Spotlight Exclusives

Food Insecurity Decreased During Pandemic for Low-Income Adults, Study Finds

Rishi Wadhera Rishi Wadhera, posted on

Federal policymakers moved many of the key levers of the government to try to provide assistance during the COVID-19 pandemic, particularly for low-income communities. A new study finds that when it comes to food insecurity, those approaches appear to have worked. Researchers from the Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, and Harvard Medical School found food insecurity among low-income adults actually decreased in 2021 from 2019. One of the researchers, Rishi Wadhera, a cardiologist at Beth Israel Deaconess Medical Center, Associate Professor of Medicine at Harvard Medical School and Section Head of Health Policy and Equity at the Smith Center, spoke with Spotlight recently. The transcript has been lightly edited for length and clarity.

Tell me a little bit about some of the previous studies that you’ve done and how this work fits into that.

My research group here at the Smith Center focuses much of our work on understanding the effects of state and federal health policies on care delivery, care quality, health outcomes, and health equity. So, this study was very much in line with prior work. We’ve also done a lot of work focused on how income-based inequities in the U.S.—educational inequality and racial and ethnic disparities—impact health outcomes and longevity, so this study very much fits into those two themes.

Tell me a little bit about how you set up the study and exactly what you did.

The primary reason we were interested in the study was because, as we know now, during the initial months of the COVID-19 pandemic in 2020, food insecurity spiked, especially amongst low-income families. And a large body of evidence has shown that food insecurity is associated with higher rates of chronic conditions like diabetes, high blood pressure, and high cholesterol. And so many of us in the healthcare community, as well as in the public health and policy communities, worried that the spike might have really major adverse consequences for health over the long term.

But fortunately, as you know, the government enacted a series of policies after the onset of the pandemic that bolstered safety net services in the country. One example of that is that nutritional benefits available through the Supplemental Nutritional Assistance parameters of SNAP were nearly doubled as a result of emergency allotments that were provided through some of these legislative actions. And also, economic impact payments or stimulus checks were dispersed to U.S. households across the country. And so the motivation for the study was we really just wanted to understand how food insecurity changed over the course of the pandemic in the face of increasing economic hardship, but also after the enactment of policies that aimed to mitigate the impact of economic loss.

And what data did you use?

We used the National Health Interview Survey, which is a nationally representative survey from the National Center for Health Statistics at the CDC. It collects a lot of granular information from patients. and then its sampling strategy allows researchers to generate nationally representative estimates of health outcomes. What we did was we evaluated changes in food insecurity in 2021 and 2022 compared to a pre-pandemic baseline in 2019. We determined the presence of food insecurity amongst respondents based on the Adult Food Security Survey module, which is a validated survey that the USDA uses. And what our study effectively did was we evaluated food insecurity during those pandemic years compared to just prior to the pandemic amongst low-income adults. And we also looked at specific subgroups of low-income adults that had received SNAP benefits compared to those that had not, as well as low-income adults that had one or more chronic condition like high blood pressure, diabetes, or high cholesterol.

And so, you found the rates went down overall, correct?

Yes. When we looked nationally at low-income adults, what we found was that food insecurity decreased from a pre-pandemic baseline rate of about 21%, meaning 21% of low-income families just prior to the pandemic experienced food insecurity. And that that rate dropped in 2021 to 15.5%, so about a 5% percentage point drop in food insecurity during the pandemic. But then we moved forward to 2022, what we found was that those gains in reducing food insecurity were sort of eliminated, as rates returned back to pre-pandemic levels.

When we stratified adults based on whether they received SNAP benefits or not, what we found was that the rates of food insecurity declined from 34% in 2019 to 21% in 2021. So, a big drop of 13 percentage points. And then when moved on to 2022 during the pandemic, things got worse again. Food insecurity rates rose to 27%, but 27% amongst SNAP recipients was still much lower than pre-pandemic.

And did you look specifically at any other safety net programs?  I’m wondering about WIC in particular.

We did not. One of the things we observed is that it’s very challenging to disentangle which policy had the most impact, as a lot of policies were enacted after the pandemic started. It wasn’t just bolstering SNAP benefits, but we also had the economic impact fund payments that were dispersed to low-income families and the expansion of the Child Tax Credit. All of these things together probably mitigated what we anticipated might be a big rise in food insecurity during the pandemic and actually helped reduce it. I think as many of those policies are being peeled back, we’re concerned that we’ll start to see another big rise in food insecurity.

What’s the message here for policymakers?

I think the first thing that we can learn from the pandemic is that federal and state efforts to bolster safety net services were effective. We’re just looking at one parameter here, food insecurity. But we know that food insecurity is inextricably tied to health, and a lot of the legislative actions that came through during the pandemic helped mitigate what we expected to be a big rise in food insecurity and actually helped to reduce it. And so, what we’re seeing is, although we can’t specifically attribute the entire decline to one policy or another, is that the collective efforts to protect, in particular low-income families during the pandemic through policy were actually very, very effective.

What we’re learning now is that as many of these policies have begun to be rolled back, it has led to an increase in food insecurity amongst low-income adults. So, as we grapple with what policies should be continued and what policies should be brought back, we should think about the fact that we have good evidence during the pandemic that many of these policies were effective and that they will likely have major long-term implications on health.

And did the study look specifically at adults or were children included as well?

This study was limited to adults aged 18 or over.

And what are your plans in terms of follow up?

A couple of things. I think it’s critically important that we continue to monitor food insecurity rates amongst low-income families through 2023 and 2024 and especially amongst minoritized and marginalized groups who are more likely to experience higher rates of food insecurity. Given the strong link between food insecurity and chronic conditions and long-term health outcomes, we are also going to keep monitoring how rates of food insecurity are changing amongst low-income adults with chronic conditions.

I think another important thing that we need to understand is as many of these policies have come to an end, we’ve seen an increase in food insecurity, but what will the implications of that be for health outcomes one, two, or three years from now? Any evidence that we can generate that shows that perhaps these policies have longer-term implications for health outcomes might be useful to policymakers. So, a lot more work to be done in this space, especially as Congress will be debating the Farm Bill in another eight months.

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