U.S. hospitals and health systems are recognizing that many of their patients lack access to affordable, healthy foods. This lack of access, known as food insecurity, affects clinical, behavioral, socioeconomic and environmental factors that contribute to health. Reducing food insecurity has therefore become a goal of many hospital population health strategies.
The nature of food insecurity
Food insecurity, as defined by the U.S. Department of Agriculture, is an economic and social condition of limited or uncertain access to adequate food, with either disrupted eating patterns or reduced food intake. In 2015, 12.7 percent of U.S. households — 15.8 million — were identified as being food insecure. Food insecurity can affect the health of all individuals, regardless of who they are and where they live. People who live in poverty or in rural areas, however, are more likely to be food insecure.
Food insecurity can occur due to limited quantities of food, lack of access to nutritious food, inability to afford food, abnormal eating patterns, or consumption of foods with high levels of calories and carbohydrates. Individuals who are food insecure are at an increased risk of developing chronic health conditions such as diabetes and obesity. Of course, having a chronic illness can affect an individual’s or family’s financial stability due to the cost of medical treatments and hospitalization. Lack of food also influences an individual’s behavioral health as it can increase stress levels and the likelihood of using alcohol and tobacco.
Hospitals and health systems have recognized the cycle that links food insecurity, chronic illness and poverty. For example, Arkansas Children’s Hospital, Boston Medical Center and ProMedica are all implementing upstream interventions and building partnerships to reduce the prevalence of food insecurity and its risk factors.
Arkansas Children’s in Little Rock offers a wide range of services focused on reducing food insecurity. In 2016, the hospital’s on-site garden produced more than 1,790 pounds of produce, which was delivered to the local Helping Hand pantry for redistribution. The hospital’s Share Our Strength’s Cooking Matters classes, led by local chefs and nutritionists, are offered to patients and employees to educate them about cooking and eating affordable, healthy food. Additionally, in partnership with the USDA, the hospital has distributed over 60,000 packed lunches to children during hospital or clinical visits since 2013. Arkansas Children’s Hospital continues to identify food insecurity among its patients by integrating a determinants-of-health screening tool in a pilot clinic. In 2016, this tool identified 2,074 individuals as food insecure from the 7,048 screened.
Through a study by the Children’s HealthWatch network, Boston Medical Center, a large safety-net hospital, recognized the need to address food insecurity. The medical center has an on-site Women, Infants and Children Nutrition Program to encourage families to apply for benefits during their hospital stay.
Boston Medical Center’s most successful approach to reduce food insecurity has been its food pantry, which operates through aid from the Greater Boston Food Bank and donations from other community organizations. For over 15 years, the Preventive Food Pantry has been providing medically referred food-insecure clients with healthy meals that last three to four days. More than 7,000 patients and their families are served every month, and more than 15,000 pounds of food are distributed weekly. Every year, this food pantry provides more than 1 million pounds of food to people in the community.
The medical center also has a demonstration kitchen, where patients can learn how to cook healthy meals and use the foods that come from the pantry. Because of its ongoing efforts, Boston Medical Center received the 2012 James W. Varnum National Quality Health Care Award.
ProMedica, a large, nonprofit health system serving counties in northwest Ohio and southeast Michigan, has integrated clinical approaches to address food insecurity, including using screening tools and establishing food pharmacies. The health system uses the Children’s HealthWatch Hunger Vital Sign survey in its inpatient admission database and screened 57,224 patients for food insecurity in 2016.
ProMedica also has established two food pharmacies in the Toledo area to identify and help food-insecure individuals and households. Physicians provide referrals or prescriptions for two or three days’ food. These food pharmacies offer free nutrition counseling with a registered dietitian.
ProMedica’s nonclinical approaches involve collaborating with other organizations to raise awareness about food insecurity. For example, ProMedica’s Root Cause Coalition is a national, nonprofit organization that addresses the causes of health disparities by focusing on hunger and other determinants. The coalition shares best practices, engages with communities in collaborative projects and participates in research to advance public policy to improve health.
ProMedica also partners with a local casino to deliver unused food from the casino’s restaurant to a local food bank for redistribution. This partnership has distributed more than 300,000 pounds of food, or about 275,000 meals, to the community. Barbara Petee, chief advocacy and government relations officer at ProMedica, says, “ProMedica is committed to meeting our mission to improve health and well-being, and as such, we must address basic needs such as food, clothing and shelter.”
Because of the stigma associated with hunger and food insecurity, many households are reluctant to seek help. Hospitals can create an environment that provides resources and care to help individuals and families feel more comfortable about their health status and encourage them to receive help.
But before implementing interventions, a hospital must first visualize food as medicine to realize the impact that food can make in the community. By integrating evidence-based clinical and nonclinical interventions within the hospital and collaborating with local, state and national organizations, hospitals can help reduce the prevalence of food insecurity and the stigma attached to it.
The American Hospital Association's Hospitals in Pursuit of Excellence team is launching a series of guides on how hospitals can address the determinants of health to improve population health. "Food Insecurity and the Role of Hospitals" will be the first guide in this series. It's coming soon at HPOE.org.
Syeda Aisha, M.P.H., is a program specialist with the Health Research & Educational Trust.