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Twitter: @ClancyCHarrisonFB: Clancy Harrison

#FoodDignity

The Ethics of Hunger: COVID-19, Food Insecurity and the Role of the

Health Professionals

Spokesperson• American Dairy Association North East• National Dairy Council Ambassador

Board Member/Advisory Panel • United Way Safety Net Council, Luzerne County, Pa• Al Beech West Side Food Pantry, Kingston, Pa • Advisor PA Academy Pediatrics Food Insecurity EPIC Program• Founder, Food Dignity® Project

Author• Feeding Baby• www.ClancyHarrison.com

Clancy Harrison’s Disclosures

Recovering Food Elitist“Food Snob”

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Al Beech West Side

Food Pantry President

& Founder, Food

Dignity® Project

Reality: most people living with food insecurity are:

•working• looking for work•disabled• ill (mental, physical, emotional)• single mothers• elderly• college students• veterans•COVID‐19 

I made assumptions and projected my personal food philosophy!

Food Security DefinitionsHigh Food Security “no reported indications of food-access problems or limitations….. access by all people, at all times to sufficient food for an active and healthy life.”

Marginal Food Security “one or two reported indications- typically of anxiety over food sufficiency or shortage of food in the house.”

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Food Insecurity Definitions Low Food Security “reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake”

Very Low Food Security “ reports of multiple indication of disrupted eating patterns and reduced food intake.”

Pre-COVID 19 Food Insecurity Rates in U.S.

Feeding America 2017

37 M people11 M children

Projection via Feeding America

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Compared to March 2019: Increase

1700%

A month’s worth of food GONE

within 3 hours!

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Pregnant Women/Fetus/NewbornSame as the adult high risks plus the following:

Anxiety & depressionBirth defectsGestational diabetesIron deficiencyLow birth weightPreterm birthStress on fetus

Anxiety and behavior disorders, depression Low Bone DensityADHDIron deficiencyLow nutrient intakeLow cognitive developmentillness and hospitalization

Suicide ideation

Child Health Risks of Food Insecurity

High Cost of Food Insecurity (FI)

•$3.5 trillion U.S. healthcare costs in 2017

•$52.9 billion in U.S. healthcare costs in 2019 caused by FI 

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Food Assistance Participation

59% households with food insecurity participated in at least 1 of the 3 major federal food assistance programs.

https://www.ers.usda.gov/webdocs/publications/84973/err237_summary.pdf?v=42979

• SNAP (food stamps)• School Feeding Programs• WIC (Women Infant & Children)

• Don’t qualify• Stigma• Treatment by staff or volunteers (i.e. racism)

• Office/work hours• Lack of knowledge• Technical difficulties • Transportation

Non-participation

Access and Access Barriers to Getting Food Stamps: A Review of the Literature. February 2008. ood insecurity, social capital and perceived personal disparity in predominantly rural region of Texas: an ndividual‐level analysis. 2011

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Hunger is an ethical issue.

Individual Institutional Community

Levels of Collaboration =

Collective EfficacyCollective efficacy is the capacity to make the changes necessary to better health and healthcare.

1.“Within the past 12 months we worried whether our food would run out before we got money to buy more.”

2.“Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”

Often true, Sometimes true, Never true

The Hunger Vital Sign

http://www.childrenshealthwatch.org/wp‐content/uploads/FINAL‐Hunger‐Vital‐Sign‐2‐pager1.pdf

Are we asking the right questions?

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Code for Food InsecurityICD-10-CM Diagnosis Code Z59.4(lack of adequate food and safe drinking water)

ICD-10-CM Diagnosis Code Z59.5(extreme poverty)

Food: Did you eat?

Time: decisions

based on survival 

Education: not a 

reality

Middle Class Wealth

Start where your cleints are……

Food: Presentation?

Time: decisions

made on tradition

Education: necessary

for connections 

Food: Did you like it?

Time: future is 

Important

Education: to climb

the ladder 

Poverty

Bridges to Health and Healthcare, 2014

Language of Food Negotiation Negotiation is generally not part of the reality of poverty because negotiation takes place only when a surplus exists. The reality of poverty is scarcity and the language of survival.

Poverty Food Discussion • 5 hotdogs• 5 people • Condiments are limited and the discussion around them will be limited

Middle-Class Discussion• How many hotdogs?• How many people?• What kind of condiments?• What other ingredients?

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Meet people at their starting point.

Challenges our Clients Face but We Don’t Know

•Transportation‐ taxi, bus, someone else’s car

•Location of grocery store (Dollar store vs full‐service grocery store)

•Unsafe home environment

You cannot eat a Suburban.

Grocery Store Talking Points/Solutions

What is your favorite store to buy food at?What is the closest store from where you live?

I know a lot of my clients rely on a dollar store for their food. Do you ever find yourself in a pinch and running into a dollar store for convenience?

I love the 10 for $10 sales at the grocery store. Do you find the sales helpful? 

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Kitchen Equipment Talking Points

I run into so many problems with kitchen equipment in my home. Do you have the same issue? 

What is working?What is not working? 

What is your favorite way to cook food? If they say microwave, ask more questions‐ this might be their only method for cooking. 

Long-Term Food Solutions Participants consume more milk, vegetables, protein food, and whole grains in the following programs:

•SNAP  Supplemental Nutrition Program•National School Lunch Program•The National School Breakfast Program•Afterschool Snacks and Meals•The Summer Food Service Program•WIC (Special Supplemental Food Program for Women, Infants, and Children)

Dietary Guidelines for Americans-Committee Report

Plant-source foodsAnimal-source

foods

"common characteristics of dietary patterns associated with positive 

health outcomes are higher intake of vegetables, fruits, legumes, whole grains, 

low‐ or non‐fat dairy, lean meat...”

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Plant + Animal Protein = Win-Win

• Affordable• Tasty• Nutrient dense• Easy/low skill level cooking• Convenient • Accessible

Milk’s Nutrition Profile is Tough to Match• Milk is leading food source of 3 out of 4 nutrients of public health concern. (Ca, K, vitamin D)

• Milk & milk products are recommended as a part of a healthy eating pattern.

National Health & Nutrition Examination Survey 2003‐2006, Nutrients 2013NHANDES 2003‐2006, Nutrients 2012Dietary Guidelines for Americans, 2015‐2020

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You have the power to make dry milk powder trendy, fun, unique, and a super food. 

• Long shelf life• Easy to add to recipes• Increases nutrition in foods

• Free at most food banks

Tips to Boost Nutrition with Dry Milk

•Cooked cereals: add 1⁄2 cup dry milk to each cup of cereal before cooking 

•Mashed potatoes: add 1⁄4 cup dry milk for each cup of potatoes 

•Meatloaf, hamburger, taco meat: add up to 1 cup of dry milk per pound of meat 

•Quick breads: add 1⁄4 cup milk powder to each cup of fluid liquid 

Tips to Boost Nutrition with Dry Milk

• Puddings, gravies, and sauces:  add 1⁄2 cup milk powder to each cup of liquid 

• Baked Beans: mix in 1⁄2 cup dry milk powder before baking 

• Canned soup: add 1⁄2 cup nonfat dry milk powder per serving 

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Follow Up – Document- Track

•Address concerns from prior appointment unique to the person•Transportation•Receiving food assistance yet?•Taking medications as directed?•Following medical meal plan?•How has their food access improved?

Individual Institutional Community

Levels of Collaboration =

Collective EfficacyCollective efficacy is the capacity to make the changes necessary to better health and healthcare.

Effective collaboration Be a connector of 

resources Don’t start something 

new, strengthen another program by adding your expertise 

Know pain points Racially inclusive  How can you connect your 

outcomes to their mission?

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Local Hunger Relief Organizations

• Feeding America• Local food

pantries• Local meal

service programs

• WIC Dietitian • Local, state,

national, referral list

Find Your Local Food Bankhttp://www.feedingamerica.org/find‐your‐local‐foodbank/

Local School Professionals •Guidance Counselors/Nurses•WIC RD• Feeding America Food Bank RD• School food service director•Director for Faculty Development and Diversity 

•HBCU (Historically Black College/University)

• Interns/Service Learning• Federal Work Study Programs 

Local Companies What businesses are suffering the most because of the COVID-19 shut down in your area?

• Retail• Hospitality • Local business associations • Ask your participants what companies they feel comfortable with?• Do your collaborations mirror the populations being served or who

must be served?

Can you provide resource materials through HR or the business owner?

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Pediatricians/Physicians• 20 dyads in PA

• Food pantry/pediatrician office• Pediatrician screens for FI• Refers to food pantry• VIP pass• Sample of produce, baby food, diapers

• 20 families coming to food pantry 

Transitional Care•Many patients who are malnourished or at risk do not receive the post‐discharge nutrition support needed to improve health outcomes

•Action to improve access to community‐based nutrition resources is CRITICAL to keep high‐risk patients healthy, enhance healing process, and avoid costly hospital readmissions. 

Know the barriers

• Survey your clients, staff• Individual Barriers

• Shame• Resources • Childhood experiences• Knowledge

• Community• Transportation• Technology challenges• Time/Work

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Your Next Action Steps• Survey the people you serve to discover information

and barriers (great marketing material)• Adapt nutrition education strategies to bust barriers

(transportation, working equipment, types of food retail, food assistance applications/identification)

• Poke holes in your professional, personal, social bubble • Follow up and document

TextDignity

to 44222

Join the Food Dignity® Project for ongoing tools and resources!

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