How food insecurity affects health – and how healthcare can help
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How food insecurity affects health – and how healthcare can help
Globally, 2.4 billion people are unable to access or afford sufficient food to meet their nutritional needs1. Even in the US, one of the wealthiest countries in the world, 13.5% of households – or 44 million people – are affected by food insecurity2. At Wake Forest University School of Medicine in North Carolina, USA, Dr Deepak Palakshappa studies how food insecurity affects people’s health, and how healthcare systems can help address these issues.
Talk like a public health researcher
Census — a process of gathering demographic information about an entire population
Chronic — long-lasting or constantly recurring
Demographics — the statistical characteristics of human populations (e.g., race, age, income, etc.)
Food insecurity — limited or uncertain access to sufficient food at the household level, due to economic or social conditions
Holistic — a way of thinking that considers a whole system, rather than focusing on its individual parts
Public health — the study and practice of promoting and improving the health of people, households, and communities
Social determinants of health — non-medical factors that influence health, such as financial stability and access to education
A lack of access to nutritional food can affect people’s lives in a variety of ways, impacting their physical and mental health, their relationships, and their ability to access the services they need. While social programmes can help address some of the causes and effects of food insecurity, they do not help everyone. At Wake Forest University School of Medicine, Dr Deepak Palakshappa is studying social determinants of health and investigating how healthcare systems can lessen food insecurity and usher in positive health outcomes for households across the US.
The United States Department of Agriculture (USDA) defines a household as suffering from food insecurity when it is unable to acquire adequate food due to insufficient money or other resources. However, food insecurity does not always mean going hungry; it can also mean that people only have access to foods with low-nutritional value, such as cheap fast food. “While food insecurity can affect anybody, there are certain populations and household demographics that are at higher risk,” says Deepak. “For example, lower-income households, households with children, or individuals with chronic disabilities may all have a higher risk of food insecurity.”
Food insecurity and health
While it is well known that a bad diet is not good for our health, the links between food insecurity and health have not been widely investigated – until recently. “Research over the past 15 years has found that food insecurity can affect people throughout their entire life, from birth to old age,” says Deepak. “Food insecurity is associated with a higher incidence of several chronic diseases, worse overall health outcomes, and higher use of healthcare services.” These effects on health can manifest in many different ways; for instance, reliance on cheap, poor-quality food can increase the risk of obesity, diabetes, and high blood pressure. “There are also mental health impacts,” says Deepak. “If you are constantly worried about having enough food at home, this can lead to chronic stress, anxiety, and depression.”
Food insecurity is typically a household issue, but can affect some members of a family more than others. Some studies have found that mothers, in particular, have higher rates of anxiety and depression when facing food insecurity. “Parents and guardians are constantly worried about being able to feed their kids,” says Deepak. “They may compensate by reducing their own food intake by skipping meals to ensure their children have enough to eat.” But children are also affected. “For instance, we ran focus groups with school students, and found that children can sense when their caregivers are stressed by food insecurity, which affects their development and familial relationships,” explains Deepak. “Additionally, students can often tell which of their classmates come from food-insecure households, which affects peer relationships too.”
Addressing food insecurity in the US
Despite the US being a developed country, more than one in eight households live with food insecurity. Some nationwide interventions have been developed to address this. “Through the Supplemental Nutrition Assistance Program (SNAP), the government provides benefits for eligible people so that they can purchase food,” says Deepak. “SNAP has been shown to be effective in reducing food insecurity, reducing poverty, and improving some health outcomes.” Another intervention, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), takes a similar approach, focusing on these specific vulnerable individuals.
So, why does food insecurity persist in the US? “First off, there are a number of criteria one must fulfil to be eligible for these programmes,” explains Deepak. “Additionally, fully engaging with these programmes typically involves time and energy that people may simply not have.” Competing priorities like work and childcare can make it challenging for households to access and take full advantage of these programmes – which signals the need for a new approach that overcomes these barriers.
From data collection to positive intervention
Deepak and his team are using two methods to investigate the links between food insecurity and health. “One method that we use is secondary research, which involves taking data that’s been collected for other purposes and looking at what it tells us about health,” says Deepak. “National datasets, like censuses, include household food insecurity and health markers, which allow us to uncover these links.”
The team also undertakes primary research, which involves collecting data through their own studies and experiments. “A lot of our primary research is focused on developing interventions or programmes designed to mitigate the effects of food insecurity on health,” says Deepak. “For example, we have one programme that delivers meals to food-insecure households, and then examines whether this helps to alleviate high blood pressure in adults from these households.”
Deepak works closely with healthcare clinics to examine how they can help to address food insecurity. “We build interventions with the practitioners within clinics to provide support for food-insecure patients,” he says. Deepak wants clinicians to have the tools to identify food-insecure patients – often as straightforward as asking patients if they have enough food at home – and then point them towards helpful interventions. “The biggest research challenge for us is identifying which interventions are helpful, and for which people,” says Deepak. “That’s the focus of my research right now.” Finding ways to help people who might slip through the net of programs like SNAP and WIC is vital, and will contribute to building a more holistic approach to food insecurity and healthcare across the US.
1 www.un.org/en/global-issues/food
2 www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics
Reference
https://doi.org/10.33424/FUTURUM550
This educational material has been produced by Wake Forest University School of Medicine in partnership with Futurum and with grant support from The Duke Endowment. The Duke Endowment is a private foundation that strengthens communities in North Carolina and South Carolina by nurturing children, promoting health, educating minds and enriching spirits.
Dr Deepak Palakshappa
Associate Professor, Department of Internal Medicine, Wake Forest University School of Medicine, North Carolina, USA
Fields of research: Public health, food insecurity, social determinants of health
Research project: Investigating how food insecurity is linked to health issues, and how healthcare systems can support socioeconomic efforts to tackle these problems
Funder: US National Institutes of Health (NIH)
About public health research
Public health research involves studying and implementing ways of making people and communities healthier, from preventing the spread of disease, to tackling pollution, to running healthy lifestyle educational campaigns. In many ways, it can be seen as ‘upstream’ of clinical healthcare, as it aims to prevent or mitigate health issues before they arise. Tackling food insecurity is a core aspect of public health, as it helps to prevent the physical and mental health conditions that arise from insufficient nutrition.
“Most other developed nations have a stronger social safety net than the US, which means that food insecurity is typically less of an issue,” says Deepak. “This presents a research opportunity for us: how do we change public policy so that every person can be as healthy as possible?” A social safety net might include a minimum income for unemployed people or access to food banks that stock free, nutritional food for those in need. These are core components of an effective public health system.
Deepak is finding that healthcare practitioners are increasingly realising that they have a role to play in addressing food insecurity. “I have been researching these links for over a decade,” he says. “When I first started, most people considered food insecurity outside the scope of healthcare, but rather the focus of public health and public policy organisations.” He has noticed a shift in recent years, where healthcare professionals are acknowledging how food insecurity impacts health and, therefore, the need for healthcare to address it.
Besides food insecurity, public health depends on many other social determinants. “Factors including poverty, structural racism, and educational inequality all affect health,” says Deepak. “These factors that affect entire communities filter down to individuals; for instance, lack of transportation, housing instability or homelessness, and domestic violence may all be the result of these structural issues.”
Public health research, therefore, has the substantial task of addressing structural inequalities to improve the health of communities and of individuals – a complex and multifaceted challenge. “A career in public health research needs passion,” says Deepak. “It’s a long journey with many bumps and turns, but it’s very exciting and meaningful. It’s what gets me up in the morning!”
Pathway from school to public health research
At school or college, Deepak suggests getting a good foundation in mathematics (especially statistics) and science, as well as psychology, social sciences, and economics, if possible.
At university, Deepak recommends courses or modules in statistics, psychology, economics, and science to prepare for a career in public health research. He also recommends seeking practical experience, such as volunteering or interning with a public health organisation or social health research group.
Explore careers in public health research
Wake Forest University has a number of Pre-College Programs (precollege.wfu.edu) that enable high school students to take part in learning experiences across a number of disciplines. Current options include Summer Immersion Programs based on specific academic fields, Online Immersion Programs available year-round, and college LAUNCH, a free scheme focusing on social justice and leadership development.
Many universities and institutions provide similar programmes and offer a range of resources that can help you explore topics related to public health.
The Centers for Disease Control (www.cdc.gov) and the World Health Organization (www.who.int) both provide useful insights into what public health looks like in action at the national or international levels.
A public health degree can lead to many different careers including working in academia as a researcher, becoming a healthcare consultant, or helping your community by becoming a community health nurse.
Meet Deepak
My parents are immigrants to the US and my father grew up poor. Education is what helped him reach a better quality of life, which ensured I didn’t face those same struggles. Because I was so fortunate, I felt driven to help those who didn’t have these opportunities.
When I was in college, I worked with a community engagement group. This included a term helping to build a school in Africa and delivering meals to older home-bound adults, giving me a first-hand look at some of the social issues people faced. This led me to take a year off after university to work for AmeriCorps, the US-serving version of the Peace Corps. I taught mathematics in a neighbourhood of low-income, under-represented minority groups. These experiences made me think about how to better address people’s unmet social needs.
In medical school, I became interested in public health. In particular, my passion was sparked by the role of research in improving the health of communities and entire populations. The level of inequity that exists both in the US and globally is still a driving force for me – the need to change this motivates me every day.
I really enjoy the process of research. In the clinic, I love talking to people, hearing their stories and finding ways to improve their health. But, I also enjoy the days when I’m just doing statistics on the computer. That is very fun and rewarding for me!
I find mentoring trainees especially fulfilling. Getting excited about different topics, learning from them, and transforming ideas into solutions is incredibly rewarding. Of course, ideas don’t always work out, but that’s okay. I find it interesting to simply find out whether something works or not.
Outside of work, most of my time is spent with my two kids. They don’t particularly care about my work, which makes hanging out with them the best way to unwind! I like playing with them and I coach their soccer team. I also enjoy playing golf and tennis.
Deepak’s top tip
Find your passion and pursue it. The best way to figure out if you are interested in something is to try it out as early as you can. Getting involved in volunteering or work experience, even when in high school, will help you work out what you want to do long term.
Do you have a question for Deepak?
Write it in the comments box below and Deepak will get back to you. (Remember, researchers are very busy people, so you may have to wait a few days.)
Learn more about how an urban farm in Florida is helping local families escape food insecurity:
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