1 Assessing Household Food Insecurity for Public Health Preparedness Planning Matthew Groenewold, PhD, MSPH Office of Emergency and Public Health Preparedness Louisville Metro Department of Public Health and Wellness Addressing Health Equity Through Social Justice in Public Health Preparedness 5/27/2008 2 Disaster Preparedness • The federal government recommends assembling an emergency supply kit that contains a minimum three-day supply of food and water as an element of household and personal emergency preparedness. 5/27/2008 3 Disaster Preparedness • This recommendation is a part of community preparedness planning in jurisdictions across the country, including Kentucky and Louisville Metro. – Severe weather events – Floods – Earthquakes – Wildfires – Chemical releases
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Assessing Household Food Insecurity for Public Health Preparedness Planning
Matthew Groenewold, PhD, MSPHOffice of Emergency and Public Health Preparedness
Louisville Metro Department of Public Health and Wellness
Addressing Health Equity Through Social Justice in Public Health Preparedness
5/27/2008 2
Disaster Preparedness
• The federal government recommends assembling an emergency supply kit that contains a minimum three-day supply of food and water as an element of household and personal emergency preparedness.
5/27/2008 3
Disaster Preparedness
• This recommendation is a part of community preparedness planning in jurisdictions across the country, including Kentucky and Louisville Metro.– Severe weather events – Floods – Earthquakes– Wildfires– Chemical releases
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5/27/2008 4
Disaster Preparedness?
• Not realistic for food insecure families– Immediate nutritional needs must be met
– Cannot stockpile food for future
5/27/2008 5
Food Insecurity
• Exists “whenever the availability of nutritionally adequate and safe foods or the ability to acquire acceptable foods in socially acceptable ways is limited or uncertain1”
• Estimated prevalence in 2006: 10.9 % of all US households
1. Life Sciences Research Office, Federation of American Societies for Experimental Biology. Core indicators of nutritional state for difficult-to-sample populations. J Nutr. 1990;120(Suppl):1559-1600.
5/27/2008 6
Food Insecurity
• Both a consequence of and a contributor to social and health disparities– Inversely correlated with household income
– Associated with poor self/parent-reported health status• Adults
• Children
– Can lead to hunger and malnutrition• Can also exist in the absence of these conditions
– Associated with increased risk of obesity
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Measuring Household Food Insecurity
• Measured in population surveys using the US Household Food Security Scale (USHFSS)– 18-item scale– Developed by USDA and HHS– Instruments includes items that refer to both children
and adults – Classifies households as:
• Food secure
• Food insecure without hunger
• Food insecure with moderate hunger
• Food insecure with severe hunger
5/27/2008 8
Measuring Household Food Insecurity
• Validated, six-item short form of USHFSS also available
• Works equally well for households with and without children
• Does not distinguish between moderate and severe hunger
• Classifies households as:– Food secure– Food insecure without hunger– Food insecure with hunger
5/27/2008 9
Health Equity and Disasters
• Disasters exacerbate existing social inequities– Economically
disadvantaged more susceptible to the health effects of environmental problems
• Higher levels of exposure
• Less access to protective or adaptive resources
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Health Equity and Disasters
• The poor during disaster or other acute emergency– Most vulnerable
– Most dependent upon intervention and rescue
– Disproportionately people of color
5/27/2008 11
Health Equity and Disasters
• Preparedness plans that fail to account for food insecure households are inherently inequitable – Expectation that all
citizens can or will be self-sufficient for up to three days
5/27/2008 12
Health Equity and Disasters
• Inequitable preparedness plans hamper response efforts– Foster mistrust of public
authorities among those most vulnerable
– Recommendations that cannot be carried out undermine trust in government/emergency response agencies
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5/27/2008 13
Project Objectives
• Examine preparedness plans and policies in light of local household food insecurity data– Prevalence– Predictors
• Determine adequacy of plans and policies from social justice and health equity perspective
• NACCHO funds used to conduct population-based
survey of household food insecurity in Louisville Metro
5/27/2008 14
Survey
• 506 Metro Households
• List-assisted, RDD telephone survey
• 6-item short form of USHFSS
• Two-stage, stratified cluster sample– Metro census blockgroups with < 90% of population at or above 200%
of FPL included (n = 449 of 557 blockgroups)
– Eligible blockgroups stratified by quintiles of percent of population below FPL
– 10 blockgroups (clusters) randomly selected from each stratum
– 10-11 households surveyed in each cluster, with 1 adult (> 18 yrs)
responding to questions for each household
5/27/2008 15
Sample v Population Characteristics: Households
Number of Households n % n % Chi-Square P-ValueTotal 506 --- 237076 ---
May 27May 27May 27May 27thththth, 2008, 2008, 2008, 2008
Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Incorporating Social Justice Principles & Addressing Health Equity Through Public Health PreparednessHealth Equity Through Public Health PreparednessHealth Equity Through Public Health PreparednessHealth Equity Through Public Health Preparedness
�� Context of project Context of project �� Issues of equity and social justice Issues of equity and social justice
specific to pandemic influenzaspecific to pandemic influenza�� Project start up and immediate Project start up and immediate
outcomesoutcomes�� Next stepsNext steps
5/27/20085/27/2008 2424
The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based The Work: Community Based OrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizationsOrganizations�� African America Health CoalitionAfrican America Health Coalition�� Asian Health and Service CenterAsian Health and Service Center�� El Programa HispanoEl Programa Hispano--Catholic CharitiesCatholic Charities�� Hacienda Community Development Hacienda Community Development
CorporationCorporation�� Immigrant and Refugee Community Immigrant and Refugee Community
�� Ensure twoEnsure two--way communication between way communication between culturallyculturally--specific populations and response specific populations and response organizationsorganizations
�� Raise awareness around the issue of public Raise awareness around the issue of public health emergency preparednesshealth emergency preparedness
�� Incorporate learning from communities Incorporate learning from communities around what may constitute an emergency around what may constitute an emergency in their communityin their community
5/27/20085/27/2008 2626
Project foundationProject foundationProject foundationProject foundationProject foundationProject foundationProject foundationProject foundation
�� Regional Hospital Preparedness ProgramRegional Hospital Preparedness Program--Cultures Uniting for Emergency Cultures Uniting for Emergency Preparedness Project (CUEP)Preparedness Project (CUEP)--evolution of evolution of projectproject
�� Parallel process with pandemic flu planning Parallel process with pandemic flu planning for use of community mitigation strategiesfor use of community mitigation strategies
�� Parallel process and synergy of local Health Parallel process and synergy of local Health Equity InitiativeEquity Initiative
��““The resiliency of those who The resiliency of those who would need to stay home would need to stay home during a pandemic will depend during a pandemic will depend on their level of preparedness.on their level of preparedness.””(Emer Infect Dis(Emer Infect Dis--May 2008)May 2008)
�� ““Community mitigation measures could Community mitigation measures could cause particular problems for persons from cause particular problems for persons from lowlow--income families and for racial and ethnic income families and for racial and ethnic minorities. With these problems in mind, minorities. With these problems in mind, communities should plan for the needs of communities should plan for the needs of vulnerable populations who may be vulnerable populations who may be adversely affected during a pandemic.adversely affected during a pandemic.””(Emer Infect Dis(Emer Infect Dis--May 2008)May 2008)
5/27/20085/27/2008 2929
Project roll outProject roll outProject roll outProject roll outProject roll outProject roll outProject roll outProject roll out
�� Offered to all CBOs involved in CUEPOffered to all CBOs involved in CUEP�� Convened 5 planning meetings to;Convened 5 planning meetings to;
��Identify community leaders and Identify community leaders and recruitment processrecruitment process
��Identify exercise objectivesIdentify exercise objectives��Design exerciseDesign exercise��Exercise held April 23Exercise held April 23rdrd, 2008, 2008
�� Moving beyond translation and Moving beyond translation and communicationcommunication--access to power and access to power and different ways of doing the workdifferent ways of doing the work
�� Emergency preparedness should build on Emergency preparedness should build on priorities in the communitypriorities in the community
�� Need an economic framework for Need an economic framework for community compliance with community community compliance with community mitigation measuresmitigation measures
�� Preliminary outcomes were used to Preliminary outcomes were used to prioritize 3 year strategic goals for prioritize 3 year strategic goals for Oregon Public Health PreparednessOregon Public Health Preparedness
5/27/20085/27/2008 3333
Next stepsNext stepsNext stepsNext stepsNext stepsNext stepsNext stepsNext steps
�� Finish final reportFinish final report--report back out to report back out to communitycommunity
�� Present to decisionPresent to decision--makersmakers�� Bridge health equity and PHEPBridge health equity and PHEP�� State and county strategic planningState and county strategic planning--
advocate for equitable structure and advocate for equitable structure and fundingfunding
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P.L.A.N. – Preparedness through Linking All Neighbors
Addressing Emergency Preparedness Addressing Emergency Preparedness through Social Capital Theorythrough Social Capital Theory
Jennifer Jennifer WeitzelWeitzelPublic Health MadisonPublic Health Madison
and Dane Countyand Dane CountyMadison, WIMadison, WI
5/27/2008 35
Objectives
�� Participants will be introduced to Social Participants will be introduced to Social Capital theory and how it relates to Capital theory and how it relates to emergency preparednessemergency preparedness
�� Participants will be introduced to how this Participants will be introduced to how this theory is being applied to emergency theory is being applied to emergency preparedness in 3 specific Madison preparedness in 3 specific Madison neighborhoods.neighborhoods.
5/27/2008 36
Social Capital Theory
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5/27/2008 37
Chicago Heat Wave 1995
5/27/2008 38
North Lawndale South Lawndale
5/27/2008 39
PLAN: Preparedness through
Linking All Neighbors
PLAN Resource Guide
A guide to creating neighborhood
emergency plansPublic Health –Madison and Dane County
�� SeattleSeattle’’ s own neighborhood s own neighborhood initiative to initiative to Get Ready, Get Get Ready, Get Connected and Get Strong Connected and Get Strong for for any potential emergencyany potential emergency
�� ““ All Together NowAll Together Now””
��““ Neighbors helping neighbors create a Neighbors helping neighbors create a resilient New York Cityresilient New York City……building by building by building, block by blockbuilding, block by block””
�� Neighborhood SummaryNeighborhood Summary�� Total population: 3,663Total population: 3,663�� Households without a vehicle: 185Households without a vehicle: 185�� Households with income less than Households with income less than
poverty level: 716poverty level: 716�� Disabilities (number of people)Disabilities (number of people)
�� Preconceived notions regarding ability of Preconceived notions regarding ability of residents to planresidents to plan
�� Immigration issuesImmigration issues
5/27/2008 45
Allied: Next Steps
�� Community Health Worker modelCommunity Health Worker model
�� Continue to develop Continue to develop ““ WelcomerWelcomer”” programprogram
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5/27/2008 46
Meadowood: Demographics
�� Majority are homeMajority are home--ownersowners
�� ElderlyElderly
�� Change in demographics over the last 10 Change in demographics over the last 10 yearsyears
5/27/2008 47
•August 16, 2007: West Side Residents Aim To Keep Pressure On City Officials About Crime•August 10, 2007: West Side Eyes Next Steps In Fight Against Crime •August 9, 2007: West Side Residents Voice Crime Concerns To Police Chief, Mayor
Meadowood: Project description
5/27/2008 48
Meadowood: Successes
�� Diversity to the table!Diversity to the table!
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5/27/2008 49
Meadowood: Challenges
�� Progress will take timeProgress will take time
�� Safety is the main prioritySafety is the main priority
5/27/2008 50
Meadowood: Next Steps
�� Contact information collectedContact information collected
�� Community GardenCommunity Garden
5/27/2008 51
Triangle: Demographics
�� Total Population: 350Total Population: 350
�� Number of Households: 339 Number of Households: 339 –– Renter Renter occupied, low income subsidized occupied, low income subsidized housinghousing
�� Percent of Households with a member Percent of Households with a member with diagnosed disability (physical, with diagnosed disability (physical, cognitive, and/or mental): 85cognitive, and/or mental): 85--9090
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Triangle: Project description
�� Personal Safety and SecurityPersonal Safety and Security
�� Fire safetyFire safety
�� Health Welfare, and CommunicationHealth Welfare, and Communication
�� Weather and Environmental SafetyWeather and Environmental Safety
5/27/2008 53
Triangle: Successes
�� Fully engaged partnersFully engaged partners
�� Improvement in residents social interaction Improvement in residents social interaction skills and mental healthskills and mental health
5/27/2008 54
Triangle: Challenges
�� Operating in a neighborhood with a large Operating in a neighborhood with a large number of agencies providing servicesnumber of agencies providing services
�� Impact of neighborhood events on residentsImpact of neighborhood events on residents
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Triangle: Next Steps
�� Floor captain trainingFloor captain training
�� Fire drillFire drill
�� Policy developmentPolicy development
�� Registration of residents in the Dane Registration of residents in the Dane County Disaster Assistance Voluntary County Disaster Assistance Voluntary RegistryRegistry
5/27/2008 56
Lessons Learned
�� Must be comfortable conceptualizing at the Must be comfortable conceptualizing at the community and systems levelscommunity and systems levels
�� Facilitation skills a mustFacilitation skills a must
�� Political will and timing crucialPolitical will and timing crucial
�� Patience!Patience!
5/27/2008 57
Questions?
Thank you for your participation!Thank you for your participation!