Social Injustice Related to Food Insecurity and Nutritional Deficiency

HLTH 5350: Public Health & Social Justice

Kenva Smith

April 25th, 2024

 Malnutrition encompasses poor nutrition resulting in an excess, deficiency, or imbalance

in the intake and expenditure of energy or micro or macro-nutrients.
 Key factors of food security include availability, accessibility, food stability, and
biological utilization
 Food accessibility demands that food is economically accessible (affordable) and
physically accessible.
 Food insecurity can result in diet-related diseases and impairments such as diabetes,
hypertension, cardiovascular diseases, wasting, stunted growth, and metabolic disorders.
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I. Overview of Food Insecurity and Nutritional Deficiency (in low-income families/areas)

Food insecurity can be described as the lack of consistent access to safe and nutritious
food required for proper and complete development for individuals and their families (Lopes et
al., 2023). The concept of food insecurity is further defined by Healthy People 2030 as “a
household-level economic and social condition of limited or uncertain access to adequate food”
(DHHS, 2020b). There are two classifications of food insecurity, according to the United States
Department of Agriculture (USDA): low food security and very low food security. People who
experience low food security express a lower variety, quality, and desirability in their diet.
However, these diets show little to no indication of a diminished amount of food consumption
(DHHS, 2020b). Comparatively, people who experience very low food security have multiple
disruptions in eating patterns and generally, less food consumption (DHHS, 2020b). In addition
to food deprivation, people struggling with food insecurity may also experience a lack of
essential nutrition, limited knowledge of healthy eating, inadequate food storage conditions,
difficulty absorbing nutrients, and poor overall nutrition (Lopes et al., 2023).

According to the Food and Agriculture Organization of the United Nations (FAO), food
security is established with the relationship of the following four key factors: availability,
accessibility, food stability, and biological utilization (Lopes et al., 2023). Some factors that may
influence food security include education, income, gender, the presence of children in the home,
and more. Malnutrition can be defined as poor nutrition that includes an excess, deficiency, or
imbalance in the intake and expenditure of energy and other macro and micro-nutrients. As such,
this nutrient deficiency and energy imbalance encompasses both over and undernutrition leading
to alterations in body composition, body function, and clinical outcomes (Siddiqui et al., 2020).
Nutrient deficiency as it relates to malnutrition, is therefore representative of all manifestations
of poor nutrition, which may range from extreme hunger and undernutrition to obesity (Siddiqui
et al., 2020). A global assessment of food insecurity, hunger, and malnutrition by the FAO from
2009 - 2014/2015 exhibited positive projections for the decline of these issues. In contrast, the
FAO’s 2021 evaluation portrayed that 40.6% of the global population (roughly 268 million
people) suffered moderate to severe food insecurity. This was a 1.1% increase from 2020 (Lopes
et al., 2023).
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Furthermore, developed countries, such as Canada and the United States, are
experiencing a steady increase in food insecurity (Roncarolo & Potvin, 2016; Urcan, 2022). This
problem is particularly prevalent in families with children and various minority groups, which
often reflects their poverty status. A 2020 Census revealed that 37.2 million people endured the
effects of poverty within that year, including issues related to food security (Urcan, 2022). The
demographic statistics of the participants in the 2020 Census were as follows: 17% Hispanic,
8.2% non-Hispanic, 19.5% Black, and 8.1% Asian (Urcan, 2022). In 2022, 12.8% of American
households were food insecure, with 5.1% (or roughly 6.8 million) of them struggling with very
low food security (Martin, 2023). This is a notable and statistically significant increase in the
prevalence of food insecurity in American households. The 2021 evaluation depicted that there
was a total of 10.2% of families with food insecurity and 3.8% with very low food security.
About 17.3% of the households that experienced food insecurity in 2022 were families with
children (Martin, 2023). However, in half of these households, only parents experienced food
insecurity or very low food security to protect their children from hunger. Nevertheless, 8% of
households with children indicated that both children and parents suffered from food insecurity,
and 1% of households with children where the parents and children had very low food security.
In essence, a lack of food security is most common among various minority groups, families
with (multiple) children, and people of low socioeconomic status.

In 2018, about $96 billion in federal funds were dedicated to the USDA’s 14 food and
nutrition programs, which pales in comparison to the $183 billion in federal funds allocated to
these programs in 2022 (Miller &Thomas, 2020; Martin, 2023). Although Federal spending on
these programs decreased by 6% in 2022 compared to 2021(with an adjustment made for
inflation rates), there was still an increase in the spending for the Women Infant and Children
(WIC) program by 7% and the combined spending on child nutrition programs by 19% (Martin,
2023). Nevertheless, the Supplemental Nutrition Assistance Program (SNAP), though marginally
lower than in 2021, continued to aid roughly 41.1 million Americans monthly. Several states
such as New Mexico, West Virginia, Louisiana, Oklahoma, Oregon, and the District of
Columbia utilized SNAP assistance with the highest rates, which all exceed 16% (Martin, 2023).

The 2020-2025 Dietary Guidelines for Americans suggest healthy dietary habits that
consist of nutrient-dense food options. Predominantly, the goal is to guide U.S. residents on
healthy food selections for better, overall public health. Dietary recommendations include
regular consumption of a variety of vegetables, fruits, whole grains, lean meat, low-fat or fat-free
dairy, and some oils (DHHS, 2020a). An ideal diet would be well balanced, containing all the
later food groups while being cognizant of portion size. The guidelines also recommend limiting
or reducing the intake of food and drinks containing excess/added sugars, sodium, saturated fats,
and alcohol (DHHS, 2020a). A healthy, sustainable diet is flexible, contains the core elements of
the guidelines, and is tailored to the person's personal, cultural, and traditional preferences.
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Accessibility of nutrient-dense foods that support a balanced diet is relevant for the
present and future health of an individual. Research consistently states that a regular, healthy diet
is linked to beneficial health outcomes in chronic diseases such as all causes of mortality,
cardiovascular disease, weight management and obesity, type 2 diabetes, bone health, and certain
cancers such as breast and colorectal cancers. Therefore, safe, affordable, healthy foods are
essential to achieving overall personal and public health (DHHS, 2020a). A person’s health may
deteriorate substantially due to a deficiency in the essential micronutrients experienced from
food insecurity (Lopes et al., 2023). It can also cause diabetes, cardiovascular diseases, and
metabolic disorders. The selection of cost-efficient foods, typically found in lower-income areas,
more often than not, contain empty calories (Urcan, 2023). This means that the foods are void of,
or limited in essential nutrients, but still provide calories. A consistent deficiency and lack of
access to healthy foods will lead to health complications, including chronic diseases such as
diabetes, obesity, hypertension, and cardiovascular disease.

II. How is Nutritional Deficiency a Social Injustice?

As human beings, we all have inherent rights, which include the right to food. Deaths
from hunger are not solely the result of famine and conflict or war. About 90% of hunger-related
deaths are a result of long-term lack of access to sufficient sustenance (FAO, 2000). Everyone
has the right to food, which the United Nations Special Rapporteur describes as, “The right to
have regular, permanent and free 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 ensures a physical and
mental, individual and collective, fulfilling and dignified life free of fear.” (FAO, 2000).

According to the FAO, food should be available. Availability means that people should
have food available through means of either farming, fishing, hunting, gathering, or grocery
shopping (FAO, 2000). Secondly, food should be accessible, which demands a guarantee of both
economic and physical access to food. Economic accessibility means that people should be able
to afford sufficient food without having to compromise on other basic necessities, such as
housing and healthcare (FAO, 2000). With physical accessibility, food should be easily
accessible even to those with physical vulnerabilities, such as the elderly, sick, children, and
people who live in remote areas. Finally, food should be adequate for the consumer, which
demands that food meet the dietary requirements of each individual based on their activity level
and stage in life (eg. toddler, adolescent, adult, etc.). Adequacy also encompasses the safety of
food from contaminants and demands that food be culturally appropriate to the consumer (FAO,
2000). Therefore, migrants living in a host country might have inadequate food if they do not
have the food that they are accustomed to from their country. Removal of either of these three
factors for an extended period would mean that the person is food insecure and may be
experiencing some form of malnutrition (nutritional deficiency).
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An example of social injustice related to food insecurity is noted in research conducted

by James et al., (2014). The study investigated whether minorities and impoverished
neighborhoods had greater access to fast-food restaurants in the United States. Accessibility to
these restaurants was measured based on driving distance from within each Census block group
(CBG). Researchers measured the proximity of the nearest 5 restaurants to most of the
population in the CBG. Neighborhood compositions were characterized based on socioeconomic
status, the percentage of Black residents, and the population density. Geocoded business data
were utilized to assess the type of restaurants that were present, but misclassification of industry
classification codes, particularly in neighborhoods with low socioeconomic status and higher
minority populations, was evident. As a result, the study chose to only use restaurants from the
list of top ten “limited-service restaurants” such as McDonalds, Subway, Chick-Fil-A, etc.

The study found that areas with concentrated poverty tend to have higher access to fast-
food compared to less impoverished areas, with mean distances ranging from 0.86 miles in areas
with the highest access to 13.25 miles in areas with the lowest access (James et al., 2014). Higher
percentages of Black residents and poverty concentrations were observed in the southeast and
southwestern states, while fast-food access was highest on the coasts, correlating with higher
population density. Research indicated that increased access to fast-food establishments is
associated with higher consumption, which is a risk factor for obesity. The study also indicated
that middle-income individuals tend to consume the most fast-food, nevertheless, there is a
higher probability of fast-food consumption among Black individuals regardless of income level
(James et al., 2014). This suggests that factors beyond poverty, such as access and advertising,
may influence fast-food consumption patterns in predominantly Black neighborhoods.

Another example of social injustice is in an article by Jiang et al., (2024) in which they
assess the nutritional deficiencies among children, globally. Based on the Global Burden of
Disease study in 2019, the four most common nutritional deficiencies among children include
Vitamin A deficiency, dietary iron deficiency, protein-energy malnutrition, and iodine
deficiency. Nutrition is exceptionally important during the childhood years since it plays a
critical role in the growth and development of a person. There are inequalities in access and
availability of health care for children in many countries and territories across the world. In many
cases, the lack of access to food and healthcare services can be attributed to a low socioeconomic
class. Roughly one-third of children younger than five suffer from malnutrition to some degree.
Malnutrition during childhood may result in wasting, being underweight, or stunted growth.
Specific examples of nutrient-deficient side effects of Vitamin A include vision loss, stunted
growth, and an increased risk of infection. Another clear correlation between socioeconomic
status and malnutrition is protein-energy deficiency, which is most commonly seen in lower
socioeconomic groups. Essentially, between 1990 and 2019, the greatest impact of the four
nutritional deficiencies was noted in regions with low socio-demographic Index (SDI) (Jiang et
al., 2024).

III. Evidence of Social Injustice in Literature

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Primarily, the James et al., (2014) article sheds light on profound social injustices
prevalent in low socioeconomic status (SES) areas and neighborhoods predominantly inhabited
by Black residents. It elucidates the way the disproportionate concentration of fast-food
establishments in these communities perpetuates systemic discrimination and fosters food
insecurity. The prevalence of convenient, unhealthy food options that are ladened with calories,
salt, sugar, and cholesterol, not only contributes to chronic diet-related illnesses but also reflects
a predatory and discriminatory pattern, as fast-food establishments strategically target
neighborhoods with high Black populations. Consequently, Black individuals are
disproportionately affected by diet-related diseases and multiple factors associated with low SES
compared to other racial groups. The unjust distribution of fast-food outlets reinforces existing
socioeconomic disparities, thus reinforcing the vulnerability of low-income individuals and
families to the adverse health consequences and nutritional deficiencies associated with limited
access to nutritious food options. This environment of limited access to nutritious food options
exacerbates malnutrition, leading to a cycle of poor mental health, diminished energy levels, and
increased susceptibility to chronic diet-related illnesses.

Similarly, nutritional deficiencies among children around the world are another great
example of social injustice as explained by Jiang et al., (2024). These nutritional deficiencies
violate the children’s fundamental human right to food, as expressed by the FAO. The right to
food does not only encompass access to sustenance but also ensures a level of comfort in life that
is free from the worry and pain of hunger, which aligns with the United Nations Special
Rapporteur's vision. Nutrition plays a pivotal role in children's growth and development, making
it essential for addressing inequalities in access to adequate nutrition and improving physical
health. Jiang et al.'s (2024) study highlights this disparity, revealing that regions with lower
Socio-demographic Index (SDI) scores experience the highest incidence of four prevalent
nutritional deficiencies among children. These disparities perpetuate cycles of poverty and illness
and impede children's growth and development, further exacerbating the interrelated pressures
created by malnutrition. amplifying the need for concerted efforts to uphold children's rights to
nutrition and healthcare as foundational pillars of human rights.

IV. Issue in Context of Human Rights

Human rights are standardized views that create a framework for the preservation of
human dignity and the maintenance of a universal moral gauge (Ayala & Meier, 2017). Relevant
human rights relate to the articles include the right to health and the right to food. The
International Bill of Human Rights is comprised of three human rights documents, namely the
Universal Declaration of Human Rights (UDHR), the International Covenant on Civil and
Political Rights (ICCPR), and the International Covenant on Economic, Social and Cultural
Rights (ICESCR) (Ayala & Meier, 2017). UDHR clarified standardized rights sufficient for
individual health and well-being. These rights were based on underlying determinants of health,
such as food, clothes, housing, medical care, and security during times of unemployment, just to
name a few (Ayala & Meier, 2017). Through the International Bill of Human Rights, norms
relative to fundamental human rights were established, which were instrumental in the creation
and evolution of the human right to food and the human right to good health. The right to health
and the right to food became interconnected rights under international law (Ayala & Meier,
2017).
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Within the United States, the right to food is protected by federal social assistance
programs through the USDA (USDA, 2021). In March of 2021, President Biden provided federal
support to the USDA by the American Rescue Plan Act. The USDA used this support to fund its
nutrition assistance program to help those struggling with food security in the United States. The
most utilized program is the USDA’s SNAP program. SNAP is geared towards helping
America’s low-income families obtain healthy and affordable groceries. Roughly 43 million
Americans depend on SNAP to feed themselves and their families. For example, in 2021, about
two-thirds of the $7 billion dollar funds allocated to SNAP were utilized by families with
children. Online grocery purchases are also possible with SNAP electronic benefit transfer,
further simplifying access and availability of food. Due to USDA waivers and flexibility,
children in need can also receive free or reduced lunches at school, and their parents/guardians
are permitted to pick up meals for themselves as well. WIC is another USDA program that caters
to providing tailored nutrition to new, breastfeeding mothers, infants, and children up to five
years of age. WIC also has Cash Value Vouchers that allow its participants to buy fresh fruit and
vegetables from farmers markets and grocery stores (USDA, 2021). Utilization of nutritional
assistance programs such as these can reduce the prevalence of food insecurity and malnutrition
among the populations mentioned in the selected articles.

V. Literature Evaluation

James et al., article presented valid information that sheds light on the disproportionate
access to nutritious foods within low-socioeconomic and predominantly black neighborhoods.
However, the researchers did not account for the accessibility of the restaurants as it relates to
walkability, driving, public transportation, or crime risks. They also did not factor in small
business restaurants to give a better idea of how saturated these neighborhoods really are with
unhealthy, yet easily accessible and affordable restaurant food. Moreover, the researchers relied
on commercially available data for the research, which are known for poor validity in assessing
the type of establishment.

Jiang et al., clearly outlined the most common deficiencies and their prevalence in
children around the world. The researchers adequately explained the physical manifestations of
these deficiencies. However, the data they used from the Global Burden of Disease database may
be incorrect based on poor records or underreporting of the disease registration within some
lower-income countries/territories. Furthermore, the research only included protein-energy
deficiency, vitamin A deficiency, iodine deficiency, and iron deficiency. The research did not
include other nutritional deficiencies such as vitamin C, Vitamin D, Vitamin K, and folate
deficiencies, which would have added a more well-rounded understanding of nutritional
deficiency in children around the world.
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Based on my perspective and experiences, food is medicine, and proper nutrition is

essential for overall mental and physical well-being of both adults and children. Primarily I have
witnessed that low-income areas and neighborhoods with many Black residents do have more
fast-food restaurants. Some of these restaurants are small businesses while others are fast-food
chains with more than one store within less than a 5-mile radius of each other. Additionally, I
have met or know of many African Americans and people of low SES who, despite their level of
income, purchase fast-food or have it delivered almost daily. Their reasons for not preparing
food at home include a lack of time, knowledge, or ability to do so. I firmly believe that despite
how quick and affordable fast-food restaurants are, they perpetuate a cycle of poverty, low
energy, poor mood, and poor physical and mental health. This perspective was reinforced after
reading the chapter on nutrition.

This is also relevant to child growth and development. Children are a vulnerable
population who grow very rapidly and require proper nutrition to support this rapid growth. I
believe that it is imperative for growing children to receive good-quality food to be healthy and
for their proper development. As noted in the textbook, low-income children are less likely to
meet height and weight standards based on the international growth charts due to inadequate
food and nutrients. Similar to malnourished adults who are mentally and physically tired and
underperform at work, children who experience chronic hunger and food deprivation are more
likely to have trouble learning, have mental disorders, experience higher rates of emotional
problems, and frequently exhibit disruptive behavior. Furthermore, the textbook explains how
low food security leads to higher rates of illnesses, hospitalization, as well as missing
school/work. Finally, the obesity paradox is another issue to consider with low-income children
and adults. Obtaining high-quality food in sufficient quantity with strained finances is an
impossible feat. The result is a constant low-quality, high-calorie food that results in diet-related
diseases and deficiencies and obesity (despite not consuming an abundance of food). Ensuring
food security for adults and children, both locally and internationally, addresses immediate
nutritional needs, fosters healthier societies, reduces preventable diseases, and may alleviate
financial burdens associated with healthcare costs and productivity losses.
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References

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