Vermont consistently ranks high for health and wellness, only recently dropping from No. 1 to No. 2 as healthiest state in the 2013 America’s Health Rankings by the United Health Foundation. Also last year, Vermont received a No. 2 overall rank from the Annie E. Casey Foundation for children’s wellbeing.
But if you dig deeper into the most recent Annie E. Casey Foundation Kids Count indicators, which use statistics from 2011, you’ll see that all is not well for Vermont children and families. Although 98 percent of Vermont children had health insurance, the study shows that 15 percent of them lived in poverty, 29 percent of their parents lacked secure employment and 36 percent lived in households with a high housing cost burden.
A Public Health Issue in Vermont
Statistics like these, according to experts, contribute to a significant public health issue in Vermont: food insecurity, which the non-profit organization Hunger Free Vermont defines as “the lack of access to enough food to fully meet basic needs at all times due to lack of financial resources.” One in eight households in Vermont suffers from food insecurity, the organization notes. Lack of affordable housing, depressed wages, lack of public transportation, a decrease in local, affordable grocery stores, and federal cuts to nutrition and social service programs all contribute to food insecurity.
“Vermont has made health a priority and has an excellent public health, health care and social service network that is collaborative and contributes to the high health and wellbeing rankings,” said Jan Carney, M.D., M.P.H., associate dean for public health and professor of medicine at the University of Vermont and an advisor for a one-hour Hunger Free Vermont online tutorial on food insecurity. “However, when you look more closely at what specific measures are collected, we do not fare nearly as well in areas related to economic wellbeing indicators as they impact children’s health. Based on these indicators, it is not surprising that we continue to see Vermont children and families at risk for food insecurity. Food insecurity remains an all-too-common public health issue in Vermont.”
Food Insecurity Education
Dorigen Keeney, M.S., R.D., program director with Hunger Free Vermont, said the organization created the tutorial to “help physicians and other health care providers appreciate that hunger is often hidden. People struggle without food in private, and families may feel ashamed if they cannot afford enough nutritious food for their children or even enough food. There is a stigma. Nobody wants to be in these programs. It’s demeaning.”
She acknowledges that “in Vermont, we kind of have a two-tiered society where, yes, we have people with means who have access to a healthy lifestyle and access to organic, local food and opportunities to ski, but some of those things are quite expensive, and there is a proportion of our society that doesn’t have the funds to access these things.”
Since 2012, more than 270 professionals have taken Hunger Free Vermont’s self-directed course, “Childhood Hunger in Vermont: The Hidden Impacts on Health Development & Wellbeing,” and a number have received continuing education credits.
“Raising awareness among health professionals, community organizations, and the general public,” Carney said, “will help link children and families to food and nutrition resources available in Vermont communities.”
Outreach and Access
The tutorial complements Hunger Free Vermont’s mission to provide nutrition education and outreach and expand access to nutrition programs across the state. The organization works with schools to expand breakfast and lunch programs and child care centers to offer healthful meals; seeks to expand access to 3SquaresVT (formerly the Food Stamp Program); assists area agencies on aging to reach seniors in need of food assistance; lobbies the state Legislature and Congress to expand nutrition programs; and more.
“The vast majority of hungry households in Vermont and across the nation are those with children,” Keeney said. “One in five children in Vermont lives in a food-insecure household. But the number of seniors experiencing hunger is increasing as well because Social Security has not kept up with the cost of living. Seniors are struggling to keep up with the cost of medication and housing and food. At same time, only 30 percent of eligible seniors participate in 3SquaresVT. Seniors who live in food-insecure households have twice the health problems as seniors who don’t and also have higher rates of disability, so they are more likely to end up in nursing homes.”
Any professional who has a developed a relationship with a family can play a significant role in making sure parents, children and seniors get adequate nutrition, Keeney said. Although doctors and nurses may observe the impact of hunger on a child’s health, teachers are more likely to experience how food insecurity affects a child’s academic work and behavior in the classroom.
“If children are not getting enough food, but also if they are not getting enough quality food, that can have a profound impact on their health and education,” Keeney said. “They can have more nutrition deficiencies, such as iron deficiencies, which makes it harder to focus. They also can have more infections, more chronic diseases, more somatic issues like headaches and stomachaches, more anxiety and depression, more developmental delays and more behavior problems in the classroom. It’s hard to focus on schoolwork when you’re hungry.”
Hunger Free Vermont offers these suggestions for those working with families:
- Understand the factors that put children at high risk for food insecurity and hunger: poverty, single parent household, parent/caregiver with depression or other mental health issue, social isolation, child with special needs, high heating and/or utility costs.
- Recognize the “red flags” for a child experiencing undernutrition: delayed growth, obesity, anemia, problems with choking/swallowing, vomiting/reflux/gastro-esophageal reflux disease (GERD), limited diet/extreme pickiness, delay in acceptance of foods/textures, constipation/diarrhea, dysfunctional feeding relationship with a caretaker, significant dental caries, and use of bottle after age 2.
- Make sure all your co-workers know about 2-1-1 so they can refer families. 2-1-1 provides free confidential information and referral, 24 hours a day and 7 days a week, on Vermont’s regional services and resources, including food pantries, housing and heating assistance.
- Never assume a family has adequate food resources. Share information with families about 3SquaresVT and 2-1-1 for food and other resources. Make sure families know to apply for free and reduced school meals.
- As you develop a relationship with a family, provide them with information on local food shelves and offer to help them apply for food/nutrition programs.
- As you feel more comfortable, you can assist with addressing some of the other risk factors for hunger such as accessing mental health services.