Background
In 2006, the United States Department of Agriculture (USDA) defined low food security as a situation where individuals report a reduction in the quality, variety or desirability of their diet. Very low food insecurity is defined as having multiple indications of disrupted eating patterns and reduced food intake.1 Food insecurity has been found to be associated with lower levels of self-reported health status and mental health, as well as higher rates of emergency room visits and hospitalizations.2
Food insecurity rates are significantly higher among adults with disabilities compared to those without disabilities. In 2021, about 28% of households that included an adult out of the labor force due to a disability were food insecure. For households with an adult who reported a disability but was employed, the rate was 24% compared to only 7% of households with adults without disabilities.3 The prevalence of very low food security was also much higher among households with adults with disabilities. For example, 13% of households with an adult unemployed due to a disability experienced very low food security, compared to just 2% of households without adults with disabilities.3
Food insecurity rates among adults with disabilities vary significantly based on the type of disability, age, and gender.4 Individuals with physical disabilities often face higher rates of food insecurity due to mobility issues and higher medical expenses. Those with cognitive disabilities may experience even higher rates of food insecurity due to challenges in managing finances and accessing food assistance programs. 5 Some people fail to qualify for food assistance programs because their disability is not considered significant enough to make them eligible.4 Younger adults with disabilities tend to have higher food insecurity rates compared to older adults (6.7% vs. 6.4%). This is partly due to lower employment rates and less stable financial situations among younger adults, along with access to retirement benefits and specific food assistance programs exclusive to older adults.5 Women with disabilities are more likely to experience food insecurity than men. In 2021, 6.5% of women lived in families experiencing food insecurity, compared to 5.2% of men.5 This disparity is often attributed to gender wage gaps, higher rates of single parenthood, and caregiving responsibilities. These differences highlight the need for tailored interventions that address the specific challenges faced by different groups of individuals within a community.
Access and Barriers in Acquiring Food for Individuals with Disabilities
The Americans with Disabilities Act (ADA) is a federal civil rights law that prohibits discrimination towards individuals with disabilities.6 The ADA impacts resources available to address food insecurity in a few different ways. Title II of the ADA and the ADA Amendments Act of 2008 prohibits discrimination based on disability by state and local governments, which includes state and local food and nutrition services.7 More recently, a final rule updated Title II of the ADA requiring state and local governments to ensure web content and mobile applications are accessible to people with disabilities, which applies to web content, applications, etc., provided by state and local food service programs.6
In addition, Title III of the ADA requires businesses and public facilities to make reasonable efforts to accommodate people with disabilities, which would include social service establishments such as food banks.6 8 With attention to Title II and III of the ADA, barriers to food accessibility include physical barriers, economic barriers, information and digital barriers, social barriers, and policy and program barriers.4 9 10 11 12 13
| Physical Barriers |
Limited access to reliable and accessible transportation makes it hard to travel to grocery stores, food banks, and food service programs. Difficulty with transportation is very apparent for people living in rural areas where public transit options are limited, creating a reliance on private transportation services.14 Title II of the ADA requires public transportation to be accessible for people with disabilities, but limited services and poor compliance continue to create a significant barrier.15 Although Title III of the ADA requires businesses and public facilities to be accessible, many grocery stores are often not designed with accessibility in mind, making it challenging for people with mobility and/or visual impairments to navigate aisles, reach shelves, or use checkout counters. |
|---|---|
| Economic Barriers |
Individuals with disabilities face higher living costs, including medical expenses, which can limit their budget for food. For instance, accessible food options, such as prepared meals, can be more expensive.11 Lower employment rates and wage gaps contribute to financial instability, making it harder to afford nutritious food. Title I of the ADA prevents discrimination in employment based on disability.11 Regardless, employment rates of individuals with disabilities as compared to people without disabilities are 22.5% and 65.8%, respectively.16 |
| Information Barriers |
Information about food assistance programs, nutrition guidelines, and food delivery services may not be available in accessible formats, such as braille, large print, or accessible digital formats compatible with screen readers, despite requirements of Title II and III of the ADA.10 11 Potentially limited access to the Internet or digital devices, along with potential accessibility barriers, also hinders the use of online grocery shopping and delivery services. |
| Social Barriers |
Individuals with disabilities face stigma and discrimination, which can affect their ability to access food assistance programs or receive help from community resources.10 11 Social isolation, particularly among those with severe disabilities, can also limit their ability to seek help or access community food resources, along with affecting motivation to shop for, prepare and eat food.10 11 |
| Policy & Program Barriers |
Existing food assistance programs may not fully address the unique needs of individuals with disabilities. Programs may have eligibility criteria that exclude certain types of disabilities such as individuals with disabilities that limit daily activities but are not severe enough to qualify for federal programs and individuals with temporary or episodic disabilities, or programs may not provide sufficient support for those with higher food and nutrition needs.12 13 Application processes for food assistance programs can be complex and difficult to navigate, especially for individuals with cognitive or intellectual disabilities. Title II of the ADA mandates that public services, such as food assistance programs, must be accessible to all living with disabilities, yet lengthy applications and inaccessible formats make it difficult for individuals with disabilities to navigate systems like SNAP and WIC.17 18 |
Current Nutrition Interventions and Support Systems
The Supplemental Assistance Nutrition Program (SNAP) program provides money for food to low-income households, and participation in this program has shown to reduce food insecurity by 30%. Individuals with incomes <130% of the poverty income level can apply to this program.17 18 A study conducted by Samuel and colleagues found 4.2 million low-income US households which included someone with a disability were food insecure.18 Of those, 1.4 million were not participating in SNAP, and another 2.8 million were food insecure despite participating in SNAP.18 Reasons why individuals might still experience food insecurity despite participating in SNAP include insufficient benefits to cover all food costs, high living expenses, limited access to nutritious food and barriers to healthy foods. A recent study investigated potential barriers that may prevent individuals with disabilities from participating in SNAP, and findings suggest SNAP programs require continued attention to flexibility in the enrollment process, efficiency of finding information on SNAP websites, and accessibility of SNAP websites to meet the needs of individuals with disabilities.19
Meals on Wheels (MOW) is another program, which provides food access for populations with restricted mobility, including housebound older adults. At times, these services may not meet culturally desired food (e.g., not offering food that meet family traditions) and may be cost prohibitive (e.g., not offering fresh produce that is rich in nutrients but out of production season).18 20
Addressing Food Insecurity Amongst Individuals with Disabilities Recommendations
Below are public health implications or policy recommendations based on the current literature to address food insecurity amongst individuals with disabilities:
- Consider food access needs of individuals with disabilities by including them in the discussion, instead of assuming needs without involving them in the process.4
- Emergency food assistance (e.g., food pantries, soup kitchens) are not often organized to accommodate mobility disabilities.10 Programs can request assistance to improve physical accessibility of buildings to reduce this barrier.
- Streamline processes of food assistance programs to meet the needs of all individuals with disabilities.18
- Health of individuals with disabilities may be affected by food availability or lack of food if they need to take medicine with food or follow a specific diet.10
- Increased knowledge among legislators and policymakers of what public health implications and policies are needed to address food insecurity for individuals with disabilities.10
Call to Action
It is imperative to determine the food insecurity of individuals with disabilities within the Rocky Mountain region and provide important information regarding individuals with disabilities’ food insecurity levels to assist with developing trainings (e.g., how to apply for different food assistance programs) and policy/public health solutions to assist individuals with disabilities in meeting their food access needs. It is also critical to better understand accessibility barriers that exist within the region related to food support programs, food banks, etc. A needs assessment further investigating all these issues would assist in identifying current barriers and future opportunities.
- 1www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/definitions-of-food-security/. Accessed on September 9, 2024.
- 2 286-293.
- 3 a b www.ers.usda.gov/data-products/chart-gallery/gallery/chart-detail/?chartId=105136. Accessed on September 9, 2024.
- 4 a b c d 107-121.
- 5 a b www.cdc.gov/nchs/products/databriefs/db465.htm. Accessed on September 9, 2024.
- 6 a b c www.ada.gov/topics/intro-to-ada/. Accessed on November 12, 2024.
- 8ccpia.org/ada-title-iii-accessibility-inspections/. Accessed on November 12, 2024.
- 9Ives-Rublee, M & Sloane, C. (2021). Alleviating food insecurity in the disabled community. www.americanprogress.org/article/alleviating-food-insecurity-in-the-disabled-community/. Accessed on September 9, 2024
- 10 a b c d e f g 220-226
- 11 a b c d e f Do economic resources matter? Social Science Research, 39: 111-124.
- 12 a b How do food insecurity, hunger and undernutrition affect people with disabilities and how can this problem be addressed? Disability Evidence Portal. www.disabilityevidence.org/sites/default/files/content/question_brief/files/2023-08/DEP%20Brief_Food%20access%2C%20undernutrition%2C%20hunger%20and%20disability.pdf. Accessed on September 9, 2024.
- 13 a b Food and nutrition. www.ohchr.org/sites/default/files/Documents/Issues/Disability/SDG-CRPD-Resource/ThematicBriefs/thematic-brief-food.pdf. Accessed September 9, 2024.
- 14Disability Belongs. (2022). Economic justice is disability justice. www.respectability.org/2022/04/economic-justice-disability-justice/. Accessed on November 12, 2024.
- 15 An investigation of barriers for people with disabilities. Journal of Disability Policy Studies, 28(1), 52–60
- 16 Labor force characteristics summary. www.bls.gov/news.release/disabl.nr0.htm. Accessed November 12, 2024.
- 17 a b United States Department of Agriculture. (2024). Supplemental Nutrition Assistance Program. www.fns.usda.gov/snap/supplemental-nutrition-assistance-program. Accessed on September 9, 2024.
- 18 a b c d e f 101486.
- 19101366.
- 20//www.mealsonwheelsamerica.org/. Accessed on September 9, 2024.