Food insecurity threatens public health in the U.S., ACP says

Inadequate access to nutritious food negatively impacts the health of approximately 10% of Americans and must be urgently addressed, ACP said in a new position paper.

Food insecurity is associated with a higher risk of lower nutrient intakes; higher rates of mental health problems, diabetes, high blood pressure, high cholesterol, and other chronic diseases; and worse reported health, sleep, and health exam outcomes in adults, the paper said. In addition, food-insecure seniors are at risk for lower nutrient intakes, poorer reported health, higher rates of depression, and more limitations in activities of daily living.

To strengthen food insecurity response in the U.S. and to empower physicians and other medical professionals to better address social drivers of health, ACP recommends the following:

• All persons need to have adequate access to healthful foods and policymakers must make addressing food insecurity and nutritional drivers of health a policy and funding priority.
• Policymakers need to sufficiently fund and support efforts that aim to reduce food and nutrition insecurity and promote safe and healthful diets.
• Policymakers should improve the Supplemental Nutritional Assistance Program to better serve the needs and health of food-insecure individuals and households.
• CMS should develop, test, and support innovative models and waivers that incorporate benefits and activities that address social drivers of health, including food insecurity.
• Physicians and other medical professionals should undertake activities to better understand and mitigate food insecurity experienced by their patients, including screening patients for food insecurity, incorporating teaching about food insecurity into medical education, and establishing mechanisms for referring patients in need to community and government resources.
• Research efforts should strive to better understand the prevalence, severity, and cost of food and nutrition insecurity; their impact on health and health care; and ways to effectively and efficiently improve them. The federal government should support nutrition research and coordinate research and other activities across federal departments and agencies.

“Strengthening Food and Nutrition Security to Promote U.S. Public Health: A Position Paper from the American College of Physicians” was published June 28 by Annals of Internal Medicine.

In a study published July 5 by Annals of Internal Medicine, researchers in California randomly assigned adult Medicaid enrollees who were at elevated risk for requiring health care to 12 months of social needs case management (n=21,422) or a control group (n=36,550). Overall, participants in the intervention group had fewer hospital encounters than controls, with ratios of 0.96 (95% CI, 0.91 to 1.00) for all ED visits, 0.97 (95% CI, 0.92 to 1.03) for avoidable ED visits, 0.89 (95% CI, 0.81 to 0.98) for all hospital admissions, and 0.72 (95% CI, 0.55 to 0.88) for avoidable admissions. The researchers found that the intervention programs saved $3,423,085, or 17% of yearly program expenses, in hospitalization costs and reduced total inpatient admissions and total ED visits by 11% and 4%, respectively.

A main limitation of the study was that only 40% of those assigned to the intervention program chose to engage in case management, the authors noted. They concluded that although social needs case management programs may reduce health care use, the resulting savings may not cover the full costs of the programs, and additional research is needed to determine whether these interventions affect use of other health services or improve health status. “A better understanding is needed of the process by which social needs case management translates to decreased hospital use and potentially improved health,” they wrote.