Hunger and Health
We are committed to addressing food insecurity as a Social Determinant of Health and to viewing consistent, reliable access to nutritious food as a critical form of medicine.
The Link Between Hunger and Health
Food insecurity is a lack of consistent access to enough food for an active, healthy life. It can mean anxiety over food sufficiency or food shortages. It can mean reduced quality, variety, or desirability of diet. It can mean disruption in eating patterns and reduced food intake.
But the experience of food insecurity is not only one of indignity, injustice, and short-term suffering. Food insecurity is also associated with some of the most costly and serious health problems in the U.S. And too often, food insecure Ohioans have to make impossible choices that further threaten their health and well-being and their ability to mitigate or manage chronic disease, including choosing between buying food or paying for medicine or medical care.
Interrupting the Cycle of Food Insecurity and Chronic Disease
The need to address social determinants of health (SDOH) as a core part of an overall strategy to drive down health care costs and improve health outcomes is not only self-evident but rigorously researched and well-documented. Increased prevalence of more than 40 serious health conditions in children, adults, and seniors has been linked with food insecurity. Ohio's foodbanks know that investing in relatively low-cost, upstream interventions to SDOH pays dividends in reducing the likelihood of higher-cost, downstream health care expenditures. Much like basic immunizations, annual physicals, or recommended health screenings, interventions addressing SDOH are now commonly viewed as cost-effective and necessary preventative services.
Evolving Models for Reimagining Food as Medicine
Ohio's foodbanks, along with peers across the country, have been testing, piloting, assessing, researching, and refining best practices for implementing community interventions that engender improved health and well-being for food insecure patients.
Screening: We encourage providers to screen patients for food insecurity using questions such as those recommended in the Hunger Vital Sign™. Foodbanks have developed processes for referral and feedback loops for providers, patients, and third-party stakeholders, including a tool to connect patient Electronic Health Records with foodbank client records.
Community-Based Clinical Services: Foodbanks encourage providers to conduct patient outreach and education, such as behavioral health referrals, tobacco cessation, or SDOH assessments, in tandem with food distributions. We value opportunities to pair clinical services, such as mobile medical clinics or immunizations, with foodbank services.
Education and Outreach: Some Ohio foodbanks have dieticians on staff or other community-based partnerships to promote nutrition education alongside hunger relief programs. The Ohio Association of Foodbanks network is also committed to connecting clients with federal nutrition programs, like SNAP, that make adequate nutrition more affordable.
Referrals and Food Pharmacies: Foodbanks can facilitate connections between health care providers and the hunger relief network. Advanced partnerships include the Food Pharmacy model, which allows providers to screen patients for food insecurity and refer them directly to a designated community-based food pantry or on-site food pantry.
Promoting Access: Ohio's foodbanks support strategies for promoting access to healthy food as part of disease intervention infrastructure. Strategies include mobile pantries paired with patient service locations, food pantries based on-site at health care clinics, delivery for patients with transportation barriers, or medically-funded transportation to food.
Assessment: Thanks to evolving technology applications, such as FreshTrak, Ohio's foodbanks can responsibly partner with health care providers and plans to monitor patient interactions with the hunger relief network and facilitate assessments of interventions on patient outcomes.
Investment: Ohio's foodbanks largely facilitate Hunger and Health work through private funding from partners with aligned goals. While these partnerships are welcomed, larger-scale efforts would benefit from the State of Ohio and/or Managed Care Organizations approving healthy foods from foodbanks as a health care benefit for Medicaid beneficiaries.
Next Steps: How to Get Involved if You're...
A Health Care Provider or Physician
While every health care setting is different, all providers can take a critical first step by screening patients for food insecurity. Along with most health and human services organizations and agencies, we recommend using the Hunger Vital Sign™. This validated, two-question food security screening tool can be integrated into Electronic Health Records.
Specialized toolkits for providers serving certain populations, such as pediatricians or providers who work with older adults, have been developed through partnership between national anti-hunger organizations and medical experts to provide further guidance:
- FRAC and the American Academy of Pediatrics developed this toolkit for pediatricians to address food insecurity.
- FRAC partners with AARP to offer this CME-eligible course: Screen & Intervene: Addressing Food Insecurity Among Older Adults
Ohio's foodbanks are natural partners in efforts to provide patients that screen positive for food insecurity with food assistance. There are a variety of ways in which we can partner with your institution or practice to make access to nutritious food an integral part of patient care. Your regional foodbank is already engaged in this work or is able and willing to get started in partnership with you. Here are just a few of the many examples of foodbank and provider partnerships in Ohio:
- Mid-Ohio Food Collective - The foodbank has found in partnerships with local FQHCs that consistent access to produce through its Mid-Ohio Farmacy network contributes to weight loss and lower health care costs for patients with chronic diet-related disease. They launched FreshTrak and lead technology and programming integration work to streamline food insecurity screening and referrals for patients and providers.
- Akron-Canton Regional Foodbank - The foodbank is currently partnering with DoorDash and local funders to provide home-based food delivery to individuals and families who are high risk due to health conditions or age, meet income guidelines, and are not able to visit a food pantry in person. They are also working with major hospitals in their region on a Food Farmacy pilot with the support of Leader Sykes and the Ohio Department of Medicaid.
- Freestore Foodbank - The foodbank launched its first Keeping Infants Nourished and Developing (KIND) program with Cincinnati Children's Hospital in 2011. Since then, the program has expanded to 10 clinics within 4 health care systems. The program screens patient for food insecurity, provides baby formula and other food to families, and connects them with nutritionists and social workers to help with long-term needs.
- Greater Cleveland Food Bank - The foodbank's Food Rx partnership begins with screening patients for food insecurity at the health care facility. Patients who screen positive are referred to the foodbank's Help Center, where they are directed to free local food resources and receive SNAP application completion assistance. The foodbank also partners with local providers to host Food as Medicine clinics on-site at health care campuses.
To read more about our network's approach to Hunger and Health initiatives, take a look at our Putting Food to Work as Medicine brief. Ready for next steps? Contact Zach Reat, director of health initiatives, to be connected to the appropriate staff member at your regional foodbank.
A Managed Care Organization, Insurance Provider, or Other Stakeholder
Consistent, reliable access to balanced, nutritious food is a core Social Determinant of Health, and promoting improved food security an evident tool for improving health outcomes and lowering health care expenditures. What's more, many providers that currently participate with Ohio foodbanks on Hunger and Health initiatives share that embedding resources for improved food security within the patient care model can provide incentive for greater patient participation with other preventative screenings and services.
Here are summaries of just a few of the ways in which your company and its members may benefit from partnering with Ohio foodbanks:
- Ohio's hunger relief network provides community-based access to emergency food in all 88 counties in Ohio. We increasingly strive to source fresh fruits and vegetables, lean protein and dairy items, and whole grain products. Partnerships can be developed to facilitate seamless referrals for emergency food services for income eligible patients.
- Many of Ohio's foodbanks operate Supplemental Nutrition Assistance Program (SNAP) Outreach projects. Our network can help to connect your patients to SNAP and other federal nutrition programs to improve their ability to afford adequate, nutritious food.
- Some of Ohio's foodbanks are testing innovative options for delivering food, transporting patients to community-based food pantries, and sourcing prescribed foods to meet dietary restrictions. Others employ dietiticians and/or have established nutrition education programs. Hunger relief providers can partner with you on efforts to eliminate these and other barriers to food security. This work is most replicable with consistent, reliable funding or reimbursement for services.
- Foodbanks are also exploring and establishing partnerships with community resource referral platforms and improving technology applications for more closely connecting food insecure patients with food and foodbank clients with coverage and providers.
The Ohio Association of Foodbanks recommends that you pursue and explore all options for making access to healthy foods from foodbanks a covered benefit for your members. For more information or to get connected with the appropriate staff member at your regional foodbank, contact Zach Reat.
A Policymaker or Advocate
Investing in food as medicine is an efficient, upstream strategy for promoting positive patient outcomes, greater household well-being, and improved population health. As acknowledged and emphasized in the State of Ohio's recent Medicaid Managed Care Procurement process, research shows that Social Determinants of Health (SDOH) can account for up to 80 percent of patient outcomes. What's more, estimates indicate that $52.9 billion in annual health care costs are associated with food insecurity among American adults and children.
It's important for policymakers and advocates to understand that food insecurity is more than the inability to consistently afford adequate, nutritious food. Food insecurity means choosing to go to work sick so that you don't miss out on the wages you need to feed your family. Food insecurity can look like buying cheaper, easier-to-prepare or ready-to-eat foods to consume between shifts at work. Food insecurity may mean not taking risks on fresh fruits and vegetables and lean protein because your child may not eat it the first, the second, or even the tenth time, and you can't afford to waste any food. Food insecurity is not having the transportation to get to a grocery store, or being surrounded by fast food chains, or being limited in choice and access to fresh foods because you live in a food desert. Food insecurity can be worsened by dietary restrictions that make purchasing food more expensive or cooking and preparing food more time-consuming.
Addressing barriers to access to and consumption of fresh, healthy foods is, therefore, a complex issue requiring a community-focused lens. Ohio's foodbanks and hunger relief network are eager and equipped to scale their ongoing work in this space with the support of public policy.
- The State of Ohio can seek, and the Centers for Medicare & Medicaid Services can encourage and approve, waivers (i.e., Home and Community-Based Services 1915(c) Waiver, Section 1115 Demonstration Waiver) and/or a State Plan Amendment (SPA) to increase access to healthy foods from foodbanks as a health care benefit for Medicaid beneficiaries.
- Managed Care Organizations (MCOs) can include, and the State of Ohio can require or encourage inclusion of, food and nutrition interventions from foodbanks as covered benefits under Medicaid MCO plans.
- The State of Ohio, and in particular its Departments of Job and Family Services, Health, and Medicaid, can better align and streamline services for Ohioans dually eligible for Medicaid and SNAP and Medicaid and Women, Infants, and Children (WIC) nutrition assistance to improve the integration of service delivery for households vulnerable to chronic, diet-related diseases, infant and maternal mortality, and other conditions linked to food insecurity.
Ohio's foodbanks strive to fill gaps in community-based food access left by a for-profit retail food system that has left significant healthy food deserts across many areas of our state. Our network provides value-added services to meet community members' needs, from connecting them to SNAP to providing nutrition education. We are natural and well-positioned partners for the expansion of a Food as Medicine lens in Ohio.
If you are a policymaker interested in exploring these or other options for connecting community-based food access with Ohio's approach to managed care, please contact Zach Reat at firstname.lastname@example.org.