Understanding Food Insecurity Risk in the U.S.

Forty-five million Americans experienced food insecurity in 2022. It is associated with a range of poor health outcomes, including cardiometabolic disease, cancer, adverse child development, and mental health conditions. But why is food insecurity such a threat in a wealthy nation like the U.S.? Understanding its causes is critical to understanding how to prevent it.

To this end, my colleagues and I recently developed a conceptual model to better understand food insecurity risk in the U.S. We started with the observation that food insecurity is closely connected to income distribution. About 50% of people in the U.S. receive income from labor—the rest do not. This division can be explained by normal social roles that people commonly fill at different points in their lives. For example, children and many adults over age 65 do not engage in paid labor. Moreover, although engaging in paid labor is the default expectation among working-age adults, many do not for a host of valid reasons. They might have a work-limiting disability. They might be pursuing higher education or performing unpaid caregiving. They might also be looking for work. We expected that roles that do not receive income from paid labor would increase food insecurity risk.

Individual roles are not, however, the whole story. People often pool resources as households. Income from paid labor supports not only the laborer, but also their children, parents, or disabled family members. As such, an amount of income sufficient for a single individual’s food security may be insufficient when spread across a household. Thus, we also expected that household composition would be an important determinant of food insecurity.

[F]ood insecurity results from failures in the way we distribute financial resources.

The goal in developing our conceptual model was to inform population health policy by providing a way to think about food insecurity risk. By thinking clearly about the causes of food insecurity, we might be able to devise better solutions. But that only works if the model corresponds well to actual conditions people face. So, we tested the model in a study using nationally representative longitudinal data from the U.S. Census’ Current Population Survey.

We found that food insecurity risk followed the patterns our model predicted. For example, children, those with work limiting disabilities, and those performing unpaid caregiving had higher food insecurity risk than those engaging in paid labor. Moreover, households with more children or adults with work-limiting disabilities had higher food insecurity risk as well. Overall, we found that about 75% of food insecurity in the U.S. occurs in households with role-related risk factors, such as age, disability, or job loss.

Our findings highlight the importance of income-support policies for people at risk of insufficient income on account of their “roles”. Older adults provide a good example of how this works. Food insecurity risk for older adults who do not receive income from paid labor was relatively low. This is likely because of income support programs like Social Security Old-Age and Survivors Insurance.

From what we saw, better income support for children, adults with work-limiting disabilities, and those who are temporarily unemployed would go a long way toward addressing food insecurity. Examples of such policies include child allowances like the 2021 Expanded Child Tax Credit, disability income policies that are easier to access and provide more support, and an unemployment insurance system that covers more workers. My recent book, Equal Care: Health Equity, Social Democracy, and the Egalitarian State, discusses in detail how these kinds of social policies can improve population health and health equity—and how to implement them.

Overall, food insecurity results from failures in the way we distribute financial resources. These distributional failures follow predictable patterns based on social roles. Fundamentally, we need to reduce the prevalence of food insecurity in order to counter its threat to population health in the U.S. To do so, we need better income support policies, to ensure that everyone can eat healthy food at all points in their lives.