Who’s Hungry?


It is no secret that growing income inequality is one of the major issues facing the nation today. Close to 50 million Americans, or 1 in 6, live in poverty and 1 in 3 children are now projected to live in poverty at some point in their lifetime. But did you know, up to 1 in 3 kids in San Francisco may go to bed hungry tonight?

As the price of housing transforms our city into one of the most expensive in the country, the national income gap seems to have landed on our doorstep. And while this topic has garnered robust media attention and local public debate, the focus on poverty remains cursory, at best. Here, the housing crisis is literally changing the face of the city, and yet it is hard to identify who is most affected by the fickle pendulum of the economy and it is easy to make affordable housing the center of the conversation.

But the impact of poverty extends from the most recognizable needs in our community to one of the least – hunger. So let’s talk about it. Who’s hungry in our city?

Meet Lani. Lani’s grandmother originally came to San Francisco from Samoa in the late 1970s and her family has lived and worked in the Bay Area ever since. Like many of us, she dreams of owning a home in the city one day, but like a growing population of San Franciscans, her immediate need is food for her family.

Lani is a 35-year-old working mother of 2 and the only employed adult in her household. Her husband was a construction worker who, because of poor health, is physically unable to work. And after losing her mother in 2008, she and her husband became legal guardians to her younger siblings. That means, it’s all up to Lani to make ends meet.

As a high school graduate, she’s worked in food and cleaning services, but with the downturn in the economy, consistent work has been hard to find. In 2012, she became a certified nursing assistant and found a part-time position that offered $14 an hour but no benefits. She took it.

All 6 members of her household live in a government subsidized apartment in Hunter’s Point and yet because of her new income they recently found out they no longer qualify for food stamps or CalWorks. Struggling to get by without any additional aid, they rely on food from her church to make it to the end of the week. Sometimes, that is only a bag of rice and a can of vegetables. Her kids, aged 6 and 7, are just starting primary school. Without the free breakfast and lunch they receive there, she says she “probably wouldn’t be able to find something nutritious for them to eat at home.”

Hunger is a problem. But the issue here is more complex than the physical sensations of inadequate caloric intake. The more insidious challenge facing family’s like Lani’s is food insecurity, or limited or uncertain access to the resources to buy, store, and prepare the nutritious and culturally appropriate food necessary to support a healthy lifestyle.

According to the 2013 San Francisco Food Security Task Force’s annual report, 1 in 4 San Francisco residents live at or below 200% of the federal poverty level. For a family of 4, that’s about an income $47,100 per year. These low-income families make up a quarter of the city’s residents are the most likely to be food insecure. But the population we seldom recognize, despite having similarly high rates of food insecurity, is our city’s children.

For these communities, food insecurity is literally changing their lives. There is mounting scientific evidence showing that food insecurity is related to poor health outcomes like increased risk of adult chronic disease including diabetes and heart disease, and in children, increased risk of obesity and learning and behavior problems. And recent data from San Francisco General Hospital’s Community to Clinic Linkage Program, indicates almost half of the patients seeking urgent care at our county hospital are food insecure.

This is a public health problem and it sits at the intersection of income inequality and poverty in every city in America, including our own. In December 2013, the San Francisco Board of Supervisors issued a charge to local legislators and community organizations, to eliminate food insecurity in San Francisco by 2020. In collaboration with the San Francisco Food Security Task Force, help address this important issue!

Here are some things you can do today:

  • Support your local food bank by making a monetary donation, hosting a food drive, or donating food. The most needed items are: tuna, canned meat, peanut butter, soup, chili, beans, cereal, canned fruit and vegetables, and granola bars. Visit the SF-Marin Food Bank website to learn more.
  • Of all the students in the San Francisco Unified School District (SFUSD), 60% qualify for free or reduced priced meals, but less than half of those who are eligible are enrolled to receive this benefit. If you know of a child who may qualify, go the SFUSD website to apply now!
  • As summer approaches, even fewer low-come students have access to nutritious food. Know of a child who may need food over the summer? Go to the Department of Children, Youth, and Families website to find out how to enroll them in the After School Snack and Summer Meal Programs.
  • If you are a medical provider, start universally screening all of your patients for food insecurity. Here is a quick, validated tool you can use. If they screen positive, call 211 to connect them to food services!
  • Contact your state representative to support AB-2385. This bill would create the Market Match Program to provide additional income to recipients of programs like food stamps, to purchase food at farmer’s markets. A similar measure is being considered for San Francisco. Want to learn more? Visit the California Legislature website.
  • Join your local pediatricians and the American Academy of Pediatrics at Supervisor John Avalos’ Office in City Hall Room 244 to view a free photo exhibit entitled “Who’s Hungry? You Can’t Tell by Looking!” This exhibit captures the faces of local children to raise awareness of this often invisible need.

National rates of poverty are the highest they have been in decades and they impact our city in unique ways. But when you ask Lani what she wants for her kids, she doesn’t talk about eliminating financial stress or putting food on the table. She simply says, “I want them to become someone.” Healthy food and snacks are the building blocks to “become someone.” If recognizing the problem starts with asking the right questions, perhaps it is time we all asked, “Who’s Hungry?”

Hunger Matters

I thought that point was obvious. But apparently, there remains some debate because on November 1, 2013, the federal government effectively cut 5 billion dollars from the most powerful anti-hunger program in our country – food stamps (or SNAP as it is now called, which stands for Supplemental Nutrition and Assistance Program).

Here’s the quick history on the issue: During the recession, unemployment rates spiked. As family incomes fell, more families were at once eligible for food stamps and in need of extra money to put food on the table at the end of the month. To account for this increased need, the federal government issued a “stimulus package,” technically called the 2009 American Recovery and Reinvestment Act. The Act did a number of things, one of which was to boost food stamp benefits. That boost expired on November 1.

The problem is, usage of the program (read: hunger) remains at an all-time high. And, the program works.

So let’s break that 5 billion dollar cut down to real numbers. For a family of 4, it means they will lose $36 dollars per month to cover their food costs. That is equivalent to losing 21 meals per month OR if you try to stretch the money out, having about $1.40 per person per meal, each month.


To put that number in perspective, in case $1.40 seems reasonable to you, the USDA has actually calculated how much it costs to eat on a super tight budget. They call that estimated value the Thrifty Food Plan. According to this bare-bones estimation, the cheapest, nutritious meal in America costs at least $1.70-$2.50 (the exact value depends on age and gender). For millions of American families, that gap between $1.40 and $1.70 will be the difference between being fed and going hungry in 2014.

In medicine, we refer to “being fed” as food security, or access to sufficient, safe, and nutritious food to maintain a healthy life. It is estimated that 1 in 6 Americans are food insecure. In 2012, that was about 49 million people. As of November 8, 2013, SNAP provided food for more than 47 million people, nearly half of whom were children.

Imagine I said 1 in 6 people have swine flu or the plague or a terrible form of cancer. There would be outrage. Frankly, we’d call it an epidemic, a real problem that someone has to stop! And yet, when nearly 20% of Americans do not have enough food on their table, there is debate about what should be done.

The answer is simple, #saveSNAP.

In 2011, it was estimated that SNAP fed 1 in 4 children in the US. Children need healthy food to build bones, grow their brain, and control their behavior. Try hurdling the achievement gap without breakfast. The challenge is obvious. People need food to live and succeed. As a society, we simply cannot tackle the major problems ahead of us if we fail to provide for the most basic needs of our country.

In the coming months, I will re-address this issue as the House and the Senate consider bills that would eliminate food stamp benefits for millions of Americans.

In the meantime, check out what pediatricians, community advocates, and I are working on to tackle hunger in the Bay Area.