Food and Poverty: Food Insecurity and Food Sovereignty Among America’s Poor

Shruti Varadarajan, MD

Fam Med. 2019;51(9):782-783.

DOI: 10.22454/FamMed.2019.853046

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Book Title: Food and Poverty: Food Insecurity and Food Sovereignty Among America’s Poor

Book Author: Leslie H. Hossfeld, E. Brooke Kelly, Julia F. Waity

Publication Information: Nashville, TN, Vanderbilt University Press, 2018, 258 pp., $79.95, hardcover

The type of food produced and the way in which it is produced has drastically changed over the last 80 years in the United States. The transformation has been from regional, small, family-owned farms producing the bulk of the food the US needs in the 1940s, to now when food is mostly a mass-produced commodity that is shipped all over the country for consumption. Although food has been a commodity since the advent of agriculture, the relationship between the producers and consumers has grown into a complex web of transactions that ends up leading to inequities. These changes and complexities have affected people differently based on their race, class, and geographic locations. Food and Poverty: Food Insecurity and Food Sovereignty Among America’s Poor is a compilation of chapters from about 40 contributors from the fields of sociology, anthropology, horticulture, public policy, health policy, economics, and public health.   

The book is organized into three parts: Concepts, Problems, and Solutions. In the first part, the authors of the three chapters discuss the concepts of food insecurity, food sovereignty, and cultural factors that affect type of food intake. It also comments on the weakness of the federal poverty line to represent a measure of those at risk for food insecurity, and proposes different ways to define poverty to better elucidate food-insecure communities. Authors in this part point out that the poverty line was meant to elucidate the income that was definitely not enough to maintain a home, not the amount sufficient, as it is used now. Although the poverty line adjusts for inflation, this does not account for the larger increases in health care and childcare costs that affect the poor more significantly. By using the poverty line, many assistance programs are underestimating or undercounting the poor and those at risk for food insecurity.

The second part has nine chapters and constiutes the bulk of the text. This part of the book focuses on the problem of inequality of access to healthy, sustainable food. These chapters discuss the impact of geography, race, and ethnicity on food spending and risk of food insecurity. Chapters in this section support their assertions with data from national government resources and academic studies. Authors of the seventh chapter (Byrd, Byrd, and Cook) bring to light the problem that coupons for food items and sales at grocery stores are most often for high-calorie, low-nutrient, highly processed foods as opposed to healthier fresh food or produce. One of the assertions in this chapter is that coupons and sale ads can offer a way for households to reduce their food expenses, but due to emphasis on profit in the food industry, the benefit comes at a price of potential negative health outcomes. 

The third part of the book has six chapters that focus on solutions. It reviews examples of successful small-scale, community-based initiatives addressing the issue of food insecurity. These chapters discuss successes and challenges faced by public-private partnerships, food activist groups, campus food pantries, and community-based food systems in the journey to get healthy, culturally accepted food to all communities. While the previous two sections of this book are appropriately heavy with the seemingly insurmountable challenge of alleviating food insecurity and institutional racism in this world of plenty, this last part provides some light and hope to start addressing this challenge.  

Overall this book reads as a textbook from which certain chapters should be read as they are relevant to one’s area of study or interest, and not from cover to cover.  I noted that when reading this book through chapter to chapter, there was some repetition and contradictions of the common themes. I found this slightly blunted the message that each of the authors asserted in their chapters.     

The audience that would benefit most from this book are those involved in the fields of health policy, public health, sociology, applied anthropology, resource equity, and community organizers. While this book may not be the best choice for the busy clinician seeking actionable steps to address the food insecurity seen in his/her patient panel, it has a wealth of data and perspectives I had not before considered. As a practicing physician I see how my patients are greatly affected by their food and lifestyle choices. This book has helped me understand that there are larger forces at play in food production and distribution that impact the daily choices our patients make.


Lead Author

Shruti Varadarajan, MD

Affiliations: Baylor College of Medicine Department of Family and Community Medicine, Houston, TX

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