Understanding the Complexities of Food Insecurity in Rural Populations


Published: 11 February 2019

Food insecurity is a reality that challenges rural residents across the globe. It is vitally important that nurses, particularly those working in rural and regional settings, understand the risk factors that residents face related to food insecurity so that this community-level issue can be recognised and addressed with evidence-based strategies and compassion. Food insecurity is defined as the absence of unswerving, reliable access to adequate food for active healthy living (Coleman-Jensen, 2016). Long-term food insecurity positively correlates with learning difficulties in children, developmental delays, an increase in chronic diseases such as heart disease and chronic depressive disorders and increased family stressors. According to a 2017 report published by the United States Food and Drug Administration (U.S.D.A.), 13.3% of all U.S. rural households were food insecure at least some of the time during the year. Although this statistic is slightly down from the previous year (15% in 2016), it identifies a crucial public health issue. The unintended consequences of food insecurity have vastly impacted public health in Australia. In 2018, 3.6 million Australians experienced food insecurity at some point during the year and 27% of those residents were children. The demand for relief from food insecurity is rising in Australia and that is evidenced by charities reporting a 10% increase in demand in 2018 (The Food Bank, 2019).

Risk Factors Related to Food Insecurity

Place may pose one of the biggest risk factors for food insecurity experienced by rural residents. Many rural areas lack access to food retailers and those areas may be food wastelands (Rural Health Information Hub, 2019). Consider areas within your local region that may have limited supplies of fresh, reasonably-priced foods. Ironically, in my region of the Northeastern United States, some of the food wastelands exist in places were crops are grown and harvested! Transportation is another risk factor that challenges many rural residents at risk for food insecurity. Last week, our region experienced a severe ice and snow storm. Meals on Wheels, which is a program that delivers food to many rural residents was suspended due to road conditions, the residents who are most at risk for food insecurity were unable to receive these services for three-days until the storm passed. For hundreds of rural residents, they were forced to rely on gas station convenience stores that offer more expensive and often less healthy choices because they were within walking distance for the healthiest family member. A lack of social protections for rural residents such as farmers, households with children, individuals living with a disability, older adults, and immigrants who may resident in rural areas are at elevated risks for food insecurity. Nurses are in the unique position to assess these vulnerable residents when they are seen in either inpatient or outpatient settings.

The Hunger Vital Sign™

During my research on the topic of food insecurity, I began to reflect upon the enormity of the issue and how nurses in rural practice could positively impact this public health crisis. I am confident that the first step to address food insecurity must include the use of a standardised screening tool.  The Hunger Vital Sign is a simple screening tool that can easily be incorporated into a nursing assessment for use in inpatient, ambulatory and community-based rural settings. Hager and Quigg and the Children’s HealthWatch team (2010) evidenced the reliability and validity of this 2-question food insecurity tool based upon the U.S. Household Food Security Survey Module with the goal of identifying individuals and families who may be at risk for food insecurity. The Hunger Vital Sign™ identifies households as being at risk for food insecurity if they answer that either or both of the following two statements is ‘often true’ or ‘sometimes true’ (vs. ‘never true’): “Within the past 12-months we worried whether our food would run out before you got money to buy more.” “Within the past 12-months the food we bought just didn’t last and we didn’t have money to get more.” The results of this survey have been cited in hundreds of publications since its release and this simple, yet insightful tool has been widely used in medical and community-based settings across the United States. The American Academy of Pediatrics (2015) released a policy statement recommending that paediatric providers screen all children for food insecurity. Additionally, the Centers for Medicare & Medicaid Services (2017) incorporated The Hunger Vital Sign™ in the Accountable Health Communities Screening Tool. There is no fee or license required to use The Hunger Vital Sign™. The authors simply ask that healthcare specialists properly cite the resource.  In 2018, U.S. residents once again rated the nursing profession as the most trusted of all professions. Therefore, I suggest that we are ideally suited to address this public health issue that is too often associated with shame, guilt, and hopelessness. As nurse educators we are ideally positioned to shed light on this health crisis and advocate for a standardised tool that would draw attention to the crisis of food insecurity. I encourage you to review The Hunger Vital Sign™ and other resources. Select a tool that has proven validity and reliability and incorporate its’ use as a “pilot project” into your nursing assessment tool after you provide education and training to your nursing team.  The leadership of your team may suggest a six to twelve-month pilot with quarterly reviews of the findings. The knowledge that will be gained through this process will allow you to then identify strategies to meet the unique needs of the rural residents within your community.  Shedding light on this important topic may change a glass half-empty to one that is half-full.



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Judith Paré View profile
Judith Paré joined the Massachusetts Nurses Association (MNA) in May, 2017 as the Director of Nursing Education/Workforce Quality and Safety. In 2014, Judith earned her Doctorate of Philosophy in the field of Nursing Education Capella University. Prior to joining the MNA she was Dean of the School of Nursing & Behavioral Sciences at Becker College in Worcester Massachusetts. She is an experienced educator in academic and continuing education settings. Judith is a member of more than ten professional nursing organisations and she devotes much of her time as an advocate for the Rural Nurse Organisation. Her expertise include curriculum design, assessment and evaluation in nursing and healthcare. Her research areas of expertise in rural healthcare and specifically the lived experiences of the rural nurse generalist. Judith is a published author and a national speaker in the field of rural nursing. Her recent writings includes: Montgomery, S, Sutton A & Paré, J 2017, ‘Rural Nursing & Synergy’, Online Journal of Rural Nursing & Health Care, vol. 17, no. 1, pp. 87-99. http://dx.doi.org/10.14574/ojrnhc.v17i1.431