An Rx for Hunger?

There’s no single cure when it comes to solving food insecurity, says USC researcher Dr. Kayla de la Haye.

As the Food Equity Roundtable convenes over the year, members will periodically share insights about their work to alleviate chronic food insecurity in Los Angeles County. Dr. Kayla de la Haye, an associate professor of population and public health sciences at the Keck School of Medicine of USC, serves on the Roundtable’s technical committee. Here she discusses a new report from the USC Dornsife Public Exchange program that found that 1 million Angelenos continue to struggle with food insecurity on a regular basis.

Researchers found adults who remained food insecure in the first half of 2021 are predominantly low-income, women, Latinos and between the ages of 18-40 years old. Although CalFresh benefits helped transition households from being food insecure to food secure, just 1 in 4 food-insecure households were receiving CalFresh benefits — federally known as the Supplemental Nutrition Assistance Program, or SNAP — as of June 2021. More than a third of them live in “food deserts” — low-income areas with poor access to supermarkets and large grocery stores.

Can you explain the link between what we think of as traditional medical science and food support?

Sometimes our mission is working with folks that are sick and to improve their lives, but a big part of it is working out how to prevent people from being sick in the first place.  There are huge disparities in who ends up not having good health in our country. At Keck, we think about early prevention, and what needs to be in place so that all people have the opportunity to live a healthy life. Food is so central to that. Food is very linked to diabetes, many cancers, heart disease–all of the things that are leading causes of illness in this country. It’s something that starts really early. Children develop their food preferences early in life, and this impacts their health trajectories over time.

And that’s where the concept of public health kicks in, right?

One of the most compelling things I heard as a graduate student doing public health work was one keynote speaker at a conference say: “If 50 years ago we had set out to say, ‘Let’s build a country that makes sure as many people get diabetes as possible,’ we would’ve built exactly what we have.” And so, the job of public health is to think about all the things that need to shift, both working with people and giving them information, and helping them make healthy choices, but also, addressing the bigger set of problems and systems that create the conditions that make it easy or accessible to eat well. That’s also the business of public health.

So how did you engage with the County on food insecurity?

I began working with the County in May 2020, right after the pandemic hit. I’d been doing research on home visiting programs, where we work with low income moms and their infants, and help support them to adopt healthy eating habits. I was doing that before that pandemic hit. But as soon as it hit, it became clear that moms couldn’t fill half their plates with fruits and veggies, they just didn’t have food at all. It became apparent that the pandemic was going to just take the rug out from everything we were trying to achieve with helping families eat well.

So what did you do next?

I started asking around at USC about who was working on food insecurity, and the Public Exchange had just started out as this new office whose job it is to help connect researchers at USC with public and private partners, which is really cool. I think it’s strange that universities don’t have more of this, but it really helps connect the right people over a problem that they’re trying to work on. The County had reached out to Public Exchange and asked: “Hey, do you guys have anyone who’s working on food insecurity, because we’ve just set up this emergency food security branch. We want to understand what’s going on, and try to get some data.”

From your perspective, how can the Roundtable best tackle food insecurity. What’s the answer?

It’s a complex problem. In science, we think of this in terms of systems thinking. We’ve had a history in public health and medicine of saying “There’s a cause and effect, and we need to find out what the main cause is, fix it, and that’ll change the outcome.”  But with eating, we know that it is a complex system. So, there’s no one thing that is going to resolve food insecurity and help everybody eat well. There’s no silver bullet.

So where do we start?

It’s going to require many different strategies, but I think we have a lot of insights about what some of the key ones are — reducing poverty and low incomes. We know that programs like CalFresh, the Supplemental Nutrition Assistance Program, really helps alleviate food insecurity. We know that there’s a lot of issues with access to healthy food, and access might mean that I have a store near me that has healthy foods that I can purchase. Even if I take the bus, I can purchase them there and bring them home. But access also means that I can afford these healthy foods, and that they’re foods I want to eat and are aligned with my cultural preferences.

What is the big picture goal?

We’ve found that folks who are food insecure and are getting food assistance often don’t have good access to healthy foods; and this can lead to poor nutrition. So what we really want to solve for is creating food systems that are going to help us get to a place where all people are nutritionally secure; so they have enough food that is high quality and nutritious, and isn’t going cause diabetes and other chronic diseases. So that’s a bigger goal — not just giving people the calories they need, but access to nutritious calories. And that’s a more complicated problem. It’s going to involve rethinking and transforming the food system as we know it.