COVID-19 Induced Recession Will Increase Food Insecurity, Resulting in Longer Term Health Effects by Rhys Richmond and Katie Bonnett Food – sourcing, eating, cooking – are cornerstones of human existence. Eating is both involuntary and voluntary in that we eat to live but also live to eat. The COVID-19 induced economic recession, in which millions of people are suddenly out of work and millions more are nervous about maintaining a stable source of food, will significantly challenge millions of families and households in the U.S. This blog discusses both the direct effects of the economic slowdown on food insecurity as well as the negative health effects when individuals get exposed to long-term food insecurity conditions. For these reasons, food security should be a primary focus of government policy and our community action. Economic and Other Effects of COVID-19 on Food Insecurity Rising Unemployment Increases Food Insecurity: Feeding America reported in March 2020, the start to the COVID pandemic driven economic freefall, that the food insecure population would rise by anywhere from 3.3 million (to a total of ~42 million) to 17.1 million (to a staggering total of ~54.5 million) depending on when and at what level the unemployment rate peaks and begins to decline in the U.S. The Bureau of Labor Statistics currently reported the unemployment level as 10.2% (a rise from 3.5% in February 2020). Feeding America reported that new unemployment claims reached a high in late March not seen in almost 40 years. Feeding America notes that the public-facing industries of hospitality, food service, and retail that have seen the most severe cuts in jobs are the industries that had the highest rates of food insecurity prior to 2020. Food insecurity and the related health deficits, especially for these groups, will only compound as the US struggles through the pandemic and its aftermath. Already Low Household Savings Will Erode, Further Undermining Food Security: The COVID-19 recession is crushing what little savings most households currently hold. Pre-COVID-19, almost 40% of Americans said they would struggle to come up with money for a $400 emergency expense (CNBC). Unique household data from USC COVID-19 Pulse surveys show that Americans worried about running out of money in the next three months peaked at nearly 28% in late March and now hovers around 16%. Implicit in running out of money is running out of food. And implicit in running out of food is the potential for serious short-term and long-term health challenges. Food Insecurity Physical and Health Outcomes in Both the Short-term AND Long-term Substantial research that shows that food insecurity worsens the physical status of humans – the more severe the dearth of food, the more wider and more severe the potential array of physical and health challenges. Some negative health outcomes are more obvious and visible – insufficient calories can lead to food insecure populations, especially kids, becoming underweight. Pre-COVID The World Bank estimated the percentage of the U.S. population unable to obtain sufficient daily calories at 3%. This percentage will likely rise post COVID-19. Underweight individuals are at higher risk of having reduced bodily function in the short run and stunted growth and lower survival rates in the long run. Underweight individuals have higher mortality rates from external causes and aging – higher than any other weight category (Lorem et. al., Roh et. al.) or comparably to obese individuals (Weitoft et. al., Ray et. al.). While counter intuitive, research shows that food insecurity can result in obesity. A 2015 report found food insecurity and obesity can be co-endemic in a population for multiple reasons (Food Research and Action Center“FRAC”) including the role of “food deserts” where low income individuals who are most predisposed to food insecurity are likely to live in areas with a plethora of high calorie, fast food options and without full-service grocery stores that provide more healthy food choices. Importantly, SNAP benefits make the cost of fresh, more healthy food less than the cost of fast food but barriers to accessing SNAP limit this preferred outcome. The risks of being overweight are numerous and touch every organ system – cancer, Type 2 Diabetes, sleep apnea, liver damage, and beyond. With the real danger of COVID-19-related food insecurity causing problems on both extremes of the weight spectrum, physical health issues at least partially inflamed by the pandemic will likely show up in the healthcare field for decades to come. COVID-19 Exacerbates Food Insecurity and Poor Food Choices: In the time of COVID-19, even people who live in neighborhoods with easy access to full-service grocery stores and healthy restaurants, to cut costs, may switch to eating at fast food restaurants, which offer food at lower cost per calorie. For example, people may lose access to vehicles if they miss car payments or, in the worst cases, may lose their home to carry groceries back to. Importantly, the potential for a sustained switch to unhealthier options has negative health effects down the line, particularly if individuals permanently adopt poor eating habits learned during the epidemic. The FRAC report highlights the dangers of entering a cycle of food deprivation when money gets limited and overeating once supplies are plentiful – any period of scarcity can trigger a sustained tendency to overeat and/or choose calorie-dense and nutrient-poor options. Food Insecurity Can Impact Mental Health in Both the Short-term and Long-term: Often less visible is the impact of food insecurity on an individual’s mental health. Food insecurity – the constant refrain of worrying about where, if at all, the next meal will come from for oneself or one’s family – significantly increases anxiety, stress, and depression (FRAC). In children, a lack of a steady food supply has gotten linked to aggression, non-cognitive school performance (behavioral and social functioning), and suicidal ideation (Gunderson and Ziliak). Health groups have made negative predictions for the outlook of mental health in the time of COVID-19 lockdown and quasi-lockdown for the foreseeable future. Recent data support these predictions – prescriptions rose 34.1% for anti-anxiety aids and 18.6% for anti-depression medication between mid-February and mid-March according to Express Scripts. At the same time, while seeking help is arguably a positive sign, voices like the American Psychological Association warn that excessive and/or sustained medication can lead to worse mental health outcomes in some patients. Food insecurity can also worsen longtime socioeconomic status. Receiving and using SNAP, an interaction of the food stamps program, or any other governmental assistance has historically gotten marred by social stigma and bias. In many states, a significant portion of eligible recipients do not apply for SNAP. Why? Social opinion about SNAP is largely negative. States like Florida employ SNAP recruiters that source eligible people and sign them up for benefits – this leads to increased revenue for the state and a corresponding increase in national debt. To casual onlookers, the curb-appeal of this deal is suspicious – if people truly need help, why does the state have to entice them to sign up, taking on national debt in the process? As The Guardian explains, there are two issues at play: an education gap and a significant uphill battle against stigma surrounding SNAP. While the program exists, low-income and food-insecure people lack the resources to educate themselves about it. Furthermore, societal understanding has painted a stereotype of SNAP recipients as being out-of-work, lazy, and fraudsters. Stigma is a sinister trade-off to accepting help. This concept is especially relevant to COVID-19 food insecurity – many people who recently lost their jobs and find themselves suddenly food-insecure consider themselves as very different from their understanding of a SNAP user. They may feel as though they will get judged if they seek assistance and use an EBT card in their typical grocery store. This stigma feeds back into poor physical and mental health outcomes – sometimes refusing assistance to get quality food and experiencing real or perceived judgment for accepting help. However, the recent federal CARES Act stimulus sending blanket aid in the form of checks to millions of Americans regardless of their job status may subvert this dynamic. This may suggest that “blind” or unmarked cash assistance may have significant advantages in avoiding stigma. The concept of a social safety net can save the worst of these effects?the hidden at-first then undyingly persistent long-term perils?from happening at all, or at least happening to a significant degree. Margerison-Zilke et. al. notes that data from 2008 appears to show that social safety net programs in Europe had a strong mitigating effect on the health effects of the global recession. The problem is that America doesn’t have a particularly strong social safety net, at least not yet. That could be changing. Calls and limited actions towards a strengthening of the social security net have rang out from multiple sides of the political spectrum (PBS) this year; however, officials and citizens alike made these calls in the aftermath of 2008 (New Yorker) with limited appreciable progress. The Importance of Immediate and On-Going Policy Support for SNAP: COVID-19 is unique in the damage it has caused in the US – particularly relating to rising food insecurity. The health shocks associated with COVID-19 food insecurity deserve significant attention, even if all of them are not immediately visible. The health and economic shocks of these times could impact future generations. If we are wise we will not wait until it is too late to prevent the often hidden wounds instigated by food insecurity. The time is now for policy makers and community understanding of these very real consequences. We need to urge our policy makers to strengthen SNAP to bolster food security as soon as possible.