Access to food (K Leff, A Prichard, M Struewing

Access to Food Kelsey Leff, Allyson Prichard, and Mitchell Strewing (PharmD) Spring 2020

Food Insecurity Production & Processing Introduction Background: Is this a global problem?

Food insecurity is a GLOBAL issue that manifests itself in different ways. One big food insecurity problem that is mainly seen in the United States, in urban areas, are food deserts. Although food deserts exist globally as well, we will focus on food deserts in the US due to more data availability.

What efforts/solutions have been done?

I have been blown away by the amount of creative solutions that rising healthcare professionals have discovered in order to make a difference in their patient’s access to food. These are just a few examples. - Geisinger Health Fresh Food Farmacy provides a “prescription” for fresh food; will receive care management, coaching, and education [1] - Eskenazi Health (Indianapolis, Indiana!) à partners with Meals on Wheels to offer medically tailored meals to seniors being discharged from the hospital; links patients to food pantries [1] - Boston Medical Center ED à screen patients for food insecurity; provides a written prescription for free groceries to be picked up at the on-site Preventative Food Pantry; feeds 7,000-8,000 patients each month. [1] Screening for food insecurity is a practice that should be implemented in healthcare procedures. Although we are just starting to find tangible solutions, knowing the nutritional state of your patient will help you make more informed decisions when prescribing medication and taking steps in treatment.

Allyson’s Opinion:

I have been very passionate about learning more about food deserts and what we can do to help since I was a senior year in high school. Unfortunately, the older I get and the more I know, the more complicated the situation becomes. I am blown away by the steps certain hospitals and other medical centers have taken in order to care for their patients who are food insecure. In my opinion, this is a very underdeveloped area of our healthcare system - caring for those who are in unavoidable circumstances - and we should be working towards developing more options to help patients who are food insecure.

Who/What is affected by this issue?

Food deserts are known to affect areas that are home to ethnic minority and low-income populations [10]. Long term health consequences of having access to healthy food is a large concern. Minority groups tend to have higher rates of obesity, type 2 diabetes, cardiovascular disease, and other diet-related conditions [3]– this cannot conclusively be solely linked to food deserts. Food insecurity is also associated with higher risks of being hospitalized, poorer general health, depression, and suicide ideation [4].

Background: What is production and processing?

Production is the cultivation of crops and the growing livestock. Processing is the transformation of agricultural products to be edible or more complex. In most cases, these words are synonymous. Production occurs around the world and on average the larger the country, the greater net production they will have (i.e China, India, United States, etc.). The U.S. is generally self-sustainable, however every country relies on one another for imports and exports that drive their economy.

Who is affected by this issue?

Everyone is affected by production and processing. Unless you have a home garden, can slaughter you own animals, and can process those raw materials, you are dependent, at least in part, by your local supermarket having a constant supply of common goods. The people who are experiencing food insecurity are commonly malnourished. Some forms of malnutrition are partly due to the nutritional value of the agricultural product not being a top goal of the producer. [7]

Are we producing high quality, nutritious food?

Essentially, some of the food produced today is not as nutrient dense as before. Granted, beyond nutrient content of food, important factors to agriculture are: water/ soil quality, avoiding health hazards, and seasonality of products. When you mess with one variable, it can affect another. Some GMO alternatives to traditional products increase the nutrient density of foods and make them net better calories for people. [6]

Is our global climate capable of increasing production at the rate our population is growing?

The short answer is no. While farming is growing natural products, it is not actually safe for the environment. The best way to increase the “environmental friendliness” of production is through technology. Microsoft is teaming up with The Yield to use Microsoft’s advanced Artificial Intelligence technology to reduce waste and produce more food by helping farmers make the right decisions. Bowery Farming has another solution, vertical farming, which can be done in urban settings and is also very high tech, producing 100x the food in the same footprint using 95% less water.

How safe is our food?

Recalls are a continual threat to access to food. Contaminated food poses a serious danger to Americans’ health, from Tyson's chicken containing metal to E. coli on romaine lettuce. Food recalls are on the rise due to many factors, but the biggest being aging factories, cost cutting, and poor inspections of equipment. To get these numbers back under control the FDA must improve the efficiency of their inspections .

Mitchell’s Opinion:

The United States, and much of the world, is on track to produce and process enough food, even amid a global pandemic. It is only with continued efforts to combat food insecurity, such as using food programs, that we can see an improvement of access to food for lower income and minority individuals. With continuous scientific and technological breakthroughs, producers will successfully serve the global community of tomorrow.

COVID-19 and Supply Chain

Continual reports indicate that the U.S. supply chain will remain intact despite the increased demand caused by fear of the coronavirus. This is thanks to decreased demand from sit-in restaurants and ample inventory of non-perishables in warehouses. All in all, with the foreseeable stock of food safe, one thing that we might not be prepared for is the workers who supply the world's food are beginning to get sick. Preceding the pandemic there was already a shortage of workers in agriculture, now it is only going to get worse. This will indeed decrease production of plants, farms, and factories that have less workers. [8] For example, strawberries are still hand planted, weeded, and picked. Now there will be less available.

What is access to food and why is it important?

According to the United States Department of Agriculture (USDA), in 2018 “37.2 million people lived in food-insecure households [9].” That means that around 11% of people living in the US do not have reliable access to food. However, insufficient access to food is “not just a national problem, it affects people all over the world. Food insecurity is frequently described as not knowing when the next meal will come.” For some people, that means that their access to food is so poor that they might go an entire day without eating. For others, that could mean that there is not enough money to have breakfast but lunch and dinner are usually available. Access to food that provides adequate nutrition is incredibly important for maintaining health and wellbeing.

What are Food Deserts?

According to the Food Empowerment Project, food deserts are “geographic areas where residents’ access to affordable, healthy food options is restricted or nonexistent due to the absence of grocery stores within convenient travelling distance” [3]. There are roughly 2.3 million people in the US who live more than one mile away from a supermarket and do not own a car, and unfortunately the solution isn’t as simple as the public transportation system-most grocery stores are so few that a shopping trip may require multiple buses or trains [3]. This lack of access to food has large implications on health, so we will be exploring what the correlation is and start to think about what healthcare providers should be addressing with their patients when it comes to food security.

Food Programs What are Food Programs?

Food programs are created to help those who have food insecurity or trouble accessing food. Some of the largest ones are created and sustained by governments. Most programs are delegated to a specific subset of a population such as students or those living in poverty.

Who is affected by food programs?

There are many different populations that are included in food programs. However, most food programs focus on those who live in poverty. Young students in public schools are also a focus of government food programs. The one thing all of these populations have in common is food insecurity.

What has the United States done to fight against food insecurity?

The United States government has created multiple different food programs. The two largest food programs are the National School Lunch Program and the Supplemental Nutrition Assistance Program (which was formerly known as food stamps).

National School Lunch Program

This program was originally formed in 1946 because of the large number of men turned away from the Army in World War 2 because of poor nutritional health [2]. In 2009, around 94% of public and private schools in the US participated in the NSLP [2]. There are 2 subsections of the NSLP, free or reduced lunch. Eligibility for eather parts of the program is based on the household’s annual income. In order to receive free lunch, the income must be at or below 130% of the poverty level which is about $1,400 a month [2]. In order to receive reduced lunch, the family household income must be between 130-185% of the poverty level [2]. While the eligibility is explicitly written, there is much more leeway in becoming eligible compared to other food programs in the United States.

Supplemental Nutrition Assistance Program (SNAP)

This program is for the general public in need of extra resources in order to afford food. It used to be known as the food stamp program. There are very strict requirements for eligibility for this program. The first requirement is having a gross monthly income at or below 130% of the poverty level, which is around $1,400 a month [9]. Another requirement for this program is that anybody that you must have a job in order to be eligible for SNAP [9]. There are some subsets of the population (i.e. children and the elderly) who this does not pertain to. Another requirement for eligibility is documentation. You are not eligible for SNAP unless you are a documented citizen of the United States [9].

Kelsey’s Opinion:

National food programs are a great way to help those living with food insecurity get the food that they need. However, the requirements for eligibility in any of the US food programs are incredibly strict. There are many people living in the United States who are suffering from food insecurity. Undocumented immigrants in the United States do not have very many options if they have food insecurity because they are not able to enroll in any national programs. In order to best combat food insecurity in the US, the public needs to be educated about how rampant it is here. The opinion that food insecurity is only a “3rd world” problem is horribly incorrect, but it is a widespread one. They only way that the national food programs will get better is if the public steps up and helps to change them. Food insecurity is a global problem, but it is a national one too.

How have we tried to fight food insecurity?

The United States has created many programs to deal with food insecurity. Two of the largest food programs are The National School Lunch Program (NSLP) and the Supplemental Nutrition Assistance Program (SNAP). The NSLP is focused on providing free or reduced lunch to students that are in need. SNAP was created to help combat food insecurity in the general population. There are many requirements to become eligible for both of these food programs. They each include the requirement of earning less than 130% of the poverty level which works out to be around $1,400 a month. While these programs are very helpful, there is still a lot to be done to help the 37.2 million people in the US suffering from food insecurity.

Are food programs used worldwide?

Unfortunately access to food is a global issue. Every country has a different view on food programs and who is in need of assistance. The United States has a program called the National School Lunch Program that provides free or reduced lunch to students. On the other hand, Canada does not have a food program for students [5].

What is food insecurity and how does it relate to access to food?

Food insecurity is the state of being without reliable access to a sufficient quantity of affordable, nutritious food. In short, it is the literal lack of access to food and according to the AAMC, “Food insecurity affects more than 12.7% of US households, roughly 15.8 million people” [1]. Food insecurity can be manifested in many different ways, but the main area we are focusing on is food deserts. Food deserts are a form of food insecurity, specifically relating to a geographic area and a radius of food insecurity.

What does production have to do with access to food?

Before the consumer is able to purchase food in most forms (i.e everything except gardening at your own home) it must first be produced and processed. A fault here creates a domino effect for everyone down the line. Production and processing is the first step for local grocery stores, supermarkets, and food pantries to have the products for consumers to purchase.

References

1. Driving innovative health care solutions for underserved populations. AAMC. https://www.aamc.org/news-insights/driving-innovative-health-care-solutions-underserved-populations. Published July 10, 2019. Accessed February 13, 2020. 2. Evans, Landon W., "The effect of Free and Reduced Lunch on Reading and Math Achievement" (2015). eses, Dissertations and Capstones. Paper 948. 3. Food Deserts*. Food Empowerment Project. https://foodispower.org/access-health/food-deserts/. Published 2020. Accessed February 13, 2020. 4. Gundersen C, Ziliak JP. Food insecurity and health outcomes. Health Aff. 2015;34(11):1830-1839. https://search.proquest.com/docview/1731536048?accountid=13360. doi: http://dx.doi.org/10.1377/hlthaff.2015.0645. 5. Harper C, Mitchell C, Wood L. The Provision of School Food in 18 Countries. ResearchGate. https://www.researchgate.net/publication/265032327_The_provision_of_school_food_in_18_countries. Published January 1, 2008. Accessed February 25, 2020. 6. Jones AD, Ejeta G. A new global agenda for nutrition and health: the importance of agriculture and food systems. World Health Organization. https://www.who.int/bulletin/volumes/94/3/15-164509/en/. Published April 16, 2018. Accessed February 13, 2020. 7. Keding GB, Schneider K, Jordan I. Production and processing of foods as core aspects of nutrition-sensitive agriculture and sustainable diets. SpringerLink. https://link.springer.com/article/10.1007/s12571-013-0312-6. Published November 26, 2013. Accessed February 13, 2020. 8. Mulvany L, Shanker D, Almeida I. The Workers Who Supply the World’s Food Are Starting to Get Sick. Bloomberg.com. https://www.bloomberg.com/news/articles/2020-03-27/food-workers-getting-sick-is-the-latest-threat-to-world-supply. Accessed March 28, 2020. 9. Tiehen L. Supplemental Nutrition Assistance Program (SNAP). USDA ERS - Supplemental Nutrition Assistance Program (SNAP). https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/. Accessed February 25, 2020. 10. Walker RE, Keane CR, Burke JG. Disparities and access to healthy food in the United States: A review of food deserts literature. Health & Place. https://www.sciencedirect.com/science/article/pii/S1353829210000584. Published April 24, 2010. Accessed February 13, 2020.