Assignment 1 – Identify a gap
Robust evidence suggests that food insecurity (FI)—the limited access to food due to a lack of money or other resources1—adversely impacts health and development.2-5Based on this recognition, multiple public and professional organizations have come out in support of FI screening within the health care setting, such as the American Academy of Family Physicians, American Academy of Pediatrics, AARP, the Center for Medicare and Medicaid Innovation,6-9the Food Research & Action Center, Children’s HealthWatch and Feeding America.10There is less guidance on how to intervene on positive FI screens, with some suggesting that simply the knowledge of a patient’s food insecurity is important to help guide medical therapies and patient-centered care, whereas others have called for direct linkages to community resources or direct provision of food resources within the health care system.10Multiple studies have provided evidence that interventions within the health care system to address FI can be successful in reducing FI,11-13increasing vegetable and fruit intake,14,15increasing use of FI resources (such as SNAP or food pantries),16-22facilitating patients getting connected with other social and/or economic resources,23and improving a range of health outcomes.24,25Absolute rates of health care-based FI screening and interventions have not been well documented, but at Health Resources and Services Administration (HRSA) Bureau of Primary Health Care (BPHC) clinics, patients have reported assistance with FI from their health center as low as 2% (2.5% at Migrant Health Centers and 2.8% at Community Health Centers) to over 20% (23% at Health Care for the Homeless clinics).26Studies reporting on clinician FI screening practices have similarly shown low rates.27,28Limited by lack of systematic documentation of FI screening and interventions across health systems, lack of high quality experimental studies on FI screening and interventions within the health care system and little to no articles on health care utilization and cost related to FI screening/interventions,29 it is challenging to project direct health consequences and costs to not addressing FI within the health care system. Many studies have linked FI and poor health outcomes and higher health care utilization and cost,30-39but there is limited literature looking at the long term impacts of FI interventions on health outcomes, utilization and cost. As more studies are published reporting on FI interventions, we are starting to gather evidence of the benefits to a patient’s health status, especially in terms of improving health outcomes for depression, obesity,15diabetes,25and blood pressure,24and rates of health care-based interventions are low. There is an opportunity for the health care system to contribute a key role in improving our patients’ health through acknowledging and assisting with social determinants more broadly, with FI being one of many social determinants that impact our patients’ health.
References
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2. Alley DE, Soldo BJ, Pagán JA, et al. Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age. Am J Public Health 2009;99 Suppl 3:S693-701.
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9. EveryONE Project Unveils Social Determinants of Health Tools. American Academy of Family Physicians, 2018. (Accessed March 22, 2018, 2018, at https://www.aafp.org/news/health-of-the-public/20180109sdohtools.html.)
10. Addressing Food Insecurity in Health Care Settings: Key Actions & Tools for Success. 2018. (Accessed April 2, 2018, at http://frac.org/wp-content/uploads/addressing-food-insecurity-in-health-care-settings-key-actions-and-tools.pdf.)
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