How do food insecurity, hunger, and undernutrition affect people with disabilities and how can this problem be addressed?

Challenge #1: Food insecurity and hunger among people with disabilities are driven by broader exclusion

• People with disabilities face barriers to education, employment, healthcare, and social protection. These exclusions create risk for food insecurity and hunger.
• These exclusions also interact with impairment-related factors to place people with disabilities in LMICs at risk for undernutrition.

Challenge #2: There is a need to tackle the social determinants of food insecurity and hunger among this population, as well as to provide specific supports for those experiencing undernutrition, regardless of its cause

• Broad-based policy and programming interventions (such as social protection) are needed to reduce rates of food insecurity, hunger, and undernutrition among people with disabilities and their families and households.
• Additionally, where certain impairments are associated with difficulty chewing and swallowing, decreased nutrient absorption, or other contributes to undernutrition, these risks need to be addressed through targeted, evidence-based services.

Challenge #3: Public health services are often disability-inaccessible, and have limited capacity to identify and treat undernutrition among people with disabilities

• People with disabilities may take longer to present at health services due to accessibility issues, such as transport and cost. Late presentation may result in more severe cases of undernutrition and poorer treatment outcomes.
• Health professionals are not usually adequately trained on providing nutritional care to people with disabilities, and there are insufficient nutrition-focused interventions and programmes developed for people with disabilities. For example, the commonly used malnutrition screening method of weight-to-length ratio may not be appropriate for people with growth restrictions, atypical body compositions, and/or postural impairments.

Challenge #4: There is a lack of knowledge around undernutrition among people with disabilities and their caregivers, which is worsened by stigma

• Caregivers and families may not be equipped with skills to effectively feed those individuals with disabilities who experience impairment-related nutritional needs, specifically those who have chewing and swallowing difficulties, increased risk of choking, or regularly insufficient food intake.
• People with intellectual disabilities, psychiatric illnesses or mental health conditions may have trouble obtaining or understanding nutritional information that is not clearly and accessibly communicated, as well as with budgeting for and prioritising healthy foods.
• Stigma may result in people with disabilities receiving smaller portions and less nutritious food. Reliance on community food programmes or welfare benefits is also stigmatised, which may deter people from accessing such programmes, even in contexts where they are available.

Challenge #5: Food is increasingly expensive, especially those foods that are nutritious and healthy, and sources may be inaccessible or difficult to find

• People with disabilities have inflated direct and indirect living costs and therefore, less income to spend on food.
• Due to educational, economic and societal barriers, people with disabilities are often poorer. Poorer people, in turn, are more likely to live in contexts where gaining access to nutritious food is difficult, such as food deserts.
• Architectural barriers (e.g. unreachable items on shelves, walkability to shops, lack of curb-cuts for wheelchairs) make shopping for food more difficult. For those with cognitive or physical limitations, it may also be hard to prepare food at home, leading to more purchases of prepacked or processed (i.e. less nutrient-dense) meals.