Achieving Health Equity Through Food Security Solutions
By Afaf Qasem, MS, RDN, LDN (Tallahassee Memorial Healthcare) and Anne Leach, MS, RDN, LD (Sodexo Healthcare at University Hospitals)
A confluence of factors influences health, including genetics, behavior, environmental and physical influences, medical care and social determinants/drivers of health (SDOH). In fact, a person’s ZIP code is more influential than genetic code in significantly impacting health outcomes. Recognizing this, efforts to address SDOH in healthcare settings and taking innovative strides to integrate solutions are crucial for achieving health equity.
SDOH encompasses the conditions in the places where people live, learn, work and play, affecting a broad spectrum of health and quality-of-life outcomes. The five key areas of SDOH include economic stability, education, social and community context, health and healthcare, and neighborhood and built environment, which includes the availability of healthy foods.
Despite sporadic efforts, addressing SDOH has often been confined to special projects with limited external funding and were not sustained or spread across organizations. To bridge the gap, healthcare organizations need established leaders and standardized structures to address healthcare disparities. These efforts should be fully integrated with other priority issues, such as infection prevention, within the healthcare organization.
The Centers for Medicare & Medicaid Services (CMS) reports persistent disparities in healthcare outcomes, underscoring the urgency for change. To effectively address SDOH, healthcare organizations must commit to five domains:
- Equity as a strategic priority
- Data collection
- Data analysis
- Quality improvement
- Leadership engagement
The Role of Food Security in SDOH
One of the most crucial social determinants of health is food security, which impacts the management of chronic conditions. Shockingly, 1 in 10 U.S. households experiences food insecurity, emphasizing the need for targeted interventions.
Initiatives such as Supplemental Nutrition Assistance Programs (SNAP), food pharmacies, and emergency food boxes have shown significant success in reducing healthcare utilization and costs. Several hospitals are leading the way in addressing food security as an SDOH, including University Hospitals in Ohio, which offers the UH Food for Life program, with its food pantry and nutrition counseling, and Tallahassee Memorial HealthCare's patient food security program, which demonstrates the practical implementation of food security interventions. Screening tools like the two-question Hunger Vital Sign™ are utilized, and funding is sourced from hospital-community benefit programs, grants, foundations, fundraisers and philanthropy.
Dietitians also play a vital role in supporting the delivery of food insecurity programs, implementing screening systems, using data for assessments, understanding the impact of food insecurity on client health, and incorporating food assistance program referrals into interventions. Community nutrition programs, emergency food boxes, weekly produce distributions, and food pantries guided by registered dietitians exemplify a systemized approach to using food as medicine. These programs not only provide sustenance but also offer education on nutrition, cooking skills and food budgeting.
Addressing social determinants of health within healthcare settings is not only ethically imperative but also economically advantageous. Food security initiatives are just the beginning, but they are a crucial step: By integrating these solutions into existing healthcare structures and engaging healthcare professionals and patients, organizations can significantly reduce health disparities and get closer to achieving true health equity in our communities.