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Assessing Household Food Insecurity for Public Health Preparedness Planning

Matthew Groenewold, PhD, MSPHOffice of Emergency and Public Health Preparedness

Louisville Metro Department of Public Health and Wellness

Addressing Health Equity Through Social Justice in Public Health Preparedness

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Disaster Preparedness

• The federal government recommends assembling an emergency supply kit that contains a minimum three-day supply of food and water as an element of household and personal emergency preparedness.

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Disaster Preparedness

• This recommendation is a part of community preparedness planning in jurisdictions across the country, including Kentucky and Louisville Metro.– Severe weather events – Floods – Earthquakes– Wildfires– Chemical releases

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Disaster Preparedness?

• Not realistic for food insecure families– Immediate nutritional needs must be met

– Cannot stockpile food for future

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Food Insecurity

• Exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain1”

• Estimated prevalence in 2006: 10.9 % of all US households

1. Life Sciences Research Office, Federation of American Societies for Experimental Biology. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(Suppl):1559-1600.

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Food Insecurity

• Both a consequence of and a contributor to social and health disparities– Inversely correlated with household income

– Associated with poor self/parent-reported health status• Adults

• Children

– Can lead to hunger and malnutrition• Can also exist in the absence of these conditions

– Associated with increased risk of obesity

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Measuring Household Food Insecurity

• Measured in population surveys using the US Household Food Security Scale (USHFSS)– 18-item scale– Developed by USDA and HHS– Instruments includes items that refer to both children

and adults – Classifies households as:

• Food secure

• Food insecure without hunger

• Food insecure with moderate hunger

• Food insecure with severe hunger

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Measuring Household Food Insecurity

• Validated, six-item short form of USHFSS also available

• Works equally well for households with and without children

• Does not distinguish between moderate and severe hunger

• Classifies households as:– Food secure– Food insecure without hunger– Food insecure with hunger

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Health Equity and Disasters

• Disasters exacerbate existing social inequities– Economically

disadvantaged more susceptible to the health effects of environmental problems

• Higher levels of exposure

• Less access to protective or adaptive resources

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Health Equity and Disasters

• The poor during disaster or other acute emergency– Most vulnerable

– Most dependent upon intervention and rescue

– Disproportionately people of color

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Health Equity and Disasters

• Preparedness plans that fail to account for food insecure households are inherently inequitable – Expectation that all

citizens can or will be self-sufficient for up to three days

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Health Equity and Disasters

• Inequitable preparedness plans hamper response efforts– Foster mistrust of public

authorities among those most vulnerable

– Recommendations that cannot be carried out undermine trust in government/emergency response agencies

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Project Objectives

• Examine preparedness plans and policies in light of local household food insecurity data– Prevalence– Predictors

• Determine adequacy of plans and policies from social justice and health equity perspective

• NACCHO funds used to conduct population-based

survey of household food insecurity in Louisville Metro

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Survey

• 506 Metro Households

• List-assisted, RDD telephone survey

• 6-item short form of USHFSS

• Two-stage, stratified cluster sample– Metro census blockgroups with < 90% of population at or above 200%

of FPL included (n = 449 of 557 blockgroups)

– Eligible blockgroups stratified by quintiles of percent of population below FPL

– 10 blockgroups (clusters) randomly selected from each stratum

– 10-11 households surveyed in each cluster, with 1 adult (> 18 yrs)

responding to questions for each household

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Sample v Population Characteristics: Households

Number of Households n % n % Chi-Square P-ValueTotal 506 --- 237076 ---

Household Size1 147 29.05% 76977 32.47%2 161 31.82% 75264 31.75%3 100 19.76% 39264 16.56%4 63 12.45% 28441 12.00%5 24 4.74% 11618 4.90%6 10 1.98% 3830 1.62%

7+ 1 0.20% 1682 0.71%Total 506 --- 237076 --- 7.33 0.292

Household Income< $15,000 79 19.85% 47071 19.85%

$15,000 - $24,999 78 19.60% 36621 15.45%$25,000 - $34,999 58 14.57% 34306 14.47%$35,000 - $49,999 73 18.34% 41624 17.56%$50,000 - $74,999 65 16.33% 41833 17.65%$75,000 - $99,999 27 6.78% 19170 8.09%

$100,000+ 18 4.52% 16451 6.94%Total 398 --- 237076 --- 9.41 0.166

Sample Households Survey Population

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Sample v Population Characteristics: Respondents

Population n % n % Chi-Square P-ValueTotal 506 --- 561520 ---

GenderMale 198 39.13% 267428 47.63%

Female 308 60.87% 294092 52.37%Total 506 --- 561520 --- 14.63 <0.001***

RaceWhite 368 74.65% 412718 73.50%Black 111 22.52% 120237 21.41%

Latino 3 0.61% 9996 1.78%Other 11 2.23% 18569 3.31%Total 493 --- 561520 --- 5.89 0.117

Age18 - 34 96 19.20% 137707 32.36%35 - 64 255 51.00% 212677 49.98%

65+ 149 29.80% 75131 17.66%Total 500 --- 425515 --- 68.53 <0.001***

Marital StatusSingle 91 18.35% 133155 29.80%

Married 243 48.99% 206404 46.19%Divorced 79 15.93% 69539 15.56%Widowed 83 16.73% 35493 7.94%

Total 496 --- 444591 --- 70.47 <0.001***Educational Attainment

No School 0 0.00% 2862 0.77%8th Grade or Less 20 4.21% 20170 5.41%Some High School 39 8.21% 54525 14.63%High School Grad 179 37.68% 117292 31.47%

Some Post-Secondary 135 28.42% 104181 27.95%Bachelor's Degree 64 13.47% 46145 12.38%

Any Post-Grad 38 8.00% 27515 7.38%Total 475 --- 372690 --- 24.84 <0.001***

EmploymentEmployed 242 90.98% 268190 94.48%

Unemployed 24 9.02% 15684 5.52%Total 266 --- 283874 --- 6.22 0.013*

Survey PopulationSample Respondents

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Analysis

• Sample weighting– Mixed weighting to adjust for:

• Scale• Unequal selection probabilities due to complex sampling design

– Product of inverse probabilities of inclusion from each sampling stage

• Complex sample design accounted for in calculation of standard errors of proportion estimates– SAS 9.1

• PROC SURVEYFREQ

• Rao-Scott design-adjusted chi-square used for tests of association

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Results

100.00243557Total

6.0083-11.8603

8.934321760Insecure w/hunger

10.8609-17.7583

14.309634852Insecure

72.4083-81.1039

76.561186945Secure

95% C.I. (%)%Households (Wt’d est.)

Food Security Status

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Results

• Food security status significantly associated with:– Income

• Chi-square 91.2231, P < 0.001

– Household Size• Chi-square 12.0344, P = 0.034

– Race• Chi-square 8.0583, P = 0.018

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Forthcoming Analyses

• Multivariable regression analyses adjusting for effect of numerous covariates– Confounding– Interaction

• Cartographic modeling to produce risk maps– Identify high-risk areas

• Preparedness planning

• Intervention• Mitigation

• Spatial association with “food deserts”

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Conclusions

• Equitable preparedness planning requires that officials take all peoples’ circumstances into account, including the poor

• Significant levels of food insecurity and hunger in Jefferson County

• Preparedness plans should address the needs of food insecure households

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Multnomah CountyMultnomah CountyMultnomah CountyMultnomah CountyMultnomah CountyMultnomah CountyMultnomah CountyMultnomah CountyHealth DepartmentHealth DepartmentHealth DepartmentHealth DepartmentHealth DepartmentHealth DepartmentHealth DepartmentHealth Department

Jessica Guernsey Camargo, MPHJessica Guernsey Camargo, MPHJessica Guernsey Camargo, MPHJessica Guernsey Camargo, MPHjessica.guernsey@co.multnomah.or.usjessica.guernsey@co.multnomah.or.usjessica.guernsey@co.multnomah.or.usjessica.guernsey@co.multnomah.or.us

May 27May 27May 27May 27thththth, 2008, 2008, 2008, 2008

Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Health Equity Through Public Health PreparednessHealth Equity Through Public Health PreparednessHealth Equity Through Public Health PreparednessHealth Equity Through Public Health Preparedness

Pandemic Influenza PlanningPandemic Influenza PlanningPandemic Influenza PlanningPandemic Influenza Planning

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Presentation overviewPresentation overviewPresentation overviewPresentation overviewPresentation overviewPresentation overviewPresentation overviewPresentation overview

�� Context of project Context of project �� Issues of equity and social justice Issues of equity and social justice

specific to pandemic influenzaspecific to pandemic influenza�� Project start up and immediate Project start up and immediate

outcomesoutcomes�� Next stepsNext steps

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The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based OrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizations�� African America Health CoalitionAfrican America Health Coalition�� Asian Health and Service CenterAsian Health and Service Center�� El Programa HispanoEl Programa Hispano--Catholic CharitiesCatholic Charities�� Hacienda Community Development Hacienda Community Development

CorporationCorporation�� Immigrant and Refugee Community Immigrant and Refugee Community

OrganizationOrganization

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Project goals Project goals Project goals Project goals Project goals Project goals Project goals Project goals

�� Ensure twoEnsure two--way communication between way communication between culturallyculturally--specific populations and response specific populations and response organizationsorganizations

�� Raise awareness around the issue of public Raise awareness around the issue of public health emergency preparednesshealth emergency preparedness

�� Incorporate learning from communities Incorporate learning from communities around what may constitute an emergency around what may constitute an emergency in their communityin their community

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Project foundationProject foundationProject foundationProject foundationProject foundationProject foundationProject foundationProject foundation

�� Regional Hospital Preparedness ProgramRegional Hospital Preparedness Program--Cultures Uniting for Emergency Cultures Uniting for Emergency Preparedness Project (CUEP)Preparedness Project (CUEP)--evolution of evolution of projectproject

�� Parallel process with pandemic flu planning Parallel process with pandemic flu planning for use of community mitigation strategiesfor use of community mitigation strategies

�� Parallel process and synergy of local Health Parallel process and synergy of local Health Equity InitiativeEquity Initiative

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Pandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planning

��““The resiliency of those who The resiliency of those who would need to stay home would need to stay home during a pandemic will depend during a pandemic will depend on their level of preparedness.on their level of preparedness.””(Emer Infect Dis(Emer Infect Dis--May 2008)May 2008)

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Pandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planningPandemic flu planning

�� ““Community mitigation measures could Community mitigation measures could cause particular problems for persons from cause particular problems for persons from lowlow--income families and for racial and ethnic income families and for racial and ethnic minorities. With these problems in mind, minorities. With these problems in mind, communities should plan for the needs of communities should plan for the needs of vulnerable populations who may be vulnerable populations who may be adversely affected during a pandemic.adversely affected during a pandemic.””(Emer Infect Dis(Emer Infect Dis--May 2008)May 2008)

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Project roll outProject roll outProject roll outProject roll outProject roll outProject roll outProject roll outProject roll out

�� Offered to all CBOs involved in CUEPOffered to all CBOs involved in CUEP�� Convened 5 planning meetings to;Convened 5 planning meetings to;

��Identify community leaders and Identify community leaders and recruitment processrecruitment process

��Identify exercise objectivesIdentify exercise objectives��Design exerciseDesign exercise��Exercise held April 23Exercise held April 23rdrd, 2008, 2008

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Project findingsProject findingsProject findingsProject findingsProject findingsProject findingsProject findingsProject findings

�� WhoWho’’s emergency is it anyway?s emergency is it anyway?�� Primary role of CBOPrimary role of CBO’’ss--need for need for

building capacitybuilding capacity�� Homogeneity of emergency Homogeneity of emergency

preparedness as a field and how that preparedness as a field and how that is reflected in the workis reflected in the work

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Project findingsProject findingsProject findingsProject findingsProject findingsProject findingsProject findingsProject findings

�� Moving beyond translation and Moving beyond translation and communicationcommunication--access to power and access to power and different ways of doing the workdifferent ways of doing the work

�� Emergency preparedness should build on Emergency preparedness should build on priorities in the communitypriorities in the community

�� Need an economic framework for Need an economic framework for community compliance with community community compliance with community mitigation measuresmitigation measures

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Immediate outcomesImmediate outcomesImmediate outcomesImmediate outcomesImmediate outcomesImmediate outcomesImmediate outcomesImmediate outcomes

�� Preliminary outcomes were used to Preliminary outcomes were used to prioritize 3 year strategic goals for prioritize 3 year strategic goals for Oregon Public Health PreparednessOregon Public Health Preparedness

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Next stepsNext stepsNext stepsNext stepsNext stepsNext stepsNext stepsNext steps

�� Finish final reportFinish final report--report back out to report back out to communitycommunity

�� Present to decisionPresent to decision--makersmakers�� Bridge health equity and PHEPBridge health equity and PHEP�� State and county strategic planningState and county strategic planning--

advocate for equitable structure and advocate for equitable structure and fundingfunding

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P.L.A.N. – Preparedness through Linking All Neighbors

Addressing Emergency Preparedness Addressing Emergency Preparedness through Social Capital Theorythrough Social Capital Theory

Jennifer Jennifer WeitzelWeitzelPublic Health MadisonPublic Health Madison

and Dane Countyand Dane CountyMadison, WIMadison, WI

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Objectives

�� Participants will be introduced to Social Participants will be introduced to Social Capital theory and how it relates to Capital theory and how it relates to emergency preparednessemergency preparedness

�� Participants will be introduced to how this Participants will be introduced to how this theory is being applied to emergency theory is being applied to emergency preparedness in 3 specific Madison preparedness in 3 specific Madison neighborhoods.neighborhoods.

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Social Capital Theory

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Chicago Heat Wave 1995

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North Lawndale South Lawndale

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PLAN: Preparedness through

Linking All Neighbors

PLAN Resource Guide

A guide to creating neighborhood

emergency plansPublic Health –Madison and Dane County

Project history

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Similar Programs

�� SNAP: SNAP: SSeattle eattle NNeighborhoods eighborhoods AActively ctively PPreparerepare

�� http://www.seattle.gov/ehttp://www.seattle.gov/e

mergency/programs/snap/mergency/programs/snap/

�� SeattleSeattle’’ s own neighborhood s own neighborhood initiative to initiative to Get Ready, Get Get Ready, Get Connected and Get Strong Connected and Get Strong for for any potential emergencyany potential emergency

�� ““ All Together NowAll Together Now””

��““ Neighbors helping neighbors create a Neighbors helping neighbors create a resilient New York Cityresilient New York City……building by building by building, block by blockbuilding, block by block””

�http://www.empowermentinstitute.net/atn/index.html

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�� Neighborhood SummaryNeighborhood Summary�� Total population: 3,663Total population: 3,663�� Households without a vehicle: 185Households without a vehicle: 185�� Households with income less than Households with income less than

poverty level: 716poverty level: 716�� Disabilities (number of people)Disabilities (number of people)

�� Sensory disability: 64Sensory disability: 64�� Physical disability: 172Physical disability: 172�� Mental disability: 156Mental disability: 156�� ““ SelfSelf--carecare”” disability: disability:

104104

Allied Drive Neighborhood: Demographics

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Allied: Project description

�� ““ WelcomerWelcomer”” programprogram

�� Improving interImproving inter--agency communicationagency communication

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Allied: Successes

�� Agency phone treeAgency phone tree

�� Neighborhood Neighborhood ““ championschampions”” identifiedidentified

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Allied: Challenges

�� Preconceived notions regarding ability of Preconceived notions regarding ability of residents to planresidents to plan

�� Immigration issuesImmigration issues

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Allied: Next Steps

�� Community Health Worker modelCommunity Health Worker model

�� Continue to develop Continue to develop ““ WelcomerWelcomer”” programprogram

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Meadowood: Demographics

�� Majority are homeMajority are home--ownersowners

�� ElderlyElderly

�� Change in demographics over the last 10 Change in demographics over the last 10 yearsyears

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•August 16, 2007: West Side Residents Aim To Keep Pressure On City Officials About Crime•August 10, 2007: West Side Eyes Next Steps In Fight Against Crime •August 9, 2007: West Side Residents Voice Crime Concerns To Police Chief, Mayor

Meadowood: Project description

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Meadowood: Successes

�� Diversity to the table!Diversity to the table!

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Meadowood: Challenges

�� Progress will take timeProgress will take time

�� Safety is the main prioritySafety is the main priority

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Meadowood: Next Steps

�� Contact information collectedContact information collected

�� Community GardenCommunity Garden

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Triangle: Demographics

�� Total Population: 350Total Population: 350

�� Number of Households: 339 Number of Households: 339 –– Renter Renter occupied, low income subsidized occupied, low income subsidized housinghousing

�� Percent of Households with a member Percent of Households with a member with diagnosed disability (physical, with diagnosed disability (physical, cognitive, and/or mental): 85cognitive, and/or mental): 85--9090

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Triangle: Project description

�� Personal Safety and SecurityPersonal Safety and Security

�� Fire safetyFire safety

�� Health Welfare, and CommunicationHealth Welfare, and Communication

�� Weather and Environmental SafetyWeather and Environmental Safety

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Triangle: Successes

�� Fully engaged partnersFully engaged partners

�� Improvement in residents social interaction Improvement in residents social interaction skills and mental healthskills and mental health

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Triangle: Challenges

�� Operating in a neighborhood with a large Operating in a neighborhood with a large number of agencies providing servicesnumber of agencies providing services

�� Impact of neighborhood events on residentsImpact of neighborhood events on residents

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Triangle: Next Steps

�� Floor captain trainingFloor captain training

�� Fire drillFire drill

�� Policy developmentPolicy development

�� Registration of residents in the Dane Registration of residents in the Dane County Disaster Assistance Voluntary County Disaster Assistance Voluntary RegistryRegistry

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Lessons Learned

�� Must be comfortable conceptualizing at the Must be comfortable conceptualizing at the community and systems levelscommunity and systems levels

�� Facilitation skills a mustFacilitation skills a must

�� Political will and timing crucialPolitical will and timing crucial

�� Patience!Patience!

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Questions?

Thank you for your participation!Thank you for your participation!