There was some great information shared, including the following op-ed written by Hannah Judge.
October 11, 2012
Re-thinking the Prescription for American Food Insecurity
Here in the United States we are facing a double burden of disease when it comes to malnutrition and food security. According to the 2012 ERS Report Summary for the USDA, 14.9% of American households were food insecure in 2011 while the CDC reports that 35.7% of U.S. adults were obese. Combined, that’s 50.6% of Americans that experienced some type of malnutrition last year.
Sixty-nine percent of Mississippian adults are obese or overweight, and twenty five percent of households can’t access “decent, healthful food” because grocery stores are often more than 30 miles away. Suzy Hansen highlights the intense irony of this, describing how: “In one of the country’s most fertile regions, people sometimes have to shop for their groceries at the gas station.”
Food insecurity is not limited to rural Mississippi, however. As reported by the Huffington Post, 46.7 million Americans – meaning one in five adults – used food stamps in June 2012, and 57% of food-insecure households participated in at least one of the major Federal food and nutrition assistance programs.
It seems preposterous that we experience inequity, inequality and insecurity around such a basic and fundamental issue as food in this country, when we spend the most money in the world on health care.
However, as Elizabeth Bradley and Lauren Taylor argue, if we expand the definition of ‘health expenditures’ to include life extending social services such as unemployment benefits, food subsides, or family support, the United States no longer stands out as a big spender. In fact, for every dollar we spend here in the United States, we’re spending 90 cents on social services, while other countries consistently spend about $2.
I agree with Hansen that we need to “confront the many aspects of people’s lives” that contribute to food insecurity and poor health. Poverty too often becomes the over-arching explanation for problems like food insecurity, serving as an umbrella term that encompasses many different things. In a way it becomes an excuse; too large of an issue to tackle, too deeply entrenched to effectively address.
In reality, there is no excuse. There are countless examples of effective programs that address the root causes of poverty and insecurity; we just need to look to countries that we typically view as needing our aid and advice to find them, according to Dr. Pauline Chen.
Indeed, Onie, Farmer, and Behforouz argue for “reverse innovation” in Realigning Health with Care: “The UN World Food Program, for example, provides nutritional supplements alongside HIV drug therapy in recognition that “Food and nutrition support is essential for keeping people living with HIV healthy for longer and for improving the effectiveness of treatment.”
Another example is the Associação Saúde Criança (ASC) in Brazil. The living conditions of hospitalized children must be assessed before children are discharged, so doctors can arm children with customized nutrition, sanitation and psychological support resources if and when needed.
Some programs that expand upon the traditional idea of service prescription in order to address food security like this already exist in the United States. The Prevention and Access to Care and Treatment (PACT) project is a Boston-based program run by Partners In Health. PACT employs community health workers to accompany patients in taking their antiretroviral medication, attending appointments, stocking their pantries, and preparing healthy meals. This model has been met with resistance, but the statistics speak loud and clear: PACT’s patients have drastically decreased their emergency room visits, reduced their hospitalization rates by 60%, and yielded 16% savings for Medicaid.
Health Leads is another example of an organization that recognizes the importance of comprehensive care packages. hey will prescribe healthy food for someone suffering from obesity, for example, but then actually “fill” the prescription by designing a tailor-made support strategy for the patient, and helping the patient carry it out.
Chen acknowledges: “the humbling reality is that we are trying to recreate innovations that have been robustly developed in the developing world.” HealthConnect in rural Mississippi, for example, has designed a community health worker program almost entirely based on Iran’s program, applying lessons and best practices from Iranian doctors and professors with remarkable success.
We can and should learn from the successes of other countries about the importance of human relationships and personalized care if we want to combat poor nutrition and improve food security here in the United States. “Prescribing food” is one way to address the root causes of poverty, and while it may seem like a labor intensive “reversal” of medical innovation, I think it is time to swallow our pride and catch up to developing countries.