ACCORDING the US Department of Agriculture (USDA), food insecurity is defined as “a household-level economic and social condition of limited or uncertain access to adequate food.”1 Recent data indicate that approximately 12.3% or 15.6 million households in the United States were food insecure at least some time during the last year.1 The adverse social, physical, and psychological outcomes associated with food insecurity are well documented, particularly in households with children, including higher rates of diabetes and hypertension, self-reported fair or poor health, maternal depression, behavioral problems/developmental delays in early life, and poor academic achievement.2–8 These outcomes are not only detrimental to the health and well-being of individual children and families but also negatively impact broader society. On the basis of a combination of lower worker productivity, higher costs of public education, greater health care costs, and the cost associated with emergency food distribution, the economic burden associated with food insecurity has been estimated to be more than $167.5 billion annually.9
For more than 20 years, food insecurity has been assessed and monitored by the USDA at the federal level. Although levels of food insecurity have declined and risen over this period, one trend that has continued to persist is the gap in the prevalence of food insecurity between people of color and whites.1 An analysis examining trends in food insecurity from 2001 to 2016 found that food insecurity rates for both non-Hispanic black and Hispanic households were at least twice that of non-Hispanic white households (Figure).1 Moreover, while race/ethnic-specific rates from the USDA are not available for all subgroups, other studies assessing food insecurity among American Indians/Alaska Natives (AIs/ANs) report similar results.10,11 Using the Current Population Survey-Food Security Supplement, Jernigan et al12 found that from 2000 to 2010, 25% of AIs/ANs remained consistently food insecure and AIs/ANs were twice as likely to be food insecure compared with whites.
The relationship between race/ethnicity and food insecurity is complex and is clearly intertwined with other established determinants of food insecurity including poverty, unemployment, incarceration, and disability. Concentration of social and economic disadvantages among people of color over the life course is clearly a significant driver of higher rates of food insecurity. Substantial gaps in the wealth of people of color and whites have long existed in the United States. For example, recent data reported by the Pew Research Center indicate that the wealth of white households was 13 times the median wealth of black households and 10 times greater than Hispanic households.13 Nevertheless, despite the intersectionality of race/ethnicity and other social/economic determinants, some evidence suggests that the higher risk of food insecurity among people of color continues even when these other social and economic factors are removed.14–18
MORE WORK NEEDED ON THE ROLE OF DISCRIMINATION AND STRUCTURAL RACISM
Given that racial/ethnic disparities in food insecurity have continued for more than a decade, the need to move beyond just adjusting for race/ethnicity in research to examining exposures that may impact people of color differently from whites is warranted. There is growing recognition in the health sciences, particularly public health, that discrimination and structural racism are key contributors to inequity in health behaviors and outcomes.19–23
The basic definition of racial discrimination is the unequal treatment of persons or groups on the basis of their race or ethnicity.24 As highlighted in the National Academies Press consensus report on Measuring Racial Discrimination, racial discrimination includes 2 components: (1) “differential treatment on the basis of race that disadvantages a racial group” (disparate treatment) and (2) “treatment on the basis of inadequately justified factors other than race that disadvantages a racial group” (disparate impact).25 Related to the first component, “disparate treatment,” studies have shown that racial discrimination limits people of color's access to educational and employment opportunities, resulting in social and economic consequences that could lead to food insecurity.26,27 The later component, “disparate impact,” also has implications for creating racial/ethnic disparities in food insecurity. For example, African Americans are incarcerated in state prisons at a rate that is 5 times that of whites.28 Consequently, policies that restrict employment for individuals who were previously incarcerated could disadvantage people of color, contributing to food insecurity. Burke et al29 examined the association between severity of food insecurity and lifetime racial discrimination in a sample of African American food-insecure households with children in South Carolina. A 1-unit increase in the frequency of lifetime racial discrimination was associated with a 5% increase in the odds of being very low food secure even after adjusting for socioeconomic and demographic confounders.
Structural racism refers to “the totality of ways, in which societies foster racial discrimination, via mutually reinforcing inequitable systems (e.g. housing, employment, earnings, benefits, credit, media, health care, criminal justice, etc.)”19(p1454) Beyond interpersonal discrimination, structural racism acknowledges the influence of historic and contemporary policies and practices that are deeply rooted within systems.19,21,22 While it is important that solutions to address disparities in food insecurity focus on combating interpersonal discrimination, the need to target structural racism is critical in the fight for achieving equity in food security and improve related outcomes in people of color.
SOLUTIONS TO ADDRESS RACIAL DISPARITIES IN FOOD INSECURITY
Several promising solutions to address food insecurity have been proposed including to strengthen and make it easier for families to connect to the existing federal food and nutrition safety net (eg, the Supplemental Nutrition Program for Women, Infants, and Children [WIC], Supplemental Nutrition Assistance Program [SNAP]); expand and increase access to federal income support benefits such as Earned Income Tax Credit; increase opportunities for employment and ability for individuals to earn a living wage; train health care providers to screen for food insecurity; and refer individuals and families to appropriate resources and, more recently, the need to take a human rights approach.8,30–33 Still, to address persistent racial disparities in food insecurity, advocates and researchers need to also examine the potential impact of utilizing approaches that address structural racism and discrimination more broadly.19,22 These efforts will likely pave the way for the emergence of policy and programmatic strategies that promote equity in food access and health by addressing the legacy of racial, ethnic, and class inequality.
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