- Diverse group. Homeless people are a diverse group characterized by a high degree of economic insecurity, social isolation, poor health outcomes, mental illness, and substance abuse (Wiecha, 1991). A growing proportion of the homeless population includes families (Strasser, 1991).
- Stress. Homeless individuals and families face high levels of stress on a daily basis. Obtaining high-quality food may not be as important as finding shelter, employment, or being able to provide food to children (Gelberg, 1995).
- Food insecurity. Homeless individuals may have limited or uncertain access to nutritionally adequate and safe foods. They may not be able to acquire foods in socially acceptable ways (Smith, 2008). Strategies that homeless individuals may use to obtain food include: participating in government nutrition programs; taking food from shelters; stretching food at the end of the month; visiting food pantries and soup kitchens; using coupons; pawning personal belongings; sacrificing food for their children; and scavenging in dumpsters (Richards, 2006).
- Underuse of food assistance programs. Many homeless individuals qualify for government programs but changing eligibility requirements and stigma associated with participation can act as barriers (Algert, 2006). In addition, research has found that food stamps do not adequately cover monthly food expenses (Richards, 2006).
- Access to services. Limited meal hours, infrequent service, and travel distances may interfere with an individual’s ability to obtain a meal from charitable services (Tarasuk, 2009).
- Storage and food preparation. Homeless individuals may not have access to refrigerators or cooking facilities, which can severely limit ability to safely store and prepare healthy food. Shelters may also have rules that limit the types of foods allowed in rooms. Some shelters only allow non-perishable items, which may force participants to buy less nutritious foods (Richards, 2007).
- Foods available to the homeless. Soup kitchens, shelters, and food pantries provide foods that are appropriate for emergencies or supplements to dietary intake; however these foods usually have limited availability and do not provide adequate long-term nutrition (Wiecha, 1991). Although some meals are nutritionally sufficient, many homeless individuals do not eat often enough to achieve an adequate diet (Strasser, 1991).
- Nutrient Inadequacy. Inconsistent food patterns from poor, and possibly unsanitary, sources of nutrition can lead to vitamin, mineral, protein, and/or energy deficiencies (Gelberg, 1995). Poor nutrition over time can increase the risk of or exacerbate health conditions (Dachner, 2002).
- Hunger-obesity paradigm. Youth and adults who are food insecure are often overweight and obese. Studies have linked food scarcity with an increased occurrence of overeating when food is available. Energy-dense foods are typically the most cost-effective and easily accessible (Smith, 2008).
Strategies to address these considerations
- Collaborative effort. Appropriate changes may be better achieved through health, housing, and charity groups working together and considering broader health, living conditions, and psychological factors that the homeless population faces (Wicks, 2006).
- Social support. Policies, legislation, and programs aimed at providing income and housing opportunities to homeless individuals can support basic survival needs and allow healthy eating to become a higher priority and more feasible (Dachner, 2002). Other programs, such as affordable day care and substance abuse programs, can provide additional social support to allow individuals to seek and obtain employment (Richards, 2006). Food providers can facilitate a more positive social climate during mealtime by ensuring a clean and well lighted dining area; respectful, courteous, and caring staff; hygiene facilities; smaller tables that seat three or four individuals; and providing several menu options (Strasser, 1991).
- Navigate the system. Helping homeless individuals get to the right place at the right time, and with necessary information, to enroll or participate in food and nutrition assistance programs can increase use of food assistance programs (Strasser, 1991). Case management has also been suggested as a mechanism to help homeless individuals overcome barriers and increase use of food assistance programs (Heslin, 2003).
- Coordination of efforts. Meal services outside of the shelter system may be intermittent and uncoordinated; an assessment of services and collaboration of efforts may provide more consistent and efficient coverage to the homeless population (Tarasuk, 2009).
- Resident autonomy. Access to kitchen and food storage facilities in shelters and hotels may have a positive influence on food expenditure, food preparation, and diet quality (Wiecha, 1993). A community garden and/or kitchen could allow residents to participate more in food production and preparation (Davis, 2008).
- Monitor nutritional quality of foods served. Registered dietitians can assist with food service management to ensure that adequate amounts and a variety of nutritious foods are available at shelters (Richards, 2006).
- Fundraising. Fundraising and seeking more nutritious donations as a priority can improve the nutritional quality of foods served to homeless individuals (Davis, 2008). These actions can assure the continuation of food assistance programs.
- Educate food providers. Training food providers in meal planning and food safety can improve their ability to feed special interest populations, such as children, pregnant women, or individuals with chronic disease (Wiecha, 1991).
- Assess food distribution systems. Including shelters in the distribution systems that serve federal school food programs will provide access to USDA commodities and allow an increased variety of foods to be offered. State and local governments could consider offering tax incentives and subsidies to local farmers, produce vendors, and larger food stores to entice donation of a portion of produce and other healthy foods to shelters and food pantries (Oliveira, 2002).
- Non-profit hunger education programs. Use of effective programs can improve the diets of those who are homeless. Successful education programs have included sessions on food budgeting, grocery shopping, basic nutrition and fitness, and food preparation and safety (Oliveira, 2002). However, in order for participants to practice acquired knowledge and skills, barriers to acquiring and preparing healthy foods need to be addressed.
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