Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries

Author:

Berkowitz Seth A.12ORCID,Drake Connor34,Byhoff Elena5

Affiliation:

1. Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA

2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

3. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center, Durham, NC, USA

4. Department of Population Health Science, Duke University School of Medicine, Durham, NC, USA

5. Division of Health Systems Science, Department of Medicine, UMass Chan Medical School, Worcester, MA, USA

Abstract

We sought to determine whether a country's social policy configuration—its welfare state regime—is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: −0.039, 95% CI −0.066 to −0.011, p  =  .006) and social democratic regimes (risk difference: −0.037, 95% CI −0.062 to −0.012, p  =  .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.

Funder

National Institute on Minority Health and Health Disparities

Publisher

SAGE Publications

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