America's Hidden Hunger Crisis

Tracy Farrell-Granat enforces the two-bite rule at the dinner table. When she serves up something new, her kids have to take at least two bites to get a full taste. If they still don’t like it after that, they’re off the hook. “I always try to do meat, vegetable and potato or rice,” she says. But preparing a well-balanced meal for a family of seven is not so easy, especially for someone in Farrell-Granat’s position.

The 33-year-old mother of five, who has lived in the South Side Chicago neighborhood of Canaryville her entire life, struggles daily to put food on the table. Her husband, Jason, takes side jobs in roofing and carpentry when he can, but the work is unsteady. In May, after many months of unemployment, Farrell-Granat was hired to make bacon bits at a meatpacking plant. But the $8.25 hourly rate and the unpredictable shifts on the factory line have already sent her looking for a second job.

The Supplemental Nutrition Assistance Program (SNAP, formerly known as “food stamps”) has been a lifeline. “I was getting $600 to $700 a month when I wasn’t working,” Farrell-Granat says. “Now I get $500.” Even the smaller benefit goes a long way, but it’s not enough to cover food costs for the month. And with their income largely spent on rent and utilities and other basic necessities, she and Jason can’t make up the difference on their own.

That’s why Farrell-Granat and her five-year-old twin daughter Addison have come to the United Methodist Church this morning. Every Wednesday the church hosts the Union Avenue Food Pantry, which welcomes SNAP-eligible residents from the neighborhood. After signing in with a volunteer at the front, Farrell-Granat and Addison work their way around the room, stopping at each table to gather staples: cans of soup and pinto beans, fresh fruits and veggies, pasta, saltines. Another volunteer opens a cooler and offers a hunk of Cotija cheese and some bratwursts. A third bags the groceries with a smile. With her wagon full of food and a community quite palpably opening its arms to her, Farrell-Granat is in good spirits. But even at this moment, she’s keenly aware of the stark reality. “Things are so hard now,” she says. “Without the pantry, my kids would starve.”

A large number of Chicagoans are in the same bind, forced to choose between food and other bills, increasingly reliant on food pantries despite receiving monthly support from SNAP and other government food programs. The Union Avenue Food Pantry serves 150–200 families a month, or roughly 2,000 individuals. It’s one of 650 sites and programs affiliated with the Greater Chicago Food Depository, a nonprofit food bank that distributed 67 million pounds of food to needy Chicagoans last year – the equivalent of 154,000 meals per day. The network estimates that it serves more than 232,100 households annually.

Other cities across the country are reporting similar figures. According to the Department of Agriculture, 14.3 percent of US households were “food insecure” at some point last year, meaning they did not know where their next meal would come from. That equates to about 49 million people, 8.6 million of whom are children. It’s no surprise that the figure shot up from around 11 percent when the financial system crashed in 2008. But many Americans don’t realize that it remains elevated six years later. The hunger crisis in this country is not just pervasive. In the wake of the recession, it’s persistent.

The rise in food insecurity has coincided with an era of fierce congressional debate over government spending. In recent years dueling budget proposals have transformed school lunch programs into a partisan football. During the government shutdown last fall, several states were preparing to turn away enrollees in the federal Special Supplemental Nutrition Program for Women, Infants and Children (WIC) – until the USDA released $125 million in emergency funds. And when the Farm Bill was taking shape, legislators with their eyes on deficit reduction targeted outlays for SNAP benefits, which more than doubled to $72 billion from 2007 to 2011 (excluding administrative costs). The final version of the bill President Obama signed in February included $8.6 billion in SNAP cuts over a decade. Some states found a way to maintain funding levels by raising a home-heating subsidy tied to food-stamp aid, but the larger point had been made: in the current political environment, federal spending on food programs had reached its limit.

With need continually hovering above the level at which government can meet it, food banks have evolved to fill the gap. Traditionally a temporary refuge for those in search of emergency aid, local food pantries and soup kitchens have become regular fixtures in the landscape for millions of Americans. This dramatic shift has prompted the need to know more about the population that has come to rely on them so heavily – and opens up a fresh opportunity to address some crucial public health concerns.

Seated in her office in the northeast corner of Chicago’s Loop, dressed casually in jeans and a patterned shirt, Elaine Waxman, AM’86, sets down a can of Arizona green tea and softly chops her desk with the side of her hand: once, twice. “In order to act in a community,” she says, “you need to understand what’s going on locally.”

As vice president of research and nutrition at Feeding America, the nation’s largest provider of charitable food assistance, Waxman helps people at all levels improve their understanding of the nation’s hunger crisis. The studies she develops and oversees add depth and granular detail to a problem many people wrongly assume is confined to small geographical pockets or marginal subgroups. Her most recent research provides the hard evidence to show that Americans across the country are relying on food banks more heavily than ever before. That work doesn’t just empower advocates who seek to bolster funding for food programs; it’s also prompting food banks to reconceive of themselves as more comprehensive community service providers.

“Some of this work can be very concrete in terms of raising awareness and debunking myths,” Waxman says. Consider, for example, Map the Meal Gap, an annual project Waxman and her team collaborate on with Craig Gundersen at the University of Illinois. The study uses USDA data on state-level food insecurity along with county-level data on drivers like unemployment, median income and racial demographics to estimate food insecurity rates for every county and congressional district in the country. This helps food banks adapt to the changing needs in their area and gives reform advocates a clear message to deliver to elected officials.

Waxman and her team don’t just work with government data; they also collect and analyze their own. The most ambitious of these efforts is the quadrennial Hunger in America report, which provides a comprehensive look at the state of charitable food assistance in the United States. The 2014 report, released on August 18, was the sixth and by far the largest installment in the series, based on interviews with more than 60,000 clients and 32,000 agencies. It was also the most expensive, with a price tag close to $5.5 million, a $2 million jump from the 2010 study.

Gathering the data was a huge undertaking, but Waxman had two key assets at her disposal: a staff of well-trained research fellows and ready access to the populations they surveyed. The vast majority of the local food pantries, shelters and soup kitchens in this country are served by Feeding America’s national network of 200 food banks. (The banks, in turn, receive food and funding from a wide range of donors, including individuals, foundations, corporate partners, farmers and government suppliers.)

For the first time, data were collected electronically instead of through in-person interviews – a shift that greatly enhanced the level of confidentiality and accuracy but was greeted with anxiety in some quarters. “I think people were wary of making that change because they thought the clients wouldn’t be comfortable with the computers, or they’d think it was impersonal and wouldn’t want to participate,” Waxman says. “But it worked beautifully. Clients were very responsive, and some of the elderly clients even got excited after we got them acclimated. That was something I didn’t anticipate, that it would actually be sort of empowering for people.”

The report, developed with help from the Urban Institute and Westat, is a treasure trove of information on partner agencies: their services and programs, their reliance on volunteers, their connectedness to the wider social safety net. It also paints a sobering picture of the clients in the Feeding America network and reveals the tough tradeoffs they’re making to survive. Last year, the report found, the organization gave food to 46.5 million people (nearly one in seven Americans), including 12 million children and 7 million seniors. One-fifth of those households have a member who has served in the US military. In the past year, the majority had to choose between food and utilities (69 percent), food and transportation (67 percent) or food and medical care (66 percent). A smaller share (31 percent) reported choosing between food and education.

“All of our reports are designed to equip people to have an intelligent conversation about the nature of these problems,” Waxman explains. “Food insecurity in many ways is a proxy for financial instability. So that naturally leads you to a conversation about, OK, what’s underneath? What are the root causes? If you want to have a conversation about ending hunger in this country, you have to have a conversation about those things.”

Even as a young girl, Waxman was aware of the shadow zone of entrenched poverty the writer Michael Harrington famously named “The Other America.” She grew up in a stable home just outside Louisville: her father was a physician; her mother, a minister. With both parents in the helping professions, it wasn’t unusual for conversations at the dinner table to touch on social issues and debates about individual responsibility. Over time, Waxman came to share her parents’ concern for those less fortunate.

Her parents had both grown up in rural Kentucky, and on visits to see her relatives Waxman discovered how wide the gulf was between her world and the one she encountered in Appalachia. In high school she read Night Comes to the Cumberlands, Harry Caudill’s unflinching portrait of Appalachian decline. “That was the first time I was introduced to a sociological frame for explaining what I saw,” she recalls. “I found that so interesting, this idea that there are structural forces at play – this is not about individuals, this is about institutions that create conditions in which individuals find themselves. All of those connections just went off, and I think it was at that point that I knew I wanted to do something in the policy world.”

At Indiana University, where she double-majored in political science and English, Waxman developed her regional interest with a thesis on Appalachian oral histories. Immediately following graduation she enrolled at the University of Chicago’s Committee on Public Policy Studies, the forerunner to the Harris School of Public Policy. “I realized at that time that the same kinds of structural issues and community struggles are relevant in all vulnerable communities,” she says. “It doesn’t really matter whether you’re in Appalachia or, frankly, Rwanda or the South or West Side of Chicago.”

A decade pursuing a career in health policy led Waxman to conclude that the health care struggles many Americans faced were often the downstream result of broader problems that originated upstream. So she returned to the University of Chicago to pursue a PhD at the School of Social Service Administration (SSA), where she focused on poverty. She wrote a dissertation on the structure of opportunity in low-wage retail jobs and graduated in 2009.

Although Waxman remains affiliated with SSA as a lecturer and regularly publishes her research in peer-reviewed journals, she has little interest in pursuing a full-time academic career. She joined Feeding America in 2009, and served as the director of social policy research and analysis until assuming her current role in 2010. “It was a very deliberate decision on my part to do applied research,” she says. “I obviously have a huge appreciation for academic research, and one of the things I wanted to do in the nonprofit sector was bring more of the rigor and expertise that I learned from the academic setting into the policy and practice world.”

Waxman’s colleague and fellow alumna Shana Alford, MPP’06, brings a similar perspective to her role as director of program evaluation at Feeding America. Alford is at the helm of an eighteen-month project involving nine food banks in six states, with results expected soon. She’s trying to answer a key question: what tools and insights do food banks need to identify and help enroll SNAP-eligible clients? The biggest takeaway so far is that “context really matters,” Alford says. “When it comes to administering SNAP outreach and application assistance, you can’t leave out the politics and policies in that environment, and you need to know what the population needs and demographics look like. Is your community multilingual? Then you’re going to need multilingual staff.”

Waxman, Alford believes, has been instrumental in making this type of work possible at Feeding America. “Her goal has been, and continues to be, to develop a strong research agenda that supports the work that Feeding America does and gives information to help leaders make better decisions,” she says.

There is no single solution to food insecurity, Waxman insists. Rather, there are a lot of ways to get results. The problem, in her view, is that policymakers tend to glom on to the latest reform trend and run with it until hitting the next roadblock. An incremental approach is more likely to gain support in a highly charged political environment – and may indeed alleviate suffering. But a challenge as complex and persistent as poverty, she believes, requires a sustained, high-level discussion about the best ways to stabilize people’s lives.

Feeding America keeps a close watch on Congress, with a robust advocacy strategy aimed at strengthening anti-hunger programs and protecting charitable tax deductions. But Waxman looks elsewhere for creative energy on the policy front. States and localities, she believes, have a lot to teach us about the value of experimenting with strategies on the full range of social issues.

For her part, Waxman is trying to bring some of that innovative spirit to the nation’s food banks. Her research has demonstrated that the majority of households in the Feeding America network are living at or below the federal poverty line (72 percent), constantly juggling cost considerations when they make decisions about food, housing, health and education. So if clients are relying on charitable food programs on a regular basis, as most of them are (63 percent), why not equip local agencies with the tools to provide more comprehensive services?

When serving this population, Waxman argues, the nonprofit sector has tended to operate in silos: the housing folks address housing needs, the health folks address health needs and so on. But with Collaborating for Clients, a Feeding America pilot project launched in 2013, Waxman and her colleagues are trying to integrate those services through partnerships with other groups. By leveraging the centrality of food banks, they hope to provide groceries and SNAP outreach while connecting clients to things like job-skills training, heat and housing assistance, and access to health care. If the model demonstrates impact and scalability, local agencies could start to look less like food pantries and more like way stations on the journey toward economic self-sufficiency.

Another effort seeks to build on recent research confirming a strong link between food insecurity and chronic disease. The 2014 Hunger in America report was the first to ask clients questions about diet-related disease. Fifty-eight percent of households said at least one member had high blood pressure, and 33 percent reported a member with diabetes – both figures rose significantly in households with seniors. Data on diet-related coping strategies were also collected, with 79 percent of households (and 84 percent of households with children) reporting that they’d purchased the cheapest food available, even if they knew it wasn’t the healthiest option.

“If people are eating from a food bank week after week, month after month, year after year, then our obligation to provide food appropriate for their health conditions is much higher than if people are just needing emergency food for two or three weeks once a decade,” says Hilary Seligman, an associate professor at the University of California, San Francisco, School of Medicine who specializes in the health implications of food insecurity. She and Waxman have been working together on a project to assess the increased risk and prevalence of chronic diseases like obesity, diabetes and heart failure among this population, and to identify opportunities for food banks to address them in collaboration with local health clinics.

Over the past decade, the nation’s food banks began to recognize and respond to the links between food insecurity and nutrition. Many now prioritize distribution of fresh and healthy foods, and some are even providing meals appropriate for people with diabetes and celiac disease. But the idea that Waxman and Seligman are developing – that food pantries can assist with diabetes intervention and management, as well as broader education on nutrition and healthy food habits – is novel. They’re just starting to build the evidence base with a pilot project at three food banks in California, Texas and Ohio. Preliminary data from a pre-post trial, Seligman says, are promising.

If the project proves effective and scalable, the research could lead to a fundamental change in the way local agencies are run. Back at the Union Avenue Food Pantry, for example, Deb Ocampo, who works for the Greater Chicago Food Depository at the Canaryville site, says she tries to put things out that people should be eating. But her clients – and, research suggests, those at sites across the country – would benefit enormously from the sort of interventions Waxman and Seligman are testing. It didn’t take long after Tracy Farrell-Granat and her daughter left to see their neighbors passing up bags of fresh produce. One child, already overweight before puberty, clutched two large handfuls of Tootsie Rolls to his chest; his mother said she’s still learning how to cook meals.

Like Waxman, Seligman believes that increasing funds for SNAP would not only pull desperate clients back from the brink but would also help set regular clients on a path toward self-sufficiency. Similarly, both argue that legislators who resist SNAP expansion on the basis of cost are not adequately considering the multiplier effects. A 2010 USDA estimate found that an increase of $1 billion in SNAP expenditures increased economic activity by $1.79 billion. Much of that money goes to big box stores, Seligman notes, but a significant portion returns to local communities.

Seligman takes the discussion a step further by putting it in a public health context. She has observed a telling correlation between the fact that 90 percent of SNAP benefits have been redeemed by the third week of the month and the increase among the low-income population in hospital admissions during the last week of the month. Recognizing the unlikelihood that Congress will expand SNAP in the near future, she’s become a big proponent of smaller voucher programs that provide money exclusively for local purchases of fruits and vegetables. And as food banks grow in importance for hungry Americans, she believes local communities have a significant role to play in making them as efficient and health-conscious as possible.

The obstacles to progress are immense, but Seligman is hopeful that it will be possible to reorient the food bank network, in part because of the leadership at Feeding America. “I had been looking for quite some time for somebody within the food banking world to get this,” she says. “From the first day I met Elaine, she has been that person. She is a really tireless fighter for what she thinks is right. So this has been easy for me, because I just ride Elaine’s coattails. She really pushes and gets things done.”

—Mark Sorkin

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