Food Insecurity and Health : Two Questions that Changed the Landscape for Human Services and Evaluation Shana Alford, BBA, MPP Director of Program Evaluation Feeding America’s Center for Research and Learning
Presentation and Discussion I. Defining Food Insecurity II. Overview of Feeding America III. Current State of Hunger in America IV. Social Determinants of Health and A New Way of Business V. Screening for Food Insecurity in a Clinical Setting A Case Example VI. Q&A/Audience Discussion
The Intersections Social Food Security Determinants of Health Poverty Health Chronic Outcomes Disease
Defining Food Insecurity • Food security means that all people at all times have access to enough food for an active, healthy life. • Food Security • High food security : no food access problems • Marginal food security : one or two reported indications (anxiety over food shortage but little or no indication of changes in diets or food intake) • Food Insecurity • Low food security : reports of reduced quality, variety or desirability of diet. Little or no indication of reduced food intake. • Very low food security : reports of multiple indications of disrupted eating patters and reduced food intake. Source: United States Department of Agriculture
How is Food Security Measured in the U.S.? U.S. Household Food Security Survey Module : 18 item survey to capture the full range of severity of food insecurity among households. It is used annually in the U.S. Census Current Population Survey. Other Surveys: o U.S. Adult Food Security Survey Module : 10 item survey o U.S. Six Item Short Form Food Security Survey Module : 6 item survey o Self-Administered Food Security Survey Module for Youth Ages 12 and Older Source: United States Department of Agriculture
Household Food Security has improved but an estimated 40+ million Americans are still food insecure.
US Economic Improvements 1. Overall, national poverty rate has declined . 2. Overall, median household income has increased. 3. More people with health insurance Source: All Key Information found here https://www.hungernet.org/research/foodinsecpov/Pages/2016Incomepovertyrelease.aspx
US Economic Improvements Trends in Health Care Coverage and Poverty Rates 60 50.6 47.9 49.9 48.6 46.9 46.5 46.6 46.3 46.4 50 46.2 45.6 45.3 46.1 43.5 43.1 42 39.8 Number of people 37.2 36.9 36.4 40 (millions) 33 29 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year Individuals living in households with incomes below poverty threshold Individuals without health care coverage
US Economic Improvements Median Household Income 2005-2015 56.5 60 53.6 51.9 51.3 51.0 50.2 50.0 49.7 49.4 48.2 46.3 50 40 (thousands) Dollars 30 20 10 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Year
Overview: Feeding America The Nationwide Network
How Feeding America Works NATIONAL OFFICE • National vision and plan to achieve clear goals • The leading hunger research organization • Highly efficient use of resources by measuring program outcomes and impact • National reach and grantmaking allow for strategic market focus and community impact • Unmatched cause-marketing, branding and communications capacity • Unmatched national advocacy capacity • Ability to scale anti-hunger activitie s • Developing approaches to ending hunger FOOD BANK NETWORK • Reaches into every county in the U.S. • Regional and local authority on hunger relief • Rooted in local communities, immediately A More connected to the people we serve and donors • Deep opportunities for community engagement Food-Secure • Tailored, responsive programs for agencies, food-insecure people, volunteers and donors Nation
The Impact of the Feeding America Network We serve We source and distribute 42 MILLION AMERICANS 11 MEALS annually, including 12 million for each $1 donated children and 6 million seniors We source We provide 1.25 BILLION POUNDS 4 BILLION MEALS of fruits and vegetables each year to people in need through the network We have 2 MILLION VOLUNTEERS 200 FOOD BANKS help carry out our vision for a in the Feeding America network hunger-free America Source: Network Activity Report and Hunger in America 2014
Overview: Hunger in America Trade-Offs and Negative Im Impact on Health
Hunger’s Impact on Our Nation HUNGER IMPACTS A child’s ability to learn A person’s social and and focus in school behavioral response in stressful situations A child’s cognitive and A person’s physical, A family’s health, as those physical development at emotional and social who are food insecure are ages 0-3, a critical period of preparedness for the more likely to be hospitalized rapid growth workforce or experience health crises Source: Feeding America’s 2009 report, Child Food Insecurity: The Economic Impact on our Nation
Making Tough Choices The people Feeding America serves report that their household income is inadequate to cover their basic household expenses. 66% 67% 57% 69% HA VE HAD TO HA VE HAD TO HA VE HAD TO HA VE HAD TO CHOOSE BETWEEN CHOOSE BETWEEN CHOOSE BETWEEN CHOOSE BETWEEN PA YING FOR PA YING FOR PA YING FOR PA YING FOR TRANSPORTA TION MEDICINE AND FOOD HOUSINGAND FOOD UTILITIES AND FOOD AND FOOD Source: Hunger in America 2014
The People We Serve Have High Rates of Nutrition-Related Illnesses Hunger in America 2014 findings show that high blood pressure and diabetes are common in the households of the people we serve. 58% 77% 33% 47% OF HOUSEHOLDS OF HOUSEHOLDS OF HOUSEHOLDS OF HOUSEHOLDS HAVE AT LEAST WITH SENIORS HAVE AT LEAST WITH SENIORS ONE MEMBER HAVE AT LEAST ONE MEMBER HAVE AT LEAST WITH HIGH BLOOD ONE MEMBER WITH DIABETES ONE MEMBER PRESSURE WITH HIGH BLOOD WITH DIABETES PRESSURE Source: Hunger in America 2014
Eating Produce and Healthier Foods Improves Health Clinical trials have shown the positive effects of eating produce on cardiovascular disease and high blood pressure: Lower risk of Lower risk of heart Reduced blood coronary heart attack and stroke pressure disease More than half of the people Feeding America serves identify fresh fruit and vegetables as the most desired foods not received at their food bank. Multiple Sources
Community Health Initiatives at Feeding America • FAITH-DM: Diabetes Trial and Intervention in Food Pantry Settings • https://hungerandhealth.feedingamerica.org/resource/feeding-americas- response-to-diabetes-and-food-insecurity/ • Health and Hunger Website: Food Banks, Nutrition and Health Professionals • https://hungerandhealth.feedingamerica.org/understand-food-insecurity/ • Nudges in Food Pantries (Behavioral Economics) • https://hungerandhealth.feedingamerica.org/resource/the-power-of-nudges- making-the-healthy-choice-the-easy-choice-in-food-pantries/ • AmeriCares Partnership (New) • Americares selected 3 free clinics that will partner with Feeding America member food banks in a Diabetes Prevention Healthy Food Integration Project.
Social Determinants of Health and New Ways of Business Progress= Advocacy + Policy+ Research + Funding
Social Determinants of Health • The World Health Organization (WHO) defines the social determinants of health as the conditions in which people are born, grow, live, work and age. o These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. • There has been growing interest in thinking more critically about these determinants when improving health outcomes and lowering healthcare costs.
New Rules for Hospitals by IRS • New Requirements for 501(c)(3) Hospitals Under the Affordable Care Act • The Affordable Care Act (ACA), enacted March 23, 2010, added new requirements that hospital organizations must satisfy in order to be described in section 501(c)(3), as well as new reporting and excise taxes. Source: Center for Medicare and Medicaid Services
New Rules for Hospitals by IRS 1. Written financial assistance and emergency medical care policies, Related to 2. Limited amounts charged for emergency or other medically Patient Debt and necessary care to individuals eligible for assistance. Financial 3. Make reasonable efforts to determine whether an individual is Assistance. eligible for assistance under the hospital’s financial assistance policy before debt collection actions. 4. Conduct a Community Health Needs Assessment and adopt an implementation strategy at least once every three years. Food Banks and Source: Center for Medicare and Medicaid Pantry Agencies
Policy and Federal Dollars Make A Difference • Center for Medicaid and Medicare Services • Accountable Health Communities Model • “addresses a critical gap between clinical care and community services in the current health care delivery system” • testing if the health-related social needs of Medicare and Medicaid beneficiaries’ through screening, referral, and community navigation services will impact health care costs and reduce health care utilization .” • 32 Participants testing new payment and service delivery models Source: Center for Medicare and Medicaid Services: Innovations. CMS. GOV
Screen & Intervene A Public Health, Pati tient-Centered Movement
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