By: Roopa Seshadri, PhD AM & Carolina Hausmann-Stabile, PhD LSW
44 million people faced food insecurity in 2022 – across the demographic and geographic spectrum, with children and minoritized populations at higher risk. Food insecurity is intertwined with other social determinants of health and cross-sector solutions are needed to make a sustainable impact. Recent collaborative initiatives between city agencies, nonprofits, foundations, and community stakeholders show promise and early success in addressing precursors to food insecurity.
Food insecurity, or the lack of consistent access to safe and nutritious food that meets dietary needs and preferences for an active, healthy life, affects around 44 million Americans as of 2022. It can involve the physical lack of access to healthy food, such as in urban food deserts, the economic lack of resources to purchase food, or a combination of both.
Food insecurity can be temporary – due to unexpected events such as an unexpected medical bill, or chronic – a persistent pattern that can carry severe physical, psychological, and social consequences. Poor nutrition due to food insecurity can lead to poor physical and mental health and learning challenges for
students in school.
Certain groups, like children, the elderly, and people of color are at elevated risk for food insecurity, but in reality, it can affect anyone. Many people are a paycheck away from needing food assistance. And worryingly, the current numbers represent a reversal of a decade-long decline in food insecurity.
Since food insecurity is primarily a result of poverty, it typically coexists with disparities in other social determinants of health (SDOH). Common accompanying challenges are a lack of safe and secure housing, limited access to transportation, and inadequate health care. Taken together, these social determinants have a significant negative impact on a person’s health and wellbeing. This presents an opportunity for investing in cross-sector partnerships that also address issues systemically.
We Need a Cross-Sector Approach to Resolve Food Insecurity
In the larger context, families experiencing poverty are often choosing between necessities – such as shelter, food, electricity, clothing, health. Faced with that choice, although food and shelter are the priority, food insecurity often precedes homelessness. Homelessness in turn is highly associated with food insecurity, mental illness, and substance abuse. This is just one example of how social determinants of health are intertwined. In 2022, over 582,000 people were homeless on a single given night.
There is a clear difference in the scale of food insecurity and homelessness prevalence. Solutions to food insecurity among these 582,000 people are different than for the housed population. It is important to meet people where they are and develop solutions that consider the demographic group's needs, including other social and environmental challenges.
Solutions to these challenges usually follow one of two approaches:
Treat the risk factors as a series of individual issues from personal to group or community contextual factors
Consider the dynamic relationship between the risk factors and complex circumstances which are further amplified by systemic issue
We illustrate these different perspectives as they apply to food insecurity interventions.
The first approach, which is the prevalent one, informs the Supplemental Nutrition Assistance Program (SNAP, formerly called the Food Stamp Program). SNAP is a federal assistance program that provides eligible low-income individuals and families with funds to purchase nutritious food. The amount of assistance a household receives is based on factors such as income, household size, and expenses. For example, in Pennsylvania, monthly SNAP benefits range from $23 to $291 per individual. Often, purchases made with SNAP assistance are supplemented with other resources, such as free meals at school, food banks, and other food assistance services.
Although SNAP plays a vital role in reducing food insecurity and improving access to food for millions of Americans, it does not address the root causes and thus, cannot provide a sustainable, long-term solution to food insecurity. SNAP is also not available to people who are not eligible for the program and yet face food shortage, even if they meet the definition of food insecurity.
The second approach calls for a cross-sector solution to food insecurity. A first step in this direction would be to target individual and family level factors such as physical and mental health challenges, homelessness, and employment. At the community level, the program would improve nutritious food availability, and strengthen service providers, vendors, and community organizations network to meet demand. Such a program would rely heavily on the integration of supportive services, most importantly healthcare, employment, and housing programs.
Cross-sector partnerships in action
One of the earlier successful implementations of a cross-sector solution to social determinants of health is the city of Houston’s approach to homelessness. In a true example of partnership, several city agencies, the county, housing agencies, community stakeholders, and nonprofit partners came together to develop and execute a strategy to move people out of homelessness using a housing first ideology. Homelessness in Houston reduced by nearly two-thirds in the last 10 years, while it increased in other major urban centers during the same time.
Successful cross-sector solutions to food insecurity are on the rise. United for Health (2012), a coalition of 12 community-based organizations, a healthcare organization and a government agency focused on equity and justice partnered to create community gardens, produce markets and expanding benefits assistance in five low-income neighborhoods in Los Angeles. Another campaign, the Be Mighty (2018) program in Little Rock, AR, grew a hunger relief agency and public library partnership into a multi-foundation anti-hunger campaign for children in school to include food insecurity screenings and referrals, nutrition education, assistance with benefit applications, and distribution of free bus passes to program participants.
Every three years, tax-exempt hospitals must complete a Community Health Needs Assessment (CHNA), as required by the Affordable Care Act. This investigation allows health-care institutions to identify areas of need and partner with community organizations to deliver SDOH targeted solutions. For example, Penn State Health Network, based in Central Pennsylvania, hosts partner forums following the assessment to identify pathways for collaboration and improvement of health needs. Programs addressing food insecurity include community gardens and farmers markets, as well as VeggieRX, an initiative where physicians can prescribe fresh foods to patients, and when patients redeem their vouchers, they can also receive nutritional education and clinical care. Similar initiatives have emerged from CHNAs nationwide, such as in Hood River, Oregon, where 33 organizations joined forces to form a robust VeggieRx program across senior centers, the housing authority, public libraries, and more.
Frameworks, like the Vital Conditions for Health and Wellbeing Framework, pave the path for government involvement in cross-sector approaches to food insecurity. Part of the Federal Plan for Equitable Long-Term Recovery and Resilience, this framework aligns federal agencies to collaborate, foster community-centered initiatives, and address health disparities, ultimately improving health and well-being. Coupled with expanded Medicaid coverage for health-related social needs (HRSN), cross-sector approaches now have both the framework and funding to be successful. An early example of this in action is the North Carolina Early Childhood Action Plan, which addresses whole-person care, including Healthy Opportunities Pilots a program utilizing $650 million in Medicaid funding to evaluate and optimize non-medical interventions targeting food insecurity, housing, and other vital conditions needs. This program is supplemented by cross-sector collaboration using data tracking to increase coordination of statewide interventions.
All social determinants of health are interconnected and no one determinant exists in a silo. Any serious effort to improve individual and community wellbeing must consider a cross-sector approach, tapping into existing frameworks and funding mechanisms on the federal, state, and community level, for efficient strategies and sustainable impact.
To cite: Hygieia Consulting. (2024) Cross Sector Solutions to Address Food Insecurity. hygieia.llc
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