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With U.S. health care costs projected to grow at an average rate of 5.5 percent per year from 2018 to 2027, or 0.8 percentage points faster than the gross domestic product, and reach nearly $6.0 trillion per year by 2027, policy makers and a wide range of stakeholders are searching for plausible actions the nation can take to slow this rise and keep health expenditures from consuming an ever greater portion of U.S. economic output. While health care services are essential to heath, there is growing recognition that social determinants of health are important influences on population health. Supporting this idea are estimates that while health care accounts for some 10 to 20 percent of the determinants of health, socioeconomic factors and factors related to the physical environment are estimated to account for up to 50 percent of the determinants of health. Challenges related to the social determinants of health at the individual level include housing insecurity and poor housing quality, food insecurity, limitations in access to transportation, and lack of social support. These social needs affect access to care and health care utilization as well as health outcomes. Health care systems have begun exploring ways to address non-medical, health-related social needs as a way to reduce health care costs. To explore the potential effect of addressing non-medical health-related social needs on improving population health and reducing health care spending in a value-driven health care delivery system, the National Academies of Science, Engineering, and Medicine held a full-day public workshop titled Investing in Interventions that Address Non-Medical, Health-Related Social Needs on April 26, 2019, in Washington, DC. The objectives of the workshop were to explore effective practices and the supporting evidence base for addressing the non-medical health-related social needs of individuals, such as housing and food insecurities; review assessments of return on investment (ROI) for payers, healthy systems, and communities; and identify gaps and opportunities for research and steps that could help to further the understanding of the ROI on addressing non-medical health-related social needs. This publication summarizes the presentations and discussions from the workshop.
The United States is viewed by the world as a country with plenty of food, yet not all households in America are food secure, meaning access at all times to enough food for an active, healthy life. A proportion of the population experiences food insecurity at some time in a given year because of food deprivation and lack of access to food due to economic resource constraints. Still, food insecurity in the United States is not of the same intensity as in some developing countries. Since 1995 the U.S. Department of Agriculture (USDA) has annually published statistics on the extent of food insecurity and food insecurity with hunger in U.S. households. These estimates are based on a survey measure developed by the U.S. Food Security Measurement Project, an ongoing collaboration among federal agencies, academic researchers, and private organizations. USDA requested the Committee on National Statistics of the National Academies to convene a panel of experts to undertake a two-year study in two phases to review at this 10-year mark the concepts and methodology for measuring food insecurity and hunger and the uses of the measure. In Phase 2 of the study the panel was to consider in more depth the issues raised in Phase 1 relating to the concepts and methods used to measure food security and make recommendations as appropriate. The Committee on National Statistics appointed a panel of 10 experts to examine the above issues. In order to provide timely guidance to USDA, the panel issued an interim Phase 1 report, Measuring Food Insecurity and Hunger: Phase 1 Report. That report presented the panel's preliminary assessments of the food security concepts and definitions; the appropriateness of identifying hunger as a severe range of food insecurity in such a survey-based measurement method; questions for measuring these concepts; and the appropriateness of a household survey for regularly monitoring food security in the U.S. population. It provided interim guidance for the continued production of the food security estimates. This final report primarily focuses on the Phase 2 charge. The major findings and conclusions based on the panel's review and deliberations are summarized.
Affecting more than 800 million people, food insecurity is a global problem that runs deeper than hunger and undernutrition. In addition to the obvious impact on physical well-being, food insecurity can result in risky coping strategies, increased expenditures on medical costs or transportation, and mental health issues. A review of the concepts an
Food insecurity rates, which skyrocketed with the Great Recession, have yet to fall to pre-recession levels. Food pantries are stretched thin, and states are imposing new restrictions on programs like SNAP that are preventing people from getting crucial government assistance. At the same time, we see an increase in obesity that results from lack of access to healthy foods. The poor face a daily choice between paying bills and paying for food.
For many Americans who live at or below the poverty threshold, access to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help alleviate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families. In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA's Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) to conduct a study to examine the feasibility of defining the adequacy of SNAP allotments, specifically: the feasibility of establishing an objective, evidence-based, science-driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments. Supplemental Nutrition Assistance Program: Examining the Evidence to Define Benefit Adequacy reviews the current evidence, including the peer-reviewed published literature and peer-reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were considered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task.
New evidence this year corroborates the rise in world hunger observed in this report last year, sending a warning that more action is needed if we aspire to end world hunger and malnutrition in all its forms by 2030. Updated estimates show the number of people who suffer from hunger has been growing over the past three years, returning to prevailing levels from almost a decade ago. Although progress continues to be made in reducing child stunting, over 22 percent of children under five years of age are still affected. Other forms of malnutrition are also growing: adult obesity continues to increase in countries irrespective of their income levels, and many countries are coping with multiple forms of malnutrition at the same time – overweight and obesity, as well as anaemia in women, and child stunting and wasting.
As healthcare, culture, and the environment remain crucial aspects of modern society, the current issues and opportunities within each sector must be examined and considered in order to ensure their success in the future. These critical fields should be studied in relation to each other as they must work in tandem to create a better society. The Handbook of Research on Interdisciplinary Studies on Healthcare, Culture, and the Environment presents innovative ideas and emerging research to highlight critical trends focusing on the relationship between healthcare, environmental wellbeing, and society and culture. Covering a range of topics such as sustainability, leadership, and food security, this reference work is ideal for industry professionals, researchers, academicians, practitioners, instructors, and students.
In the United States, people living in low-income neighborhoods frequently do not have access to affordable healthy food venues, such as supermarkets. Instead, those living in "food deserts" must rely on convenience stores and small neighborhood stores that offer few, if any, healthy food choices, such as fruits and vegetables. The Institute of Medicine (IOM) and National Research Council (NRC) convened a two-day workshop on January 26-27, 2009, to provide input into a Congressionally-mandated food deserts study by the U.S. Department of Agriculture's Economic Research Service. The workshop, summarized in this volume, provided a forum in which to discuss the public health effects of food deserts.
Food Security, Poverty and Nutrition Analysis provides essential insights into the evaluative techniques necessary for creating appropriate and effective policies and programs to address these worldwide issues. Food scientists and nutritionists will use this important information, presented in a conceptual framework and through case studies for exploring representative problems, identifying and implementing appropriate methods of measurement and analysis, understanding examples of policy applications, and gaining valuable insight into the multidisciplinary requirements of successful implementation.This book provides core information in a format that provides not only the concept behind the method, but real-world applications giving the reader valuable, practical knowledge.* Identify proper analysis method, apply to available data, develop appropriate policy* Demonstrates analytical techniques using real-world scenario application to illustrate approaches for accurate evaluation improving understanding of practical application development* Tests reader comprehension of the statistical and analytical understanding vital to the creation of solutions for food insecurity, malnutrition and poverty-related nutrition issues using hands-on exercises