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A Rights-Based Approach to Food Insecurity in the United StatesMariana Chilton, PhD, MPH, and Donald Rose, PhD, MPH

Food insecurity is a serious public health problem associated with poorcognitive and emotional development in children and with depression and poorhealth in adults. Despite sizable continued investments in federal food assis-tance, food insecurity still affects 11,1% of US households—almost the same rateas in 1995, when annual measurement began. As a fresh approach to solving theproblem of food insecurity, we suggest adoption of a human rights framework.This approach could actively engage those affected and would ensure that foodsecurity monitoring would be compared to benchmarks in national action plans.We describe key elements of a right-to-food approach, review challenges toimplementing it, and suggest actions to foster its adoption, (Am J Public Health.2009:99:1203-1211, doi:10,2105/AJPH,2007,130229)

Ask most Americans to name a food problemin this country and obesity is likely to be thefirst response. However, food insecurity—thelack of access to enough quality food for anactive and healthy life—is also an urgent publichealth problem in the United States, affecting11,1% of the population in 2007, The problemis of special concern for women and children.Female-headed households had a food insecu-rity prevalence rate of 30,2%, or almost 3times the national average, and more than 12,4million children experienced food insecurity in2007,''^ After controls for low income andeducational status, food insecurity has been as-sodated with poor health status in children andadults,"*"® depression and anxiety among ado-lescents and adults/"" and adolescent suiddalideation,'̂ Even the mildest form of food inse-curity is assodated with risk of poor cognitive,sodal, and emotional development of childrenyounger than 3 years,'^

Currently, the United States spends morethan $50 billion per year on nutrition assis-tance programs for the US population. Theseinclude the Supplemental Nutrition Assis-tance Program (formerly known as the FoodStamp Program); the National School LunchProgram; the Special Supplemental NutritionProgram for Women, Infants, and Children;and others. Despite this comprehensive net-work of assistance, the United States hasmade no advancement toward the HealthyPeople 2010 goal of reducing food inse-curity by half—to 6%, In fact, there has beenlittle change in overall rates since annual

measurement of household food insecuritybegan in 1995,

The persistence of food insecurity rates ismore than just a health problem. With morethan 12 million children living in householdsthat are food insecure, sizable segments of thepopulation are at risk for poor developmentand impaired performance in school, an out-come that can diminish national productivity.Food insecurity costs about $90 billion peryear in increased medical care costs, lost edu-cational attainment and worker productivity,and investment burden into the emergencyfood system,'^ However, for many observersissues of economic competitiveness may be sec-ondary. The existence of widespread food inse-curity in a country with the world's largesteconomy—one that produces a cornucopia offood even to the point of grand-scale exports ofsurplus commodities—is morally reprehensible.

We suggest that the United States adopt anew approach to address food insecurity thatopenly and explidtly engages a human ri^tsframework, A human ri^ts framework reposi-tions our understanding of food insecurity toacknowledge and actively address its sodal andeconomic determinants. It provides a venue forpublic partidpation in the food and nutritiondiscourse from people most affected by foodinsecurity. Perhaps most importantly, it providesa mechanism throu^ which the general publiccan hold the US government accountable formaking progress in ending food insecurity.

The human rights framework itself, ofcourse, is not new. More than 3 generations

ago. President Roosevelt emphasized the needto protect basic human freedoms—induding"freedom from want"'^ It was his administrationthat launched development of the Charter of theUnited Nations, and, ultimately, the UniversalDedaration of Human lîights,"' More than 60years later, however, the United States is the onlynation besides Australia that refioses to embracethe right to food, perhaps the most basic formof freedom from want'^ Other investigators haveasked why this is so from an historical perspec-tive, suggesting that United Nations representa-tives from the US government assume such aright contradicts constitutional law. Otherinterpretations are that poor understcinding ofconcepts regarding rights prohibit the generalacceptance of sodal and cultural rights, and thatCongress lacks the political will to integrate thehuman right to food in its national agenda,'^''*

The United States already has a strong rec-ord of documenting food insecurity. Adoptingkey elements of the human rights framework isthe obvious next step in improving humannutrition and well-being. The common defini-tions of food security and the right to food lendthemselves to common strategies for imple-mentation. We describe a rights-based ap-proach to food and its key elements, considerbarriers to adopting this approach, and suggeststrategies to foster the adoption of a humanrights framework to address food insecurity inthe United States,

What Is a Human Rights Framework?

A human rights framework is a system ofideas based on the Universal Dedaration ofHuman Rights, adopted by the United Nationsin 1948, and its assodated treaties and legalcovenants. Although the human rights frame-work is not new to the United States, much ofthe language that surrounds the framework-including discourse regarding the need to re-spect, protect, and fulfill human rights—may beunfamiliar to many Americans, To respect theright to food is to not interfere with one's abilityto acquire food. To protect the right to food is to

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make sure that others do not interfere withaccess to food. To fulfill the dght to food has 2components; to facilitate or create social andeconomic environments that foster human de-velopment, and to provide food to people inan emergency or in drcumstances when self-provisioning is beyond their control.'®

The right to food and the right to he freefrom hunger stem from Artide 25 of theUniversal Dedaraüon of Human Rights, whichlays out the right to a minimum standard ofliving.'̂ Expanded upon in the IntemationalCovenant on Economic, Sodal and CulturalRights, the right to food is dearly integral tothe overall right to a minimum standard ofliving that indudes right to housing, clothing,health care, and social services. The right tofood is comprehensively defined in GeneralComment 12 written hy the Spedai Rappor-teur on the Right to Food,^° and endorsed hythe Committee of the Intemational Covenant onEconomic, Sodal and Cultural Ri^ts, whichoversees accountability and utilization of theCovenant In addition there have heen severalintemational summits regarding the r i^t to food.At the Rome Declaration on World Food Secu-rity in 1996, all countries except the UnitedStates and Australia agreed to adopt the notionthat food is a basic human right and pledged tomake efforts to cut world hunger in half by2015.'^

THE LINK BETWEEN THE RIGHT TOFOOD AND FOOD SECURITY

The working definition of the right to food is:

The right to have regular, permanent and unre-stricted access, either directly or by means offinandal purchases, to quantitatively and quali-tatively adequate and sufficient food corre-sponding to the cultural traditions of the peopleto which the consumer belongs, and whichensure a physical and mental, individual andcollective, fulfilling and dignified life free of

2«2>

The definition of food security parallels thedefinition of the right to food. The UnitedNations Food and Agriculture Organizationdefines food security as;

A situation that exists when all people, at alltimes, have physical, sodal and economic accessto sufficient, safe and nutritious food that meetstheir dietary needs and food preferences for anactive and healthy life.^'

The absence of food security implies a stateof food insecurity. Food insecurity can strike atmultiple levels—individual, household, com-munity, and nationwide^^—and has multipleimpacts ranging from a protein or micronutrientdefidency that has severe health consequencesto milder forms that affect attention and cognitiveability. '̂' Food insecurity is considered an out-come of sodal and economic processes that leadto lack of access to food. These are; lack ofadequate education and living wages, lack ofaccess to health care and health information, andexposure to unsafe living conditions such as unsafewater, poor housing, and dangerous neig^bortioodenvironments. Each of these is recognized to beintegrally associated with poverty.̂ '̂̂ "*"̂ ®

Definitions of food insecurity and hungerhave been debated for several decades.̂ '̂ Thework of Jean Drèze and Nobel Laureate AmartyaSen is widely dted in the intemational commu-nity. They assert that hunger is not simply amanifestation of an involuntary lack of food, butrather, that hunger is a result of "entitlementfailure."''" In other worcis, access to adequatenutrition depends upon political and legal sys-tems that allow one to meet basic needs. More-over, entitlement indudes access to sodal sup-port systems to assist individuals—sudi as smallchildren, the elderly, and the infirm—who cannotmeet their own needs.

The US Department of Agriculture's(USDA's) definition of food security is similar tothe United Nations'. In the United States, foodsecurity is "access by all people to enough foodfor an active and healthy life." In 1990, whenthe USDA formally established and endorsedthis definition, it induded 2 domains; (1) readyavailability of nutritionally adequate and safefoods, and (2) an ability to acquire acceptablefoods in sodally acceptable ways.^'

Evidence of the doseness of the UnitedStates' understanding of food security and theUnited Nations' concept of the right to food liesin their respective definitions (Table 1). Al-though one is a right that implies govemmentobligation to uphold a state of being amongindividuals and the other defines a conditionwith no implidt govemmental obligation, theyindude parallel domains that address the im-portance of health, accessibility, and quality offood, and sodal acceptability of available foods.In addition, both have been shown to influenceother states of well-being such as physical and

mentid health, safe housing, and educationalattainment'^'^°'32-^* Both the H^t to food andfood security have recdved ofßdal govemmentrecognition and widespread translation intopractice. The similarity in the US definition offood security and the intemational definition ofthe right to food suggests that by promoting theright to food, the United States can make betterprogress in resolving domestic food insecurity.

KEY ELEMENTS OF A RIGHT-TO-FOOD APPROACH

Adopting the human rights framework foraddressing food insecurity seems a natural ex-tension of the progress already made in thehealth and human d^ ts movement—for exam-ple, in the prevention and treatment of HIV/AIDS and other diseases worldwide.^^"^^ Thoseadvancing a human d^ts framework in publichealth have had success in promoting health,well-being, and dignity'"*^^ throu^ attention toseveral key elements, induding (1) govemmentaccountability, (2) public particç)ation, (3) ananalytic framework that accounts for vulnerabil-ity and discrimination, and (4) stronger connec-tions between polides and health outcomes.

Promote Government Accountability

The human dghts framework is premised onthe concept of accountability. Every year, theUS government collects data on food insecudtyin the US population and publishes a report onthe findings.' Since 1995, rates of food insecudtyhave changed very little. There is no apparentlinkage of the report's findings to any action planto reduce rates. Measurement is a key compo-nent of tracking the magnitude of food insecudty,but accountability implies dear targets for re-ducing food insecudty.''^ This indudes ensuringthat there are governmental actors charged withestablishing these reference goals with deartimeframes for implementation of action plans toachieve them.

In 1990, the Interagency Board for NationalNutdtion Monitoring and Related Researchwas instituted under a 10-year legislativemandate.'*'*'*^ This board was responsible forensuring that the public had timely access to up-todate information collected by 22 differentgovemment agendes involved in nutdtion mon-itoring. This mandate was not renewed in 2000,leaving no similar mandate for leadership in the

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TABLE 1-Slmllaritles Between the International Right to Food and US Definition ofFood Security

Similarity Right to Food-lnternationai Food Security-US Domestic

Domains

Consistent access

Quality and quantity

Health and well-being

Dignity and acceptability

How utilized:

interrelated with

health and well-being

Official endorsement

"ITjhe right to have regular,

permanent and unrestricted

access, either directly or by

means of financial purchases,

to quantitatively and qualitatively

adequate and sufficient food

corresponding to the cultural

traditions of the people to which

the consumer belongs, and

which ensure a physical and

mental, individual and collective,

fulfilling and dignified life

free of fear."^"

Related to all other human

rights, especially right to health,

water, social services, education.

International legal apparatus and

accepted international norms.

national infrastructure for food security or nu-trition oversi^t in place. The task of producingmonitoring reports on food insecurity, dietaryintake, and nutrition-related health outcomes isspread throu^out different governmentalagendes with no monitoring boand to pull theseresults together. With the human rights ap-proach, such an interagency efFort could berevitalized to monitor, to set reference goals, toinform and educate the public, and to informnutrition-related and poverty-related legislation.

The Food, Conservation, and Energy Act of2008, known as the Farm Bill, reauthorizesnational nutrition monitoring activities for thefirst time in more than 15 years.''® This is animportant step. But accountability implies thatmonitoring must be tied to action. There needs tobe a board or agency that takes the lead inreducing food insecurity, not just measuring itThe USDA's Food and Nutrition Service is alikely choice at the agency level, because theyadminister most of the federal food and nutrition

Access by all people at all times to

enough food for an active, healthy life,

and includes, at a minimum: (1) the

ready availability of nutritionally

adequate and safe foods and (2) an

ability to acquire acceptable foods

in socially acceptable ways (e.g., without

resorting to emergency food supplies,

scavenging, stealing, or other coping

strategies).'^'

Provides reliable, validated

population measure; it has been

associated with overall health, child

development, academic performance,

mental health.

Endorsed and utilized by US

governmental agencies (US

Department of Agriculture,

Centers for Disease Control and

Prevention).

assistance programs. Indeed, their mission is "toprovide chñdren and needy families better accessto food and a more healthfiil diet'"*^ But foodinsecurity is integrally comiected to many othersocial problems, such as poverty, ill health, andlack of schooling. Thus, as with monitoring, itmakes sense to have an interagency body thatcan coordinate government efforts across anumber of types of interventions.

Accountability also implies that, in caseswhere government does not follow through onappropriate reference goals, there is legal re-course for those affected. Lawsuits against thegovernment over food assistance are not typi-cal. However, such lawsuits could play animportant role in ensuring food security. Forexample, initial resistance by the Departmentof Agriculture during the Nixon administrationto begin the Special Supplemental NutritionProgram for Women, Infants, and Childrendemonstration program was countered suc-cessfully by a lawsuit.''®

Increase Public Participation by

Clarifying Terminology

A human rights approach is predicated onthe idea that people have the right and the dutyto partidpate in dvic Ufe, including the devel-opment, implementation, and evaluation ofpolides and programs.^°'"''^° To facilitate andensure partidpation, there must be administra-tive commitment to establish and maintain openavenues to legitimate forms of partidpation bypeople with all types of backgrounds.'^'^' This isan area in which those advocating a humanrights approach to health problems have yet tosucceed.'''' Sharing information and encouragingeducation throu^ direct, easy-to-understandlanguage, dear venues for feedback and publicpartidpation, and reference to dear benchmarksand targets for food security would facilitatepartidpation.

Transparency is vital to increasing partid-pation of the public. One clear improvementcould come in the very definition of foodinsecurity. The US Household Food SecuritySurvey Module, first fielded in 1995, is an 18-item survey that has been used to monitor foodinsecurity at national, regional, and state levelsthrough an annual implementation in the Cur-rent Population Survey.̂ ^ Althou^ the termi-nology used in this report should be easilyunderstood by all concemed, the report is oftenmisunderstood by the American public and bythe media^'' Of greater concern are changes tothe definition of food insecurity (e.g., eliminatingthe word hunger from the most severe form offood insecurity) made by the US Government in2006 without public partidpation. Lack ofbroadly accepted definitions makes it difficult forthe public to demand accountability and com-plicates the flow of information and educationabout the importance of hunger and food inse-curity to national well-being. This limits thepublic partidpation and transparency that areessential to the human rights ñ-amework.

Address Vulnerability and Discrimination

Certain groups, by nature of sodoeconomicconditions or previous discrimination, are morevulnerable to food insecurity than others. Ahuman rights approach entails focusing onthose who are most vulnerable, understandingwhat causes this vulnerability or susceptibilityto adverse outcomes, and changing conditions

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to improve their situation. For example, female-headed households have a high prevalence ofhousehold food insecurity—30.2% comparedwith 11.1% in the general population. ̂ "̂ A low-income female head of household may he vul-nerable to food insecurity hecause she may havelower income and less diildcare support com-pared with women who are married. Her lowincome may he related to having less education,fewer skills, less access to hi^er paying johs, and,thus, more stress and anxiety ahout affordingfood. These processes may lead her to he morevulnerable to food insecurity and poor health.

The more food-insecure a woman is, the morerisks she may take to get food on the table, such astaking low-wage johs requiring long hours thatmay jeopardize her health®; paying less for chnd-care and, thus, putting her children in higher-dskenvironments; or, at an extreme, trading sexualintercourse for money and thereby inaeasing herexposure to sexually transmitted diseases andviolence.®'̂ ^ Among homeless or poorly housedwomen in Massachusetts, posttraumatic stressdisorder because of adverse childhood experi-ences was assodated with a 2-fold increase in theodds of household food insecurity.̂ ®

These examples show how vulnerability canlead to food insecurity. However, food insecu-rity itself can exacerbate already-existing vul-nerability. Food-insecure women have de-scribed experiences of alienation and anxietycoupled with worries about family strife orlosing their children.^'''^^ In a nationally repre-sentative sample in Canada, individuals ñnmfood-insecure households reported higher oddsof depression and stress.̂ '̂ Among AfricanAmerican women who chronically utilize foodpantries, anxiety, violence, and stress werestrongly assodated with the experience of hun-ger® Food-insecure households have docu-mented lower nutrient intakes,^'' poor duld de-velopment,®^ poor health,̂ ®"®' and forcedtrade-offs between paying for basic needs such ashousing,̂ ^ heating,®'' and medical care.®** Eachtrade-off situation increases vulnerability.̂ '® "̂®®

The vulnerability of women to hunger andfood insecurity has long been recognized in thehuman rights documents of the United Na-tions.'® One of the greatest concerns is theintergenerational transmission of malnutrition—that is, pregnant women that are malnourishedare more likely to have low-birthweight babies.As a result their children are more susceptible

to undemutiition and poor cognitive develop-ment, which in turn affects the children's abilityto earn enough money to support themselvesand their families when they become adults.®^Because women and children are espedallyvulnerable to food insecurity and to sodoeeo-nomic processes that cause it, ensuring women'sri^ts is an important correlate of the right to

A rights-based approach would investigatehow US polides and programs might createor maintain vulnerability for some groups andnot others, and, thus, have inequitable andnegative effects on health and well-being. '̂Such an investigation would require that data hedisaggregated whenever possible. Highli^tingthe trends in radal/ethnic and gender disparitiesin national datasets helps monitor changes indisparities over time. Since 1998, disparities infood insecurity rates have not changed, andAfrican American and Latino households con-tinue to have 2 to 3 times the prevalence ofhousehold food insecurity compared with Whitehouseholds.' It has been well documented thatgeographic disparities also exist in access tohealthy foods.̂ ^ A human rights approach fo-cuses attention on who and what mi^t beaccountable for these continuing disparities.

Link Policies to Outcomes

A human rights framework applied to theright to food can interpret how food-relatedpolides affect one's ability to purchase foodand how such polides affect health and well-being. For instance, research demonstrates thatchanges in food stamp laws are assodated withaltered health and well-being of families andchildren.^'''^'' Other research shows that theodds of food insecurity for those cut off fromfood stamp benefits were 2 times hi^er than forfamilies who had no change in food stamps.The same study showed that the loss of foodstamps was also assodated with a 40% increasein the odds of fair or poor health.''^ A ri^tsanalysis would indude an assessment of the illhealth and greater vulnerability that sanctionpoKdes—i.e., those that disallow families to par-üdpate in federal programs such as food stamps,TANF, and Medicaid—might'create.

Recently, USDA's Food and Nutrition Servicehas developed historic changes to the SpedalSupplemental Nutrition Program for Women,Infants, and CMdren's food packages.̂ ® These

changes, the first comprehensive ones since 1980,were developed in part to make the food packagesmore consistent with current nutritional guide-lines and in part to address the increasing prev-alence of overweight and obesity among low-income children and adults. This is a positiveexample of government action and "fulfills" theright to food by facilitating an environment thatfosters human development

CHALLENGES TO ADOPTING ARIGHTS-BASED APPROACH

Why is the United States one of the onlycountries that has not endorsed the right tofood? There are 2 general misperceptions re-garding human rights and the right to food.Finding ways to address them can create newopportunities for the adoption of a rights-basedapproach to food insecurity.

A iVIisperception of Economic, Sociai,

and Cultural Rights

Since the passage of the Civil Rights Act in1964, the United States has had a formidablerecord of formally seeking to protect dvil andpolitical rights. The United States has ratifiedthe International Covenant of Civil and PoliticalRights and the Convention on the Eliminationof Discrimination Based on Race and Ethnidty.On the other hand, the United States is slow toaccept sodal, economic, and cultural rightsgenerally referred to as "positive rights"'^ or"basic rights."^^ These sodal and economic rightsindude the right to a minimum standard of living,to health and well-being, to education, to hous-ing, and to food. Sudi rights are integrated intothe Universal Dedaration of Human Ri^tswithout distinction, hut they are largely coveredin the International Covenant of Economic, So-dal and Cultural Rights, which the United Stateshas signed (meaning they agree with the tenets)but has not ratified (meaning they are not willingto hold themselves legally accountable forimplementation).

The lack of acceptance of sodal and eco-nomic rights is related to a common misper-ception that they indicate direct provision ofservices and food for everyone.'^'^^ But this isnot the primary intention of these d^ts. Eco-nomic, sodal, and cultural rights are rights thatHenry Shue defines as "subsistence dghts."^^They are predicated on the idea that sodal.

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economic, and political structures should tangi-bly support populations and individuals in pro-viding for themselves. In more precise terms, theright to food means the right to expect reason-able opportunities to provide food and goodnutrition for oneself,'̂ The government's role isto fadlitate these opportunities. In the event thatsomeone is incapable of providing for himself orherself, then the government should make pro-visions to provide food directly,

A second misperception is that acceptance ofthese positive rights implies that the govern-ment must instantly solve all sodal ills relatedto poverty and deprivation,'^ This is not thecase. The rights approach helps to identify waysof codifying a national wül to end poverty andhunger, to provide a framework for continuedprogress in this area, and to provide a means formonitoring this progress.

To overcome these misperceptions, under-standing is needed of the importance of basicrights (i,e,, food, shelter, and water) to thehealth and well-being of the population, to thecapadty of the population to partidpate inthe workforce, and for the fulfillment of otherfreedoms, such as parddpadng in dvic lifeand cultural institutions,̂ '̂̂ ® But this under-standing involves a cultural shift and likelyrequires media attention, widespread education,and community partidpation activities. Morefederal legislation is needed that protects safetynet programs as entitlement programs, as is thecase for the Food Stamp Program, More invest-ments are needed in sodal programs that havebeen proven to reduce poverty rates. In the sameway that dvil rights legislation, over time,changed culturally dominant views on race andradsm, legislative and administrative action thatincorporates rights language related to healthpromotion and income support polides mayhave a tangible effect on food insecurity.

Public health research c£in also play a rolein changing attitudes about rights. Goodhealth is valued in sodety, both for its ownsake and for its potential to reduce skyrocket-ing medical costs. Soda! epidemiology andother public health research provides empiricalevidence that sodal, economic, and culturaldimensions of life determine health status,^ '̂*°This research can provide a basis for rightspromotion by demonstrating that sodal, political,and economic interventions have a positiveimpact on health. The research in sodal

epidemiology and the research on health andhuman rights have begun to merge in pro-moting the concepts of sodal and economicinterventions and in framing these interven-tions in a rights-based context, ""

A Misperception That Solving Food

Insecurity Requires Charity

A common misperception about hunger inthe United States is that involuntary lack ofaccess to food ought to be solved with charity.The emphasis on charity for solving foodinsecurity and hunger is a "needs-based" ap-proach to food. The needs-based approachassumes that people who lack access to foodare passive redpients in need of direct assis-tance. Programs and policy efforts that use thisapproach tend to provide assistance withoutexpectation of action from the redpient, with-out obligation and without legal protections,

A needs-based approach does not requireinformed legislation, political will, and coordi-nated action. But a ri^ts-based approach createsenabling environments that support people innourishing themselves while providing a struc-ture for legal recourse,®' A ri^ts-based approachfocuses on ways in which conditions and envi-ronments can be altered so that people take anactive role in procuring food. It incorporates theidea that good nutrition is not something basedsolely on benevolence or charity but is, rather,the duty and obligation of a country to its people.

Further action on the part of local communi-ties as well as academic and health professionalsis required to shift the emphasis from a needs-based to a dghts-based approach. Food securityand good nutrition must be established as cen-tral aspects of the fundamental entitlement to aminimum standard of living. These groups canencourage the United States to take legislative,administrative, and regulatory action to ensurethat all households have enou^ food for anactive and healthy life. This can be done notonly by providing food assistíince, but alsothrough ensuring that people have skills, edu-cation, health care, income, and other supportsto procure healthy foods for themselves,

ADOPTING A HUMAN RIGHTSAPPROACH

The US government could revisit the op-portunity to ratify the Intemational Covenant

of Economic, Sodal and Cultural Rights, Thiswill require strong support in the Congressand a clear presidential mandate,® '̂®'' In themeantime, there are other ways to begin toimplement the rights-based approach,

Nationai Pian to End Hunger

Following the recommendations of the Com-mittee on Economic, Sodal and Cultural Rights(General Comment 12), there should be a na-tional strategy to implement the r i^ t to food. Toimplement the r i^ t to food means to put thestructural processes in place whereby agendes,organizations, and dtizens are working towardthe common goal of actively respecting, pro-tecting, and promoting the right to food.

The flrst step in any strategy should be tomap the prevalence of food insecurity fordifferent groups and regions within the coun-try, taking into account the differences thatexist on the basis of gender and race/ethnidtyand between rural and urban areas. Suchmapping is necessary to identify those most atrisk for food insecurity and to develop appro-priate, targeted responses to food insecurity,'^According to the Spedal Rapporteur on the Rightto Food, a national strategy should establish theappropriate mechanisms that (1) utilize monitor-ing systems to identify emerging threats to theright to adequate food, (2) improve coordinationbetween relevant agendes at the national, state,and local level, (3) improve accountability, with adear allocation of responsibilities and timeframesfor progressive implementation of the right tofood, and (4) ensure the adequate public partic-ipation that indudes the most food-insecuresegments of the population,®"*

In addition to a national plan, there shouldbe a clear delineation of US obligations in eachdomain of the rights framework: respect,protect, fadlitate, and provide. In Table 2 weprovide examples for each domain of USobligations (respect, protect, and frilfill), someof which the United States is already doing;others, the United States might do if it adopteda rights-based approach to food insecurity.

Other Related StrategiesAside from establishing a national plan to end

hunger, other, more immediate steps can betaken. First, we recommend that there be opendebate on the current food insecurity and hun-ger measures to ensure broad-based agreement

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TABLE 2-Examples of US Governmental Obligations Within the Human Rights Framewori(

Domain of

Responsibility

Definition

Individual: protect

against individual

vulnerability

Household:

ensure supportive

environment for

families, especially

women and children

Community:

protect against

community

vulnerability

Respect

Noninterference

Do not deny

qualifying citizens

and legal

immigrants access

to nutrition

assistance.

Do not deny food

assistance to

felons who have

served their prison

term.

Do not enforce a

"family cap" limit on

number of children

when calculating food

stamp allotment

amounts,"

Do not change food

insecurity definitions

without pubiic debate

and participation.

Protect

Protect people from others

doing harm

Ensure all public

assistance staff are

properly trained about all

programs.

Reduce vulnerability by

ensuring access to all

supports available.

Ensure that food quality is

monitored and considered

just as important as

accessibility.

Protect against predatory

lenders.

Improve targeting for nutrition

programs so those eligible

receive them.'

Investigate or revise

zoning laws that ensure

nutritious food

retail options.

Reassess measures of poverty

to account for housing and

child care costs.

Establish national

monitoring or leadership

role on nutrition.

Hold agencies

accountable for actively

addressing disparities in

food insecurity.

Facilitate

Develop policy environment

that enables economic

and food security

Increase minimum wage.

Promote access of all children

to quality education, health

care, and housing. Consider

"comprehensive eligibility,"

For instance, if a mother

is eligible for WiC, then she

could be entitled to other

assistance programs without

having to apply for each

program separately.

Consider comprehensive

eligibility (i.e., if a child

qualifies for health insurance

through Medicaid, the family

shouid automatically qualify for

food stamps).

Promote job training

and job placement

services."

Provide tax breaks for

supermarkets and food retailers

to locate in low-income

neighborhoods.

Legislate for safe

neighborhoods

(safe housing, places for

exercise and play.

generous lighting).

Fund research in food

insecurity interventions.

Provide meaningful venues

for participation in

diaiogue, poiicies, and

programs regarding

food security and

right to food.

Provide

When fulfillment of other obligations

have faiied, or in circumstances

beyond people's control-i,e..

emergency situations, vulnerable

children, the destitute

For very low-income children, grant free

schooi breakfasts and lunches, and

meals during the summer months."

Provide nutritious food or adequate

food stamps on a temporary basis to

families who experience personal

emergency, ie, household fire or

broad-scale natural disaster."

Directly provide opportunities to

purchase nutritious foods in

communities that otherwise have

limited access to nutritious foods.

Have rapid.

organized, and sustained

response in disaster

situations.'

Notes. WIC=Special Supplemental Nutrition Program for Women,

^ e US Government is already engaged in these approaches.

'Some states do not enforce the family cap.

Infants, and Children, Not a comprehensive iist. For related strategies, see US Action Plan on Food Security: Solutions to Hunger."'

1208 I Framing Health Maters I Peer Revieviied I Chilton and Rose American Journal of Public Health | July 2009, Vol 99 , No, 7

FRAMING HEALTH MÄHERS

on a consensus definition. This endeavor shouldinvolve sdentific experts, legislators, advocates,members of the media, and representatives ofthe poor who have experienced food Insecurityfirst-hand. A national conference with repre-sentatives from these stakeholder groups, alongwith international experts, would help to estab-lish a definition and measurement approach thatcould last for decades. With agreed-upon ter-minology, benchmarks, and targets, cross-agency accountability for reaching those targetscan be more dearly articulated.

Second, position statements on food as afundamental human right from the AmericanPublic Health Assodation, the American Sodetyfor Nutrition, the American Dietetic Assoda-tion, the American Academy of Pediatrics,and others would help to inform sdenüsts,advocates, and legislators about the negativehealth and developmental effects of food inse-curity.

Third, these statements can also call on theUSDA and other govemmental agendes tointegrate an accountability component intotheir food security reporting. Current foodinsecurity rates could be released with refer-ence to progress toward national goals.

Finally, these activities should have a venuefor encouraging partidpation of key commu-nity leaders who have experienced food inse-curity first-hand. Examples of such partidpa-tion would be invitations for commentary onresults of food insecurity reports, collaborationwith local people regarding intervention pro-grams to prevent food insecurity, and estab-lishment of local forums where national nu-trition experts meet with and learn from localpeople who are food insecure abouttheir needs and perceived effectiveness ofprograms.

CONCLUSIONS

Given the recent change in administrationand a réévaluation of our domestic agenda,food insecurity and hunger ought to be one ofthe first health issues our nation addresses. Wehave attempted to demonstrate how a humanrights framework can be used to address foodinsecurity in the United States. From the ex-amples presented here, it is clear that such aframework is not foreign to the cultural andpolitical climate of the United States and that

many advances have been made in the nutrit-ion landscape. However, since the USDAstarted measuring food insecurity, there hasbeen either increase or stagnation in these foodinsecurity rates. The rights framework is a freshapproach with a concrete methodology to ad-vance the US government's leadership in im-proving the well-being of its vulnerable popu-lations.

Dominant US cultural beliefs express strongvalues for ways that the US system unleashesthe spirit, energies, and ingenuities of the indi-vidual. This resonates with the rights-basedapproach that seeks to create enabling envi-ronments for people to procure their own food.By convincing others that the right to food isabout creating enabling environments andconditions for people to feed themselves; byinsisting that nutritious food is not simply abasic need, but a fundamental human right;and by having a clear and convincing definitionof food insecurity and hunger, it will be possi-ble to advance a human rights approach. Wehave presented concrete examples of activitiesand polides so that no matter what our exper-tise—research, policy analysis, advocacy, oreducation—we can all follow through on ourobligation to promote well-being and enhancebasic human dignity. •

About the AuthorsMariana Chilton is with the Drexel University School ofPublic Health, Department of Health Management andPolicy, Philadelphia, PA. Donald Rose is with the Departmentof Community Health Sciences, School of Public Health andTropical Medicine, Tulane University, New Orleans, LA.

Requests for reprints should be sent to Mariana Chilton.PhD, MPH, Department of Health Management and Policy,Drexel University School of Public Health. 1505 Race St,11th Roor, Mail Stop 1035, Philadelphia, PA19102-1192 (e-mail: mariana.chilton@dre.xel.edu).

This article was accepted November 11, 2008.

ContrihutorsM. Chilton originated the article and led the writing.D. Rose contributed editorial and critical expertise at allstages of the analysis and writing.

AcknowledgmentsThe authors would like to thank Jennifer Breaux forassisting with the research in support of this article. Theauthors would also like to thank the anonymous re-viewers for their extensive comments. They have con-tributed to the strength of this paper.

Human Participant ProtectionNo human partidpants were involved in this study.

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