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The Social Determinants of Health: Food Insecurity

Janelle Schrag
September 29, 2014

Every day, 49.1 million Americans do not have adequate access to nutritional food or cannot afford it. Of this population, 1 in 6 is a child.

Hunger, food assistance programs, malnutrition, food deserts – these are all words that may come to mind when you hear food insecurity. For essential hospital patients, food insecurity may be one of the most significant social determinants of health. Essential hospitals such as Boston Medical Center (BMC), are taking the lead on this issue and prioritizing food insecurity in patient care.

Meals or Medication?

Food insecurity can include the inability to access to nutritional food (e.g., food desert), disrupted eating patterns, or reduced food intake. Many essential hospital patients, especially low-income, minority groups, are highly likely to experience one or both of these challenges. Such nutritional insufficiencies lead to worse health outcomes and can have a number of repercussions on disease management, prevention, and treatment strategies.

One of the most devastating realities of food insecurity is that patients are forced to choose between food and other essential living expenses. In a poll of more than 60,000 of Feeding America’s clients (i.e., those who receive food assistance through their affiliated food programs), 66 percent reported that they had to choose between food and their medical care in the past year. These trade-offs (see Figure 1) not only exacerbate other social determinants of health, but they also drastically hinder critical medical interventions such as check-ups and medications.


Figure 1: Household Spending Trade-Offs in the Past Year

A Prescription for Better Living   

Boston Medical Center (BMC) is a leading essential hospital that has chosen to face this issue head-on and make food insecurity a priority in patient care. In 2001, BMC launched its Preventive Food Pantry, an on-site resource for patients dealing with food insecurity. BMC also has a Demonstration Kitchen in which patients can learn how to cook healthier meals using the ingredients they receive from the food pantry. In a video documenting the powerful impact of this program, one patient said, “I didn’t really know how to cook my food in a healthy way until I came here.”

One of the most unique factors about BMC’s Preventive Food Pantry is that it is 100 percent prescription based. Receiving food assistance can be a difficult step for patients due to existing stigmas, but receiving doctor’s orders may relieve some of that pressure. Additionally, this patient referral system is built into the electronic health record system and allows providers to customize the type of food a patient or family should receive.

BMC’s program is also the first of its kind to collocate a food pantry and demonstration kitchen on-site. Starting with just 500 patients a month in 2001, the nationally awarded pantry now serves roughly 80,500 patients annually.

Looking to Essential Hospitals

Food pantries, farmers markets, demonstration kitchens – these are words inspiring essential hospitals. Along with BMC, more than 50 members of America’s Essential Hospitals have implemented some form of food insecurity intervention on-site, and countless more are partnering with local organizations or linking patients with helpful resources.

Food insecurity is a crucial issue for patient health that ultimately affects health system sustainability. BMC is just one of many essential hospital leaders addressing food insecurity as a social determinant of health.

Are you fighting food insecurity in your community? Tell us about it in a comment below.

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