Medical Examiner

The Other Public Health Crisis Threatening Thanksgiving

Americans are facing almost unprecedented levels of food insecurity.

three people standing around an orange bag containing a turkey
Tracy Morgan volunteering with Food Bank For New York City to distribute turkeys. Michael Loccisano/Getty Images

Although the number of chairs around the Thanksgiving table may be fewer this year to stave off the spread of COVID-19, many festive smorgasbords are bound to be loaded. Yet, this holiday season, over 20 percent of American households will worry about having enough food on the table, a level of food insecurity the nation hasn’t seen since the Great Depression. In California, where I see patients, food insecurity—the lack of access to nutritionally adequate meals—has more than doubled since March, driven by heightened unemployment and school closures.

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Our nation’s hunger crisis manifests inside the walls of America’s community hospitals. Food insecurity is linked to a higher risk of developing hypertension, heart disease, stroke, cancer, diabetes, arthritis, kidney disease, and hepatitis, which may in turn increase the risk of mortality from COVID-19. Food-insecure adults are 50 percent more likely to visit our already-strained emergency rooms and, when admitted, are hospitalized for 50 percent longer than food-secure adults. In New York City, the boroughs with the highest COVID-19 mortality also have the highest rates of food insecurity, poverty, and chronic disease. Fundamentally, akin to other social determinants of health, the types of foods that people have access to are associated with a significant and clinically observable impact on health outcomes.

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The federal efforts to alleviate food insecurity have not been enough. Over 43 million families now rely on the Supplemental Nutrition Assistance Program (SNAP), and another 6.4 million rely on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These federally funded programs, administered by state and local governments, help low-income families and their children put food on the table. But SNAP benefits cannot be used to purchase supplies that might be especially crucial in a pandemic when time and money is tighter than ever, like pre-cooked meals, vitamins and medicines, or household staples. WIC benefits are even more restrictive, limited to a narrow list of federally approved products. SNAP benefits are distributed to families anywhere from 10 to 40 days apart, which can make it hard to purchase large quantities of food at the beginning of the month in order to prepare for shelter-in-place orders, or quarantining. Furthermore, food stamp benefits average only $1.39 per person per meal, leaving recipients dependent on food banks and other charities. Food pantries, unsuited to handle a nationwide surge in demand, are currently overwhelmed.

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While food insecurity dropped slightly after unemployment benefits were increased this summer, that federal aid was not renewed. Congress adjourned prior to agreeing on a winter pandemic relief package, leaving many Americans heading into the holidays facing uncertainty over their jobs, rent, food, and health. During the Great Recession, the temporary SNAP benefit increase served as an effective bottom-up stimulus and was crucial to prevent worse outcomes for those in poverty. Today’s food insecurity numbers dwarf 2008 levels. Increased benefits and flexibility would not only feed our most marginalized communities, but also boost the economy, and, in the long run, reduce strain on the healthcare system.

Fortunately, under both the Tenth Amendment and the Families First Coronavirus Response Act, state and local leaders have increased regulatory flexibility to fight food insecurity in times of national emergency and can take immediate, creative actions to alleviate the relatively restrictive nature of nutritional assistance. With renewed shelter-in-place guidelines in effect across the country, shelf-stable foods are in incredibly high demand and prone to shortages. State and local policymakers can apply for waivers to give SNAP and WIC recipients the flexibility to purchase a wider range of foods, and to use their benefits to stock up in fewer shopping trips to help dampen the third wave of COVID-19.

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Food benefits should also be extended to low-income households who need additional food assistance while sheltering-in-place because of loss of income. Disaster SNAP, traditionally intended to replace benefits to those who lost food to natural disasters or extends benefits to households which would not ordinarily be eligible for but suddenly need food assistance, was an effective response to Americans affected by Hurricane Katrina in 2005. Today’s pandemic should be a call for states to implement the same emergency benefits today.

My colleagues and I can do our best to manage the worst symptoms of COVID19 in the hospital, but the restrictive benefits that many of our patients receive once they are discharged often forces them to turn to either the cheapest calories­–processed foods made from refined sugars and oils–or go without food at all. In a time of social, economic, and emotional uncertainty, local governments should follow the evidence. Expanding nutritional benefits will give our country’s most vulnerable population financial freedom in a time of incredible stress and reduce the load on local health systems already strained to a breaking point.

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