Food insecurity is one of the most important social determinants of health, but unfortunately the problem is widespread in the United States and far from easy to solve.
Many people living in poverty often have to choose between food and their other needs, including medical care, housing, utilities and transportation. They often have to wait a long time before they have the money to buy more food.
Food insecurity is a social and economic situation where access to food is limited or insecure. It’s not just about hunger, though — the quality of food people have access to can affect their health, too.
Because healthier foods are generally more expensive than processed or packaged foods and are not as readily available in low-income areas, food insecure households tend to eat fewer healthy options that are filled with empty calories and fewer essential nutrients. This lack of proper nutrition can often lead to chronic illness.
The effects of poor nutrition
According to the US News & World Report, the US Department of Agriculture reported that approximately 38 million Americans did not have enough food to meet their needs in 2020. In addition, the ongoing COVID-19 pandemic continues to exacerbate the problem.
In a March 2021 report, Feeding America predicted that 42 million people — one in eight — could experience food insecurity, including 13 million children.
Food insecurity has been shown to not only cause mental and physical stress, but also increase the risk of chronic health problems such as diabetes and hypertension.
One study found that adults with food insecurity are at increased risk of obesity, while another study reported higher rates of chronic disease in low-income and food-insecure adults ages 18 to 65.
Children are especially at risk. A lack of proper nutrition affects both the brain and body of children, who are still developing. Studies have shown that food insecurity in children is associated with anemia, asthma, depression, anxiety, cognitive and behavioral problems and a higher risk of hospitalization.
In a pediatric study, children in food insecure households had more asthma and depressive symptoms than children in food insecure households. They also had a higher percentage of emergency department use.
Food insecurity affects people of all ages. A CDC survey found that of 2,150 participants, about 14% of older adults reported being food insecure. Health care costs were also higher than those who were food-safe, regardless of whether they had a chronic condition or not. Another study published in the Journal of General Internal Medicine found a link between chronic disease and obesity in young adults with food insecurity.
Skipping meals can also interfere with proper disease treatment. Many medications must be taken with food, but if a patient has to skip a meal, they may need to skip or adjust a dose. If patients take their full dose on an empty stomach, they may experience a side effect, according to Pharmacy Times.
This is especially true for patients taking insulin and patients taking metformin. If metformin is not taken with meals, a patient may develop gastrointestinal problems.
According to the America’s Health Ranking, the prevalence of food insecurity in black and Hispanic households is more than two times greater than in non-Hispanic white households. Lower-income households, especially those below 185% of the poverty line, were most at risk.
“The research found that 80% of chronic diseases can be prevented, better managed and in some cases even reversed by focusing on diet and exercise.” dr. Lisa Harris, chief executive officer of Eskenazi Health, told US News & World Report. †However, this requires that access to, for example, healthy food and a stable, safe environment must be available to everyone, not just the lucky ones.”
What resources are available?
While it is clear that improving access to healthy food and nutrition leads to better health outcomes, particularly when it comes to chronic diseases such as diabetes, obesity and hypertension, the logistics of how best to do this are not always so clear. .
Some resources include the Supplemental Nutrition Assistance Program and the National School Lunch Program, which provide free or inexpensive meals to students in school, and local food banks that also provide free food to those in need.
Many health systems have started food-as-medicine programs where prescriptions for discounted fresh vegetables, fruits and other healthy foods are written for patients. They then go to fill the recipe at convenience stores, food markets, community gardens, food pantries, and farmers’ markets. This type of program has been on the rise in the last ten years.
Health systems also screen patients for social needs, including food insecurity, and then connect them to assistance programs.
Food insecurity is a major problem in the Philadelphia area, especially in the city. Feeding America estimated that nearly 29% of Philadelphia residents will face food insecurity by 2021.
The nonprofit also estimates that about 1 in 9 people in Pennsylvania are starving. In New Jersey, that’s 1 in 12 people.
With the number of chronic diseases on the rise, local health systems are trying to do their part to help food insecure patients.
Cooper Health has partnered with No Kid Hungry to provide eligible families with free fruits and vegetables once a week, grocery shopping tours including gift cards to shop for healthy food options, nutrition classes, and free rides to and from the grocery store for parents who the nutrition lessons.
Steven Carson, senior vice president of public health for Temple University Health System, said that through Temple Health Community Connect, they assess the needs of social determinants, connect patients to the right resources, and then follow up to make sure they’re getting what they need.
The health system also has several partnerships with civil society organizations. Through a partnership with the St. Christopher’s Foundation and the Lancaster Farm Fresh Cooperative, Temple Health offers the Farm to Families program.
Eligible families in North Philadelphia can use a FreshRx “recipe” from a temple doctor or food coupons to purchase inexpensive fresh, organic produce year-round and also learn how to better maintain healthy habits. Through the program, families can purchase weekly boxes of seasonal fruits and vegetables, attend cooking demonstrations and participate in taste tests, as well as learn tips for budgeting money and shopping.
Temple also partners with Thomas Jefferson University on the Frazier Family Coalition for Stroke Education and Prevention. The program addresses social determinants of health to prevent stroke among residents of North Philadelphia. To be funded by a $5 million gift from Andréa and Ken Frazier – CEO of the pharmaceutical company Merck & Co.
In addition, Temple maintains a food supply in the Community Health Workers Department. Community health workers in Temple are trained to help patients gain better access to health and social services and even visit patients at home and accompany them to clinical appointments.
Carson said the biggest challenges health systems face in tackling food insecurity are financing, logistics, engagement and trust.
“That’s why community health workers are so important,” he said. “They live in the community and are more related to patients. There is no white coat syndrome.”
Jefferson Health is constantly researching how to better meet the nutritional needs of patients. dr. Kristin Rising has studied the needs of type 2 diabetes patients. She said the main themes they discovered focused on nutrition and access. She explained that many patients had trouble identifying what is healthy food and what is not.
“All of our research starts fundamentally with what’s broken in the system,” Rising said. “The patients tell us they need better access to food.”
Through an ongoing clinical trial, Rising is exploring how the delivery of medically tailored meals and nutritional advice via telehealth can help these patients better manage their disease. She explained that the ultimate goal is to change policies around medical meals.
Rising highlighted the difference between people who struggle to access food on a regular basis and those with medical needs who may need meals specifically tailored to their condition. She said both are important and need to be addressed by health systems.
Health systems say how effective they are at tackling problems like food insecurity depends on the number of support programs and clinical trials like this one. While interest and support can sometimes wane, it all depends on the willingness of individuals and society to help.