Food insecurity and hunger have had a volatile history in the United States during the past 40 years. The earliest concepts of hunger were linked to clinical signs of malnutrition. With renewed interest in food insecurity and hunger, policy makers and program implementers have been seeking measurements that are simple to use and easy to analyze and interpret. New paradigms for assessing food insecurity and hunger are discussed.

Food security is an essential element of overall well-being. Increasingly in the last decade attention has been focused on means of eliminating food insecurity and hunger worldwide. The 1992 International Conference on Nutrition and the 1996 World Food Summit both emphasized the critical need to decrease food insecurity and hunger globally. At the 1996 World Food Summit, 182 nations agreed to the definition of food security as "access by all people at all times to enough nutritionally adequate and safe food for an active and healthy life."

With a renewed interest in food insecurity and hunger, policy makers and program implementers have been seeking measurements that are simple to use and easy to analyze and interpret. The article by David Holben in this issue provides an excellent overview of newer qualitative approaches for measuring food security and hunger that have been developed for the United States. These methods can be used either alone or in tandem with some of the more traditional methods of food insecurity.

What may be less evident from the Holben article is the volatile history of food insecurity and hunger issues in the United States. In the late 1960s, increased awareness of the food insecurity and hunger problems in the United States emerged, in part, due to the media attention in the television documentary on Hunger in America. Government leaders were incredulous that hunger could exist in a country with such a plentiful food supply as the United States.

The earliest concepts of food insecurity and hunger in the United States had been linked to clinical signs of malnutrition. This was the image perpetuated in the media. There was, however, a clear need to distinguish between clinical and medically defined hunger and food insecurity, on the one hand, and hunger and food insecurity as commonly experienced on the other hand. A 1984 report by the President's Task Force on Food Assistance 1 outlined the divergent views on whether and to what extent the problem of food insecurity and hunger existed in the United States. Although all members of the task force agreed that hunger was not acceptable in the United States, the task force indicated that the lack of any authoritative measure of the number of hungry people in the United States precluded any firm conclusions about the magnitude of the food insecurity and hunger problem. The 1984 Task Force Report clearly stated that the clinical definition and measures do not provide sensitive indicators of food insecurity and hunger as they are experienced in the US context:

To many people hunger means not just symptoms that can be diagnosed by a physician, it bespeaks the existence of a social, not a medical problem: a situation in which someone cannot obtain an adequate amount of food, even if shortage is not prolonged enough to cause health problems. 1

An important step was taken in the 1984 Task Force Report in articulating the need to distinguish medical definitions of hunger from poverty-driven hunger. The report catalyzed the research community to develop valid and reliable measures of the prevalence and severity of hunger and food insecurity in the Unites States. As a result, a body of research and field survey work emerged that produced methodologically sophisticated and empirically grounded measurement scales for food security. This research is summarized in the Holben article.

Two events in the 1990s were critical in further advancing work on food security and hunger. In 1990, the National Nutrition Monitoring and Related Research Act was passed and required the US Department of Agriculture and Health and Human Services to:

Recommend a standardized mechanism and instrument(s) for defining and obtaining data on the prevalence of "food insecurity" or "food insufficiency" in the U.S. and methodologies that can be used across the nation and at State and local level. 2

Secondly, a national association of nutrition researchers, the American Institute of Nutrition, sponsored and published a major report on food security. 3 The report clarified from the scientific literature the meaning of hunger and also clarified the links between food insecurity and hunger. In essence, the report served in the US context to provide for the first time authoritative definitions of hunger and food insecurity. Food security, at a minimum, required both the ready availability of nutritionally adequate food and an assured access to foods in a socially acceptable manner (eg, without resorting to emergency food supplies and scavenging).

The US Food Security Measurement as described by Holben is based on solid science and input from a range of knowledgeable people and has been refined and updated during the past 4 years to be even more rigorous than originally designed. An essential element of this qualitative approach is that the perceptions of people most affected by food insecurity and hunger are incorporated. Thus the qualitative measure is a more direct measure of food insecurity than other proxy measures.

There is a clear demand worldwide for direct, simple, and rigorous methods to measure food insecurity and hunger. Increasingly, both industrialized and developing countries have devoted efforts to create a context-specific qualitative measure of food insecurity. The experiences documented in the Holben article offer some practical guidance on a framework for developing appropriate qualitative measures.

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