Food Insecurity Associated with Negative Health Indicators at the County Level

by Adam Dewey Research Manager, Feeding America

For the ninth consecutive year, Feeding America has conducted the Map the Meal Gap study to estimate the prevalence of food insecurity for every county and congressional district in the United States. To better understand the relationship between food insecurity and poor health outcomes at the local level, this year’s study includes an analysis of food insecurity in the context of health, one of four report briefs that summarize key findings from our Map the Meal Gap 2019 study.

To accurately estimate the number of people who may be food insecure in every U.S. county and congressional district, Map the Meal Gap uses publicly available state and local data on factors that research has shown to be correlated with food insecurity. These factors include unemployment and poverty, as well as other demographic and household characteristics.

Research has also shown that having a disability is a key risk factor for food insecurity and that food insecurity is associated with a wide array of negative health outcomes, including obesity and diabetes, as well as other factors that contribute to poor health, like housing cost burden.

To explore these relationships at the local level, we analyzed one-year (2013) county data on diabetes and obesity from the Centers for Disease Control and Prevention (CDC) and the most recent five-year (2013-17) data on disability, health insurance and rental burden from the American Community Survey (ACS).

We find that, compared to all other counties, those with the highest rates of food insecurity – the 317 counties with food insecurity rates in the top 10 percent of all counties – tend to have a higher (unweighted) average share of people with a disability (18.7% vs. 15.6%), diabetes (12.4% vs. 9.3%), and obesity (35.4% vs. 30.3%).

Disabling or chronic health conditions can increase household expenses, which may be especially burdensome for food-insecure households without health insurance who may be forced to choose between paying for medical expenses and food. We also find that counties with the highest rates of food insecurity also tend to have higher average uninsured rates relative to all other counties (15.0% vs. 10.7%).

High rental burden, which occurs when a household pays 35% or more of their income on rent, may also indicate a lack of resources for a household to afford adequate food and health insurance coverage, potentially increasing the risk for negative health outcomes. Compared to all other counties, those with higher rates of food insecurity tend to have higher average rates of rental burden (43.1% vs. 35.0%).

The local confluence of food insecurity and both negative health outcomes and contributing factors underscores the need for collaborative, cross-sector public-health and food-security interventions. This is especially true in counties with higher rates of people struggling with hunger. Although federal nutrition programs serve as the first line of defense against hunger, not all individuals in need qualify for assistance or receive adequate support. This reality underscores the importance of charitable food assistance, but also the need to protect and strengthen federal nutrition assistance programs.

Adam Dewey is a Research Manager at Feeding America where he manages the Map the Meal Gap project, an annual study that estimates local food insecurity and food cost in the United States to inform strategies to end hunger in America.