Doctors and health systems find novel ways to address hunger and its causes

Poverty, hunger and poor health are interlinked problems, ones that some doctors and medical systems are trying to address by screening patients for food insecurity, connecting them with food and other resources, and advocating broadly against inequality.

About 12 million children in the U.S. live in food insecure households, said Kofi Essel, a pediatrician and assistant professor of pediatrics at Children’s National Hospital and The George Washington University School of Medicine and Health Sciences. Speaking at the National Anti-Hunger Policy Conference on Wednesday, he said health professionals should screen all patients for hunger, since it won’t necessarily show up in lab results. “Food insecurity is invisible,” he said.

Essel helped start an anti-hunger program at two pediatric clinics in Washington, D.C., where about 17 percent of patients are food insecure. The program, a collaboration with city government and community partners like the local YMCA, identifies families experiencing food insecurity or diet-related chronic diseases. It then connects those families with “navigators” who help them access resources like SNAP or community programs. The navigators follow up with families, and report back to the patients’ health providers. Families can also get a prescription for produce; for six months to a year, they’ll get boxes of food (much of it grown by farmers of color) delivered to their homes.

Doctors’ efforts to address hunger and other disparities will vary depending on the setting they work in, Essel said. He described the work of a pediatrician in rural Texas who found that about half of the food-insecure families she saw were eligible for SNAP but weren’t enrolled in the program. Stigma and pride seemed to be at the root of this reluctance, and the doctor found that talking with families about how they had paid into the system through taxes helped convince some to sign up for benefits.

Meanwhile, a colleague of Essel’s working in a large urban setting found that many food insecure families with immigrant parents were afraid to take part in programs like SNAP because of public charge rules. The Trump administration added SNAP benefits to the list of government assistance programs that could prevent immigrants from getting green cards. And while the expanded rule was rescinded by the Biden administration last year, advocates say its “chilling effect” will take time to thaw.

Essel also described the work of a pediatrician in suburban Fairfax County, Virginia, which is one of the wealthiest counties in the U.S., yet still has pockets of food insecurity. The pediatrician’s patient screenings revealed that food-insecure families weren’t necessarily “poor” by the federal government’s definition—45 percent of his food-insecure patients came from families making more than 185 percent of the poverty limit. That meant they earned too much to qualify for safety-net programs like SNAP and school meals, but still struggled to afford food. Connecting these patients with food prescriptions and food pantries was crucial since they didn’t qualify for federal benefits, Essel said.

Allison Bovell-Ammon, director of policy strategy at Children’s HealthWatch, an advocacy and research organization headquartered at Boston Medical Center, described some of the ways the medical center addresses the drivers of health inequities. It started the first hospital-based food pantry in the country and has subsequently added a range of programs that address poverty, housing instability and unemployment. Parents can get free tax preparation help while their children see their pediatricians, and they can also get financial counseling and help repairing their credit scores. Another program addresses unemployment and affordable housing.

Bovell-Ammon also presented research highlighting disparities in families’ access to the programs that were intended to help them endure the economic hardships related to the pandemic. A survey of 1,200 pediatric patients’ families found that, early in the pandemic, families overall reported increases in household food insecurity, child food insecurity and being behind on rent. But families with U.S.-born mothers were better able to access help—96 percent of these families received either SNAP benefits or stimulus payments.

The scenario was different for families with an immigrant mother; a quarter of these families got neither SNAP nor stimulus payments. And these families were more likely to report greater increases in household food insecurity and falling behind on rent. Some of this disparity was due to the rules of the programs—certain immigrants must wait five years before getting SNAP, for example. Other barriers weren’t structural but were still significant. For instance, people who were unbanked or hadn’t filed taxes faced barriers to getting the stimulus payments.

“Food insecurity and nutrition are related to so many other parts of people’s lives that we cannot address them in policy silos,” Bovell-Ammon said.