Exploring the Critical Link between Food Insecurity and Healthcare Access Among African Americans in Alabama’s Black Belt

Background. In the context of healthcare access among African Americans in Alabama's Black Belt Region, the connection between food insecurity and barriers to healthcare access remains underexplored. While extensive research documents the medical challenges faced by food-insecure households, the impact of food insecurity on healthcare access is not well understood. Financial constraints often force food-insecure households to delay or forgo medical care, leading to adverse health outcomes. Although it is established that racial minorities and low-income individuals face a higher likelihood of food insecurity, a research gap exists for African Americans in the rural Deep South. This study fills this gap by examining food insecurity levels and their correlation with difficulties in healthcare access among African Americans in Alabama's Black Belt Region.

Method. Data were collected in 2018 from 254 African American residents in rural Alabama. Dependent variables included (1) difficulty in healthcare access due to transportation and (2) healthcare access barrier due to financial barriers to healthcare access. As the independent variables, participants were categorized into three groups: (1) those with high food security (59.4%), (2) those with low food security (30.3%), and (3) those with very low food security (10.2%). Depression, social isolation, financial hardship, and limited health literacy were also used as independent variables. Logistic regressions were employed to analyze the association between food security levels and difficulties in healthcare access after controlling for gender, age, and education.

Findings. The majority of the respondents were female (75.2%) and did not have a college degree (73.6%). More than half reported experiencing financial hardship (53.9%). Transportation barriers affected 14.6% of the respondents; financial barriers to healthcare access burdened 19.3% of the respondents. Respondents with very low food security had a greater likelihood of experiencing difficulty in healthcare access due to transportation (OR=4.24, p = 0.017) and financial barriers (OR=2.94, p = 0.048) compared to those with high food security. Those with depression had a greater likelihood of experiencing both types of healthcare access barriers (OR=1.06, p = 0.045 for transportation and OR=1.06, p = 0.040 for financial). Financial hardship was associated with an increased likelihood of difficulty in healthcare access due to financial hardship (OR=6.76, p < 0.001); limited health literacy was associated with an increased likelihood of difficulties in healthcare access due to transportation barriers (OR=6.48, p < 0.001).

Conclusions. This study highlights the intricate relationship between food insecurity and healthcare access barriers among African Americans in Alabama's Black Belt Region. Individuals with very low food security face increased difficulties in healthcare access due to transportation and financial barriers. Understanding more about the nature of food hardships and healthcare access barriers could assist policymakers and social service providers in generating strategies to reduce food insecurity as well as transportation and financial barriers for healthcare access in this population. This will help to mitigate the adverse effects of healthcare access on the health and wellbeing of this historically marginalized population in Alabama.