Pennsylvania Association of

Community Health Centers

Supporting Pennsylvania's health centers in increasing access to quality primary health care for all

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Pennsylvania Association of Community Health Centers serves as the collective voice for Pennsylvania's Federally Qualified Health Centers (FHQCs), FQHC Look-Alikes (FQHCLAs), and non-profit Rural Health Clinics (RHCs).  Our members are unique nonprofit primary care facilities that provide a wide array of services to Pennsylvanians in underserved areas of the state. There are nearly 300 sites in 52 counties serving over 800,000 Pennsylvanians.  At these primary care facilities, patients will receive high quality care at a price they can afford with sliding fees based on income and family size.

PACHC News

Wednesday, January 17, 2018

The Intersection Between Hunger And Health

The USDA defines food insecurity(FI) as a household-level economic and social condition of limited or uncertain access to adequate food.  For your patients, being food insecure means they do NOT have access to the foods they need for a healthy, active life. This 3-part series will define the social determinants of health, specifically food insecurity, its impact on health, and finally how healthcare systems across the country are aligning with our nation’s emergency feeding network to not only identify need, but assist with access to existing community support systems. Lastly, healthcare providers are asked to consider ways to engage in health and nutrition education outreach at the food distribution level, effectively “meeting people where they are” with the care that they need.
Like many regional food banks across our nation, the Central Pennsylvania Food Bank is engaged in creating partnerships with healthcare providers throughout their 27-county service area.  Along with an aggressive move over the last 8 years to source and distribute highly nutritious “foods to encourage”, the Food Bank’s goal in its new Health Innovations Initiative is to introduce healthcare providers to, and encourage implementation of, food insecurity screening as a part of the routine patient assessment process. Not only is it important to screen patients seeking medical attention for food insecurity, but also to know how to refer patients to food distribution programs, i.e. pantries, meal programs, SNAP, WIC, etc.).  Regional food banks statewide, are also engaging in these efforts and are at various levels of implementation strategies.Community engagement in health and nutrition outreach can take many forms from sponsorship of produce distributions, providing food pantry services onsite at hospitals or clinics, provide health screenings and intervention activities at food distribution sites, or health outreach activities with low-income school populations.

What is Food Insecurity?

The U.S. Department of Agriculture (USDA) defines food insecurity as a lack of consistent access to enough food for an active, healthy life.  In 2016, an estimated 1 in 8 Americans were food insecure, equating to 42 million Americans including 13 million children.

It is important to know that hunger and food insecurity are closely related, but distinct concepts. Hunger refers to a personal, physical sensation of discomfort, while food insecurity refers to a lack of available financial resources for food at the household level.

Policy evaluation, through both quantitative and qualitative research, reveals food insecurity to be a complex problem. It does not exist in isolation, as low-income families are affected by multiple, overlapping issues like affordable housing, social isolation, health problems, medical costs, transportation challenges, and low wages. Many do not have what they need to meet basic needs and these challenges increase a family’s risk of food insecurity. Effective responses to food insecurity will need to address these overlapping challenges.

Taken together, issues such as affordable housing, social isolation, education level, unemployment or underemployment, and food insecurity are important social determinants of health defined as the “conditions in the environments in which people are born, live, learn, work, play, worship and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.” HungerandHealth.org, a website sponsored and maintained by Feeding America®, explores the impact of food insecurity as a social determinant of health and its effect on individual and population health outcomes.

Poverty and food insecurity in the United States are closely related. People living below the poverty line are not always experiencing food insecurity, and people living above the poverty line can experience food insecurity. Wages and other critical household expenses (such as caring for an ill child) can also help predict food insecurity among people of many socioeconomic levels living in the United States.

Who does Food Insecurity Affect? 

There is no single face of food insecurity. It impacts every community in the United States. To learn more about child and overall food insecurity in your state, congressional district and even county, visit the Map the Meal Gap study conducted by Feeding America®. http://map.feedingamerica.org/.

 

Ranges of Food Security

While households are often described as either food secure or food insecure, there are four levels of food security that describe the range of households’ experiences in accessing enough food. Households with high food security and marginal food security make up the food secure category, and households with low food security and very low food security make up the food insecure category. 

Sources

  1. Alisha Coleman-Jensen, Matthew P. Rabbitt, Christian A. Gregory, and Anita Singh. 2017. Household Food Security in the United States in 2016, ERR-237, U.S. Department of Agriculture, Economic Research Service. 
  2. Social Determinants of Health. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed January 24, 2017.
  3. Definitions of Food Security. United States Department of Agriculture Economic Research Service. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/#ranges Updated October 6, 2016. Accessed January 12, 2017.

How do households cope with food insecurity?

Food insecurity is a high stress condition for a person or household. When people do not know where their next meal is going to come from, finding that next meal often becomes their central focus and can take priority over things that are less immediately urgent but still important for one’s health (such as refilling medications, making doctor appointments, and addressing with insurance issues).

According to the Hunger in America 2014 survey, many households who visit charitable food programs make difficult choices in order to meet basic needs. Specifically, households served by the Feeding America network report choosing between:

  • Food and medicine (74 percent)
  • Food and utilities (59 percent)
  • Food and transportation (67 percent)
  • Food and housing (57 percent)

Oftentimes, households must use many coping strategies in order to meet their food needs. 

These coping strategies may include:

  • Receiving help from friends (53 percent)
  • Watering down food or drinks (40 percent)
  • Purchasing inexpensive, unhealthy food (83 percent)
  • Selling or pawning personal property (35 percent)
  • Growing food in a garden (23 percent)
More than half (55 percent) of all households served by the Feeding America network report having to use three or more coping strategies to deal with tough choices. Some of these coping strategies may help to support one’s health. Others make sense in the short term, but can have a negative impact on health in the long term, particularly in households with children and among people who are already coping with a diet-related, chronic diseases including diabetes and hypertension.

While additional research will allow us to better understand these connections, we already know that improved food security is associated with better dietary intake and lower weight. It may also lead to better disease management, lower health care costs and overall better health.

Sources

  1. Shah AK, Mullainathan S, Shafir E. Some consequences of having too little. Science. 2012;338:682-685.
  2. Sleek S. How poverty affects the brain and behavior. Association for Psychological Science. 2015. https://www.psychologicalscience.org/observer/how-poverty-affects-the-brain-and-behavior#.WJkAo9UrKM9. Accessed February 7, 2017. 
  3. Mani A, Mullainathan S, Shafir E, Zhao J. Poverty impedes cognitive function. Science. 2013;341(6149):976-980.
  4. Nguyen BT, Shuval K, Bertmann F, Yaroch AL. The Supplemental Nutrition Assistance Program, food insecurity, dietary quality, and obesity among U.S. Adults. Am J Public Health. 2015;105(7):1453-9.
  5. Hanson KL, Olson CM. School meals participation and weekday dietary quality were associated after controlling for weekend eating among U.S. school children aged 6 to 17 years. The Journal of nutrition. 2013;143(5):714-21.
  6. Gundersen C, Kreider B, Pepper J. The impact of the National School Lunch Program on child health: A nonparametric bounds analysis. J Econometrics. 2012;166(1):79-91.
  7. Clark MA, Fox MK. Nutritional quality of the diets of US public school children and the role of the school meal programs. Journal of the American Dietetic Association. 2009;109(2 Suppl):S44-56.
  8. Tarasuk V, Cheng J, de Oliveira C, Dachner N, Gundersen C, Kurdyak P. Association between household food insecurity and annual health care costs. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2015;187(14):E429-36. PMCID: 4592315.
    Seligman HK, Bolger AF, Guzman D, Lopez A, Bibbins-Domingo K. Exhaustion of food budgets at month's end and hospital admissions for hypoglycemia. Health affairs. 2014;33(1):116-23. PMCID: 4215698

How do households cope with food insecurity?
Food insecurity is a high stress condition for a person or household. When people do not know where their next meal is going to come from, finding that next meal often becomes their central focus and can take priority over things that are less immediately urgent but still important for one’s health (such as refilling medications, making doctor appointments, and addressing with insurance issues).

According to the Hunger in America 2014 survey, many households who visit charitable food programs make difficult choices in order to meet basic needs. Specifically, households served by the Feeding America network report choosing between:
Food and medicine (74 percent)
Food and utilities (59 percent)
Food and transportation (67 percent)
Food and housing (57 percent)
Oftentimes, households must use many coping strategies in order to meet their food needs. 

These coping strategies may include:
Receiving help from friends (53 percent)
Watering down food or drinks (40 percent),
Purchasing inexpensive, unhealthy food (83 percent)
Selling or pawning personal property (35 percent)
Growing food in a garden (23 percent)

More than half (55 percent) of all households served by the Feeding America network report having to use three or more coping strategies to deal with tough choices. Some of these coping strategies may help to support one’s health. Others make sense in the short term, but can have a negative impact on health in the long term, particularly in households with children and among people who are already coping with a diet-related, chronic diseases including diabetes and hypertension.

While additional research will allow us to better understand these connections, we already know that improved food security is associated with better dietary intake and lower weight. It may also lead to better disease management, lower health care costs and overall better health.


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