Addressing Food Insecurity During the COVID-19 Pandemic and Beyond 

As the pandemic raged in Pima County, Ariz., and the number of families in need of food assistance spiked, the Tucson Food Bank reached out for extra volunteers.  

That’s when Ruthann Smithrud, a former first grade teacher and executive director of the nonprofit, Faith That Works Tucson, stepped in. Smithrud’s small group of outreach volunteers had been organizing clothing drives and operating a mobile shower unit so that anyone in town could bathe in a safe, private place. Now, suddenly, a call from the Pima County Health Department brought the group into the region’s COVID-19 response operation. 

The health department, with support and technical advising from Partners In Health United States, had established a care resource coordination system so that COVID-19 case investigators and contact tracers could connect people with food, housing, and other needed services. When health department staff  told Smithrud about the food bank volunteer shortage, she immediately agreed to help, organizing a team to create custom-made food boxes for COVID-19 patients stuck at home   “This was a connection birthed out of desperate need,” Smithrud said.  

In cities and states across the nation, for people forced to isolate, quarantine, or care for a relative sick with COVID-19, perhaps the most frequently requested basic item was not a mask, or hand sanitizer, or even cash assistance to help pay the bills. It was food. 

Indeed, a recent federal report on food insecurity, defined as the lack of reliable access to enough food to live an active, healthy life, found that Black households, families with children, people in the South, and others teetering economically suffered far worse from food insecurity in 2020 compared to the previous year. Consider these numbers from the government report and various media analyses: 

• The gap between Black and white households widened further, with 21.7% of Black households experiencing food insecurity, compared with 7.1% of white households. That gap of 14.6 percentage points is up from more than 11 points in 2019. 
• In households with an adult who was either unemployed or prevented from looking for work due to the pandemic, 20.4% reported being food insecure for the 30-day period from mid-November to mid-December 2020. 
• Children in 2.9 million households were hungry, as close to 8% were food insecure in 2020, compared to 6.5% in 2019. Many of these households had very low food security among children, meaning they were hungry, skipped a meal, or did not eat for a whole day because there was not enough money for food. 

PIH-US seeks to eliminate such inequities. Working alongside public health departments and community organizations to set shared health and racial equity agendas, the organization provides technical advising and operational support in seven regions across the U.S. to deliver on those commitments. 

Emily Wroe, a PIH senior advisor on the COVID-19 response, said that even in a rich country like the United States, hunger remains a dire problem. 

“We know that many families in America don’t have enough food on their tables and that even more are one paycheck away from devastating food insecurity,” Wroe said. “The pandemic made this worse, but PIH was able to map out food resources and develop partnerships in the communities where we work, allowing us to make many connections to support these families.” 

Such connections, as well as broader initiatives to expand the food support network, were tailored in response to individual community needs, Wroe said. 

“Sometimes this was simply a matter of connecting people affected by COVID-19 to food banks in their communities; sometimes it involved making connections across town or county lines; sometimes it meant identifying gaps in access related to food delivery or languages spoken; and sometimes we identified larger gaps necessitating higher level advocacy. It also led to connecting people with long term benefits such as SNAP (previously called food stamps), for longer lasting support, and ultimately, this work set up invaluable pathways and partnerships for impact far beyond the pandemic.” 

Resource Coordinators Expanding Food Access 

The Massachusetts Community Tracing Collaborative (MA CTC), a contact tracing workforce, was launched in April 2020, as a partnership between PIH and the Commonwealth. Central to the mission was connecting people in need—those who tested positive for COVID-19 and their close contacts—to basic support, such as food. To support this effort, a team of care resource coordinators identified and helped build local networks to help people gain greater access to the essentials they would need to make it through quarantine and isolation.  To date, the MA CTC has connected more than 100,000 people in in the state with social services, often to combat food insecurity.

Anne Moller, assistant director for the MA CTC's care resource coordination program, said the team immediately began reaching out to partners who were scaling up food delivery and increasing other modes of food assistance in regions around the state. Care Resource Coordination Program Manager Odessa Holt described regular meetings and ongoing calls to ensure that all people in need— no matter where in the state they lived—would have access to food. Coalitions of community organizations worked alongside the MA CTC to monitor trends in food needs and offered tailored responses. 

For example, Holt and Moller said, in Mystic Valley, MA CTC data helped the local YMCA secure a grant to develop an Instacart-style app and delivery system from their food pantry. Further east, the New Bedford Immigrant Support Network partnered with the care resource coordination program and others meeting the food needs of hard-to-reach households.  

A Food Hub, and a Vision for the Community  

In Revere, a city of about 62,000 just outside of Boston, Charlie Giuffrida is a key point person for the care resource team. When the pandemic hit, Giuffrida, then assistant director of parks and recreation, was quickly named director of outreach, part of the mayor’s emergency response team managing the health crisis. “It became very clear we had to scale up the operation quickly,” Giuffrida said. “People needed PPE, transportation, help getting medications and then, instantly, food.”  

Before the pandemic, Revere’s 38-year-old food pantry at the First Congregational Church provided food to 60-80 households per week. That number jumped to 300-500 households after March of 2020. Overall, since the start of the pandemic, an expanded coalition—including the food pantry, Food for Free, FEMA, Farmer Dave, Cambridge Health Alliance’s Mobile Market, the Revere Farmers Market, and others—have distributed more than 135,144 food bags, boxes, and meals.  

While COVID-19's toll has been devastating, Giuffrida said, there is a silver lining. Revere’s city government “has been transformed” by the crisis, he said, shifting focus to become more community-oriented and attuned to the needs of residents in a region becoming increasingly diverse.   

For example, there’s a new Food Hub downtown, a 4,400 square foot building acquired by the city where volunteers arrive on Tuesday nights to help fill 500-600 bags with a variety of basic, healthy foods, from cereal and shelf stable milk, to pasta, bread, peanut butter and cheese. Each bag includes an insert with local resources listed in English, Spanish, Arabic, and Portuguese, the city’s dominant languages; separately, more than 200 boxes of produce are distributed weekly.  

Dimple Rana, Revere’s director of community health and engagement and leader of the city’s Emergency Response Team, said the long-term vision for the “Grow in Revere Food Hub” is to increase access to healthy food for residents while also establishing food and economic security  for low-income families, youth, seniors, newcomers, people with disabilities, and others.  Ultimately, she said, the bustling food center could include an outfitted teaching kitchen; space for a year-round farmer’s market; education and training on food, nutrition, and business development; and an expanded drive-through food pantry 

Megan Witter, a former volunteer and now co-coordinator of the Food Hub, said Revere’s shifting demographics—it's now a majority minority city—informs her decisions about ordering and distributing food. For instance, she said, she provided many bags of dates to Muslim families during Ramadan. 

“They break their fast with dates and milk,” she said. “I take that to heart. I want to be able to help all residents, all the different cultures here. Some people don’t want PB and J, but they might want dates.” 

A Statewide Safety Net in North Carolina  

In the state of North Carolina, a different kind of shift in government has been taking place.  

Addressing the social needs of residents in marginalized communities was already a priority of the North Carolina Department of Health and Human Services before the pandemic, but the COVID-19 crisis further exposed the vulnerability of these populations statewide. Indeed, more than 41,000 food boxes were distributed during the pandemic, as well as financial assistance and other basics under a DHHS program supported by the PIH-US team.

Idalia Arellano, a community health worker employed by Southeastern Healthcare of North Carolina, also a PIH-US partner, has seen those vulnerabilities up close. As she traveled from home to home to check on patients, she said almost “every conversation came down to food.” Even when the discussion started with questions about assistance paying a utility bill or arranging a COVID-19 vaccine appointment, it ended with the need for food, Arellano said.  

That’s partly why the department recently announced the expansion of its food support program in parts of the state where nearly 600,000 people face hunger. Working with the Food Bank of Central & Eastern North Carolina, the state began offering food assistance to residents in 34 counties—many in rural regions—who are experiencing food insecurity related to COVID-19 or are at high risk for severe cases. Last year alone, this regional food bank provided over 115 million meals to families and individuals.  

Undergirding the new, revised “Support Services” food program, as it’s called, is an expansion of the community health worker initiative from 55 to all 100 counties in the state. The PIH-US team provided technical assistance on coordination, resource development, integration, and strategy for these complementary programs.    

Maggie Sauer, with North Carolina’s office of rural health, said there are currently 462 community health workers statewide and the plan is to hire and train a total of 650.  Under the program, all requests for food assistance must come through a community health worker, Sauer said, adding that in the first five weeks, 184 food boxes have been delivered to 25 households. “There are a few intricacies we are trying to work through,” Sauer said, noting that NCCARE360, the platform for tracking community health worker referrals, will be modified to accommodate the new effort. Still, funding has been set aside to provide up to 40,000 food boxes over six months.  

‘I Saw So Much Need’ 

Back in Pima County, Smithrud’s volunteers are still packing three basic types of food boxes: regular, low-glycemic, and one for soft food diets. But Smithrud often included extras in the boxes. Some families needed baby food, others made special requests for beans, rice, and tortillas. Volunteers also contributed their own money, time, and transportation to provide families stuck with other crucial supplies, from pet food and toilet paper to household essentials. 

Over the past 18 months, Smithrud said, she learned a few new things about the region she thought she knew so well. 

“I’ve lived in Tucson all my life,” she said, “but I’d never been to some of the places we delivered to. I saw families living in trailers on rough dirt roads far out of town. The poverty level was much more noticeable.  

"I used to be one of these people who said, ‘Why doesn’t that person just get a job.’ I now see it in a different way," Smithrud added. "My eyes were opened when I did mission work in Mexico and saw poverty at a new level, then I realized there was poverty in Tucson at those levels, people who were homeless or living in motels with COVID-19. It gave me real insight.... I saw so much need.” 

Late last week, Smithrud's team delivered free turkeys for Thanksgiving along with the food boxes. “It’s been a huge gift to be able to work with the health department and the community and use my contacts in the city to help those in need,” she said. “If everyone does a little bit, we’ll all be better off.”