For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families. In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA's Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task.

How to focus anti-hunger efforts not on charity but on the root causes of food insecurity, improving public health, and reducing income inequality. Food banks and food pantries have proliferated in response to an economic emergency. The loss of manufacturing jobs combined with the recession of the early 1980s and Reagan administration cutbacks in federal programs led to an explosion in the growth of food charity. This was meant to be a stopgap measure, but the jobs never came back, and the “emergency food system” became an industry. In Big Hunger, Andrew Fisher takes a critical look at the business of hunger and offers a new vision for the anti-hunger movement. From one perspective, anti-hunger leaders have been extraordinarily effective. Food charity is embedded in American civil society, and federal food programs have remained intact while other anti-poverty programs have been eliminated or slashed. But anti-hunger advocates are missing an essential element of the problem: economic inequality driven by low wages. Reliant on corporate donations of food and money, anti-hunger organizations have failed to hold business accountable for offshoring jobs, cutting benefits, exploiting workers and rural communities, and resisting wage increases. They have become part of a “hunger industrial complex” that seems as self-perpetuating as the more famous military-industrial complex. Fisher lays out a vision that encompasses a broader definition of hunger characterized by a focus on public health, economic justice, and economic democracy. He points to the work of numerous grassroots organizations that are leading the way in these fields as models for the rest of the anti-hunger sector. It is only through approaches like these that we can hope to end hunger, not just manage it.

In the United States, people living in low-income neighborhoods frequently do not have access to affordable healthy food venues, such as supermarkets. Instead, those living in "food deserts" must rely on convenience stores and small neighborhood stores that offer few, if any, healthy food choices, such as fruits and vegetables. The Institute of Medicine (IOM) and National Research Council (NRC) convened a two-day workshop on January 26-27, 2009, to provide input into a Congressionally-mandated food deserts study by the U.S. Department of Agriculture's Economic Research Service. The workshop, summarized in this volume, provided a forum in which to discuss the public health effects of food deserts.