Food insecurity is one of the most important social determinants of health, but unfortunately the problem is widespread throughout the United States and is far from easy to resolve.
Many people living in poverty often have to choose between food and their other needs, including medical care, housing, utilities and transportation. They frequently have to wait long periods of time before they have the money to buy more food supplies.
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Food insecurity is a social and economic condition where access to food is limited or uncertain. However, it's not just about hunger – the quality of food that people have access to can also affect their health.
Because healthier foods are generally more expensive than processed or packaged foods and not as easily available in low-income areas, food insecure households tend to eat less healthy options filled with empty calories and fewer essential nutrients. This lack of proper nutrition can often lead to chronic disease.
The effects of poor nutrition
According to the U.S. News & World Report, the U.S. Department of Agriculture reported that about 38 million Americans did not have enough food to meet their needs in 2020. Additionally, the ongoing COVID-19 pandemic continues to exacerbate the issue.
In a March 2021 report, Feeding America projected that 42 million people – one in every eight – may 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 conditions such as diabetes and hypertension.
One study found that food-insecure adults may be at an increased risk of obesity, while another study reported higher rates of chronic diseases in low-income, food-insecure adults between the ages of 18 and 65.
In particular, children are at the greatest risk. A lack of proper nutrition impacts both children's brains and bodies, which are still developing. Studies have shown that among children, food insecurity is associated with anemia, asthma, depression, anxiety, cognitive and behavioral problems and a higher risk of hospitalization.
In a Pediatrics study, children in food-insecure households had higher rates of asthma and depressive symptoms than children from food-secure households. They also had higher rates of emergency department use.
Food insecurity affects people of all ages. A CDC study found that out of 2,150 participants, about 14% of older adults reported being food insecure. Health care costs were also higher than those who were food secure, regardless of if they had a chronic condition or not. Another study published in the Journal of General Internal Medicine found a connection between chronic diseases and obesity in young adulthood with food insecurity.
Having to skip meals can interfere with the proper treatment of diseases, as well. Many drugs need to be taken with food, but if a patient has to skip a meal, they may either need to skip a dose or adjust it. If patients take their full dose on an empty stomach, they may experience an adverse reaction, according to Pharmacy Times.
This is especially true for patients on insulin and those taking metformin. When metformin is not taken with meals, a patient may experience gastrointestinal problems.
According to America's Health Ranking, in Black and Hispanic households, the prevalence of food insecurity is more than two times greater than non-Hispanic white households. Lower-income households, particularly those below 185% of the poverty threshold, were at the greatest risk.
"The research has borne out that 80% of chronic disease can be prevented, better managed and, in some cases, even reversed by focusing on nutrition and physical activity," Dr. Lisa Harris, chief executive officer of Eskenazi Health, told U.S. News & World Report. "This requires, though, the access, for example, to healthful food and stable, safe environmental be available to all, not just the fortunate few."
What resources are available?
While it's clear that improving access to healthy food and nutrition leads to better health outcomes, particularly when it comes to chronic disease such as diabetes, obesity and hypertension, the logistics of how best to carry this out isn't always so clear.
Some resources include the Supplemental Nutrition Assistance Program and the National School Lunch Program, which provide free or low-cost meals to students at school, and local food banks which also provide free food to those in need.
Many health systems have started food-as-medicine programs where prescriptions for discounted fresh fruit, vegetables and other healthy foods are written for patients. They then go fill the prescription at neighborhood corner stores, food markets, community gardens, food pantries and farmers' markets. These types of programs have been growing in the last decade.
Health systems also screen patients for social needs, including food insecurity, and then connect them to assistance programs.
In the Philadelphia region, food insecurity is a big concern, especially in the city. Feeding America estimated that nearly 29% of Philadelphians experienced food insecurity in 2021.
The nonprofit also estimates that about 1 in 9 people in Pennsylvania face hunger. In New Jersey, it's 1 in 12 people.
With the rates of chronic diseases increasing, local health systems are trying to do their part to help food-insecure patients.
Cooper Health has a partnership with No Kid Hungry to provide qualifying families with free fruits and vegetables once a week, supermarket shopping tours including gift cards to shop for healthy food options, nutrition classes and free rides to and from the supermarket for parents who attend the nutrition classes.
Steven Carson, senior vice president of population health for Temple University Health System, said that through Temple Health Community Connect, they assess social determinant needs, connect patients to the appropriate resources and then follow up to make sure they get what they need.
The health system also has several partnerships with community 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 "prescription" from a Temple doctor or food stamps to buy low cost fresh, organic produce throughout the year and also learn how to better sustain healthy habits. Through the program, families can purchase weekly boxes of seasonal fruits and vegetables, observe 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 strokes among North Philadelphia residents. It's funded by a $5 million gift from Andréa and Ken Frazier – CEO of the pharmaceutical company Merck & Co.
In addition, Temple maintains a food pantry in the department of Community Health Workers. Community health workers at Temple are trained to help patients get better access to health and social services and even to visit patients in their homes and accompany them to clinical appointments.
Carson said the biggest challenges health systems face in addressing food insecurity are funding, logistics and engagement and trust.
"That is why community health workers are so important," he said. "They live in the community and are more relatable to patients. There is no white coat syndrome."
At Jefferson Health, there is ongoing research on how to better meet patients' nutritional needs. Dr. Kristin Rising has been studying the needs of type 2 diabetes patients. She said that the primary themes they uncovered focused on nutrition and access. She explained that many patients had difficulty identifying what are healthy foods and what are not.
"All our research fundamentally starts with asking what is broken in the system," Rising said. "The patients tells us they need better access to food."
Through an ongoing clinical trial, Rising is exploring how the delivery of medically-tailored meals and nutritional counseling via telehealth can help these patients better manage their disease. She explained that the ultimate goal is to change policy on medical meals.
Rising emphasized the difference between people having trouble regularly accessing food in general and people 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 that how effective they are at addressing issues like food insecurity depends on the amount of support programs and clinical trials like these get. While interest and support can sometimes wane, it all depends on individuals and society's willingness to help.