The Foodbank of Santa Barbara work I’ve been privileged to participate in has taught me a lot: especially that food insecurity is actually an undiagnosed but treatable medical problem. Why haven’t I recognized it as such until recently?
Maybe because so much of what clinicians see has to do with overeating (and underexercising). Exercise–even at your desk counts, on a desk treadmill which almost walks for you or using a new a 2015 gadget, as both kill appetite.
Maybe because of the terrible images of starving, skeletal African children and adults which are seared into my memory as starvation, kwashiorkor, and marasmus, which are rare in the U.S., but sad that we husband them at all.
Or maybe because it’s so clear to me (and to the medical literature) that some food works as well or better than some medication in fighting chronic disease (and that women and men need different general approaches and very specific personal ones). Or that some sticks work better than carrots.
But I think it is primarily because the literature documenting the wasteful use of medical services in response to food insecurity is apparently known only to very few. And because physicians consider food insecurity a “public health” and “social problem” of “lifestyle habits” in which no practicing physician can reasonably make a difference. And because the disproportionate lack of access to sustained treatment of common chronic diseases is the result of distrust of the health care system, and not reaching people where they live.
If payers, hospitals and decision-makers identified security’s impact on the cost and quality of medical care and health conditions, and worked with community organizations from beauty salons to the YMCA to pharmacies, health care decisionmakers might be able not only to improve health, but reduce costs. A lot of costs.
This is the true meaning of population health: health equity in outcomes, identifying core reasons for illness. Food insecurity is one of them.
Here are six sample research ideas I’d like to refine and test: let me know what you think, and if you’d like to help!
a. give docs free prescription pads with pre-printed 1/4 cup extra virgin olive oil or 1 ounce of mixed nuts daily, and fill those prescriptions free, at a grocery store or with a mobile food truck, with a week’s worth of olive oil and nuts, for those with a measurable cardiovascular risk factor. This precise intake of these two foods recently prevented stroke in a group asked to adopt the Mediterranean Diet, but not given other foods. The control was the American Heart Association diet. Track cardiovascular factors which cause physician office visits, emergency department visits, and health care utilization.
b. swap your drink drive: behavioral economics research shows that negative messages about soda and fruit juice are even more powerful than positive messages about what to eat among SNAP and WIC populations: a food truck, loaded with water or iced tea or a protein-rich milk, would travel to neighborhoods and worksites, and exchange any soda or sweet drink for a better one, and offer free foodbank sugar free, starch free, protein-rich, vegetable-rich take-home boxes for diabetes. Track glycohemoglobins at a once a month at pickup. This has been tried in overweight adolescents, and with adults, albeit with diet drinks, and found to help them lose weight.
c. a food pharmacy on wheels, with dispensing of specific culturally appropriate foods in poor neighborhoods, especially Hispanic neighborhoods, in return for a BMI, and give people the tools to measure/re-measure something they are trying to control: hibiscus or flax or berries for high blood pressure, for example.
d. specific food supplementation (and subtraction), beyond conventional dietetic advice upon hospital discharge for patients with one of those 6 diagnoses hospitals are assessed a 3% penalty for re-admission: heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and elective hip or knee replacement. Hospitals with readmission rates that exceed the national average are penalized: all of their Medicare admissions are penalized, not just the diagnoses on which CMS is focused. There has been surprisingly little attention to proper diets for each of these diagnoses as part of prevention of re-admission strategy.
e. use c. above, but instead of asking for a specific measurement, ask for completion of a standardized, sensitive, specific food-insecurity assessment tool, driving a regular route daily or weekly to see the same people. Re-assess at specific intervals.
f. use that same assessment tool, or an even simpler one question survey and diagnose food insecurity as people enter the clinic, and wait to see the MD, NP, DO, giving them a specific box of shelf-stable food for their trouble, tracking health care utilization.