Social Work's Role in Addressing Food Insecurity: Exploring the Relationship between Food Insecurity and Chronic Health and Mental Health Conditions in the U.S

Background

Sixty percent of U.S. adults have at least 1 chronic illness (CDC, 2021), and over a quarter have multiple chronic illnesses (Boersma et al., 2020), which are leading causes of death, disability, and health care spending. Additionally, research has found a relationship between chronic illness and depression (Roy & Lloyd, 2012), compounding risk for poor outcomes. However, risk and access to treatment for chronic physical illness and serious mental illness (SMI) vary and models of care for treating medical, mental health, and social needs remain fragmented. Social determinants of health (SDOH), or the environmental conditions in which people live, contribute greatly to physical and mental health risks, outcomes, and well-being (Healthy People 2030, 2021). Social workers are well positioned to address SDOH through clinical practice and policy advocacy, as highlighted in the 2019 National Academies Report, “Integrating Social Care into the Delivery of Health Care.” One SDOH that has received increased attention is food insecurity (FI). Impacting over 10% of the population, food insecurity negatively effects overall well-being and is related to increased health care spending (Leddy et al., 20202; Dean, 2020). The current study aims to better understand the relationship between FI and chronic conditions, including SMI, in a nationally representative sample.

Methods

We used the 2016 Medical Expenditure Panel Survey and Food Security Supplement to examine relationships between food security, chronic illnesses (N=34,655). The supplement included 10 food security questions, based on a validated instrument from the USDA. Chronic illness was defined as any diagnosis of heart disease, cancer, stroke, lung disease, diabetes, or SMI, which was defined as score >13 in the Kessler 6. Population-based descriptive statistics explored the prevalence of FI by chronic illness. Associations between FI and chronic conditions were tested using multivariate logistic regression. Survey weights were applied in all analyses.

Results

Results indicate a range of FI prevalence across chronic conditions, from 13% of respondents with cancer to 43% of respondents who screened positive for SMI. Controlling for key sociodemographic and health factors, including insurance coverage, having a primary care provider, and self-reported health status, we found a strong relationship between FI and the diagnosis of chronic illness overall (OR: 1.36; 95% CI: 1..22, 1.54). Additionally, there is a strong relationship between FI and co-morbid illness (respondents diagnosed with 2 or more chronic conditions as compared to respondents diagnosed with 1) (OR:1.45; 95% CI: 1.22, 1.73).

Conclusions/Implications

The prevalence of food insecurity among those with chronic illness is higher than the general population. As indicated by previous research, there are likely complex and bidirectional pathways between food insecurity and chronic conditions (Leddy et al., 2020), with populations with cumulative vulnerabilities (e.g. comorbidities and need for services across fragmented care delivery) being at additional risk. Social workers are well-positioned to address FI by spearheading clinical programs in various health settings (e.g. routine FI screening in outpatient mental health settings and/or interventions such as food pantries in healthcare settings) as well as advocating for policy changes (e.g. expansion of SNAP).