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COVID-19 Resource Center
April 27, 2020
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Unemployment affects health during COVID-19 pandemic

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Photo of Meredith Niles
Meredith T. Niles

Unemployment in the United States is reaching record highs, with 4.4 million people filing for unemployment benefits in the week of April 18, according to the U.S. Department of Labor.

A survey recently conducted by the University of Vermont found that food insecurity increased by 33%, which researchers said strongly correlates with unemployment in the state.

While the survey only involved residents of Vermont, Meredith T. Niles, PhD, assistant professor in the department of nutrition and food sciences at the University of Vermont and principle investigator on the survey, told Healio Primary Care that “our work is the first in-depth research to explore this more completely across a state population, but Vermont is likely not alone.”

“I would be surprised if it’s not happening across the country,” Michael Prelip, DPA, MPH, professor and chair of the department of community health sciences at the UCLA Fielding School of Public Health, told Healio Primary Care.

However, Prelip noted that food insecurity was already high in the United States, and “COVID-19 is demonstrating yet another weak place in our social health fabric.”

Impact of food insecurity on health

According to Prelip, patients’ health can deteriorate soon after becoming food insecure.

Most of those under assistance programs only receive resources once per month. Prelip explained that at the start of the month, patients are often able to maintain a better diet, but “as the month progresses, their diet becomes worse because of having limited resources in the household.”

“People who are food insecure are more likely to be unhealthy and more likely to have chronic conditions,” Prelip said.

Studies have linked food insecurity to a variety of conditions, including diabetes, CVD and migraine.

There are several programs to help those who are food insecure, including the Supplemental Nutrition Assistance Program (SNAP); Women, Infants, and Children (WIC) program; and the National School Lunch Program, according to Niles. She added that “charitable organizations are also stepping up to help meet the demand through food pantries and other charitable giving.”

In addition, communities are helping each other more during the pandemic —according to the survey, the percentage of those receiving food from friends and neighbors increased from 10% to 20% during the COVID-19 pandemic.

According to Niles, this “highlights that all of us can help someone in need during this time.”

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Loss of health insurance

Sudden loss of employment means that many in the U.S. are also losing their health insurance.

“We do know that people who have health insurance are healthier, and we know people who have a usual source of care are healthier,” Prelip said. “And so, when health insurance goes away, usually your usual source of care goes away too.”

The prevalence of people in the U.S. receiving primary care was decreasing before the pandemic. According to a study published in JAMA Internal Medicine, the percentage of people in the U.S. with an identified source of primary care decreased from 77% in 2002 to 75% in 2015.

Prelip noted that losing health insurance and access to care likely results in patients forgoing care for chronic conditions.

In addition, he explained that patients who lose their health insurance could also lose their ability to pay for prescription medications, because “the market price of them is makes them unavailable for most people. That’s a real concern.”

Unemployment and stress in COVID-19

“I have yet to talk to someone who isn’t more stressed today than they were 6 weeks ago,” Prelip said.

“We know that often during times of intense stress, we rarely increase our health-promoting behaviors,” he explained. “If anything, we reduce our health-promoting behaviors and unfortunately, sometimes we increase our behaviors that are health damaging.”

For instance, since the start of the pandemic, off-premise sales of alcohol have drastically increased.

According to Niles, “health care practitioners could use screening questions about food security and mental health with patients, especially if there is a known job loss in the household.”

The Nutrition and Obesity Policy Research and Evaluation Network developed two questions for screening food insecurity in adults, which Niles explained “can be quickly asked and ideally would not add additional burden on the PCP.”

“Of course, the PCP and their office should also be prepared with resources on hand for assistance such as for SNAP, WIC or information about local food pantries should patients present with food insecurity,” she said.

In addition, she said that to help people who lose their jobs, “unemployment offices could also provide additional information and resources for food assistance and mental health programs when individuals sign up for potential benefits.”

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Prelip explained that community health workers have always played a critical role in their communities by helping connect those in need to these resources.

Therefore he said, these workers will be even more essential during the COVID-19 pandemic, as “they will be the ones who help connect community residents to new services and to services that many community residents have never used before, such as food assistance program.”

In addition to help residents connect to these resources, Prelip noted that community health workers can help in contact tracing efforts during the COVID-19 pandemic. – by Erin Michael

References:

DOL. Unemployment insurance weekly claims. https://www.dol.gov/sites/dolgov/files/OPA/newsreleases/ui-claims/20200691.pdf. Accessed Apr. 24, 2020.

NOPREN. Food Insecurity Screening Algorithm for Adults. https://nopren.org/wp-content/uploads/2017/10/Clinical-Linkages-Adults-FI-Screening-Algorithm-10.9.17.pdf. Accessed Apr. 27, 2020.

UVM. UVM Survey: Food Insecurity in Vermont Rose 33% During Pandemic. https://www.uvm.edu/uvmnews/news/uvm-survey-food-insecurity-vermont-rose-33-during-pandemic. Accessed Apr. 23, 2020.

Disclosures: Prelip reports no relevant financial disclosures. Healio Primary Care was unable to confirm Niles’ relevant financial disclosures prior to publication.