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Hunger as a health issue

Food insecurity adds to health systems' costs; October summit seeks solutions

Five years ago, officials at ProMedica, a hospital system based in northwest Ohio, launched a campaign to address nutrition problems in its communities. As social conditions worsened throughout the region, in part because of the Great Recession, it increasingly found that its hospitals and services were being used to treat conditions associated with malnutrition.

The system created a program to direct patients to local resources where they might have access to healthy food. In January, it launched a food distribution effort that has redirected 30,000 pounds of excess food from a local casino to area homeless shelters and food banks. More recently, the provider began screening hospital patients for food insecurity, who then receive an emergency food supply upon discharge.

“With the weight on the industry right now on the demands of reform and all there is in front of us, this truly is prevention,” said Barbara Petee, chief advocacy and government relations officer for ProMedica. “If we can educate people into how putting healthy meals into our mouths helps cut costs at the back end, then we believe that's a really solid message.”

But that approach could get a lot harder in the months ahead. The 13% expansion of the Supplemental Nutrition Assistance Program, under the 2009 American Recovery and Reinvestment Act is about to expire, slashing $5 billion from the food stamps program for fiscal 2013. And last week, the U.S. House of Representatives voted 217-210 in favor of a bill that would cut SNAP funding by another $39 billion over the next 10 years. The Senate has not approved it.

The Center on Budget and Policy Priorities, which advocates for poverty alleviation programs, calculates the House-proposed cut would mean a loss of about $29 a month for a family of three, bringing down the average benefit to less than $1.40 per person per meal. For the 48 million Americans receiving aid through the program, the move would put them further at risk of becoming food insecure, which would likely increase the rate of health conditions normally associated with malnutrition.

“Everyone is going to lose 13% of their benefits, which is about 21 meals a month for a family of four starting Nov. 1,” said Dr. Deborah Frank, professor of pediatrics at Boston University's School of Medicine and founder of Children's HealthWatch. “If the other proposals pass, the level of the epidemic is going to become much higher.”

The U.S. Department of Agriculture estimated that 14.5% of households were food insecure during 2012, a figure that has remained relatively unchanged since 2008.

That is exacerbating the problems of healthcare systems grappling with numerous patients with multiple chronic conditions, which are often associated with people living in deteriorated social conditions, including malnutrition. Even the nation's obesity epidemic is being driven in part by a different form of malnutrition—the absence of decently stocked grocery stores in many inner-city neighborhoods and rural areas.

“Hunger is link(ed) to obesity,” Petee said. “Oftentimes, obesity is exacerbated by the lack of ability to purchase or have access to nutritious food.”

In October, company executives will be joined by other health providers, as well as health and human service agency officials and anti-hunger advocates for a summit in Washington to further discuss the need to address food insecurity as a health issue.

ProMedica is one of many providers attempting to reshape the conversation over hunger as providers struggle to avoid the added cost burden that an increase in the number of chronic conditions caused by malnutrition could cause for the nation's health system.

In an article published in the July 1, 2010 issue of the New England Journal of Medicine, authors cited research conducted at the Center for Vulnerable Populations at the University of California Center that found a causal link between the availability of nutritious food and the prevalence of such chronic conditions as diabetes and obesity. Researchers found that adults living with severe levels of food insecurity were more than twice as likely to develop diabetes as those who had access to healthy food.

The report estimated that food insecurity increased the cost of illness by about $130.5 billion.

“People typically, when they think about the issue of bad nutrition and food insecurity, are not really thinking about the health consequences of it,” said Ken Thorpe, former deputy assistant secretary at HHS and current chairman of the Partnership to Fight Chronic Disease. “So having that link in way of support is a way to draw attention on a really important problem.”

As more focus is given toward preventive care in wake of the Patient Protection and Affordable Care Act, health advocates said more attention must be given to addressing the social determinants that affect health outcomes. A 2011 report produced by the Robert Wood Johnson Foundation found that while 85% of physicians surveyed said they thought social needs were directly leading to worse health, only 20% felt confident in their ability to address the social needs of their patients.

Follow Steven Ross Johnson on Twitter: @MHSjohnson

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