Summarize food insecurity > healthcare cost lit review

[lippytak]

Pull from Joel and Rebecca lit reviews.

[lippytak]

From RebeccaC

Note: Most of the existing literature focuses on kinds - 1/2 kids in the US will be on SNAP at some point.

Prevalence of food insecurity:

http://www.ers.usda.gov/publications/err-economic-research-report/err125.aspx

Coleman-Jensen, A., Nord, M., Andrews, M., and Carlson, S. (2011), “Household Food Security in the United States in 2010,” Economic Research Report ERR-125, Report, U.S. Department of Agriculture, Economic Research Service, Washington, DC. [958,961,963,965]

Health implications of food insecurity:

Tons of these articles showing relationship with chronic disease http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2806885/

and being overweight: http://jn.nutrition.org/content/131/6/1738.short

and bad health outcomes for infants and toddlers; http://naldc.nal.usda.gov/download/44419/PDF

food-insecure children had odds of “fair or poor” health nearly twice as great [adjusted odds ratio (AOR) 1.90, 95% CI 1.66–2.18], and odds of being hospitalized since birth almost a third larger (AOR 1.31, 95% CI 1.16–1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. F

Newer article assessing the methods previously employed to measure adverse health outcomes and food insecurity:

we can identify that food security has a statistically significant positive impact on favorable general health and being a healthy weight. Our work suggests that previous research has more likely underestimated than overestimated the causal impacts of food insecurity on health.

we can identify that food security has a statistically significant positive impact on favorable general health and being a healthy weight. Our work suggests that previous research has more likely underestimated than overestimated the causal impacts of food insecurity on health.

Does SNAP actually decrease food insecurity or improve health outcomes?

Article that discusses why this research is so hard to do, and still comes to the conclusion that SNAP has a positive health impact.

http://www2.econ.iastate.edu/faculty/kreider/webpage/papers/downloads/jasa_kpgj_online.pdf

In the absence of measurement error, the joint MTS–MIV model reveals that SNAP reduces the prevalence of food insecurity by at least 12.8 percentage points (28%), from 0.459 to 0.331. The strength of this finding naturally weakens when we allow for misclassified participation Downloaded by [Iowa State University] at 18:25 21 October 2012 Kreider et al.: SNAP and Child Health Outcomes 973 status. Nevertheless, we can still identify that SNAP reduces the prevalence of food insecurity by at least 2.7 percentage points (6.5%), from 0.417 to 0.390, when allowing for errors of omission in participation status to be consistent with the estimated true participation rate of P∗ = 0.50. Identification decays rapidly with the degree of misreporting, however, and confidence intervals for the ATE include 0 unless it can be known that only a small fraction of households misreport. Under the stronger joint MTS–MIV–MTR model, which may be less credible for obesity than the other health outcomes, the basic conclusion that SNAP improves health outcomes holds even for large degrees of measurement error. Given that errors of omission are consistent with P∗ = 0.50, SNAP is estimated

...to reduce the prevalence of child food insecurity by at least 8.1 percentage points, poor general health by 3.1 percentage points, obesity by 5.3 percentage points, and anemia by 1.6 percentage points. These impacts are significantly different from 0 for food insecurity and poor health. Our findings suggest that at least some of the potentially troubling correlations between SNAP and poor health outcomes provide a misleading picture of the true impact of SNAP. The program appears to lead to at least modest reductions in food insecurity and other poor health outcomes, with little downside risk that the program has significant deleterious effects. Our estimated bounds are also consistent with the possibility that SNAP dramatically improves the well-being of children in the United States.

[lippytak]

From Joel:

White Paper Gleaning (2).docx

[lippytak]

Via ST: http://www.rwjf.org/en/library/research/2011/12/health-and-wellness-survey.html

[lippytak]

Food insecurity and health outcomes

Food insecurity is common and leads directly to poor health for many Americans. In 2014, approximately 15% of Americans experienced food insecurity. This represents a substantial increase since the 2007 recession that has remained despite an improving economy in recent years [1]. While social needs, such as food security, are challenging to address in the current health care system, the Supplemental Nutrition Assistance Program (SNAP) is an effective and underutilized resource.

Food insecurity leads to worse health and increased healthcare costs, especially for children, seniors, and other vulnerable populations. In the general population, food insecurity is associated with increased rates of mental health problems, hypertension, hyperlipidemia, worse outcomes on health exams, and poor sleep outcomes [2]. Children further show elevated risk of anemia, cognitive problems, aggression, anxiety, hospitalization, asthma, behavioral problems, depression, suicide ideation, and poor oral health. Similarly, food insecure seniors are more likely to be in poor health, have limitations in daily living, and over 50% more likely to be depressed [3]. Overall, food insecurity is associated with increased health care costs and likelihood of becoming a ‘high cost’ health care user [3]. More severe food insecurity is associated with significantly larger health care costs [4].

SNAP decreases food insecurity and improves health but is still greatly underutilized. Most directly, accessing SNAP reduces the prevelance of food insecurity by nearly 30%. Consequently, SNAP decreases the likelihood of self-reported poor general health, obesity, anemia [4], and is associated with decreased BMI [5]. These data are further supported by physician's qualitative assessments; among physicians working in low-income communities, 90% believe that "patients' social needs are as important to address as their medical conditions [6]." However, despite the demonstrated efficacy of SNAP and near consensus among physicians, participation rates remain low in many states. In California, approximately 30-40% of individuals eligible for SNAP in California are still not enrolled [7].

Given the robust link between social needs and health outcomes, Dr. Goldstein of the Robert Wood Johnson Foundation emphasizes that "leadership and commitment from health care decision makers is required to create system-wide and lasting change [6]." Investing in SNAP access is a substantial and largely unrealized opportunity for the health care system to improve population health for low-income communities.

[1] John T Cook et al., “Estimating the Health-Related Costs of Food Insecurity and Hunger”, 2014, http://content.healthaffairs.org/content/34/11/1830.abstract?=right

[2] Craig Gundersen et al., "Food Insecurity And Health Outcomes", 2015, http://content.healthaffairs.org/content/34/11/1830.abstract?=right

[3] David Beckman et al., "2016 Hunger report, The Nourishing Effect: Ending hunger, improving health, reducing inequality", 2015, http://hungerreport.org/2016/wp-content/uploads/2015/11/HR2016-Full-Report-Web.pdf

[4] V. Tarasuk et al., "Association between household food insecurity and annual health care costs.", 2015, http://www.ncbi.nlm.nih.gov/pubmed/26261199

[5] Food Research and Action Center (FRAC), "SNAP and Public Health: The Role of the Supplemental Nutrition Assistance Program in Improving the Health and Well‐Being of Americans", 2013, http://frac.org/pdf/snap_and_public_health_2013.pdf

[6] D. Goldstein et al., "Health and Wellness Survey", 2011, http://www.rwjf.org/en/library/research/2011/12/health-and-wellness-survey.html

[7] United States Department of Agriculture (USDA), "Estimates of State Supplemental Nutrition Assistance Program Participation Rates in 2012", 2013, http://www.fns.usda.gov/sites/default/files/ops/Reaching2012.pdf

[lippytak]

More great resources on the topic:

• http://www.cbpp.org/blog/snap-promotes-long-term-gains-especially-for-children via @daguar
• https://www.whitehouse.gov/sites/whitehouse.gov/files/documents/SNAP_report_final_nonembargo.pdf via @alanjosephwilliams
• https://www.whitehouse.gov/sites/default/files/docs/snap_report_-_final.pdf (oldie that I didn't come across before)