Our hope for all of the patients we see in the pediatric clinics at Arkansas Children’s Hospital is that they will thrive in families that have enough money for basic needs, including rent, utilities, medical bills, and prescriptions and still have enough each month to pay for adequate food for all family members (food security). Unfortunately, this is not the case for many families in Arkansas where food insecurity rates are the second highest of any state in the US. Twenty seven percent of households with children are food insecure in Arkansas. For the 196,950 children in our state living in these food-insecure households, the effects are documented on their bodies y brains.

Recently, a new patient–a young child–was referred to our clinic after being hospitalized twice for Failure to Thrive, a condition of poor physical growth which can be due to malnutrition. This child lives with his mother and father and two siblings who all rely on the meager wages his father brings home. They try to stretch earnings of $420 per month to pay for utilities, rent, clothing, gas, a car payment, and food. However, due to the father’s fluctuating wages making them eligible some months and ineligible in others, the family has stopped receiving SNAP (Supplemental Nutritional Assistance Program – formerly known as food stamps). Without this assistance, each month they do the best they can to make ends meet, but often run out of food before the next pay day. Our team of physicians, nurses, dieticians, and social workers will work intensively with this patient and his family to stabilize his health, but unfortunately he is just one of many, many more children whose health is jeopardized, despite his parents’ efforts, by scarce financial resources.

For many families, including the family in this story, traditional safeguards of growing up in a two-parent household with a working parent do not guarantee food security. When families, regardless of marital status, employment, or education, struggle to pay for expenses in a basic household budget, they are  often forced to make trade-offs between necessities, including rent, utilities, food, medical care, and prescriptions.

Today, Children’s HealthWatch is releasing a informe demonstrating the harmful impacts of food insecurity on young children and their mothers and families in Arkansas. As part of this research, we also explored the impact of food insecurity particularly among families with an employed caregiver who attended technical school, college, or higher.

Compared with young children in similar food-secure families, young children from food-insecure households with an employed caregiver with education beyond high school were more like to be in fair or poor health. Additionally, compared to similar food-secure families, food-insecure mothers and families with an employed caregiver with education beyond high school were more likely to:

• Be in fair or poor maternal health
• Report maternal depressive symptoms
• Have been in a crowded housing situation or doubled up or moved frequently (>1 in the past year)
• Be behind on rent
• Have received a threatened or actual utility shut-off notice, had an unheated or uncooled day or used the cooking stove for heat
• Make a health care trade-off between paying for other basic living expenses such as food, rent, or housing in order to pay for health care
• Forego seeking health care for household members other than the young child due to cost

These data show the reverberating impacts of food insecurity on children, mothers, and families.  Interlocking and multidisciplinary solutions are within reach that will help to alleviate hardships experienced by families with children. In our report and in a blog published in October 2014, we outlined ways in which health care facilities can help their patients be as healthy as possible byscreening them for food insecurity and connecting them with necessary resources. Existing programs designed to address food insecurity within the health care system are a model and provide thousands of children and families each year with much needed assistance. However, these programs alone cannot effectively relieve the burden experienced by families struggling to stretch household budgets each month to pay for food.  As physicians, we want to ensure we have something to offer that helps over both the short and long terms.

Screening for food insecurity and offering interventions to stabilize families are steps toward identifying the problem and ensuring food security for families, but are often not enough to maintain food security over the longer term. Working families rely on wages and work supports to meet their needs, but may fall through the cracks of our economic system. Without coordinated public policies that address their needs, the health and development of children in working families will continue to suffer.

Many states and cities across the nation have begun to recognize the necessity to implement policies that not only benefit the low-income families, but also boost the economy, such as raising the minimum wage and providing a state Earned Income Tax Credit. Raising the minimum wage and ensuring that the lowest wage earned in the state are not taxed at a higher rate than those with the highest incomes would help to reduce poverty, and likely also food insecurity, rates in Arkansas. Now is the time to call upon decision makers to pass a state level Earned Income Tax Credit (EITC), which would allow low-income, working adults in Arkansas to receive a refund on their income taxes. By implementing a state EITC in Arkansas, families who rely on low wages to get by would have more money in their pocket, enabling them to direct the funds where they are most needed in the family budget – for example, affording basic needs or catching up on overdue bills. Ultimately, a state EITC would move many families out of poverty, enable them to become food secure, and thus improve child health.

Parents should never have to choose between paying the rent, utility bills, and medical expenses and feeding their family. Policy solutions that address food insecurity by boosting household budgets are necessary for the future of Arkansas’ children, families, and economic prosperity.