The Impact Of Food Insecurity On Adult Health & Well-Being: SDoH Series, Part 1

Following the Healthy People 2030 model, this article series focuses on the 6 aspects of social determinants of health, including food insecurity, economic stability, neighborhood and the physical environment, education, community, social support, and healthcare access. First, we'll discuss the impact of food insecurity on adult health and well-being, share national and regional programs, and highlight the programs and models that are making a positive impact.

Defining and quantifying the challenge of food insecurity

While food insecurity doesn't always cause hunger, it indicates a lack of access to adequate, affordable, healthy food. The US Department of Agriculture (USDA) defines food insecurity as "a household-level economic and social condition of limited or uncertain access to adequate food." In 2021, more than 38 million Americans were food insecure.

The USDA classifies food insecurity into 2 levels:

1. Low food security indicates a lack of dietary quality and variety. In this scenario, individuals may rely on inexpensive, low-quality food because they lack access to affordable or healthier options.
2. Very low food security is when a person may eat less food than they need overall, regularly skipping meals or eating very small portions to make food last or to feed others in their household before themselves. People with very low food security are at greater risk of going hungry, which is both a medical and physiological condition.

Who is most at risk of food insecurity?

Four groups of adults are more at risk for food insecurity.

1. Low-income households made up more than twice the national average for food insecurity, with 28.6% of low-income households experiencing food insecurity compared to the national average of 10.5%.
2. Older adults ages 60-69 who rent their homes and are from historically marginalized racial or ethnic groups are twice as vulnerable to food insecurity.
3. Adults living with a disability can be at a higher risk for food insecurity due to limited employment opportunities and healthcare-related expenses that reduce the monies available to buy food.
4. Individuals from historically marginalized groups face greater food insecurity due to systematic racism and discrimination. In 2021, 19.8% of Black households experienced food insecurity, as did 16.2% of Hispanic households, compared to 7.0% of White households.

What increases the risk of food insecurity?

Neighborhood conditions affect physical access to food. Some urban areas, rural areas, and low-income neighborhoods can have limited access to full-service supermarkets or grocery stores. Easy access to expensive convenience stores and inexpensive, fast food options limit choice. Lack of transportation options and long-distance food options increase risk.

A study conducted in Detroit revealed that people living in low-income, predominantly Black neighborhoods traveled an average of 1.1 miles farther to the closest supermarket than people living in primarily low-income White communities.

How does food insecurity affect health?

Eating healthy is challenging for most Americans. Consider that in 2019, only about 1 in 10 US adults met recommendations for daily fruit and vegetable intake. For people living with food insecurity, the lack of affordable, accessible, and nutritious foods profoundly affects their health and well-being. Food-insecure adults can experience:

• Higher risk of obesity
• Higher rates of chronic disease
• Higher incidence of diabetes and poorer glycemic control
• Increased likelihood of living with a chronic illness 
• Increased likelihood of poor medication adherence
• Increased likelihood of healthcare utilization and paying higher costs for care

Among working-age and older adults, several studies found that food insecurity is associated with underusing medications due to cost. Working-age adults from food-insecure households were 4 times more likely to exhibit poor medication adherence because of cost than those in food-secure households.

Even people in households with marginal food security are about 50% more likely to have at least 1 cost-related medication issue. Those with low food security are twice as likely to struggle with medication underuse. Those with very low food security are more than 3 times as likely to skip medication doses.

Food program trends in light of the public health emergency and high inflation

While the US government moved quickly and spent billions on improving and expanding food access nationally, the public health emergency (PHE) ending in May 2023 and 40-year high inflation and food costs threaten the gains made during the pandemic.

For example, in 2021, food insecurity for households with children fell to 12.5%, and child poverty rates fell from 9.7% in 2020 to 5.2% in 2021. The American Rescue Plan Act (ARPA) provided funding for meals via home delivery and within congregate settings, as well as delivery of produce to participants over age 60. An additional $95 a month or more was paid to Supplemental Nutrition Assistance Program (SNAP) beneficiaries in 32 states and Washington, DC; however, that benefit ended in February 2023.

The Biden-Harris Administration highlights their view as the impacts of food insecurity and diet-related diseases, which not only affect an individual, their family, and community, but also impose a higher societal cost.

Their administration has put forth a national strategy built on 5 pillars:

1. Improve food access and affordability
2. Integrate nutrition and health
3. Empower all consumers to make and have access to healthy choices
4. Support physical activity for all
5. Enhance nutrition and food security research

According to Healthy People 2030, out of the 14 nutrition and healthy eating objectives, only 3 are improving, 2 show little or no detectable change, 3 are worsening, and 5 are establishing baselines. An essential metric for measuring food insecurity is improving.

The number of households that were food insecure in 2018 was 11.1%, improving to 10.2% in 2021. The goal is to decrease food insecurity in households to 6%. Despite these reported results, food programs around the US positively impact health and well-being. They provide needed nutritional support that align with adherence to a healthcare plan, managing chronic illness, giving mothers and children a healthy start, as well as helping patients heal after surgery.

Some food programs are positively impacting health, well-being, and care plan effectiveness

There are a number of federal food programs that have demonstrated a positive impact on health. Additionally, with the growth of SDoH funding, Section 1115 waivers, and other value-based and Medicaid programs, many programs have realized a measurable and meaningful effect on health and well-being.

Federal food programs

Adult food assistance includes the Women, Infants, and Children (WIC) program and SNAP, serving 6.2 million people monthly. Studies have shown that these programs can reduce food insecurity and improve health outcomes.

A literature review published in the Annals of Internal Medicine identified 20 studies that revealed measurable benefits to WIC participation. These included improved maternal, infant, and child health outcomes like lower risk of preterm birth, lower risk of low birth weight, and lower risk of infant mortality. Medicaid and WIC participation reduced low birth weight risk by 24%.

Research on SNAP participation is associated with lower healthcare costs and improved health outcomes. As the primary source of nutrition assistance for people living on a low income, SNAP use is linked to improved access to preventive healthcare and spent about $1,400 (nearly 2%) less in medical care costs annually compared to non-participants with low incomes. This spending disparity is more significant for those with hypertension (~$2,700 less) and coronary heart disease (~$4,100 less). Lastly, SNAP benefits reduced the likelihood of hospitalization by 14%.

Food programs leverage state, city, payer, provider, and vendor partnerships

Several programs stand out for their innovative strategies, creative solutions, and measurable impact.

Kaiser Permanente: Their Food for Life Program connects patients with CalFresh, California's SNAP benefits program. Kaiser representatives help raise awareness of available benefits and support in navigating the application and enrollment process for patients with lower literacy or self-efficacy levels.

CalAIM Community Supports: CalAIM is California's value-based Medicaid program. CalAIM health plans can offer medically tailored meals (MTM) and medically supportive food instead of higher-cost services traditionally covered by Medicaid. Beneficiaries with complex medical profiles or chronic conditions, like congestive heart failure or diabetes diagnosis, or at risk for readmissions can participate. These programs have been shown to reduce hospital stays and healthcare costs. Benefits can include:

• Meals delivered to home after hospitalization
• Behavioral, cooking, and nutrition education
• Tailored dietary meals
• Help from a registered dietician
• Healthy food vouchers
• Medically tailored groceries
• Food pharmacies

Their program saw measurable and profound impacts on health outcomes and healthcare costs:

• Reduced the number of patients with poor diabetes control by 17%
• Increased medication adherence by 50%
• Reduced emergency department (ED) visits by 22-58%
• Decreased hospitalizations by 27-63%
• Decreased 30-day readmissions by 38-59%
• Reduced healthcare costs for patients with complex needs by 16%, creating a 20% reduction in food insecurity

Grady Health System: A safety net hospital in Atlanta, Georgia, Grady uses an in-house fresh food market as a hub for its Food Prescription program. The program also supports patients living with diabetes through lifestyle changes. With more than 1,000 patients enrolled, their multi-stage, year-long curriculum includes free healthy food boxes, cooking classes, nutrition counseling, and checkups with providers. Participants who begin the program with A1C levels over 9% have an average reduction of 2.3 points.

San Francisco Health Network (SFHN): Their food as medicine collaborative created food pharmacies–a medical treatment or preventative service co-located within healthcare settings where patients access food and often additional behavioral, cooking, and nutrition education. In 2020, the SFHN program helped 2,740 patients through 16 clinics and 5 health systems, reducing an 8% disparity in blood pressure control rates between all patients and Black patients down to 3% disparity. They improved blood pressure control for Black patients by 9%. Participants were quoted saying, “The program has helped me balance my health. I am eating healthier and changing my eating habits." “Since we've been doing this healthy eating and stuff, I was taking 9 to 10 medications a day. Now I'm down to 6!... And my blood pressure is normal."

Other outcomes included:

• 30% increase in food security
• 28% of participants extended their monthly food budget by 1 additional week
• 92% of patients adopted healthier eating habits
• 93% reported feeling like part of the community
• 90+% participant satisfaction
• 83% were more likely to seek care at their clinic

Anthem: Their pilot of Project Angel Food worked with 252 patients with 1 or more complex, chronic medical conditions identified as food and nutrition insecure, with complex dietary needs, and socioeconomically disadvantaged. Program outcomes impacted health and mental well-being:

• 35% said the program improved their quality of life
• 87% maintained or decreased hospitalizations over a 6-month timeframe
• 83% maintained or improved medication adherence

Innovative food programs bring together various healthcare, vendor, and community partners to address the health effects of food insecurity. Their accomplishments point to the value of food to healthier lifestyles, as well as better health plan adherence and management for complex, chronic illnesses and recoveries.

Build and scale cost-effective food security programs that impact health

RTI Health Advance supports organizations at the forefront of SDoH interventions like food programs. Our team of experts covers the spectrum of issues faced by payers, providers, and vendors today. From health equity, data analytics, quality improvement, population health, and digital health technologies, we can help you achieve care, quality, and cost goals. Contact us.