The Relationship between Food Insecurity and Healthcare Costs
In its November 2015 report, “The Nourishing Effect: Ending Hunger, Improving Health, Reducing Inequality,” the Bread for the World Institute cited the significant costs of food insecurity to society as a whole:
“Hunger and food insecurity cost the United States as a nation much more than we may realize.
In 2014, the most recent year for which we have data, the estimated health-related costs
of hunger and food insecurity in the United States were a staggering $160.07 billion.”
Although the costs of obesity and other diet-related diseases have been well documented, including low birth weight (particularly in low-income neighborhoods with low food security), direct causation between food insecurity and healthcare costs is only beginning to be established. A recent study published in the Canadian Medical Association Journal showed that household food insecurity is tightly linked to higher healthcare costs, based on data collected from almost 70,000 Canadians in the province of Ontario. This study demonstrated that healthcare costs of households with low or very low food security can be 49-121% higher than those of food secure households, and concluded that household food insecurity was a robust predictor of healthcare utilization and costs, regardless of other social determinants of health.
While the Canadian and U.S. healthcare and food systems differ, the results of this study are enlightening for two reasons. First, the measure of food insecurity used in Canada is virtually the same as that employed in the U.S. Second, across most economic indicators, Canada is quite similar to the U.S. Some experts make the argument that the healthcare costs resulting from food insecurity may be even higher in the U.S. because of the higher rates of food insecurity and the generally less comprehensive healthcare coverage in the U.S. (compared to the Canadian system of universal coverage). Nonetheless, to date, no comprehensive analysis of the impacts of food insecurity on healthcare costs in the U.S is available.
To address this deficit, food security experts are calling for the collection and analysis of longitudinal data on U.S. food insecurity and its long-term healthcare consequences. In addition, further research pertaining to nutrient adequacy as a mechanism for reducing poor health across the life span, from pregnancy to old age is necessary, along with any resulting healthcare savings. As one dialogue participant pointed out, “Right now, food insecurity is being treated as a social welfare problem. But it’s really a public health problem.” Moreover, long-term measurements of impact need to be factored better into fiscal policy. Although Congressional Budget Office (CBO) scoring is limited to ten years, the more long-term benefit to children and young adults of improving food insecurity could have a dramatic downstream effect.
Another area highlighted by dialogue participants for further research is the cost drivers for payers and patients for services and prescription drugs related to obesity or nutrition-influenced conditions or illnesses. For example, bolstering food security might contribute to preventing the transition from pre-diabetes to diabetes, with a potentially significant effect on service utilization and costs given that the presence of diabetes can double other healthcare costs.
With further data and studies of both macro and micro nutrient adequacy as a mechanism for reducing healthcare costs, there may be potential for improving the ability of federally subsidized food programs to promote both nutrition and positive overall health in food insecure communities.