In 2018, 11.1% of Unites States households faced food insecurity accounting for 14.3 million of the approximately 129 million households in the United States. Ohio has food insecurity above the United States average and ranks 43rd for overall health. Ohio has a 14.5% food insecurity rate with a 13.3% food insecurity rate in my residence, Lorain County. Patients who struggle with food insecurity and financial limitations often purchase lower-cost foods lacking nutritional value, are unable to follow medical diets such as for diabetes, and forgo preventative medical care. This can lead to a variety of health conditions and exacerbation of chronic diseases such as diabetes, end stage renal disease, pregnancy complications, and obesity. This can lead to poor health outcomes, reduced quality of life, increased health care utilization and cost, and even death. This increased health care utilization can lead to an increase in physician office visits, emergency room visits, and hospitalizations. A study in 2014 determined that the average direct and indirect healthcare cost due to food insecurity was $160.07 billion. Food insecurity, as well as many other aspects of poverty, ultimately lead to poor patient health and financial strain on the United States healthcare system.
Background on Poverty and Food Insecurity
The Merriam-Webster defines poverty as “the state of one who lacks a usual or socially acceptable amount of money or material possessions”. Although people may have been lived in poverty conditions since the beginning of time, national concern about Poverty did not develop until 1964 when President Lyndon Johnson declared the war on poverty. This lead to many actions taken to fight poverty such as the creation of Medicare and Medicaid in 1965, expanding Social Security benefits, the Food Stamp Act of 1964, and the Economic Opportunity Act of 1964. This lead to an overall decline in poverty rates.8 Many of these programs are still in place today with amendments and changes made. Poverty is something that many Americans will face during their lifetime with an article stating that almost two-thirds of American will fall below the 20th percentile at some point in their lifetime.
In 2016 there were an estimated 40.6 million Americans living in poverty. This accounted for approximately 12.7 percent of the United States population and nearly 18 percent of all children in the United States. In 2018 the National poverty rate fell to 11.8% which was the lowest it had been since the recession. In Ohio specifically, in 2019 the poverty rate was 14% according to the Ohio Developmental Services agency.
Researchers have found that people living in poverty overall have poorer health, shorter life expectancy, higher prevalence of diseases, and increased sadness and hopelessness. Positive social determinants of health are also often lacking in neighborhoods with people living in poverty. Some examples including limited access to health food stores or unsafe environments for children to play and get exercise.5Poverty also had a large impact on healthcare access, cost, and provision of care. Patients experiencing poverty often have various clinical factors limiting access to care. These barriers include less people in poverty having employer sponsored insurance with statistics showing that less than one third of employers having access to employer sponsored insurance compared to almost two thirds of people not in poverty. In 2018 after the affordable care act was passed there were still over twenty-sever million Americans without health insurance. Patients without health insurance often are not able to afford health care leading to lower provision of care. Research shows that low-income Americans often participate in unhealthy behaviors such as tobacco smoking, but unfortunately access to health care for services such as smoking cessation is limited.
The Merriam-Webster dictionary defined food insecurity as “Unable to consistently access or afford adequate food”. Like poverty, food insecurity has also been informally an issue in the United States, but it was not until the War on Poverty when hunger began a national United States issue. This lead to the passing of the Food Stamp Act of 1964. This was the first permeant food program in the United states and have been changed to the SNAP program we currently have today. This SNAP regulatory program has helped millions of Americans when they have faced food insecurity. Similar to the American poverty rates, the rate of food insecurity is also declining and reached 11.1% in 2018.One financial aspects of feed security is that people in poverty have a significantly higher rate of food insecurity than the general population.Social impacts of food insecurity are widespread including reduced quality of life due to disease exacerbations and complications. This can lead patients to become isolated and experience various mental health conditions such as depression and suicide.
For a patient to qualify for the supplemental nutrition program (SNAP) program they must meet federal poverty income levels as well as work or train for 20 hours a week. Although there are some exceptions to this working requirement such as having children under 18, being pregnant, or taking care of someone with a disability, this leaves many Americans unable to qualify for food stamps. Currently, Ohio has 42 counties exempt from the 20-hour work requirement rule, but the Trump Administration introduced a new rule on December 8th which will tighten this to only wave counties with an unemployment rate of greater than 6%. This could lead to up to 700,000 Americans losing food stamps including 45,000 Ohio residents. This could lead to increased demands for local food banks as well as an overall increase in food insecurity.
Assessing Implications from Food Insecurity
As far as the health and economic implications of food insecurity there are many studies that show that poverty, and in particular food insecurity lead to poor health outcomes and an overall increase in healthcare utilization and cost. For example, one study examined health care utilization of emergency room visits, hospitalizations, and days hospitalized in food insecure patients. They found food insecure patients had significantly more ED room visits hospitalizations, and days hospitalized. Another study specifically looked at patients with diabetes facing food insecurity. They found that patients with food insecurity had a higher blood sugar than those without food insecurity. This means that the patients with food insecurity had less control on their diabetes with could lead to future health complications.
Another study examined the health care costs associated with food insecurity between 2011-2013. This study used data from the National Health Interview Survey and the Medical Expenditure Panel Survey to examine health care costs and from the Map the Meal Gap on food insecurity. They found that food insecure adults had a statically significant greater health care cost of $1,834 more than food secure adults. In children, there was also an average of $80 higher each year, but were not statically significant. Researchers were able to use this data to conclude that an average of $52.9 billion was spent each year due to excess health care costs due to food insecurity.This would account for approximately 3-6% in total yearly health care costs in America.
The current effect of the to reduce poverty and food insecurity are slowing reducing poverty and insecurity. This can be seen from the national trend of a decrease in both poverty and food insecurity since the 1960’s. The most notable of these include actions taken after the war on poverty and especially the SNAP program. With this I would recommend that the Government takes three actions in order to continue to reduce food insecurity and poverty.
First, I would recommend that the Government continue to fully support and fund the SNAP program and reconsider the recent tightening of work requirements of the SNAP program. Participation in the SNAP program allows people to have the ability to “purchase” food to reduce hunger and food insecurity. Unfortunately, if exceptions from the 20 hour working requirements are reduced, up to 700,000 Americans and 45,000 Ohio residents could lose SNAP benefits. This could lead to increased food insecurity and increased health care costs as research currently shows that low-income adults participating in the SNAP program had an approximate $1,400 reduction in healthcare costs per year.
Second, I would recommend a 30% subsidy on fruits and vegetables for patients on Medicare and Medicaid. One study looked at the effects of a 30% subsidy on fruits and vegetables on the Medicare or Medicaid population. They found that is a 30% subsidy was placed on fruits and vegetables 1.93 million cardiovascular diseases could be prevented saving 39.7 billion dollars in national health care costs. Their showed that although initial cost may increase, that after five years this program would become cost effective and save the government money. Having health food subsidies would also lead to improved quality of life.