How Food Security Programs Target Social Determinants of Health

December 26, 2019 - You are what you eat, the old adage says, but what comes of patients who live in food deserts or who otherwise struggle to access food? New strategies to tackle the social determinants of health are working to answer those questions specifically by building food security programs.

Access to food – nutritious food, specifically – is regarded as a key social determinant of health that has a direct impact on a patient’s wellbeing. Individuals who cannot afford or obtain quality food rich in vitamins run the risk of developing chronic illnesses or exacerbating illnesses they may already have.

Limited access to food can also have a domino effect on other social determinants or medical issues. Children who are food insecure may experience more difficulty focusing in school, stunting their educational attainment and ultimately harming their chances of success. And at the end of the day, education is another key social determinant of health that can impact access to care.

As the medical industry continues to recognize the significant role social factors play in patient health and well being, they are turning specifically toward food security programs.

Food security programs can take a number of forms, from writing patients a prescription to a hospital-run garden filled with fruits and vegetables to grocery delivery for elderly patients to the SNAP program.

Below, PatientEngagementHIT.com outlines how the public health community is addressing food security and how these programs can impact patient care.

Identifying food deserts, high-risk neighborhoods

Foremost, healthcare experts are working to understand the communities that can benefit food security and food access interventions. Aside from the social determinants of health screenings that providers are beginning to employ during care encounters, experts are looking at population-level data from innovative sources to learn more about food access.

Experts from the University of Michigan Medical School has used Twitter to learn more about food trends in various neighborhoods throughout the state, finding that the social media platform can point them in the right direction for understanding food access.

An assessment of geo-located Tweets and neighborhood demographic data revealed that individuals living in low-income neighborhoods Tweeted more frequently about less healthy foods. Those living in more affluent neighborhoods Tweeted about healthier foods, or more costly foods.

These results suggest that social media, specifically Twitter, could help public health officials shape policy. Understanding how certain demographics approach their food intake could help policymakers develop new regulations about building fast-food restaurants or offering more nutritious school lunches in specific neighborhoods.

Other high-level neighborhood analyses have confirmed what many have long believed to be true: individuals living in neighborhoods more densely populated with less healthy chain restaurants were more likely to be obese. Specifically, 20 percent of kids living a half block from a fast food chain were obese, highlighting the link between neighborhood, food access, and health outcomes.

These types of neighborhood- or population-level assessments can help public health experts and policymakers create regulations that could address food access inequities. Additionally, they may help providers screen patients living in certain areas for the social determinants of health and flag patients who might benefit from programs connecting them with healthy foods.

Connecting patients with nutritious food

While food security and access has thus far proven largely a public health initiative, many medical organizations are beginning to dip their toes. Most recently, Oakland-based Kaiser Permanente, which also has care facilities across the country, announced a new program to address food security.

The Food for Life Program out of Kaiser will help connect patients with CalFresh, California’s SNAP benefits program.

Public benefits are notoriously challenges to navigate, especially for low-income patients who may have lower literacy or self-efficacy levels. Marketing these programs likewise presents a challenge.

Eligible patients will receive text messages from the Food for Life Program explaining that the patient may enroll in CalFresh and help coordinate the enrollment process for patients.

“It is unacceptable for anyone to suffer from poor health because they can’t get enough nutritious food to eat,” said the late Bernard J. Tyson, chairman and CEO of Kaiser Permanente at the time of the program’s rollout. “The association between good health and healthy food is indisputable, and if we want to make our communities the healthiest in the nation, it is crucial that we connect people with the resources they need to achieve total health.”

Other organizations not traditionally associated with the medical industry are also becoming involved in the food access problem. In April 2019, Lyft announced the Lyft Grocery Access Program, which will offer low-cost rides to grocery stores for individuals who experience transportation barriers.

This program comes after successful rollout in Washington DC, where Lyft connected individuals living in food scarce parts of the District. In partnership with Martha’s Table, a community organization that aims to improve food access, Lyft offered a $2.50 flat rate ride to area supermarkets and grocery stores. Families with children in one of seven participating elementary schools qualified for the program.

“The Lyft Grocery Access Program is an innovative partnership that aligns with our mission to support strong children, strong families, and strong communities,” Tiffany Williams, chief programs officer at Martha's Table, said of the program. “By offering discounted flat-rate rides to three full-service grocery stores and to Martha’s Table Market, the program has helped to reduce the time, transportation, and financial barriers to healthy food access.”

Do food security programs actually work?

While the ethical draw for creating food security programs is clear, organizations are also working to create programs that are sustainable and yield a return on investment.

These programs largely have not been in operation long enough to truly assess return on investment, but evidence has emerged to suggest food security interventions might be successful.

March 2019 data from the Friedman School of Nutrition Science and Policy at Tufts University showed that food security programs, while not net neutral, are “best buy” public health programs. In an assessment of two separate food subsidy programs – one that covers some costs for fruits and veggies and one that covers fruits, veggies, nuts, seeds, and plant-based oils – researchers found that both programs are very cost-efficient.

Although the models do not result in a net cost savings, they can be categorized as cost effective health interventions that deliver on a key patient need.

Model one cost $18,184 per quality adjusted life-year (QALY), an industry standard quality of life measure. For model two, that cost was $13,194. For less than $20,000 each year, Medicare and Medicaid programs could improve the quality of life for all of its beneficiaries, the researchers suggested.

These totals are remarkably less than what industry experts say are cost efficient programs. For a program to be considered cost efficient, it must cost less than $150,000 per QALY. Programs that cost less than $50,000 per QALY are considered extremely cost effective and a “medial best buy,” the researchers said.

Data published in 2017 revealed that individuals enrolled in the SNAP program use the hospital less often than those who are not enrolled on the public benefit.

SNAP benefits reduced the likelihood for hospitalization by 14 percent, and reduced the likelihood of each individual day in the hospital by 10 percent.

The program also reduced the likelihood of nursing home admissions by 23 percent, and reduced each additional day in the nursing home by 8 percent.

SNAP benefits had no statistically significant effect on ED utilization, but the researchers maintained that the results nonetheless showed great potential for SNAP in healthcare.

These issues have become especially pressing for the healthcare industry, as new SNAP eligibility requirements threaten to revoke the benefit from Americans across the country. Healthcare advocates at the Robert Wood Johnson Foundation (RWJF) have spoken out against this move, saying the changes jeopardize patient health and the ability for children especially to perform well in the classroom.