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Linking Hunger and Health: The Place of Food Security in the Battle over Healthcare

Image from Robert F. Kennedy’s visit to the Mississippi Delta in April 1967. Photo copyright James Lucas Estate, used by permission.

On the fiftieth anniversary of what became known as “discovery of hunger” in the United States, it should not be lost upon us that the tropes now being mobilized to reduce, restrict, and restructure funding for the Supplemental Nutrition Assistance Program (SNAP)—the current rendition of the 1964 Food Stamp Program—are not new inventions but inheritances from its original opponents: the poor need to be forced to work, taught to be responsible, and weaned from their predilections for bad food. But the most insidious aspect of today’s assault is that it goes hand in glove with the congressional assault on affordable health care, especially as it concerns the lowest-income Americans. The food stamp program, in fact, is one of the most successful health programs in our history.

Today, we call the problem “food insecurity.” That was not the case in April 1967, when U.S. senators Joseph S. Clark Jr. (D-Pennsylvania) and Robert F. Kennedy (D-New York) toured the Mississippi Delta as representatives of the Senate Subcommittee on Employment, Manpower, and Poverty. A day after hearing testimony from local activists in Jackson about conditions in their home counties, the senators chose the terms “malnutrition” and “hunger” to name what they witnessed as children thronged around them, especially Kennedy, whose slain brother’s photograph hung on the flimsy walls of shacks they visited. Thus, hunger was “discovered” in the United States.

Kennedy compared these conditions to what he had observed in Latin America. Later that spring, a team of pediatricians conducted an epidemiological follow-up investigation funded by the Marshall Field Foundation and released a report detailing the visible and invisible health impacts of “chronic hunger and malnutrition” among children they examined. Published by the Southern Regional Council under the title “Hungry Children,” the report named a plethora of serious ailments, including abdominal edema (swollen bellies), osteoporosis, and heart disease. Testifying before the subcommittee in July, the team’s child psychiatrists, including Dr. Robert Coles, also assessed the impact of chronic malnutrition on mental health, based on their longer-term research.[1]

These alarms about hunger and malnutrition sounded elsewhere. In Memphis, St. Jude Children’s Research Hospital doctors found that poor kids suffering from malnutrition weren’t responding to cancer treatment as other children were, at the same time as black community activists discovered malnutrition was one of the most serious problems facing residents. In San Antonio, the medical staff at the public Robert B. Green Memorial Hospital reported on severe malnutrition among children there, while in Tuba City, Arizona, a physician with the Indian Health Service on the Navajo reservation reported a high incidence of infant mortality caused by undernutrition. Back in Mississippi at the Tufts-Delta Health Center, doctors began prescribing food to bolster immune systems.

These “discoveries” in the late 1960s triggered the public, political, and medical campaigns that ultimately led to the expansion of the food stamp program and creation of the Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC, in fact, was built on the model initiated by physicians and community activists in Memphis.[2] The embattled 1964 Food Stamp Program reached its current “entitlement” form in 1977, only after a decade of pressure against restrictive regulations. Food stamps were meant as an alternative to the Surplus Commodities Program, by which the USDA supported farm prices by purchasing bulk commodities from growers and distributing them to needy families. It was no secret that malnutrition could result from a diet based on flour, rice, lard, and the like, which supplied calories but few necessary nutrients. Proponents envisioned the Food Stamp Program as a dietary solution, but opponents such as Jamie Whitten (D-Miss.), chairman of the House Subcommittee on Agricultural Appropriations, succeeded in giving county officials authority to decide whether to implement stamps, commodities, or neither, and requiring payments from recipients, which made the program inaccessible to the neediest people. Once it began to serve all who qualified, the Food Stamp Program, together with WIC and the national school breakfast and lunch programs, reduced malnutrition and infant mortality to the point where it is not hard for comfortable Americans to forget the intimate links between health and hunger.

Even so, medical research conducted in recent years makes clear that access to food is right up there with Medicaid and the Children’s Health Insurance Program (CHIP) as the best guarantees of health within the lowest-income households. And figures released by the U.S. Department of Agriculture show that 12.7 percent of families still lacked food security for part or all of 2015, 21.5 and 19.1 percent respectively for African American and Latino families, even though the Great Recession officially ended in 2009. In a study published in 2015 in Pediatrics, researchers with the Council on Community Pediatrics’ Committee on Nutrition reported on “poorer overall health and more hospitalizations” among infants and toddlers suffering from undernutrition, iron deficiency among children of all ages, and “lower bone density in preadolescent boys.” In a domino effect, parents who reduce their own food intake so their children can eat more suffer from frequent illnesses and, as a result, cannot care for these children properly. A September 2016 report by the Urban Institute confirms that teenagers, too, sacrifice for the youngest family members, but by shouldering this responsibility they jeopardize their ability to concentrate in school.

Unfortunately, political commentary on the current Republican attack on the Affordable Care Act (ACA) and Medicaid rarely takes into account the parallel threats to the food stamp program. From a couple of vantage points, this makes sense. Health falls under the aegis of the Department of Health and Human Services (HHS), food under the U.S. Department of Agriculture (USDA), and the congressional committees follow suit. The USDA’s deliberate shift in language away from hunger and malnutrition also helps explain this split. In the early 1990s, the USDA determined the measurable category of “food security” would allow it to generate economic data based on questionnaires about whether families experienced a lack of access to sufficient food for all or part of the year. Breaking this data down by state, race, gender, and other variables offers a crucial snapshot of economic disparity; however, it obfuscates the health impact of chronic hunger. In 2006, the agency discarded its one category that straddled the divide, “food insecure with hunger,” which acknowledged physiological feelings in addition to empty cupboards, and replaced it with “very low food insecurity.” As historians we need to recognize the “work” such shifts in language can do.

Unita Blackwell and Fannie Lou Hamer testify before the U.S. Senate, 1967. Copyright, Jim Lucas Estate, used with permission.

For the activists whose testimony in Jackson spurred the senators’ famous tour 50 years ago and the hundreds of black Delta residents who packed the hearing, such a separation would have been inconceivable. Consider how Fannie Lou Hamer seized on Chairman Joseph Clark’s simple informational question about whether Sunflower, where she lived, was a “plantation county”: “It’s plantation,” she responded, “and people are hungry this evening because [it’s] the only way after the minimum wage bit, Senator Clark, we really are having it in Sunflower County. And not only that, but when they said they are going to replace the commodities, the surplus food, with stamps, then somebody is going to starve. There’s a lot of people in Sunflower County have suffered from malnutrition.”[3]

The 1966 minimum wage law, the first to cover agricultural workers, did “bite” because it signaled the end of the cotton plantation system based on human laborers, not machines and pesticides. In a tragic irony, two years earlier, the Mississippi Freedom Labor Union had struck for a minimum wage and members had testified at minimum wage hearings in Washington, D.C. Now, it wasn’t the minimum wage but access to food that had become deeply politicized. Hamer viewed the replacement of surplus commodities with food stamps—the twisting of a liberal reform—as a reprisal, one harsh enough to cause malnutrition, even starvation, if not migration from the region. Two counties over in Issaquena, according to activist Unita Blackwell, who also testified, newly minted black voters were using the threat of the ballot to stop county supervisors from implementing food stamps. Malnutrition and starvation (a term the senators would replace with hunger) weren’t simply results of poverty; both could have been avoided. It was this context that led the activists, supported by then-attorney Marian Wright [Edelman], working in Mississippi with the NAACP Legal Defense Fund, to bring their situation to the senators.

These intensely local struggles became ones of national politics. To simply label food stamps an “entitlement program” misses this history. Even with the creation the following year of the Senate Select Committee on Nutrition and Human Needs, headed by Sen. George McGovern (D-South Dakota), it was not until 1973 that Congress required every political jurisdiction to implement the Food Stamp Program, taking the decision out of local hands. Although then-Secretary of Agriculture Orville Freeman reduced prices, the USDA required payments until finally eliminated by Congress in 1977.

Dangerous current proposals by leaders in the Republican-dominated Congress to place power over food programs back into local hands—in this case into state hands—need to be considered against this historical backdrop. House Speaker Paul Ryan’s proposed plan to slash SNAP funding and repackage it as block grants to the states became a veritable crusade when he served as House Budget Committee chairman from 2011 to 2015. With Ryan’s “opportunity grants,” each state would receive a fixed amount of money to cover food stamps and related social programs, then have the authority to prioritize and regulate use of those funds.

State control of health care for needy people already has a track record: offered the opportunity to continue state Medicaid expansions by the Obama administration, 31 states and the District of Columbia took advantage of the proposal, while governors of 19 states, ten in the South, rejected it. The Affordable Care Act replacement bill released by Ryan on March 6 could further lock in state inequalities through the “per capita cap” on Medicaid. It may appear that the per capita approach is better than a block grant; after all, it would allow states to raise the number of enrollees at a time of crisis, which block grants would not. However, there are big inequalities in state eligibility rules and spending levels per enrollee, and these could become the basis for the caps. The Kaiser Family Foundation reports that some states literally spend half as much as others on their enrollees. Even if states that spend the least now, like Alabama and Nevada, wanted to adopt different policies, they could not.

Historians provide an important voice in these looming crises, not only by positing food stamps and other food programs as central to the battle over healthcare but by placing them in the context of historical struggles emanating out of much larger conflicts.

Laurie B. Green is an associate professor of history at the University of Texas at Austin and an OAH Distinguished Lecturer. Her first book, Battling the Plantation Mentality: Memphis and the Black Freedom Struggle (2007), won the Philip Taft Labor History Book Award. Her current book project is entitled “The Discovery of Hunger in America: The Politics of Race, Poverty, and Malnutrition after the Fall of Jim Crow.”

[1] Joseph A. Loftus, “Clark and Kennedy Visit the Poor of Mississippi,” New York Times, April 12, 1967, 29; Southern Regional Council, “Hungry Children” (Atlanta, Georgia: Southern Regional Council, 1967); and Hunger and Malnutrition in America Hearings before the United States Senate Committee on Labor and Public Welfare, Subcommittee on Employment, Manpower, and Poverty, Ninetieth Congress, First session, on July 11, 12, 1967 (Washington, D.C.: Government Printing Office, 1967), pp. 1-2, 24-6.

[2] See my chapter, “Saving Babies in Memphis: The Politics of Race, Health, and Hunger during the War on Poverty,” in Annelise Orleck and Lisa Hazirjian, The War on Poverty: A New Grassroots History, 1964-1980 (Athens: University of Georgia Press, 2011), 133-58.

[3] Hearings before the Subcommittee on Employment, Manpower, and Poverty of the Committee on Labor and Public Welfare, United States Senate, Ninetieth Congress, First session, on Examining the War on Poverty, Part 2, Jackson, Miss., April 10, 1967 (Washington, D.C.: Government Printing Office, 1967), p., 582