The U.S. Department of Agriculture (USDA)1 has reported that food insecurity affects nearly 34 million Americans or approximately 10% of the U.S. population. Although food insecurity is not a new issue, it dramatically increased during the COVID-19 pandemic and continues to affect many Americans as a result of inflation and rising food prices. For healthcare providers focused on whole-patient care, this presents a critical challenge.
Food insecurity exists when a person does not have access to safe and sufficient foods to meet their dietary needs and personal preferences, thus allowing for a healthy and active life. These challenges have been associated with chronic diseases in adults such as hypertension, diabetes, obesity, and high cholesterol, as well as behavioral health disorders such as anxiety and depression. Food insecure individuals with diabetes often experience more hospitalizations due to their increased risk for hypoglycemia, or episodes of low blood sugar. Data from the USDA1 demonstrates that food insecurity does not affect all people equally. Low-income individuals, racial and ethnic minorities, households with young children, and people living in principal metropolitan areas are at a higher risk for food insecurity compared to others.
What does this have to do with our focus on kidney health management? According to the hunger-relief organization Feeding America,2 “Food insecurity is a public health crisis in the United States.” Because food insecurity is closely associated with obesity, diabetes, and hypertension, the primary causes of chronic kidney disease (CKD), it is a contributing factor in the rise of CKD. To effectively manage patients with CKD, it is critical to understand and address all issues that individuals face, including food insecurity.
Food Equity is Health Equity
Oftentimes, food insecurity goes hand in hand with “food deserts” and “food swamps.” Food deserts are areas where affordable and nutritious food is not readily available, particularly fruits and vegetables. Food swamps are areas where fast-food chains and convenience stores abound, swamping neighborhoods with unhealthy eating options, as opposed to healthy options. This combination can mean living on foods that do not provide nutritional value out of necessity, but not by choice.
Food deserts have long been a problem for many families across the country. An article3 in the USDA's Amber Waves magazine defines a food desert as a low-income census tract where at least a third of its residents must travel an inconvenient distance (over a mile in an urban area and over 10 miles in a rural area) to reach the nearest grocery store. Based on this definition, food deserts are present in every state. According to the USDA, approximately 13% of Americans live in food deserts. That’s around 40 million people!
Thus, “Food insecurity is an important social determinant of health that affects millions of Americans. Those who are food insecure are more likely to experience poor health outcomes,” says Dr. Tom Frieden, President and CEO of Resolve to Save Lives. This makes food insecurity a significant aspect of health equity, a topic we covered in the Issue Brief Health Equity and Kidney Disease Management.4
While poor food choices are a cause of poor health, healthy food choices have been shown to improve overall health. According to the Centers for Disease Control and Prevention,5 “A healthy diet helps children grow and develop properly and reduces their risk of chronic diseases. Adults who eat a healthy diet live longer and have a lower risk of obesity, heart disease, type 2 diabetes, and certain cancers. Healthy eating can help people with chronic diseases manage these conditions and avoid complications.”
However, people living with food insecurity or in food deserts or swamps may be limited in the food choices they have for themselves and their family members. Considering the long-term impact food inequity can have on one’s health, Healthmap believes that addressing food equity is a key step in improving health equity.
What Providers Can Do
In addition to supporting patients in the management of their CKD and other chronic diseases, frontline healthcare providers can consider the following:
- Screening for food insecurity during check-in (“In the past month, was there any day when you or anyone in your family went hungry because you did not have enough money for food?”).
- When prescribing medications for food-insecure individuals, keep medication affordability in mind. If a person can spend less on a given medication, it helps free up finances for food.
- To limit the risk of hypoglycemic episodes among food-insecure individuals with diabetes, providers can consider long-acting antiglycemics as opposed to short-acting antiglycemics.
- Identifying and working with local food banks that can leverage their resources to provide medically tailored items (e.g., low-salt food boxes or diabetes-friendly food boxes) for little or no cost.
How Healthmap Can Help
Providing the kind of patient support outlined above puts additional demand on doctors and staff who are already being stretched to meet basic care requirements. This is where Healthmap comes in. The Healthmap team sees first-hand the persistent and sometimes debilitating impact food insecurity can have on a person’s everyday life and health. When present, food insecurity makes it exponentially more difficult for a patient to effectively control their disease, afford medical appointments or medication regimens, and maintain a healthy lifestyle.
Along with the management of CKD and all comorbidities, Healthmap’s Care Navigation team is dedicated to supporting the whole patient, including social barriers to care and food insecurity issues. Healthmap’s team consists of registered nurses, social workers, pharmacists, behavioral health professionals, and registered dieticians, all of whom interface directly with patients, in coordination with their providers, to address barriers that may prevent them from achieving their health goals. Care Navigators can identify food insecurity, deliver nutrition education, assist with finding consistent meal sources, and provide referrals to local food pantries and other resources, all of which take a considerable burden off the healthcare providers we support.
By addressing food insecurity, improving access to healthy eating, and educating patients about their nutrition needs, we all, as a community, can improve clinical health outcomes for kidney patients, reduce healthcare utilization and costs, and promote health equity for all.
We Are Health Equity in kidney disease management. We Are Healthmap!