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SDOH: Food insecurity adds $53 billion annually to healthcare costs

Food insecurity is more than about being hungry, it's about the estimated 1 in 8 Americans who do not have access to nutritious food.

Susan Morse, Managing Editor

Food insecurity costs the health system an additional $53 billion a year, according to Dr. Hilary Seligman, senior medical advisor for Feeding America and co-author of a study that looks at the issue state-by-state.

Food insecurity can lead to diabetes, heart disease and other chronic conditions, all of which are costly to health and the healthcare system.

"What's important to understand is the connection between food insecurity and health," said Seligman, an associate professor at the University of California San Francisco. "When people don't have enough money for food, they use coping strategies, shifting their dietary intake to unhealthy food. It's these coping strategies that are so poor for your health."

Also, she said, "Being chronically ill is expensive in the U.S. Money is going to healthcare rather than the food budget."

Over a lifetime, it's hard to undo the effects of a poor diet and its consequences.

"A small improvement in children may have enormous outcomes in the future," Seligman said.

Food insecurity encompasses more than hunger, or wondering where the next meal is coming from. The U.S. Department of Agriculture defines food insecurity as a lack of consistent access to enough food for an active, healthy life.


Food insecurity has become a major issue for hospitals, which have been making the transition to value-based care and its goal to keep people healthy.

Chronic conditions are a major reason for hospital admissions, readmissions and emergency room visits, all of which are targeted in value-based payment models.

Illness in a value-based system cannot be addressed without identifying the underlying environmental, social and behavioral issues that drive ill health.

Payers Medicare, Medicaid and private insurers offer incentives to reward wellness, coordinated care and better health outcomes.

Anthem Foundation Executive Director Lance Chrisman, who has worked for  Anthem's philanthropic arm for about 13 years, said food insecurity has always been an issue, but in the past five years, the talk about addressing the social determinants of health has ramped up.

The foundation is flooded with requests for funding and gives an estimated $16 million to various programs each year.

But one of the primary areas of focus for the Anthem Foundation is food insecurity.

"When we start seeing the data and background: one in eight Americans, 40 million adults, 12 million children struggle with food insecurity," Chrisman said.


The Anthem Foundation recently partnered with The Food Trust and its community-based program, the Healthy Food Retail Initiative, to increase access to healthy food in Indianapolis, Indiana; Cleveland, Ohio; and San Jose, California.

The Anthem Foundation gave a $350,000 grant to the Food Trust Program to launch beta testing in those cities to take the Healthy Food Retail Initiative to scale.

The money subsidizes the cost of fresh fruit, produce and other healthy food to be sold at low cost in 37 existing brick and mortar markets and convenience stores. This includes five additional communities on the Eastside of Indianapolis, where these locations also serve as community health hubs providing health screenings, nutrition education and cooking lessons.

A 2019 Fitness Index found that only 33.9 percent of Indianapolis residents are eating two or more fruits a day and just 15.1 percent of residents are eating three or more vegetables each day. Data also showed more than one in three Indianapolis residents live in low food access areas where fresh food is difficult to find.

Anthem has made other food insecurity investments in the Feeding America program, a nationwide network of more than 200 food banks, a program for college students in Virginia and in Blessings in a Backpack for elementary school kids.

This is food as medicine, Chrisman said.

"We believe eating healthy is just as important as taking medications,"

Seligman said individuals pay more attention to the edict to take advantage of better food choices available on-site at the hospital grocery pantry or the local food bank, if that comes from their physician.

"It feels the same as getting a prescription," Seligman said.

However, she said, "The best answer for a food insecure household is SNAP (Supplemental Nutrition Assistance Program)."

Hospitals are also a good source of finding people who are food insecure.


"We're just at the tip of the iceberg to understand whether they're working," Seligman said of programs. "We think if they're supporting food security, they're working."

Hospitals, insurers and organizations nationwide have launched food insecurity, housing and other social determinants of health initiatives. When Montifiore in New York City invested in housing the homeless, it realized a 300% return on investment from savings, such as fewer emergency room visits.

Massachusetts recently introduced the Massachusetts Food as Medicine State Plan.

At last count, 28 health systems had joined the Medicaid Transformation Project to improve the health of underserved individuals and to drive new solutions for untreated depression, teen suicide, post-traumatic stress disorder and mental illness.

"There is a vision of a much more broad scale support," Seligman said, adding, "there is no financing mechanism."

What motivated her report was being approached by food banks and healthcare partners that wanted to know the impact of food insecurity in their local communities.


The study, "State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity," includes an interactive map that breaks down healthcare costs associated with food insecurity on a state level.

For the analysis, the authors used 2011-2013 data from the National Health Interview Survey the Medical Expenditure Panel Survey, 2012-2013 data from the Dartmouth Atlas and 2016 data from Map the Meal Gap 2018.

The authors found that among approximately 28 million food-insecure adults and 13 million food-insecure children in the United States in 2016, the excess cost associated with food insecurity translates to approximately $52.9 billion in excess healthcare expenditures.

Key findings include:
On average, healthcare costs for food insecure adults is $1,834 higher than people who are food secure.
The state with the highest healthcare cost per capita associated with food insecurity is Mississippi, at $243 per person. Texas, Louisiana, Florida, and Oklahoma are also among the top five states.
The state with the lowest healthcare cost per capita associated with food insecurity is North Dakota, at $78 per person.


"We've known for a long time," Seligman said, "if we eliminate programs in food security, we end up with extra cost in the healthcare sector."

Twitter: @SusanJMorse
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