How many people starve to death in America?

Do thousands of people starve to death every year in the USA? No.

20-30 people starve to death annually in America.

Phew! I’m glad to get that out of the way - writing that first sentence motivated me to create this blog. I’m not like the other blogs, I’m happy to go directly to the point without fluff, but, now that we’ve answered the titular question, lets expound a bit, shall we? I mean, a blog can’t just be a single sentence.

There’s a lot of misinformation around starvation, spread, in part, by none other than Google.

Above we see a screenshot documenting the current result of searching for “how many people starve to death in America”. The incorrect answer, presented on Google’s search results page, is nearly 14,000 people. This is an absurd overestimate, off by three orders of magnitude. The number comes from an SEO blog spam site called thehivelaw and is just made up - though if we are feeling charitable we can guess at how they picked a number.

As I mentioned, my mission in creating this blog is to write an accurate estimate for the number of annual starvation deaths in the USA. I hope to replace The Hive Law Blog with the truth in Google’s answer card so that Google will stop misleading people.

For the remainder of this blog, we will:

1. See what the actual numbers are and how we know.

2. Look at starvation misinformation.

   1. Some people conflate increased mortality from food insecurity with starvation.

   2. Some people conflate deaths from malnutrition (lack of nutrients) with starvation (lack of food).

How do you know?

We know that 20-30 people die from starvation thanks to CDC death records. Every person who dies in America gets a death record and the death record includes an ICD-10 code. The code indicates the primary cause of death and you can search the CDC records using the WONDER tool for ICD code “X53” (lack of food - starvation).

Here are starvation deaths over the past few years.

• 2018: 24

• 2019: 22

• 2020: 32

• 2021: 21

You can also use Google news to search for “starved to death” to get an idea for what starvation deaths are like. Add in your city and state too for local flavor.

If more than a thousand people were starving to death every month you would see news stories about the ongoing famine in the US. You would see stories about the 14,000 people who wasted away for lack of food.

In reality, you will see no such stories because there are no such people starving to death. Instead, what you will see is stories about parents who murder their children through criminal abuse or neglect. Perhaps an inmate has been killed by guards in a similar manner. Maybe someone has been lost in the woods, died in a hunger strike, or did not eat due to mental illness. You will not see stories about people starving to death because they couldn’t afford food as The Hive Law Blog implies.

Misinformation

Food Insecurity and Starvation.

The Hive Law Blog says the actual number is nearly 14,000 (I’m intentionally avoiding writing out their claim because I don’t want to supplant The Hive Law Blog only to have Google Answers read the spurious claim from my own blog!).

The author reaches what they generously refer to as “an estimate” by making the completely unsupported assumption that 0.37 people starve to death for every 1,000 food insecure people. The blog doesn’t provide any sources or links to validate this statistic but instead just multiplies their made-up figure by the number of food insecure people in the United States to reach their estimate.

Perhaps the blog author meant that there is an increased mortality risk among food insecure people. This is true, but food insecure people are not dying of starvation. Food insecure people are at greater risk of death from a variety of causes.

This article examines mortality risk among the food insecure in more detail. I’ll summarize it in the next paragraph.

The food insecure are younger, more likely to smoke, less likely to exercise, and more likely to be obese. If you don’t control for any of these facts then the food insecure are less likely to die too - because they are younger. If you control for just demographics (age, race, and gender) then food insecurity is associated with a 49% increased risk of death. If you control for the rest of the factors in the study (smoking, not exercising, etc.) then the risk declines to only 15% and is no longer statistically significant.

Presumably, there are other factors that are not included in this study which would reduce the apparent risk even further. For example, not included in this study is the fact that the food insecure are more likely to engage in binge drinking and use illegal drugs. If we controlled for those factors would the risk decline further still? I’d guess so.

It is true that the food insecure have increased mortality (controlling for age). It does not seem to be the case that the food insecure are starving to death or dying for reasons related to not having food. Instead, the food insecure are likelier to die for reasons not obviously related to a lack of food (smoking, drinking, sedentary lifestyle, use of illegal drugs, obesity, diabetes, and so on).

Malnutrition is not Starvation

The other way people try to claim famine within the United States is by pointing to malnutrition. This colorful webpage points out that the United States has a malnutrition death rate of 0.9 per 100,000. If you simply multiply 0.9 by 330 million (population of the US) and divide by 100,000 you get 2,970. Are that many people starving to death every year in the United States!?

No, though you could certainly be forgiven for assuming so. Malnutrition certainly sounds like it is connected to starvation. Starvation is a lack of calories. Malnutrition is a lack of nutrients - either you can’t acquire the nutrients (which is practically quite similar to starvation) or something prevents you from absorbing nutrients that you could acquire - the latter is the predominant cause of malnutrition in the United States.

This report from the Healthcare Cost and Utilization Project (A department of Health and Human Services) goes through the causes of malnutrition in the United States.

1. Post-surgical non-absorption - they operated on your intestines and now they don’t work so good.

2. Nutritional neglect - either through ignorance or malice parents did not feed their children.

3. Cachexia - you are physically wasting away because of some other disease (e.g. aids or cancer).

4. Protein Calorie Deficiency / “Failure to Thrive” - circulatory/respiratory/digestive systems failing, parasites and infections, injury and poisoning, or cancer.

Notably not on this list is “couldn’t acquire food and now malnourished to death.”

Maybe malnourishment is more common among the food insecure? Quite a reasonable guess, but the answer is apparently not. Here is a literature review of 23 studies on the association between malnourishment and food insecurity among children. I’ll quote from the conclusion -

Overall, the evidence currently available does not demonstrate an association between food insecurity and the risk of malnutrition related to undernutrition for the pediatric population in the United States. The evidence for food insecurity and risk of malnutrition related to overnutrition is mixed.

As before, we see a reference to the fact that the food insecure are more likely to be obese (hence some evidence of risk from “overnutrition”). No apparent risk from undernutrition though.

I was not able to find similar research for adults but I see no reason to assume that the pattern is meaningfully different in adults than in children - especially because in countries that really are plagued by starvation and malnutrition the youth suffer disproportionately.

Conclusion

Malnutrition and food insecurity are real problems. Don’t mistake what I’ve written here as minimizing those problems. Imagine being a child and not being able to eat the food you want, or not being able to eat as much as you want, or missing meals, or going a whole day without food. Imagine being distracted in school by the grumbling of your stomach.

Food insecurity is absolutely a real concern and a horrible difficulty for anyone experiencing it - child or adult. If you are an American, as I am, then you should first feel proud that your country does so much to combat food insecurity and second be willing to do more, if necessary, to address the issue.

That said, there is not any significant amount of starvation in the United States. 20-30 people die of starvation a year in the USA - these are cases of criminal neglect, mental illness, or getting stuck in a cave. Neither food insecurity nor malnutrition produce the famines that some people claim happen in the US.

You know that starvation is not a problem in the US from your own personal experience. Many times you have witnessed homeless people on the streets, drug addicts, or the mentally ill - but you have not seen the swollen body of a child lying in the street. You have not heard a story in the local news about a man starving to death because he couldn’t buy food and you haven’t read a news article about the 14,000 people who die of starvation annually.

You know starvation is not a problem in the US from common sense. If you were on the brink of starvation, would you simply wait to die? Or would you shoplift from a grocery store until you were put in jail where you would be fed?

Finally, you know starvation is not a problem in the US because of the mortality records I showed above.