A Call to Action: Health Care Delivery Systems Must Address Food Insecurity

Part One of the Institute's New Hunger and Health Care Series


Roger hasn’t been taking his blood pressure medication, even though he agrees cex07d066with his doctor that it will reduce his risk of a stroke. Josephine, usually a star student, is having trouble in school because she is often distracted in class. And these days, Alejandro is depressed and often craves alcohol or cigarettes to cope. What Roger, Josephine, and Alejandro have in common is a condition often invisible to others: they are struggling with food insecurity.

Food insecurity – the lack of consistent access to enough nutritious food for an active, healthy life – affects more than 17 million American households a year, or 14 percent of the population. For those affected, it can be a matter of having to choose between food and medicine because you can only afford one, feeling so constantly hungry that you cannot concentrate on other things, and developing harmful coping strategies that can lead to increased risk of chronic disease.

Despite the fact that nearly 50 million Americans struggle with food insecurity at some point during the year, access to food is often left out of conversations in health care. Beyond having the conversation, however, health care delivery systems must take action to address this critical issue.

The Health Consequences

Food insecurity is the leading nutrition-related public health issue in the United States. Adults living in food-insecure households consume fewer weekly servings of fruits, vegetables, and dairy than do other adults, creating a dietary pattern that is low in essential nutrients and associated with the development of chronic diseases such as diabetes, high blood pressure, and high cholesterol. Food-insecure children may have increased rates of iron-deficiency anemia, acute [and] chronic illness, and developmental and mental health problems.

The Costs

In 2014, U.S. hunger and food insecurity-related health costs amounted to more than $160 billion. A number of medical conditions are worsened by food insecurity, adding to treatment and disease-management costs. In addition, people who are food-insecure often engage in coping strategies to avoid feeling hungry. The strategies, such as opting for low-cost, high-calorie foods, skipping meals, disordered eating, and putting off other important purchases (for example, medicine and personal hygiene items), do not always resolve when the episode of food insecurity comes to an end. As a result, prolonged use of coping strategies increases a person’s risk of chronic disease, which leads to increased health care expenditures.

The Health Care Delivery System’s Role in Addressing Food Insecurity

Although more and more providers are becoming aware of the health implications of food insecurity, there has not been enough action taken by the health care delivery sector. Widespread efforts to address food insecurity can save billions in health care spending and, more importantly, improve the quality of life in communities nationwide. Both medical professionals and health care delivery systems can take the following steps to ensure patients have access to adequate nutrition.

  1. Identify at-risk patients. Screen patients for hunger during office visits using a survey as brief as just one or two questions.
  1. Make meaningful referrals to healthy food resources. During office visits, health care providers may write food prescriptions and referrals to federal assistance programs such as Supplemental Nutrition Assistance Program (SNAP) and Women, Infants, and Children (WIC). Providers may also refer patients to relief resources such as food banks and pantries.
  1. Work with partners to alleviate food insecurity in the community. Outside of the clinical setting, health care providers and delivery systems can recognize, support, and collaborate with local, community-based organizations that work to eliminate hunger and food insecurity.

In the coming months, this blog series will highlight health care delivery system initiatives designed to reduce hunger and food insecurity. In addition, we’ll explore how some of this work can be implemented on a broader scale. Look for the next article: a spotlight on hunger screening as part of providers’ routine checks of vital signs.