BY JANET COULTER, MSN, MS, RN, CCM, FCM
Food insecurity, defined as the lack of consistent access to enough food for an active, healthy life, is an issue affecting millions of individuals and families. Understanding the causes of food insecurity and implementing targeted interventions are essential for case managers. Food insecurity can be either temporary or long-term. It is a complex issue caused by a variety of interrelated factors including economic, social, environmental, race/ethnicity, geographic location and individual causes. Economic factors play a significant role in food insecurity. Low income, unemployment, poverty, high cost of living and economic instability force individuals and families to make difficult choices between food and other essential expenses like housing, utilities and healthcare. Even in situations where income is moderate, the high cost of living and economic instability can lead to chronic or sudden food insecurity.
Social factors further complicate the issue. Mobility issues and a limited social network cause many individuals to struggle to access food banks, soup kitchens and social support programs like SNAP (Supplemental Nutrition Assistance Program) and WIC (Women, Infants and Children). Food insecurity is linked to a range of chronic health conditions, including diabetes, hypertension, obesity and higher rates of anxiety and depression. Individuals who need a special diet may have higher food costs, which competes with covering other essential expenses including healthcare. Individuals with moderate incomes may also experience food insecurity due to the high prices of housing, transportation and other necessities, leaving little money for food.
Environmental factors also contribute to food insecurity. In rural areas, the long distance to grocery stores or food pantries and lack of reliable transportation limit access to affordable and nutritious food. People in those areas may rely on convenience stores and fast-food restaurants, which typically offer few healthy options. These food desserts can lead to food insecurity.
CASE MANAGEMENT INTERVENTIONS
Case managers can play a crucial role in addressing food insecurity through a variety of interventions. Routine screening for food insecurity should be implemented using validated tools such as the Hunger Vital Sign or the USDA’s six-item short form food security module. This screening should include specific questions about food availability, such as whether patients run out of food before they have money to buy more.
It is important to assess the broader context of a patient’s life, including housing, employment, transportation, social support and access to healthcare. This holistic approach ensures that interventions address the full spectrum of factors contributing to food insecurity.
Connecting patients with local food banks, SNAP benefits, WIC program, and other community resources is essential. Assisting patients with applications for government assistance programs and school meal programs for children can also help alleviate food insecurity. Additionally, developing partnerships with local organizations that provide food assistance and collaborating with social workers, nutritionists and community health workers will ensure a coordinated approach to providing assistance to those with food insecurities.
Education and advocacy are key components of addressing food insecurity. Case managers should provide education on healthy eating within patients’ budgets, including tips on food budgeting, grocery shopping and meal planning. Advocacy for policy changes at the local, state and national levels is necessary to improve access to healthy food and other essential resources.
Cultural competence is critical in this process. Being aware of cultural preferences and potential barriers that might affect a patient’s ability to access or accept help is important. Interventions should align with cultural norms and values.
Transportation is another critical issue that must be addressed. Assisting patients in accessing transportation to grocery stores, food pantries or farmers’ markets can involve providing bus passes, arranging volunteer drivers or coordinating ride-sharing services. For patients with mobility issues or those living in food deserts, arranging for home delivery of groceries or meals through services like Meals on Wheels or local community programs can be a lifesaver.
Community initiatives can also make a significant impact. Promoting and supporting the development of community gardens or school gardens where residents can grow their own fruits and vegetables helps increase access to fresh produce. Establishing or supporting mobile food pantries that bring food directly to underserved areas can also make a difference. Supporting food co-ops that allow members to work in exchange for discounted prices, as well as implementing backpack programs that send food home with children over the weekends or during school breaks, can further alleviate food insecurity. Another effective strategy is providing food vouchers or grocery store gift cards as an immediate form of assistance for those in urgent need.
SUMMARY
Case managers play a critical role in advancing health equity, particularly for individuals experiencing food insecurity. Health disparities and food insecurity are deeply interconnected issues that significantly impact the well-being of vulnerable populations. Addressing food insecurity requires a multifaceted approach that includes immediate relief, long-term solutions and systemic changes. As professional case managers, it is crucial to recognize that food insecurity is not merely a matter of access to food, but a complex social determinant of health that exacerbates existing health inequities. Individuals facing food insecurity are more likely to experience chronic conditions which are often compounded by limited access to healthcare, lower socioeconomic status and systemic barriers rooted in racial and ethnic disparities. Food insecurity is often linked to other social determinants of health, such as housing instability, unemployment and lack of education. Case managers can work to address these broader issues by connecting patients with services that support housing, employment and education, thereby tackling the root causes of health inequities. Addressing food insecurity through targeted interventions, culturally competent care and advocacy for equitable policies is essential in our role as case managers. By doing so, we can help bridge the gap in health outcomes, ensuring that all individuals, regardless of their background or circumstances, have the opportunity to lead healthy and fulfilling lives.
REFERENCES
Centers for Disease Control and Prevention (CDC). (2021). Health disparities and inequalities report—United States, 2021. Retrieved from https://www.cdc.gov/mmwr/volumes/70/su/su7001a1.htm.
Commission for Case Manager Certification (CCMC). (n.d.). Certified Case Manager (CCM). Retrieved from https://ccmcertification.org/.
Seligman, H. K., & Berkowitz, S. A. (2019). Aligning programs and policies to support food security and public health goals in the United States. Annual Review of Public Health, 40, 319-337. https://doi.org/10.1146/annurev-publhealth-040218-043706.
U.S. Department of Agriculture (USDA). (2020). Definitions of food security. Retrieved from https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-us/definitions-of-food-security/.
U.S. Department of Health and Human Services (HHS), Office of Disease Prevention and Health Promotion. (2020). Healthy People 2030: Social determinants of health. Retrieved from https://health.gov/healthypeople/objectives-and-data/social-determinants-health.
Wolfson, J. A., & Leung, C. W. (2020). Food insecurity and COVID-19: Disparities in early effects for US adults. Nutrients, 12(6), 1648. https://doi.org/10.3390/nu12061648.
World Health Organization (WHO). (2018). Health equity and its determinants. Retrieved from https://www.who.int/health-topics/health-equity.
Janet Coulter, MSN, MS, RN, CCM, FCM,
President of the Case Management Society of America
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