Q&A The intersections of disability & food insecurity

True before the pandemic and even more so now: Data shows people with disabilities are unemployed at a disproportionate rate compared with those who don’t live with a disability. This creates several economic barriers – including food insecurity.

Nearly 1 in 3 food-insecure households (31.8%) include a working-age adult who has a disability, according to research from the United States Department of Agriculture.

Just over 349,000 Iowans in 2017 reported having a disability — representing 11.3% of the state’s civilian, noninstitutionalized population, according to data from the Office of Persons with Disabilities. The number of Iowans between the ages of 18 and 64 with a disability who were employed in 2017 was 77,746, according to the agency.

During the summer, national data showed 20% of working people with disabilities lost their job as a result of the pandemic, compared with 14% of nondisabled workers. Employment status and income directly relate to food security.

I recently talked with Lyndi Buckingham-Schutt, associate director of wellness and nutrition policy at the Harkin Institute, about the disproportionate effects of food insecurity for Iowans with disabilities.

Is there anything specific that might lead to people with disabilities struggling adversely with food insecurity compared with other portions of the population?

When you think about food insecurity overall there's some of the major reasons for the big barriers for food insecurity. Cost is the really big one that people automatically think about that can be a barrier. We know that people with disabilities are not employed in the same way that people without disabilities are. So that's a big deal for the overall cost [of food] just based off of the way that people with disabilities are employed, and the income that they have.

But then we start to think about the other big barriers to food security. A big one could be location-based if you're living somewhere where you don't have access to a good grocery store – that's kind of an obvious one for anybody. But then what if we start to think about someone with a disability? We're going to layer on other things like it might be harder for them to get to the grocery store because of their disability. If it's a physical disability, maybe they can't drive there by themselves and someone has to take them. If it's a mental disability, maybe they can't get out of the house and go to that social setting or something of that sort. Or they can't navigate the grocery store by themselves and they don't have someone to help them.

Think about accessibility within the grocery store. It really shouldn't be an issue in terms of accessibility because of the Americans with Disabilities Act. The ADA was put in place to reduce those barriers in terms of access and whether someone with a wheelchair could get into a location, so that should be reduced. However, we still know that there are a lot of barriers in terms of getting into a grocery store, the aisles, if you can reach things. … When we go back to location-based [accessibility], what if they can’t get onto a bus? What if they do have access to public transportation and the bus is not handicap accessible for whatever reason?

Do you see a big barrier with accessibility with food pantries as well as grocery stores?

There are different barriers for different food pantries or food pantry networks. … When we think about food pantries in the state of Iowa, our rural food pantries … aren't open all the time and have limited hours. So they're already maybe not ideal for a lot of people to go to for those reasons. Then when you start to think about the barriers, … a person with a disability, if they don't have someone to take them there at that time, or if they're not able to be where they need to be, that is another barrier to accessing pantries.

Pantries are great and they're doing a better job of this, but coming from a health perspective, food pantries offer for the most part a lot of shelf-stable foods – and shelf-stable foods are not always exactly what I would call healthy. They can be if they have canned beans and canned fruit and those kinds of things. But overall, what we see in a lot of food pantries is limited produce, and especially fresh produce. You see a greater quantity of baked goods and those kinds of things that are perishable get donated to the food pantry. And then you see a lot of nonperishable things like box meals – so macaroni and cheese, Hamburger Helper, those kinds of things. So even if you can access [food], it's not going to help them necessarily have a healthy diet.

People with disabilities are more likely to have one type of chronic disease, and a lot of chronic diseases are nutrition-related. So Type 2 diabetes, heart disease – both very much tied in with what you're eating. If you only have access to unhealthy foods, or let's say someone's bringing them that food because it's free, it eliminates that cost barrier, but it might not be what's best for them.

What does it mean for people with disabilities to not be able to have food security?

There's firstly a very obvious physical manifestation of being food insecure. … [The cost barriers] tie in with the work we do at the Harkin Institute around making sure people with disabilities have meaningful employment opportunities so that they can afford food. Because even when people with a disability can qualify for Supplemental Nutrition Assistance Program [SNAP] benefits, just like anybody in the public can, those benefits are not going to be enough to provide them a healthy diet or reduce those other barriers [to accessibility].

Food insecurity should be important overall, but when we start to dig down we see there's a lot of disparity. We're seeing more in terms of racial groups, but then we're also seeing this disparity with people with disabilities. It’s important to think about anybody who has food insecurity, but we really need to start thinking about it for people who are at higher risk of being food insecure and for people with disabilities. They're at higher risk for these other things like these health-related chronic conditions … and there's a lot of research out there that’s kind of a chicken and the egg situation. Is it because they're food insecure that they have these chronic diseases or do they have these chronic diseases that are exacerbating making them more food insecure? It's something that I think we need to solve overall but we really need to pay attention to how it's disproportionately affecting certain people in our population. …

Social determinants of health are important. It's thinking outside of the traditional way you would think about what affects our health – so not only what I'm eating or if I'm seeing my doctor, but where I live, or how much money I make, or what kind of education I have. That gets to the equipment or housing that they have. Maybe they don't have a stove that's accessible for them to cook at or they don't even have a fridge they can put food into. So I think that that is a really important thing. Overall, our society just needs to start coming at food insecurity and health in general from that perspective. It's not just about going to your doctor. It's about what else you have surrounding you in the rest of your life that is uplifting you to a place where you can buy food and then you can buy healthy food on top of that.

Have you seen any programs, either in the state or elsewhere, that have really done a good job of addressing some of the accessibility needs that are out there?

One thing that's helping, but there's still some barriers to overcome, is grocery stores offering more delivery options. It's not a perfect thing, but it's definitely helpful in reducing that transportation barrier that I was talking about. There's still a ways to go for it.

They’re piloting it, but right now you're not allowed to use [SNAP benefits] if you do an online grocery order. So if someone is on SNAP, which they would likely be if they're food insecure, they can't do those grocery orders online. Making that available is a really good thing, especially during COVID. SNAP users are also probably more likely to have some of those chronic conditions that would make them high risk and not necessarily want to go to the grocery store.

So is that a SNAP mandate that the online delivery services can't use your SNAP benefits or is that just the grocery stores not allowing that?

It's not that it's not allowed – they're just piloting it right now because they've never done it before. And pretty much any changes they make, it's a giant task. SNAP is the largest nutrition program in the United States. … The important thing about SNAP is it’s a very responsive program. So if our economy goes down, SNAP enrollment increases. But the wonderful part about increasing is that money that we're funneling into that is then going to funnel back into the economy. It's so it's what they call a countercyclical assistance program. It's meant to be an economic booster because if they give people money and that's going into our economy through our retailers, then that kind of trickles down all the way to distributors and then we think about farmers. It's a way to funnel money back into our economy, but also while doing this wonderful thing of making sure people have food.

But because it is this beast of a program, obviously they don't make big changes without testing things first. With a lot of these online grocery ordering, I think they've rolled it out pretty quickly because of COVID. But I think there's already been a lot of struggle internally, from my understanding, just to get [online ordering] rolled out within grocery stores for normal customer use. So then when you layer on top of that having to figure out how to do that with SNAP benefits, then that's adding on that extra piece of work.

Is there anything else nutrition- or health-based that you think is important for people to understand about this issue?

Just in general with COVID-19 and people with disabilities – whether or not it's a food insecurity issue or just an overall issue in terms of health – but everyone is already struggling so much with their emotional health right now. But then we think of someone with a disability who maybe their social interaction was cut off, even the time they can get out and go to the grocery store or have someone bring them food that they can interact with [is cut off]. The emotional impact of COVID-19 on persons with disabilities is something to think about as well, whether it relates to this directly or indirectly. It's just a concern that I think I have overall for COVID-19 – for everybody and for people with disabilities.

What kinds of things can the business community do to help on this issue?

The food pantry network is wonderful and they do such an amazing job, but they will tell you this themselves, they eventually want to not be [in business] because they don’t want to be relied on by people needing to access food. But with that said, I think this is an important time to recognize they do need our help. So asking them how they want our help is important. …

We need to find ways to make people less food insecure. I'm going to obviously come at it from a policy angle, so that's making sure that we are offering people who are food insecure enough money so that they can become food secure. But then if we dig down even farther, we should be making sure people are employed so they don't have to rely on benefits. And then if we think about people with disabilities specifically, finding ways to employ them so that they can have a job where they can buy food, because food insecurity, at the end of the day, is really a financial economic issue.