ACP: Policymakers, health officials must address food insecurity

Access — or lack thereof — to nutritious food directly impacts Americans’ health, and more must be done to address food and nutrition insecurity, according to a position paper from the ACP.

The paper, published in Annals of Internal Medicine, notes that food insecurity, which roughly 10% of people in the U.S. experience, “functions as a social driver of health.” The paper also points out the snowball effect at play, stating that food insecurity directly impacts “health status and outcomes, which can further negatively impact employment and income and increase medical expenditures — all of which exacerbates food insecurity.”

“Ensuring that all persons are able to feed themselves a healthful diet, with dignity, is an important component of a just society,” Josh Serchen, BA, a health policy associate for the ACP, and colleagues wrote. “ACP believes that the United States has a moral and public health imperative to address food insecurity comprehensively.”

The effects of food insecurity can be far-reaching and varied, depending on age and other factors. For children, food insecurity is associated with an increased risk for mental and behavioral health problems, asthma, worse oral health, cognitive problems, anemia and birth defects, according to the ACP. In non-senior adults, food insecurity can mean higher rates of mental health problems, high blood pressure, high cholesterol, diabetes and other chronic diseases, as well as reported poorer general health and sleep. Senior adults facing food insecurity are at risk for higher rates of depression, more limitations in an activity of daily living and poorer reported health.

“These health effects can be observed in the heightened health care utilization rates and costs experienced by food insecure individuals,” Serchen and colleagues wrote.

The paper lists multiple recommendations to combat food insecurity in the U.S., addressing all parties involved in health care from policymakers to physicians.

In its top recommendation, the ACP asserts that all people need to have access to healthful foods and “urges policymakers to make addressing food insecurity and nutritional drivers of health a policy and funding priority.”

The ACP recommends that primary care physicians and other medical professionals “undertake activities to better understand and mitigate food insecurity experienced by their patients.” Specifically, the paper notes that “screening tools and other resources for addressing food insecurity should be developed and validated” and that health care teams should begin screening for food insecurity as part of regular visits. The ACP further called for curriculum surrounding food and nutrition insecurity to be incorporated into medical education, and for practices and hospitals to “establish referral mechanisms to community and government resources, with financial, technical, and policy support from policymakers and payers.”

Another top recommendation is that policymakers should “sufficiently fund and support efforts that aim to reduce food and nutrition insecurity and promote safe and healthful diets,” Serchen and colleagues wrote. The authors list several ways in which policymakers can better address food insecurity, such as by protecting all nutrition assistance programs “while recognizing the need to provide local flexibility where feasible”; streamlining nutrition assistance program enrollment processes; supporting efforts to increase nutrition assistance program uptake among eligible individuals; not including unnecessary conditions in nutrition assistance programs that reduce uptake, increase stigma, increase costs and more; and by basing nutrition assistance efforts on “strong nutritional science.”

Other recommendations include:

• improving the Supplemental Nutrition Assistance Program (SNAP) “to better serve the needs and health of food-insecure individuals and households”;

• increasing CMS support and developing and testing “innovative models and waivers that incorporate benefits and activities that address social drivers of health, including food insecurity”; and

• conducting research to better understand food and nutrition insecurity’s cost, prevalence, severity and impact on health and health care.

“The federal government should support nutrition research and coordinate research and other activities across federal departments and agencies,” Serchen and colleagues wrote.