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John Cook, PhD, MAEd Stephanie Ettinger de Cuba, MPH Ana Paula Poblacion, MSc Loaves & Fishes Community Services Naperville, Illinois April 16-17, 2015 Hunger is a Vital Sign; Vaccinating Communities Against Hunger By Empowering Food-Insecure Families

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Childrens HealthWatch Non-partisan network of pediatric & public health researchers research & policy center MISSION: Improve health & development of young children public policies alleviate family economic hardships Hunger (Food Insecurity) Unstable Housing (Housing Insecurity) Keeping Heat or Lights on (Energy Insecurity) Provide policy makers with evidence to develop policies that protect young childrens health and development

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Where our data come from: A household survey Interviews - caregivers with children 0 to 4 years old invisible group critical growth and development window Emergency Departments and Primary Care Clinics in Boston, Baltimore, Philadelphia, Little Rock and Minneapolis.

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Use evidence from empirical research results to: Inform actionable policy decisions Support policy recommendations

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1.How food insecurity & hunger impact the health of families and children. 2.How the health of families & children influence the health of communities. 3.How empowering families to escape food insecurity and become self-sufficient influences their health, and the health of their community. How Do Food Insecurity and Hunger Influence the Health of Communities? Overview

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Food Insecurity and Hunger are Linked to Other Family Hardships Children in food-insecure families also are more likely to be: Housing insecure (crowded, doubled-up, two or more residential moves in last year, behind on rent/mortgage payments), Energy insecure (threatened with or have had a utility shutoff), To have foregone needed health care (visits for treatment or adherence to prescription medication), To have traded off health care against expenditures for other necessities, compared to children in food-secure families.

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Food Insecurity and Hunger are Vital Signs Linked to Adverse Child Health Outcomes Children in food-insecure families are more likely to: Have been hospitalized since birth, Have their health status reported as fair/poor versus excellent/good,** Have parents report concerns indicating risk of developmental problems, Have iron deficiency anemia, Have anemia without iron deficiency, compared to children in food-secure families.

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Food Insecurity and Hunger are Vital Signs Linked to Adverse Maternal Health Outcomes Children in households with child food insecurity are more likely to: Have mothers who report having depressive symptoms, Have mothers who report their own health as fair/poor, Have mothers with unhealthy weight status, Have mothers with chronic diseases, e.g., diabetes, compared to children in food-secure families.

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**NOTE: Meaning of Self-reported Health Status Based on a question that emerged around the mid-twentieth century (exact source unknown; maybe UN/WHO, maybe US government) Used by the US government and RAND Corporation in early 1950s, and since in the NHIS and NHANES, Has been validated in US, European, and Global contexts. Would you say {your/SP's} health in general is... (excellent, very good, good, fair, poor)?

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NOTE: Meaning of Self-rated Health Status In the US, according to Census Bureau data: Of all children (ages co-enrollment Sandel et al. JARC, 2015.">

Building the evidence for change > co-enrollment Sandel et al. JARC, 2015.

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OK, this is interesting but what can I do with this information? Well, consider this: Strong physical infrastructures; strong bridges, buildings, roads, parks, bike paths, trains, buses, subways, libraries, schools, ports, housing stock, utilities, are all part of the foundation for a strong, healthy public, & strong, healthy communities, and, Strong social infrastructures; fire departments, faith-based institutions, police departments, PTOs, civic organizations, mutual aid societies, private food assistance food banks, food pantries, food rescue disaster relief, public food, housing, & energy assistance SNAP, WIC, CACFP, school meals, summer feeding, etc., housing subsidies, LIHEAP, legal aid, are also essential parts of the foundation for a strong, healthy public & communities. They enable all of us to be healthy and to prosper. They are for all of us, and we all benefit from them, whether we use them or not.

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Housing, Food, Energy Insecurity Policy Failures Regulatory Failures Failures of Representative Democracy Market Failures Food, housing, and energy insecurity are results of systemic failures, not individuals or families failures

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Bringing food security & health together for positive change Hospital systems/health care partners Incorporating the hunger vital sign into EHRs; screening routinely Health care providers investing in the food security vaccine; access to healthy food via on-site & community-based food pantries, WIC offices, demo kitchens, nutrition education, farmers markets, etc. IRS approved nutrition access as community benefit; tax exemption/deduction for non-profit hospitals under the ACA Broad, Multi-sector Coalitions Human beings arent divided into government departments Co-enrollment for benefits, including food, housing, energy assistance State-level EITC & Child Tax Credit increases, minimum wage increases Advocacy/coalition building using the health argument with partners, helping to build momentum for empowerment and achieving economic self-sufficiency

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New understanding of interplay of food security and the health of individuals, families, and communities Nutrition and non-nutrition pathways of influence Toxic stress, brain plasticity, bio-embedding, epigenetics, immune system functioning Nutrition programming in utero affects health in later life Food security and healthy food can act as a vaccine Provide multiple, long-lasting benefits Differential benefits to individuals, families, and communities A strong, healthy public, benefits to society as a whole Food Security & Healthy Food act as a Vaccine

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WE ARE ALL IN THIS TOGETHER! Thank you! John.Cook@bmc.org www.childrenshealthwatch.org @childrensHW

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Recommended reviews: Gunderson C, Kreider B, Pepper J. The Economics of Food Insecurity in the United States. Applied Economic Perspectives and Policy (2011) volume 33, number 3, pp. 281303. doi:10.1093/aepp/ppr022. Nord M. Food Insecurity in Households with Children: Prevalence, Severity, and Household Characteristics. EIB-56. U.S. Dept. of Agriculture, Econ. Res. Serv. September 2009. http://www.ers.usda.gov/Publications/EIB56/ http://www.ers.usda.gov/Publications/EIB56/ Cook JT, Frank DA. Food Security, Poverty and Development in the United States. Ann. N.Y. Acad. Sci. xxxx: 116 (2008). 2008 New York Academy of Sciences. doi: 10.1196/annals.1425.001 http://www.childrenshealthwatch.org/page/Publications http://www.childrenshealthwatch.org/page/Publications What Have we Learned in 20 Years About Food Insecuritys Impacts on Child Health & Development?

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Reviews (Contd.) Reviews from ASN EB Symposium 2012 (Food Security and Health Across the Lifespan) Laraia BA. Food Insecurity and Chronic Disease. Adv. Nutr. 4: 203212, 2013. http://advances.nutrition.org/content/4/2/203.full.pdf+htmlhttp://advances.nutrition.org/content/4/2/203.full.pdf+html Cook, JT, et al. Are Food Insecuritys Health Impacts Underestimated in the U.S. Population? Marginal Food Security Also Predicts Adverse Health Outcomes in Young U.S. Children and Mothers. Adv. Nutr. 4: 5161, 2013. http://advances.nutrition.org/content/4/2/51.full.pdf+html http://advances.nutrition.org/content/4/2/51.full.pdf+html Gundersen C. Food Insecurity Is an Ongoing National Concern. Adv. Nutr. 4: 3641, 2013. http://advances.nutrition.org/content/4/2/36.full.pdf+html http://advances.nutrition.org/content/4/2/36.full.pdf+html In addition, all Childrens HealthWatch publications can be found at http://www.childrenshealthwatch.org/page/Publications