

Counting the Food Insecure in the U.S.: Questions address

Fear and anxiety related to food insufficiency Experiencing food shortages w/o money to buy more Perceived quality and quantity of food eaten in household Atypical food usage (substituting fewer/cheaper foods) Episodes of reduced food intake, hunger, weight loss

Older Adults

Fixed incomes Health problems cause competition for household funds

Community Nutritionists in Action: Delivering Programs

Food Insecurity The Food Assistance Programs

Poverty

Having too little money to meet minimum needs for food, clothing, shelter

Suitability

Is it culturally acceptable? Can it be stored safely and prepared appropriately?

Programs for Women and Young Children

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) WIC Farmers' Market Nutrition Program

The Young

16.6% of households w/children experienced food insecurity Adults typically protect children

Supplemental Nutrition Assistance Program: SNAP

Established by Food and Nutrition Act of 2008 Enables participants to buy approved foods in approved grocery stores -Goal to improve diets by increasing access to food Entitlement program Participants: eligibility and allotments based on income, household size, assets, housing costs, work requirements, and other factors

Counting the Food Insecure in the U.S.: U.S. Census Bureau

Food Security Survey Module of Current Population Survey Annual since 1995

Thrifty Food Plan

Food guide for a nutritious diet at a minimal cost Used as basis for SNAP allotments Maintained by USDA's Center for Nutrition Policy and Promotion

Inner-City and Rural Dwellers

Food insecure exceeded those in suburbs and other metropolitan areas Lack of transportation and access to quality supermarkets

Very low food security was more prevalent than the national average for the following groups:

Households with children headed by a single woman (10.5%) Women living alone (6.7%) and men living alone (7.5 %) Black, non-Hispanic households (9.7%) Hispanic households (5.8%) Households with incomes below 185 percent of the poverty line (13.3%) Households located in principal cities (5.9%) and in nonmetropolitan areas (6.6%) Households located in the South (5.4%)

How many people are food insecure in the U.S.?

In 2016: 41.2 million people lived in food-insecure households. 10.8 million adults lived in households with very low food security. 6.5 million children lived in food-insecure households in which children, along with adults, were food insecure. 703,000 children (1.0 percent of the Nation's children) lived in households in which one or more child experienced very low food security.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Participants

Infants and children up to age five Pregnant women Breastfeeding women Non-breastfeeding postpartum women

Quality

Is the food nutritionally adequate

High Food Security

No problems or anxiety

Who are the Food Insecure in the U.S.?

Poor and working poor Young and older adults Ethnic minorities Inner-city and rural dwellers Certain south and western states Many farmers Homeless

Facts Related to Food Insecurity

Poverty is a chronic cause Household diets are inadequate Can lead to physical, social, and mental health problems Low-paying jobs result in incomes inadequate to meet fixed expenses Various coping skills are used to limit very low food insecurity Families rely on emergency food assistance facilities -For emergencies and as a steady source of food Individuals self-select to participate in food assistance programs Private charity cannot solve the food insecurity problem

Farmers lack control over:

Products they produce -Commodity programs Prices for supplies -Cost of seed, fertilizer, equipment, loans steadily rising Prices they receive for commodities -Crop prices have been declining

Congregate Meal Programs

Sites selected to maximize participation Provides socialization benefit

Soup kitchens

Small feeding operations attached to existing organizations, such as churches, civic groups or nonprofit agencies Serve prepared meals consumed on-site Generally do not require proof of need

Child and Adult Care Food Program (CACFP)

Support public or private nonresidential child and adult day care programs to provide nutritious meals Receive USDA commodities or cash in lieu of commodities Participants -Children up to age 12 -Older adults -Certain people with disabilities

Low Food Security

reduced quality, variety, and desirability, but quantity of food intake and normal eating patterns not substantially disrupted

Working Poor and the Homeless: What is the "Housing Wage"?

represents the hourly wage a full-time worker must earn in order to afford a modest rental home while spending no more than 30% of their income toward housing costs.

Background of Food Assistance Programs

1930's, Federal government given authority to buy and distribute excess food commodities during the Great Depression 1946, Congress initiated an experimental Food Stamp Program and passed the National School Lunch Act 1960's-1970's, Evidence accumulated that hunger was prevalent, poverty and hunger became national priorities

Poverty Rates in the U.S. are Declining

2014 poverty rate 14.2% 2015 poverty rate 13.5% 2016 poverty rate 12.7% -40.6 million people (2.5mil < 2015, 6.0mil < 2014) -Median household income $59,000 2018, DHHS defines poverty level income as $25,100 for a family of four

Housing Wages

2017, National two-bedroom Housing Wage was $21.21. Federal minimum wage in the U.S. is $7.25 per hour. -Last re-set on July 24, 2009 Michigan minimum wage in 2017 was $8.90, now $9.25

U.S. Households by Food Security Status, 2016

87.7% Food-secure households 7.4% Households with low food 4.9% Households with very low food security

Food Security

Access by all people at all times to sufficient food for an active and healthy life

Food Distribution Disaster Assistance

Administered by Federal Emergency Management Agency (FEMA) in the Department of Homeland Security Provides food to state relief agencies and organizations (Red Cross, Salvation Army) during emergencies FNS may: -Provide commodity food packages for distribution to shelters and mass feeding sites -Distribute commodity food packages directly to persons in need -Approve emergency SNAP benefits -Represents most expenditures

United States Department of Agriculture (USDA)

Administered by Food and Nutrition Service (FNS) 15 programs

Social

Are the methods of acquiring food socially acceptable? Can they avoid scavenging garbage, stealing food or money to buy food

Very Low Food Security

At times, eating patterns of one or more household members were disrupted/food intake reduced due to lack of money/resources for food

Food Pantries

Attached to existing non-profit Distribute bags or boxes of groceries for food emergencies Food prepared and served elsewhere Often require referral or proof of need

Supplemental Nutrition Assistance Program

Benefits are issued on a debit card -Known as EBT (Electronic Benefits Transfer card)

Special School Milk Program (SMP)

Encourages fluid milk consumption -Provides cash reimbursement for each half-pint of milk served -For schools and child care institutions not participating in NSLP

Older Americans Act (OAA) Nutrition Program

Formerly known as Elderly Nutrition Program (Title III) Intended to: -Improve their nutrition status -Enable them to avoid medical problems -Allow them to continue to live in communities of their choice -Enable them to stay out of institutions Administered by the DHHS, Administration on Aging Congregate Meal Programs Home-delivered meal programs

Counting the Food Insecure in the U.S.: Questions reflect stages of food insecurity

From worry about running out of food To children missing meals for a whole day

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): Eligibility based on income & being at nutritional risk

Income -At or below 185% of poverty guideline -Participation in SNAP or medicaid Nutritional risk determined by health professional 1. Medically-based-anemia, maternal age, history of high-risk pregnancies 2. Diet-based risks-inadequate dietary pattern 3. Conditions that predispose to 1or 2 Alcoholism or drug addiction -Homelessness or migrancy

Certain Southern and Western States

Insecurity varies from state to state Southern states generally higher-than-average

Quantity

Is there access to enough food

Psychological

Is there enough nutrition food to alleviate anxiety, lack of choice, and feelings of deprivation?

Department of Health and Human Services (DHHS)

Nutrition Services Incentive Program Older Americans Nutrition Program Head Start/Early Head Start

Beyond Public Assistance:What Can Individuals Do?

Support government programs by: Volunteering -Safe food-handling and healthful diet education for providers -Give creative ways to provide needed nutrients with limited resources -Teach participants how to shop for economical nutritious foods Increase awareness of services to eligible low-income families Increase accessibility of programs and services to the needy Document hunger-related needs that exist in the community Monitor household food security of clients served Support local food production

Beyond Public Assistance:What Can Individuals Do?

Support government programs by: Work with other interested citizens in the community Participate in research to document effectiveness of food assistance programs Represent nutrition issues at community health planning meetings Document the impact of welfare reform on food security Learn more about the problem and sustainable solutions Become familiar with organizations advocating for food insecurity solutions Follow food security legislation; contact legislators about food security issues

Who are the Food Insecure in the U.S.?

The Poor The Working Poor The Young Ethnic Minorities Inner-City and Rural Dwellers Certain Southern and Western States Many Farmers The Homeless

Federal Domestic Nutrition Assistance Programs Today

USDA - FNS administers 15 food assistance and distribution programs to low-income citizens Programs serve an estimated 1 in 4 Americans Designed to improve food security and diet quality for children and low-income families Participation appears to help protect the health of children from low-income households, particularly girls

Hunger-related needs that exist in communities: Documented in USDA tools

USDA Tools Food Environment Atlas - spatial overview of a community's ability to access healthy food Food Desert Locator - maps and provides selected population characteristics of census tracts defined in food deserts

Food Insecurity in the U.S. : Causes

Unemployment Poverty Low wages High housing and health care costs

Causes of homelessness:

Unemployment or underemployment Lack of affordable housing Poverty Mental illness w/lack of needed services Substance abuse w/lack of needed services

Marginal Food Security

occasional problems or anxiety but quality, variety, quantity not substantially reduced

Prevalence of Food Insecurityby Household Characteristics: Rates of Food Insecurity Higher than the National Average for these Groups

All households with children (16.5%) Households with children under age 6 (16.6%) Households with children headed by a single woman (31.6 %) Households with children headed by a single man (21.7%) Women living alone (13.9%) Men living alone (14.3%) Black, non-Hispanic households (22.5%) Hispanic households (18.5%) Low-income households with incomes below 185 percent of the poverty threshold (31.6%)

Primary indicators of infant's future health status

Birth weight Length of gestation

Summer Food Service Program for Children and Seamless Summer Option (SFSP)

Funds meals and snack for eligible children during school vacation periods Program sponsors are -Local schools or colleges -Government units (parks and recreation department) -Summer camps, community action agencies, and nonprofits Participants -All meals free to kids eligible for free or reduced price NSLP meals These meals must meet NSLP nutrition guidelines

Filling in the Gaps to Strengthen the Food Resource Safety Net

Gap between government resources and need Community resources are straining to bridge the gap Demand has steadily increased over the past three decades Much of the increased demand comes from the working poor and families with children

Many Farmers

Number of hungry farm families not known, but demand for food aid to rural poor is increasing

Infant Mortality Rate (IMR)

Number of live born infants who die within first year of life, per 1000 births Used as indicator of health status and quality of life of populations U.S. IMR is higher than many other industrialized countries, despite higher spending on healthcare IMR more than twice as high in African American infants as in white infants

Mothers and Infants

Nutrition impacts one generation to another This is especially evident during pregnancy For infants born from malnourished mothers, it is more likely that: -The fetus may develop poorly -The infant may become ill -The child may have impaired learning abilities and/or physical development Impaired intrauterine growth may "program" fetus for chronic diseases (CHD, HTN, DM) in adult life

Poverty and Poverty Thresholds in the U.S.

Official poverty line defines eligibility for most federal assistance programs The food budget allotment used in the poverty threshold calculation: -Reflects a diet that is just barely adequate -Is designed for short term use when funds are extremely low

Programs for Older Adults

Older Americans Act (OAA) Nutrition Program Senior Farmers' Market Nutrition Program

Federal Domestic Nutrition Assistance Programs Today

Programs referred to as nutritional "safety net": United States Department of Agriculture (USDA) Department of Health and Human Services (DHHS) Department of Homeland Security (DHS)

Older Americans Act (OAA) Nutrition Program: Goals

1. Low cost nutritious meals 2. Opportunities for social interaction 3. Nutritious education and shopping assistance 4. Counseling and referral to other social services 5. Transportation services

The five leading causes of infant death in 2015 were:

Birth defects. Preterm birth and low birth weight. Sudden infant death syndrome. Maternal pregnancy complications. Injuries (e.g., suffocation).

Supplemental Nutrition Assistance Program: Benefits

Can be used to purchase food and seeds, garden plants Cannot be used to buy foods eaten in store, ready-to-eat hot foods, vitamins or medicines, pet foods, tobacco, cleaning items, alcohol, or nonfood items

Food Security Scale: High to Low

High Food Security Marginal Food Security Low Food Security Very Low Food Security

Home-delivered Meal Programs

Homebound seniors, encourages to come to congregate meals when able

The Working Poor

Jobs paying minimum wage Current U.S. minimum wage $7.25, Michigan $9.25 Does not lift family above federal poverty level

Food Insecurity

Limited or uncertain to acquire or consume an adequate quality or sufficient quantity of food in socially acceptable ways

The Homeless

Make choices between food and other needs including housing Lack of food, inadequate diet, poor nutrition status, and nutrition-related problems are common

The Poor

Most compelling single reason for hunger is poverty Poor experienced hunger 3x greater than national average

Temporary Assistance for Needy Families (TANF)

Replaced former Aid to Families with Dependent Children program (AFDC) States determine eligibility, benefits, and services Welfare reform gave states flexibility in job training opportunities Major target group for job placement and training is single women with children Created two critical issues for long-term success in placing women in jobs: -Transitional child care assistance -Maintenance of health care benefits

After-School Snack Program

School based after school programs Healthful snacks to children through age 18 Expansion of NSLP

Supplemental Nutrition Assistance Program: Major problems with SNAP

Benefits insufficient to meet needs Environmental factors impact dietary choices -Access to supermarkets -Access to high-quality, healthful foods Many eligible households do not participate -1 in 4 eligible do not participate -Due to embarrassment, complex rules, confusing paperwork, caseworker hostility, lack of public knowledge of eligibility requirements Benefits rarely last till end of month Many still need emergency food assistance Surveys demonstrated that -Food expenditures including cash, SNAP benefits, and WIC benefits averaged just under 80% of the food cost of the food guide for low-income families -Thrifty Food Plan -SNAP households may be at nutritional risk despite benefits

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA)

Changed welfare system from income-support based system to work-based system with 5-year time limit Encouraged self-sufficiency Showed: -Decline in numbers on welfare -Dramatic increase in employment of low-income mothers -Increases in earnings by females heading low-income households -Decline in child poverty As a result of this welfare reform law, TANF was established

Food Distribution Programs

Commodity Supplemental Food Program (CSFP) The Emergency Food Assistance Program (TEFAP) Nutrition Services Incentive Program Food Distribution Disaster Assistance

The Emergency Food Assistance Program (TEFAP)

Commodity foods -Foods vary with agricultural market conditions -Not disaster relief Participants -Low-income, unemployed, receive welfare benefits including elderly State distributing agencies, typically food banks -Distribute foods to public from soup kitchens and food pantries Food bank

Community Food Security:Enhancing Local Food Access

Community Food Security Initiative USDA initiative to partner with states, local municipalities, non-profit groups, and public to reduce hunger Community-based initiatives -Increase the availability of affordable, high-quality foods, culturally acceptable foods -Through local nonemergency food sources at all times -Reconnect local farmers with urban consumers Develop strategies and activities to fight hunger and strengthen local food systems

Rising Tide of Food Assistance Need

Community programs and churches trying to fill gaps National Nonprofit "Feeding America" -Nation's largest supplier of surplus foods -Distributes >2.6 billion pounds of food to food banks and other agencies Food Banks, Soup Kitchens, & other agencies for emergency foods Prepared and perishable food programs (PPFPs)

Nutrition Services Incentive Program

Grant funding to states, territories, and eligible tribal organizations exclusively to purchase food For meals served, agencies can accept grants as: -Cash -USDA commodities -Combination of both Incentives for efficient delivery of nutritious meals to older adults Administered by DHHS -Formerly USDA Nutrition Program for the Elderly -Transferred to Administration on Aging in 2003 Participants -Age 60+ and spouses -Certain disabled persons <60 -Program volunteers

Child Nutrition and Related Programs

National School Lunch Program (NSLP) School Breakfast Program (SBP) After-School Snack Program Special School Milk Program (SMP) Summer Food Service Program for Children and Seamless Summer Option (SFSP) Child and Adult Care Food Program (CACFP)

Both obesity and food insecurity are serious public health problems, and at times coexist in same family or individual: Due to

Need to maximize caloric intake -Consume lower-cost foods with relatively higher calorie levels to avoid hunger when resources to buy more nutritious foods not available Tradeoff between quantity and quality -Along continuum of coping strategies, generally food quality is affected before food quantity Overeating when food available -Chronic ups and downs in food availability, people eat more than normal when it is readily available, over time this cycle can result in weight gain

The Emergency Food Assistance Program (TEFAP): Food bank

Nonprofit community organizations Collect surplus commodities from the government and edible but unmarketable foods from private industry -For use by nonprofit feeding programs at nominal cost Soup kitchens Food Pantries

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Not an entitlement program Preventive and remedial services: -Food packages, vouchers, or EBT for supplemental food -provides specific nutrient known to be lacking in target group -protein, calcium, iron, and vitamins A&C -Nutrition education -Referrals to health care services

Supplemental Nutrition Assistance Program: SNAP-Ed

Optional state nutrition education program To increase likelihood of purchase of healthy choices

Leading Causes of Infant Mortality

Over 23,000 infants died in the United States in 2015.

School Breakfast Program (SBP)

Participating schools get cash payments on the basis of number of meals served in the free, reduced-price, and full-price categories -SNAP families automatically eligible for free meals -Household income at or below 130% of poverty level-reduced-price Also receive food commodities Meals must meet specified nutritional guidelines and must offer free or reduced-price meals to eligible students

Welfare Reform: Issues in Moving from Welfare to Work: Mid-1990's challenge to reform welfare system resulted in:

Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) Temporary Assistance for Needy Families (TANF)

Older Americans Act (OAA) Nutrition Program: Eligibility

Persons 60+ and spouses of any age, regardless of income-level Priority given to economically and socially needy

Food Insecurity in the U.S.: Recommended actions

Provide more affordable housing Increase SNAP benefits Provide more job training programs

Five Components of Food Security

Quantity Quality Suitability Psychological Social

Senior Farmers' Market Nutrition Program

Receive coupons $20-$50/year Participants -60+ year old w/incomes _< 185% of poverty guidelines Coupons may be used to purchase fresh, unprepared, locally grown fruits, vegetables, and herbs at: -Farmer's markets -Roadside stands -Community-supported agriculture programs Some programs provide: -Nutrition education/info -Transportation for seniors to and from markets -Transportation for farmer's to senior housing

WIC Farmers' Market Nutrition Program

Receive coupons for $10-$30/year Participants: -WIC eligible, but infants must be > 4 months old Two goals: -expand awareness and use of farmers' markets -Provide fresh, nutritious, unprepared fruits and vegetables to low-income, at-risk women, infants, and children