“Eat healthy, stay healthy.” What could be simpler? Unfortunately, there are many barriers to achieving a healthy diet. Knowledge, access, resources and culture can all work against good eating habits. Sadly, the health system often does little to address these issues. Only recently have doctors started asking patients if they have trouble getting the food they need to be healthy. It took a patient to help me discover my ignorance about the challenges some families face in eating healthy. He had serious diabetes, kidney disease and poor circulation, but mentioned he often ate at the local all-you-can-eat buffet. I immediately scolded him for his bad food choices, “…loaded with sugar, fat…easy to overeat.” He looked me in the eye and said, “Doc, for $9.95, I can get a whole day’s worth of food. I can’t eat that cheaply at home.” At that moment, I realized I was writing him a prescription he just couldn’t fill. The USDA estimates that 12.7% of American households were food insecure at least some time during the past year. Some live in “food deserts.” In these communities, both urban and rural, meals often come from fast-food outlets and poorly stocked grocery stores where the healthiest items—fresh fruits and vegetables—actually look least appealing and downright unhealthy. Beyond the obvious human impact, food insecurity has a significant economic cost. One study found that emergency department visits for treatment of low blood sugar went up 27% at the end of the month—but only in low-income patients. It seems that patients with diabetes were running out of food while maintaining the same dose of sugar-lowering medicine, resulting in overtreatment and a life-threatening complication. The lack of sufficient resources, either in the form of pay or social benefits, resulted in a very expensive but preventable hospital admission. Under new alternative payment systems, health-care providers are incentivized to prevent unnecessary treatment. It now makes economic sense to identify patients who have trouble getting the food they need to stay healthy. Not all hospitals have to set up a farmer’s market and food pantry, though some do. Lankenau Medical Center hired a farmer to tend the field next to the helipad. The 2,600 pounds of food produced is distributed to the poor and used in the cafeteria. Perhaps, most importantly, the hospital farmer runs DIY gardening classes—a great twist on the old adage about “teaching a man to fish.” The community dividends are obvious, but the hospital itself should someday see an improved bottom line in the lower cost of caring for a healthier population. The CDC’s Community Health Improvement Navigator site lists dozens of proven food-related interventions, so hospitals interested in improving the diet of the people they serve will find no shortage of great ideas. Beyond the specific actions health-care providers can and should be taking, they should also work with local, county and state policymakers to raise awareness of the issue of food insecurity. Ultimately, this is a responsibility that goes beyond the health-care sector. Dr. Jack Geiger is the co-founder of the nation’s first community health center in the poverty-stricken rural community of Mound Bayou, Miss. The federal auditors discovered he was using his pharmacy budget to buy groceries for malnourished patients. He explained, “The last time we looked in the book, the specific therapy for malnutrition was food.” Source
