Food insecurity in GI: ‘Steps can be taken’ as a provider to further equity
The accompanying article in this month’s issue on food insecurity in our gastroenterology patients in many ways is eye-opening and discomfort-producing.
Many of us practice in centers or in locations where these issues are not so apparent on the surface. If you practice in a location outside of the inner city, it may be easy to convince yourself that all your patients have broadly similar socioeconomic status. And the bigger the practice or clinic, the easier it is for the provider to be relatively insulated from issues of financial toxicity.
The recently published paper by Nguyen and colleagues, using the National Health Interview survey, is groundbreaking in that it identifies the prevalence of food insecurity and lack of social support in patients with inflammatory bowel disease, and shows that these determinants were significantly associated with financial distress and non-adherence to medical regimens due to costs. This also was significantly associated with increased health care use in the form of emergency department use.
This article is quite timely in 2020 for several reasons. We have seen more focus on the relationship between diet and IBD risk and IBD severity in recent years. It stands to reason that a poor diet rich in processed foods and lacking in whole foods would be associated with increased IBD risk and increased severity. Patients with food insecurity unfortunately will not have access to a healthy diet. The COVID-19 pandemic has exposed and magnified socioeconomic disparities in the United States economy. As mentioned in the article, up to a third of households with children had some level of food insecurity during the pandemic.
The average provider might feel powerless, but steps can be taken to work toward a more equitable future, including volunteering at food banks, becoming more politically aware and voting accordingly. This is a type of “no-brainer” topic that just shouldn’t be an issue in 21st century America.