Submitted by: Sara Robinson, MD, Gretchen Mauerman, BS, and Marjan Jahani Kondori, MD

Desired actions:

• Advocate legislatively
• Bring awareness to members, the public, media and/or specific groups/stakeholders

WHEREAS food insecurity is defined as “a household level economic and social condition of limited or uncertain access to adequate food¹”. It is estimated that 1 in 6 people experienced food insecurity in Minnesota in 2021². These numbers are on the rise, as it was reported that there was a 45% increase in food shelf usage in 2021 compared to 2019. SNAP applications in September 2022 were also 213% higher compared to 2019³;

WHEREAS lack of nutrition has been associated with increased risk for hypertension, mood disorders, impaired cognition, anemia, birth defects, hyperlipidemia, diabetes, cancer, and overall poorer health. Children in households without adequate food supply were found to have 2-3 times higher chances of having poor health compared to children from food-secure homes^4,5. A systematic review of data from 195 countries attributed 11 million deaths in 2017 to poor diet, such as high sodium consumption, low whole grain consumption, decreased intake of fruits and vegetables, and so on. This finding indicates that poor diet causes more deaths than any other global risk factor, including smoking⁶;

WHEREAS there are numerous barriers that prevent access to adequate and appropriate food. The first and foremost is cost. In 2013, a Harvard review of studies from 2000-2011 found that healthier diets were more expensive than less healthy options, with the difference being around $2,200 for a family of four each year⁷. A cross-sectional study that analyzed data between 2009-2012 found that healthier options cost nearly twice as much as their unhealthier counterparts⁸. Higher calorie, nutrition-deficient foods are more cost-effective, but it is coming at the price of one’s health and wellbeing. Another barrier is food deserts, which are areas with decreased access to food sources. Furthermore, the food sources that are present tend to have less nutritious options. These areas tend to be rural and of lower income, and they also disproportionately affect minority populations⁵. An urban area is considered a food desert if one lives more than one mile away from a supermarket. In rural areas, it is more than ten miles. Rural areas account for 63% of counties in the United States, but 87% of individuals with food insecurity live in these areas. Per the USDA, around 19 million people lived in a food desert without access to a vehicle in 2015⁹. This leads to another barrier often experienced by individuals, which is lack of transportation access to food sources. From 2012-2013, the average distance between homes and a grocery store was 2.19 miles. This finding is again disproportionately affecting the minority communities⁵. This distance is an extra burden on those without personal vehicles or public transportation options;

WHEREAS there are support programs available for those experiencing food insecurity, but they are not without flaws. The USDA has been receiving pressure to limit what items can be purchased through the SNAP program, potentially limiting healthy food options for at-risk individuals. The requirements for a grocery store to become certified are also constantly changing, creating challenges for retailers to continue participating, which leaves participants at risk for having limited access to sites. There have also been concerns that the SNAP program does not provide enough benefits, especially since geographic variations in price of food along with nutritional requirements of everyone in the household are not taken into account. Finally, there is a work requirement by some states, which provides an additional hurdle for participants¹⁰;

WHEREAS the Commercial, Industrial, and Institutional sector contributes to up to 50% of all food waste in the United States. There are tax deductions available for businesses who donate food rather than dispose of it¹¹;

BE IT RESOLVED that the MAFP will work to support or collaborate with established food insecurity organizations to address the ongoing disparities seen in Minnesota;

BE IT FURTHER RESOLVED that the MAFP raise awareness and education around the challenges that those experiencing poverty face with food insecurity and possible solutions or policy changes with policy makers and the public.

References and Supporting Information

1. Food insecurity. Food Insecurity – Healthy People 2030. (n.d.). https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/food-insecurity
2. Hunger Facts and Statistics for Minnesota and Wisconsin. Second Harvest Heartland – Help End Hunger. (n.d.). https://www.2harvest.org/end-hunger-together/hunger-facts
3. Gunderson, D. (2022, November 21). Food insecurity is Increasing Across Minnesota. MPR News. https://www.mprnews.org/story/2022/11/21/food-insecurity-is-increasing-across-minnesota
4. Gundersen, C., Ziliak, J. P. (2015). Food Insecurity and Health Outcomes. Health Affairs, 34(11): 1830-1839. DOI: 10.1377/hlthaff.2015.0645.
5. Access to Foods that Support Healthy Eating Patterns. Healthy People 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/access-to-foods-that-support-healthy-eating-patterns.
6. GBD 2017 Diet Collaborators. (2019). Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 393(10184): 1958-1972. DOI: 10.1016/S0140-6736(19)30041-8.
7. Rao, M., Afshin, A., Singh, S., Mozaffarian, D. (2013). Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open, 3(12). DOI: 10.1136/bmjopen-2013-004277.
8. Kern, D. M., Auchnicloss, A. H., Stehr, M. F., Diez Roux, A. V., Moore, L. V., Kanter, G. P., Robinson, L. F. (2017). Neighborhood Prices of Healthier and Unhealthier Foods and Associations with Diet Quality: Evidence from the Multi-Ethnic Study of Atherosclerosis. Int J Environ Res Public Health, 14(11): 1394. DOI: 10.3390/ijerph14111394.
9. Silva, C. (2020, September 27). Food Insecurity in the U.S. By the Numbers. NPR. https://www.npr.org/2020/09/27/912486921/food-insecurity-in-the-u-s-by-the-numbers.
10. Oliveira, V., Prell, M., Tiehen, L., Smallwood, D. (2018, January). Design Issues in USDA’s Supplemental Nutrition Assistance Program: Looking Ahead by Looking Back. United States Department of Agriculture. https://www.ers.usda.gov/webdocs/publications/86924/err-243_summary.pdf?v=0.
11. Reducing Food Waste Through Donation. Minnesota Department of Health. (2020, April 15). https://www.health.state.mn.us/communities/environment/food/docs/fs/reducefoodwaste.pdf.

Testimony

More and more, we are recognizing how the social determinants of health, especially food insecurity, greatly impacts the health and wellbeing of our patients. The purpose of this bill is to reduce unnecessary waste and increase availability of nutritious food to our patients in need. It is also difficult for us to fully understand how severe a problem is if we do not experience it for ourselves, which is why we are also asking for those who govern to take some time to see what it is like when you are food insecure. Knowledge empowers us to make mindful decisions and will hopefully give insight into this ongoing issue.

Comments in support (8):

Elizabeth Ingersent – Food insecurity is a huge issue for many of our patients here and we should be doing everything we can to alleviate this.

Keith Stelter – Would encourage that the resolution add language and be more specific in crafting a couple examples of specific interventions that could address this concern.

Andrew Slattengren – Educating MAFP members on this issue and providing resources for action will allow us to better care for our communities.

Chris Reif – Agree.

Sola Adegoke – Support.

Roli Dwivedi – Definity agree.

Emily Onello – I support.

Kim Krohn – Support.

Comments against (0):

None