Garden Harvest

Hunger in Appalachia

  
While the devastating effects of hunger touch the lives of many Americans, Jaime Ciavarra reports on the unique challenges facing the country's rural communities. This powerful article, first published in Perspectives Magazine (University of Ohio) adds another voice to the Back to Basics on Food series, a collection of articles for WHY Speaks.

The Hunger of Rural America

Text by Jaime Ciavarra

About 23 percent of people in Appalachia don't get enough food to eat, according to studies by nutritionist David Holben. And they aren't just hungry - they also report more health problems.

Things are getting better for Dee and Don. After eight months of staying with friends, they finally moved into a place of their own in the small town of Nelsonville, Ohio. It's been a tough year, and they've had a hard time finding jobs. The kitchen cabinets and refrigerator shelves of their new home are like their stomachs: empty.

"Sometimes we just don't have money for food," Dee says. "I worry about food every single day."

It's another cold Monday night in mid-November, and Dee, Don, and Dee's 14-year-old daughter Paula file into Nelsonville Children's Services, greeting a few other families with quick hugs and smiles. Dee snuggles a friend's baby against her gray sweatshirt as her free hand fingers the table below for a plastic bowl and spoon. Most already are gathered around the tall cooking pot of chili. At this family program, where dinner is always served, the fiery pot seems to steam out smoke signals: Eat me while you can.

"I'm hungry," Don says with a laugh, as he pours a second helping of red-hot chili into his bowl. "I've only had a cup of coffee today. I finally get to have a meal."

Don, Dee, and Paula, like thousands of other families across the nation, depend on food assistance to get through the week. Nearly 10 percent of the United States population lacks access to enough food, and many depend on food assistance programs, skip meals, and seek help from soup kitchens and pantries to get by. Almost 700,000 U.S. households in small towns and communities did not have enough food in 2000, according to the U.S. Department of Agriculture's Economic Research Service (ERS).

Don and Dee have been hungry for years. Both grew up in rural areas of Ohio and West Virginia, and their families also relied on food stamps. Someday they would like to have enough money to quit the program, but until then, they need the assistance.

"Buying food is so expensive," says Dee, who has had minimum-wage jobs, usually in fast-food restaurants and bakeries, her entire life. "When I worked 50-hour weeks, I still didn't have enough money."

Dee and her family seem to be caught in an unending struggle. While some Americans may be unaware of the extent of such hunger problems in this country, nutritionist David Holben has dealt with the issue on a personal and professional level. He grew up in a rural community and witnessed the high rate of poverty and unemployment in the region.

"I lived in poverty," he says, "and now I'm interested in its effects on rural people."

Holben, an associate professor of human and consumer sciences at Ohio University, studies hunger in rural Appalachia, and he hopes his results will alert community and government organizations to take greater action. His research links poor access to food and self-reported health problems, and strives to clarify the prevalence of food insecurity in this area of the country.

The rate of households without enough food appears to be even higher in rural Appalachia than the overall national level, reaching nearly 23 percent, according to his research. Holben and his colleagues surveyed 1,006 people in southeastern Ohio and found that a substantial number didn't have good access to food. The researchers questioned people at grocery stores, health fairs, and church festivals in Athens and surrounding counties, and at clinical settings such as hospitals and doctors' offices. They used a questionnaire developed and approved by the USDA that determined a person's access to food and weight loss over a year.

Of those Holben surveyed, 227, or nearly one-fifth, were hungry. About 98 people said they were in severe hunger, according to the study, which was published in the Journal of Rural Health. For many Americans, wages have not risen enough to cover the increased cost of living. Rural residents' average per capita income is $7,417 lower than in urban areas, and rural Americans are more likely to live below the poverty level, according to the ERS. A low income, coupled with high housing and health care costs and fewer opportunities for employment, can make groceries an unaffordable luxury.

Low-income rural residents also often lack transportation, making it even harder to use food stamps or get to a food bank.

"Grocery stores and pantries aren't exactly around the corner" in rural America, Holben says. Though the situation is bad in Appalachia, hunger is a national problem, and Holben's study is part of a growing effort to examine food insecurity in America. The federal government implemented the National Nutrition Monitoring Act of 1990 to measure levels of food security, which is defined as having enough food at all times for a healthy diet. The USDA monitors hunger through an annual food survey, and Second Harvest, the nation's largest domestic hunger relief organization, supports food security research about every five years. In 1997, Second Harvest interviewed nearly 28,000 emergency food recipients face to face in order to develop an accurate profile of hungry Americans.

Every few weeks, Don and Dee buy groceries with the Ohio Direction card, which replaced paper food stamps in 1999. Don likes using the card because it resembles a credit card.

"No one needs to know," he says.

But the couple aren't ashamed of using the program - they've paid into it through taxes, they point out. Because of the federal programs, they have enough food to help them through the week if they carefully budget. Some days Don has only a cup of coffee so that Paula will have a decent meal. The family would like to stop using the federal programs - and when things are better, they do - but they are accustomed to using assistance, Dee says. It's always been a part of their lives.

One in every 15 Americans, some 18 million people, benefits from the Food Stamp Program, according to the ERS. The program is part of the larger National Nutrition Safety Net, which is managed by state and local governments and includes the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), school lunch and breakfast programs, and most private-sector emergency food programs, such as food banks and pantries.

Paula receives free lunch tickets at her school, and using them doesn't always bother her, she says.

"I understand when they are going through a hard time," she says about Don and her mother.

Holben can relate to Paula, although his experience, like that of many other children, affected his pride. He grew up in a rural, low-income household in Pennsylvania and received free lunch tickets during junior and senior high school. Although he was proud of his family, he wished his orange meal tickets were blue, like those of his classmates.

"It's hard to be different than everyone else," he says. "I was just so embarrassed."

After the hot chili dinner, Jeannette Ray, instructor of the program at Nelsonville Children's Services, sets up a buffet of oats, corn oil, peanut butter, and raisins on a long wooden desk. "Tonight," she screeches over chitchat and children's screams, "we're going to use those items on your shelf at home to make a real treat - no-bake cookies."

Ray teaches nutrition classes at Children's Services about once a month, instructing families on how to keep food safe in the home, plan healthy diets, and use food pantry items to the fullest.

"Many people get food from a pantry, but they don't know what to do with it," Ray says. "And every time you go, they give you the same thing."

Those who want help, and take advantage of it, often find problems with the Nutrition Safety Net. There are about 10 food pantries in Athens County alone, and participants may pick up food items about every two months. Although the food is nutritious and, for the most part, has a long shelf life, it is packaged as a bulk item.

"Most people wouldn't know what to do with 10 pounds of oats," Ray says, "including me." Ray's class is one of only a few available for area residents. It covers issues such as hygiene and children's chores, but emphasizes a healthy diet. A similar federal program, the Expanded Food and Nutrition Education Program (EFNEP) was discontinued in Athens County in 2000 because too few people attended - due, in part, to lack of transportation. Also, most rural counties have too few residents to fund the program (EFNEP requires at least 17,000), regardless of need. Today, only 22 of Ohio's 88 counties offer the EFNEP program. Most in rural Ohio have been discontinued, while those in urban areas are thriving.

But rural residents have ways to cope with not having enough food that urban residents don't. Holben's research indicates that people in Appalachia are more food secure if they garden or hunt.

"In rural Appalachia," Ray adds, "people are used to living off the land."

In fact, Ray wraps up the meeting with a promise to bring game recipes to the next class.

"Fresh meat is very healthy," she says to the group of five families at the Children's Services Center. "And that's what we care about, right? Our family's health."

After his initial food insecurity study, Holben wanted to learn more about the actual health problems experienced by families who have a tough time putting enough food on the table. He and his colleagues surveyed 2,608 people in Athens County and surrounding areas using a food questionnaire. Of those, 815 people participated in a mini-clinical exam, where researchers took blood samples to compare statistics such as weight, blood pressure, hemoglobin, total cholesterol, and blood sugar.

Holben's research suggests that people without a steady diet were more likely to be overweight. In fact, obesity was greater among food-scarce households compared with households that had enough food, and, surprisingly, obesity increased as levels of food security worsened. While the reason for this is still unknown, Holben poses a few possibilities: People overeat when they have food because meals often are few and far between. Others simply are not educated on which foods are nutritious, or think that they can't afford to buy healthy food. In poverty-stricken households, low-cost, high-fat foods usually reach the table first.

"A package of hot dogs may be 99 cents and last you a week, but they aren't necessarily nutritious," Holben says.

The research also indicates that about 11.9 percent of those surveyed were diabetics, and individuals with high blood sugar were more likely to be food scarce. "Skipping meals or overeating in a following meal can cause a lot of stress on the body," says Melanie Moynan Smith, diabetes educator and nurse practitioner at Nelsonville Clinic's Community Service Programs. Smith, who screens people for diabetes at food pantries, community centers, and health fairs, confirms that some correlation exists between food insecurity and diabetes. Those who are anxious about paying for food or having enough food often also have high glucose levels, she says, which indicate a risk for type II diabetes.

Ironically, the costs to control diabetes actually can worsen food insecurity, Holben says.

"Many times, people from low-income families need to make choices: Do I pay for rent, or do I pay for food? Do I pay for my medications, or do I pay for food?" says Holben, adding that food is often a lower priority.

Don, 43, although not diabetic, has his own health problems. He suffered from two heart attacks in the past five years. Although heart disease is genetic, his overall health may be affected by the lack of enough nutritious food, Smith says.

Holben's research also indicates that even minimal food insecurity affects a person's perception of health - a finding that doesn't surprise him. Many people believe that food is a large part of being healthy, he says.

"How can I feel healthy if I don't know where my next meal is coming from?" he asks.

Feeling well often is a mental and physical challenge for people without enough to eat, adds Smith, noting that many suffer from depression, anxiety, and a sense of hopelessness from not being able to provide food for themselves or their families.

At 7:30 p.m., the families in Ray's nutrition program gather their bags of no-bake cookies and shuffle out the door, some giving hugs and rides home. It's only a matter of time until they'll see each other again. "See you later," Dee says to a friend, and she follows Paula and Don outside.

The factors that force families such as these into food insecurity are complex, and will remain the focus of Holben's studies for some years to come.

"In this region, there is a cycle of poverty and hunger," he says.

Holben and a team of researchers are studying food security factors among families in the Athens area whose children participate in the Head Start program. Another project examines the link between food security and depression in women.

As for Don and Dee, the couple will continue to fight hunger - when they can.

"I'm trying new techniques to budget money for food," Dee says as she walks out the door. "People say, 'When you go to the store, never go hungry.' But with me, that's kind of tough."

Reprinted with permission. This article first appeared in the Spring / Summer 2003 issue Ohio University's Perspectives Magazine (Volume VII Number I).

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