Hunger and food insecurity (limited or no access to safe and nutritious food) are not seasonal, and for those who suffer, it is on their minds 24/7, making it difficult for children to concentrate in school and fail to thrive physically.1-3 For heads of households, it distracts them during the day, adding more stress to an already burdensome day. Food insecurity is a public health crisis and yet as public health providers, we do not think about hunger in our space. Why is that? Why is that we only see urgency in food collection and distribution around holidays and natural disasters? According to the US Department of Agriculture (USDA), in 2016, more than 41 million Americans were food insecure, including almost 13 million children.4 We need to do more to make Americans food secure.

As a society, when we see people who are obese, we do not consider that they may be food insecure and suffering from the trifecta of obesity, diabetes, and hypertension. Worse is that many people with these chronic diseases have not even been diagnosed. Studies by the USDA Economic Research Service have shown that there is a strong relationship between hunger and chronic disease.5 People who live in food swamps (neighborhoods with easy access to inexpensive, low-nutrition, and calorie-dense food) or food deserts (areas with a lack of access to affordable fruits, vegetables, and other nutritious food) continue to make food choices dense in calories and nutrition poor.

I recently returned from an exciting visioning summit with 4 exemplar food bank chief executive officers (CEOs), board members, and staff, as well as folks from Feeding America. The conversation was around leveraging capacity and capabilities at the community level and bringing hunger into the public health discussion. As such, CEOs from several hospital systems and insurers were at the table to initiate that dialogue.

Ironically, an issue for many food banks and their partners is their capacity-they are constrained. In some cases, they cannot distribute the food fast enough, and in other cases, they do not have the space to organize and store food before getting it into the distribution pipeline. Some places do not have the capacity to collect perishable food for quick distribution. Layer on the recent disasters requiring emergency food distribution, and these systems are strapped.

A physician I recently spoke with had seen a patient at a follow-up visit for his uncontrolled hypertension. The physician asked the patient if he needed a refill for his medication. The patient pulled out his bottle of pills that was still more than half full. The physician asked him why he had not taken the medication as prescribed. The patient replied, "It says take with meals." Where should that conversation go?

It is incumbent upon health care providers to initiate conversation with patients regarding food security. Physicians should routinely ask families 2 questions from the USDA's survey regarding food security and worrying about the next meal. Then they should start a discussion about availability and access to healthy foods, hunger, and barriers to adherence, including directing them to accessible sources of nutritious food.

As public health professionals, we should initiate and facilitate conversations with leaders across sectors. Better and more stable distribution mechanisms need to be created, and it is here that the health care community should play a larger role. Partnering with local farmers and farmers' markets to make nutritious foods more available and accessible is a requirement. For the more than 45 million Americans using Supplemental Nutrition Access Program (SNAP) benefits, including working families, we need to pilot different mechanisms to increase fruit and vegetable consumption. Cash Value Vouchers, bonuses, and rebates are several options6 that should be matched with the accessibility of fresh fruits and vegetables in the communities, as well as existing consumption habits. Everyone gains, the farmers and the communities.

There is much work to do. Pilot projects through Feeding America are focusing on distributing foods targeting leading chronic diseases such as diabetes and hypertension, both with high incidence in lower-income families who frequently live in food deserts. County departments of health are partnering with communities to create and sustain neighborhood gardens where families are connected to fresh produce; however, in many parts of the country, these are not year-round sustainable solutions. Weekend backpack programs are a great option, but there is still stigma associated with these programs.

We all need to speak a common language and recognize the opportunity to improve food security and wellness. Taking a community-based approach will improve health and well-being and reduce the economic burden to all participants. Food insecurity and hunger are a public health crisis that requires immediate action. We need to catalyze the conversations with community leaders and take action to improve food security and well-being.

References