Food is life. A consistent, nutritious diet can improve overall health and protect against chronic conditions. But not everyone can access or afford a nutritious diet. In 2022, 1 in 8 households in the U.S. and 1 in 6 households with children were food insecure.
Black and Latinx households experience more than double the rates of food insecurity than white households. And a February 2024 article in Medical Care found that among Virginia’s adult Medicaid population, members of color had almost twice the odds of unmet medical and social needs including food insecurity.
Food insecurity has an adverse effect on health outcomes
Food insecurity is making people sicker. Children living in food insecure households are more than two times as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma. Food insecurity also leads to higher rates of chronic diseases such as obesity and a higher risk of developmental issues.
For adults, food insecurity can lead to death. In a retrospective study of 27,188 U.S. adults, those with marginal, low, and very low food security had a higher risk of all-cause mortality. And those with marginal or very low food security had a higher risk of cardiovascular death even after adjusting for baseline diabetes mellitus, hypertension, hypercholesterolemia, and body mass index.
Food insecurity takes a significant toll on physical health. But food insecurity also greatly impacts mental health outcomes. According to a 2020 systematic review, food insecurity is associated with higher psychological distress. And this distress was found among children, adolescents, and adults alike as well as those living with chronic conditions.
During Covid-19, food insecurity and mental health outcomes only worsened. One survey of 2,714 low-income adults found that pandemic-era food insecurity was associated with a 257% higher risk of anxiety and a 253% higher risk of depression – three times the mental health impact of losing a job during the pandemic.
Addressing food insecurity has the potential to improve health outcomes, mental well-being, and mortality rates.
“Food is Medicine” programs can combat food insecurity
Food insecurity is a social determinant of health (SDOH), so we need population-level solutions to address it. Many neighborhoods lack access to affordable grocery stores with nutritious options. Others are saturated with unhealthy, low-cost options. This access disparity disproportionately affects low-income communities and communities of color.
Food insecurity programs have been around for decades. The “Food is Medicine” model uses food as an intervention to improve food security and health outcomes. Some of the more common interventions include medically tailored meals, produce prescriptions, and nutrition assistance programs. And there is ample evidence that Food is Medicine programs are successful.
A 2019 study of one such program, for example, found that after one year of a medically-tailored meal delivery service, patients had 49% fewer inpatient admissions and a 16% cut in healthcare costs. Last year Meals on Wheels America published a comprehensive report on meal delivery service outcomes for seniors. The program increased food security, improved or reduced decline of nutritional status, and reduced overall healthcare costs.
A focus on food to reduce healthcare expenditures
The U.S. spends an estimated 90% of the $4.3 trillion annual healthcare costs on chronic health conditions like cardiovascular disease, diabetes, and obesity. So the potential healthcare savings of Food is Medicine programs has health plans taking note.
In 2020, Massachusetts launched a pilot through an 1115 waiver allowing the use of Medicaid dollars for SDOH programs. One participating nutrition services provider served 5,000 beneficiaries in 2 years. And after the first 6 months of the program, 25% of participants were no longer food insecure.
Federal health plans expect to continue reimbursing for Food is Medicine programs. In 2022, the White House hosted a conference on hunger, nutrition, and health. It announced expanded access to Food is Medicine interventions for Medicare and Medicaid beneficiaries. California, New York, New Jersey, Oregon, Washington have since followed the Massachusetts Medicaid model to expand interventions.
The White House also promised to work with other federal programs and private health plans to further expand Food is Medicine programming. If we continue this progress for people with mobility challenges and diet-related conditions alone, predictive modeling shows potential to avoid 1.6 million hospitalizations with a net savings of $13.6 billion annually.
Food is Medicine interventions strengthen health equity, improve the bottom line, and save lives. Continued and expanded reimbursement for these interventions will allow us to reach larger populations and help more people.
Michelle Sabia