Screening children for hunger is only the first step

In a number of countries, including the Philippines, “have you eaten?” is a greeting as common as “how are you?” Recognizing the important place of food in the culture, this greeting is seen as warm way of extending friendship and hospitality.

Thanks to recent action by the American Academy of Pediatrics, many physicians will now be essentially asking their patients the same question – but for a very different purpose.

Driven by concerns about food insecurity in the United States, the academy is recommending that pediatricians screen all children for hunger by asking caregivers to respond to the following two statements: “Within the past 12 months, we worried whether our food would run out before we got money to buy more,” and “Within the past 12 months, the food we bought just didn’t last and we didn’t have money to get more.”

Given the impacts of food insecurity on the physical and mental health, behavioral and educational outcomes of our children, the academy should be applauded for taking the bold and necessary steps to identify food insecurity, which can’t be assessed by visual inspection.

Screening is a critical first step, but without follow-up action it does no good.

In some parts of China, the “have you eaten?” greeting is a holdover from days of food scarcity. Foreigners can be surprised when this greeting is just a greeting, and not followed by an invitation to eat. In this country, we must ensure that this hunger screen is followed up by an invitation to eat – by providing resources for the family to help meet their food needs.

To its credit, the academy is promoting federal nutrition programs like WIC (Women, Infants and Children), CalFresh and school meals as resources for families struggling to afford enough food. These programs are extremely effective in bridging the hunger gap and mitigating the effects of poverty on health.

But more can be done, and policymakers in California can play an important role. A critical first step is to move school breakfast after the start of the school day. Moving breakfast into the school day dramatically increases student participation – meaning many more students are fed – and improves student health and academic achievement.

California can raise expectations that schools with higher percentages of low-income students serve breakfast after the school bell and provide start-up funds and reimbursement to do just that.

Legislators can also target aid. While most of the tap water in California is safe and drinkable, there are a number of communities, especially in the Central Valley, where tap water is not safe to drink. As a result, low-income families must use already limited resources to purchase water, squeezing food and other basic household needs out of the family budget.

Policymakers can and should create a water benefit for low-income Californians living in communities where the public water system is unsafe to drink.

And policymakers can fill in hunger spikes, such as in the summer when school is out and children no longer have the opportunity to eat school breakfast and lunch.

One approach that decreases food insecurity and supports healthy eating during the summer months is Summer EBT. Summer EBT allows families to purchase groceries for their children from supermarkets and other food stores with a debit card. Summer EBT works, but it is not at work in California.

Screening children for food insecurity is a great first step in identifying who in our community is hungry. In order to make a difference, however, we must make sure that our communities are also supporting hungry families.

Our hope is that when physicians, friends or family ask “have you eaten?” in the future that the answer is “yes.”

Dr. Hilary Seligman is a physician at San Francisco General Hospital and Trauma Center, and an assistant professor at the University of California, San Francisco’s Center for Vulnerable Populations. George Manalo-LeClair is the executive director of the California Food Policy Advocates.