‘It’s really hard to cut a lot of vegetables if you don’t have a sharp knife’
Dr. Sarah Bowen on thinking beyond food insecurity
Food insecurity is a major issue in the U.S. For example, a recent JAMA Internal Medicine research letter found that “nearly 1 in 10 Medicare enrollees 65 years and older and 4 in 10 enrollees younger than 65 years experience food insecurity.”
While food security is a major factor contributing to an individual’s health, it’s only one part of the bigger factor. Many underlying factors can go into whether or not a person can even take advantage of the food at their disposal, including time and money.
Dr. Sarah Bowen is one of the authors of “Pressure Cooker: Why Home Cooking Won’t Solve Our Problems and What We Can Do About It.” Along with authors Joslyn Brenton and Sinikka Elliott, the book explores nine families in North Carolina and their relationship with food. The authors conclude that advancements can be made at multiple levels, including federal policy and at the community level.
We spoke with Bowen to discuss her research, what lurks beneath the definition of food insecurity, and what can be done.
This interview has been lightly edited for brevity and clarity.
Patchwise Labs: Can you give a quick overview of Pressure Cooker and how it might relate to food insecurity?
Sarah Bowen (SB): Our book is not exclusively about food insecurity although I think it has a lot to say about food insecurity. When we got started back in 2011/2012, we were hearing a lot of messages in the media — from celebrity chefs and food activists — that something is wrong with the food system. Everyone basically agreed on that but the emphasis was that the way we’re going to change is by getting back into the kitchen, cooking from scratch, and thinking carefully about what we eat.
The book is based on a larger research study involving interviews with over 150 mothers of young children in North Carolina. Most of those are poor, working class. The book is organized around the stories of nine families. We take on seven foodie mantras and show how they resonate or don’t resonate in lots of families. Some of them have something to offer and some of them are really out of touch. We wanted to look at how are real people eating and what challenges they face in getting dinner on the table.
PL: One of the stories involves a woman named Patricia who is living in a hotel room with her family. She lives across the street from a grocery store but is limited to what she can cook despite having “easy” access to food. Were there any “a-ha” moments in the research were you saw that access to food wasn’t a solution to itself?
SB: Patricia was a good example of how having access to food in the form of a nearby grocery store matters but isn’t the main thing. When we started, there was —and still is — a lot of talk about food deserts. These are places where people don’t have access to a nearby grocery store. I’ll start out by saying I think that does matter; it certainly made it easier for Patricia. She had a grocery store across the street from the hotel where she was living when her family — her daughter and her two grandchildren — was evicted from her home. We saw other families where it was much harder because they didn’t have a store nearby.
But it’s not the only thing. Patricia’s family was living in this cramped, crowded hotel room that held most of their stuff. They had some stuff in storage but a lot of it was in this little hotel room. They had to do all their cooking and eating there so they made a lot of their meals in the microwave. They also had a hot plate, a little mini-fridge, and had to eat most of their meals just sitting on their beds. That meant they bought a lot of processed food, frozen dinners, frozen pizzas, and the like.
That’s just one example but I think when we’re talking about if families have access to food and/or if they have enough food, there are many factors. Money is a huge part of it but even money is not the only factor.
PL: How did money factor into what you saw in your research and food insecurity?
SB: To reduce food insecurity, one of the main things we could do is offer more support to people in the form of food stamps or wages. Almost all of the poor and working class families in our research told us that they couldn’t buy all of the healthy foods that they wanted to because they were too expensive.
One mom for example said “I wish I could buy more fruits and vegetables and even organic” and she really cared about health and worked hard to teach her kids about health but she had a low budget for food so she said she just bought necessities. She tried to not to buy a lot of treats but that also means she couldn’t buy things that were considered healthy. We heard that from many moms.
Money is a big factor but it intersects with other things, such as time. Time is another factor that cut across our studies — not just for the poor and working class but for the middle class families as well. Many people felt they didn’t have enough time to cook the way they wanted to. If you have enough money, you can buy your way out of some of those restraints. You can buy pre-cut vegetables or have your own food delivered so that you can eat closer to the way you want to if you don’t have a lot of time.
If you don’t have money or time—which is true for many of the poor, working class families in our study—you can’t buy your way out in terms of food hacks so there’s little you can do. One thing you can do is take shortcuts with food like make boxed mac and cheese and things that maybe you don’t feel great about but they don’t cost a lot or require that much time.
“Food waste is a bigger risk, a bigger deal if you don’t have a lot of money to spend on food.”
PL: Some healthcare providers are exploring “prescribing” healthy meals to patients. Did you see any of that in your research?
SB: I have heard a little bit about the prescriptions for fresh produce though we didn’t see that in the communities in this study. We had some examples that might be similar to that. We had food pantries trying to increase fresh produce and also tie that to classes with families to better use that produce.
There are lots of initiatives that are trying to use creative ways to increase access to fruits and vegetables. To be successful, it requires thinking about the big picture. In general, that’s our argument in our findings. For example, think about kitchen tools. A lot of the families in our study did not have basic kitchen tools like sharp knives or a big pot to boil things in or a good pan. It’s really hard to cut a lot of vegetables if you don’t have a sharp knife. That’s relatively small but it’s a huge deal if you don’t have it.
Also, time matters. It takes time to cut and use that produce. A lot of the poor, working class families in our study did most of their shopping once a month. Some of them didn’t have a car so they had to take a bus to the store and then maybe get a taxi to come back. Some of them had a car but still preferred to do most of their shopping monthly as a budgeting strategy so they know they have the food.
PL: What conclusions did you make about what could be done moving forward?
SB: In the book, we talk about how we can make changes on multiple levels, which I think is important because sometimes certain policy choices do not look realistic. I think federal policy changes are really important and fundamental but there are also things we can to at a community and family level as well.
I think for healthcare providers, talking and listening and trying to pay attention to family experiences of food insecurity is important. I think some providers are doing assessments of food insecurity but I would imagine not all. We definitely saw that in our study. In one of our observations, we were with Patricia, who we were talking about earlier, at a doctor’s appointment. We were talking about the youngest child; he was underweight and having some issues with eating at the time. Patricia and the doctors were talking and the doctors were giving advice but they never realized the whole time that Patricia and her family were living in a hotel. It was really relevant to what they were talking about but it never came up. She didn’t mention it and no one asked.
I think that is something providers can do and I think there are — from what I understand — some shifts being made in the right direction on that. In terms of policy, making food is a human right.
What does that mean? It means instead of debating whether people deserve — or which people deserve — support for food in terms of food stamps or other things, we should start on the assumption that everyone in the U.S. deserves to have enough to eat and operate from there.
That means expanding SNAP instead of restricting it. A lot of the families in our studies were getting SNAP and it was incredibly critical to their well-being in terms of food and otherwise. That also means addressing not just food assistance but also the underlying conditions that cause poverty, including wages.
The other big policy idea is about support families. This book focused on families and mothers of young children between the ages of 2 and 8 years old. Everyone in our study, including the middle class mothers, was working very hard and felt like they were failing. This is distinct in the United States because our support for families are worse than any other wealthy country in terms of paid parental leave, guaranteed healthcare, and subsidized childcare. That’s the other place where we can make some real difference for moms, children, and families.
PL: What’s next for your research?
SB: We interviewed poor, working class moms three times over five years and did observations two times. The book is based mostly on the first year of interviews and observation. We have all this longitudinal data that we’re just starting to analyze.
One of the things that I want to do is look at food insecurity longitudinally. As families move in and out of food insecurity, we want to look at what are the different factors and social processes attached to that. We saw over the five years that families changed as they moved, got jobs, lost jobs, and had changes in terms of who was in the family via separations, divorce, and babies born. We can look at this over time and compare families to each other and their trajectories over time to try and untangle what is causing food insecurity, what’s associated with it, and what are the outcomes.
One thing we saw was that a lot of families did experience health crises and those had major spinoff effects in terms of health and well-being as well as financially so that’s something I think we’ll be looking at more closely as well.
