Among the primary focus areas at the Hawaii Appleseed Center for Law & Economic Justice: hunger and food insecurity.

While Hawaii has made strides in addressing this issue in the growing senior population, current estimates place food insecurity in the age 60-and-older bracket at between 5% and nearly 10%.

Using the more conservative estimate, more than 16,700 seniors here are at risk of going hungry.

In a just-released report, “Feeding Our Kupuna,” the nonprofit’s assessment of the problem is illustrated with three pillars: access to resources, health and nutrition, and community resilience.

Together, they serve as a “framework that acknowledges the complexity of what it takes to truly address hunger,” said Daniela Spoto Kittinger, director of anti-hunger initiatives at Hawaii Appleseed, which advocates on behalf of low-income and marginalized people, and conducts data- driven research to inform public policy and systems change.

“Traditionally, anti-hunger solutions have focused only on the access-to-resources pillar — making sure that all people have food. Little attention has been paid to how healthy that food is, or whether we see our food system as an opportunity to generate community wealth and address hunger at its root,” she said.

Kittinger, who grew up in California, holds a bachelor’s degree in nutrition, kinesiology and cellular biology from University of California-San Diego, and a master’s degree in public health from the University of Hawaii-Manoa.

After undergrad commencement, she said, “I tried out a career in personal training and nutritional coaching, but became frustrated with the realization that people’s health behaviors often have more to do with their environment and the systems that they are placed in, than with their knowledge about what a healthy lifestyle looks like.”

While in grad school (2007-2009), Kittinger became fascinated with “how our food system incentivizes the proliferation of cheap, unhealthy calories.” She added, “Since then, I’ve been a passionate advocate for policies and systems that increase community ownership of the means of food production.”

Question: One of the “Feeding Our Kupuna” report’s recommended goals is to increase Hawaii’s senior enrollment in the federal Supplemental Nutrition Assistance Program (SNAP) from 50% to 70%. What accounts for under-enrollment?

Answer: Under-enrollment of seniors in SNAP is a problem in every state. … Even so, we are actually doing better than the national average of 41% of eligible seniors participating.

There are a few reasons for this. The first is stigma. Seniors, perhaps more than some other populations, may be skeptical of the social image that relying on SNAP may present to others, or concerned over the implications that SNAP has on their autonomy and independence.

Another reason is mobility. While social workers and caregivers can provide at-home application assistance, there are components of the SNAP application process — such as picking up benefits cards — that require travel to SNAP centers. While the process can be delegated to authorized representatives, not all seniors have relatives who can take on this responsibility.

Finally, the application can be particularly challenging for seniors. It requires the completion of several pages of documentation, and may also require home visits by a case worker, or meetings with an additional family member or friend to help with collection of documentation.

One thing we recommend … is that the state Department of Human Services apply for a collection of waivers called the Elderly Simplified Application Project. This process would shorten the application, reduce documentation requirements through the use of “data matching” with other benefits programs, and eliminate the re-certification interview.

When Alabama put these procedures in place, they were able to gradually add over 42,000 additional senior households to the program. A similar scale increase in Hawaii would get us halfway to the 70% enrollment goal and draw down millions of additional federal dollars into our local economy.

Q: Another goal is to expand access to the federal Senior Farmers’ Market Nutrition Program (SFMNP)?

A: The SFMNP program offers $50 in vouchers for seniors to spend at participating farmers’ markets. The program is popular in Hawaii, serving over 9,000 seniors last year with a wait list of 400 seniors. What’s nice about it is that the eligibility requirements are much less stringent than SNAP.

It’s also an added benefit that it channels federal dollars into the local economy — a perfect example of a solution that addresses the pillar of community resilience. … Access to the program could be improved further if we subsidize with state funds. … Just $25,000 in state funding could eliminate the wait list.

Q: The report mentions “food-as-medicine.” What does that mean, exactly?

A: That nutritious food is important, not just as a part of a healthy lifestyle, but also as a critical component in our health-care system. The idea has … become more commonplace with the emergence of tangible practices, such as with “prescriptions” for fresh produce, or for home-delivered, medically tailored meals. In these models, physicians prescribe nutrient-dense foods to patients in food insecure households or with diet-related illnesses.

In other states, health-care organizations are piloting “shop with your doc” programs, where you can meet a physician at the grocery store who will help you make a shopping list, create a menu, and read food labels. The implications of these programs go beyond food access, by amplifying the message that what you eat impacts your health in very direct ways.

Funding is often the limiting factor for these programs, but that is starting to change. In the most recent Farm Bill, Congress authorized $4 million in grants for produce prescription pilot programs for each fiscal year 2019 through 2023.

Q: Regarding keiki hunger, Hawaii Appleseed is working with partners to increase participation in school breakfast offerings?

A: Research shows that students who eat breakfast perform better on tests and have a lower incidence of behavioral issues. Unfortunately, too many Hawaii students don’t get breakfast. Our state currently ranks 50th for participation rates in the National School Breakfast Program.

The good news is that there are solutions that we know work. … We have partnered with the state Department of Education (DOE) and first lady Dawn Amano-Ige, with support from national partners No Kid Hungry, the Food Research and Action Center, and local Safeway stores, to launch a program we call “Jump Start Breakfast.”

The program encourages schools to try out innovative breakfast models, such as grab-and-go, eating breakfast in the classroom, or placing a breakfast truck or kiosk where kids tend to congregate before school. Every school is different, so we encourage schools to work with their safety-and-wellness committee to discuss what might work best for them. … Last year, we tested some of these models at 10 schools … and are planning to expand to more schools across this year.

Q: Have Hawaii’s food-related challenges changed significantly over the past decade or so?

A: I’ve seen a dramatic shift in the narratives and practices around nutrition, food and agriculture in Hawaii since I first started working in the field. There have been the pioneers: MA‘O farms in Waianae and the Kohala Center come to mind. Because of them and many others, we’ve seen a resurgence in indigenous foodways, and an increase in the number of small farms and food businesses that cater to local residents and tourists than there was just 10 years ago.

The DOE is taking farm-to-school seriously, and we’ve also seen an incredible increase in the number of schools with gardens where students can learn applied nutrition.

Wealthier residents have largely driven the shift toward more local, sustainable produce, through farm-to-table restaurants and large retailers like Whole Foods. Unfortunately, low-income communities are still largely left out of the conversation, which is why it’s so important that we focus on the three pillars. …

True food justice means ensuring that everyone, including those who struggle to make ends meet, have access to the same quality, locally produced foods as those with means. … There is much more to be done, but we’ve come a long way.