Who’s hungry: Erasing food insecurity
“Have any of you have experienced hunger in your life?”
For about 10 years, I asked participants this question at the Diabetes Self-Management classes at the General Medicine Clinic where I was the attending physician in classes for Spanish-speaking Latino patients, before teaching the basic components of good diabetes or pre-diabetes diet.
A young immigrant woman from Mexico in the class in late 2016 shared her response to the group.
“I was so hungry, that for a long time I could not even feed my five kids. The only thing I could give them was tea and some bread. When I came here to the U.S., I could not stop eating hamburgers. They were cheap and tasty, and that is how I gained weight. Now I am 400 pounds and have diabetes.”
I was not prepared to hear their accounts of extreme hunger.
When I suggested to my patients during their regular visits that they buy fresh vegetables or 1 percent fat milk for a healthier diet, many stated those items were not available close to where they lived.
The same geographical areas also correlated with high rates of obesity, congestive heart failure, hypertension and obesity, and diabetes. Fresh food was not grown or sold there, but diseases, nourished by racism, were. The food that people bought was not healthy and did not last until the end of the month. They did not have money and access to buy healthy food.
Now when patients attend primary care clinics, a medical assistant asks them screening questions; including questions about food insecurity. Many patients say they are ashamed to admit they cannot provide for themselves or the family, even though they are working.
Respondents who acknowledge food insecurity are referred to a social worker to help them get access to the Supplemental Nutrition Assistant Program, or SNAP, if they qualify. Alternatively, staff offer them a list of resources including food pantries and food banks. Some hospitals are establishing food pharmacy services.
Of course, this is not isolated to Chicago or large urban areas. Food deserts are also found in rural areas with similar health consequences to local residents.
More than 37 million people struggle with hunger in the U.S., including more than 11 million children. Hunger and food insecurity are particular concerns for seniors, college students, and infants. Among other diseases, food insecurity has been linked to the growing obesity epidemic.
Across the country, many organizations are piloting programs to bring healthier food into these deserts. Some grassroots initiatives around the country work directly with communities. App- based delivery services may help make fresh, healthy food more accessible in some areas.
Once someone brings the food home, the next step for many is to learn how to cook and prepare it — a vital skill with a direct impact on the health and well-being of the community. This is necessary because those who have eaten inexpensive fast-food meals– the only meals available when they were growing up — may have never learned to cook at home.
Many neighborhood organizations offer and are developing free cooking classes, in Philadelphia for instance. School programs now offer free classes to children and their teachers in several areas of Chicago, New York and other cities.
Indeed, food pantries and food banks are options, but they depend on donations. Some food banks are working hard to improve the quality of groceries beyond non-perishable items. Some are targeting more vulnerable populations like seniors.
Good food is a basic human need. Ending food insecurity should not depend solely on charity, food donations and community organizations. Long-term solutions are essential. The Rev. Dr. Martin Luther King, Jr. and other social justice advocates fought for equality for all, including food access.
Federal and local government can improve food access and resolve food insecurity by offering well-paying job opportunities, education, nutrition, safety in the streets and ensuring everybody eats well. By addressing hunger and food insecurity, food deserts can disappear. As a result, some chronic diseases, including obesity and diabetes can be better treated.
Many can agree food is the best medicine for all. No one needs to go hungry.
Irene Martinez M.D., FACP is an attending physician at Division of General Medicine, Stroger Hospital of Cook County, assistant professor Rush Medical Schools, clinical ethicist.
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