As a medical student on an OB-GYN clinical rotation, I sat down with a patient who would soon deliver her baby. The patient had screened positive for gestational diabetes, and my job was to educate her on the implications that it would have on the pregnancy. This “high-risk” diagnosis meant that mother and baby could both face serious complications. Throughout the course of our discussion, the patient informed me of her daily struggles to obtain adequate, healthy food.
My patient certainly wasn’t alone — nearly 25% of women in our high-risk obstetrics care report food insecurity at some point during their pregnancy Unfortunately, this soon-to-be mother was just one of the many Iowans whose health is compromised because of food scarcity.
Since the onset of the COVID-19 pandemic and its associated economic fallout, food insecurity has been making front page news in Iowa. Defined as, “the state of being without reliable access to sufficient, affordable, nutritious food” food insecurity is closely linked to health outcomes and is known as one of the many Social Determinants of Health. The recent attention shown to food insecurity doesn’t necessarily mean that this situation is new; even during a strong economy, far too many Iowans are food insecure. In 2019 for example, Feeding America, a non-profit that runs a nationwide network of food banks, found that 1 in 9 Iowans struggled with hunger and that 1 in 7 children in Iowa went to bed hungry. Feeding America also reported that over 42% of Iowa households who receive Supplemental Nutrition Assistance Program (SNAP) resources have children at home 2.
The economic impacts of COVID-19 have exposed and expanded the struggle of food insecurity. With schools closing, many children who relied on their cafeteria for up to two meals a day may be going without. As food factory workers across Iowa test positive for COVID-19, plants have closed and production has slowed-down. With supply chains faltering, food shortages become an even greater risk. It begs the question: How can a state which proudly feeds millions across the globe allow such a high percentage of Iowans to live without adequate food? And what approaches can be taken to move us in a better direction?
The “Upstream” initiative is already part of the solution. This multidisciplinary approach to health-care addresses upstream factors, such as food insecurity, that affect patients’ downstream health, such as obesity, diabetes and high blood pressure. Fortunately, as an Upstream provider, I knew how to help my patient when she screened positive for food insecurity. I referred her to a local food pantry in her hometown, creating a healthier situation for mom and baby.
The Upstream approach highlights one of two steps that can be taken to address food insecurity in Iowa. Health-care workers across the state should be supported in identifying the social needs of their patients. A standardized screening process (think, “Are you allergic to any medications?”) should be implemented to allow for identification of Social Determinants of Health. What if, “Do you ever encounter difficulty with getting adequate nutrition?” was asked, allowing resources to be immediately deployed to support patients in need. Secondly, there should be opportunities for government, non-profit, and private sector bodies to increase the supply of resources. What if farmers who would previously let a portion of their crop go to waste (a common practice due to market factors) were instead compensated for their product, which was then sent to a food bank? These steps will not only address the immediate issue of food insecurity but will also play a role in improving the long-term health of the population at large, all while driving-down healthcare costs.
Iowans are already going through extraordinary efforts to keep our state safe during this pandemic. When we defeat COVID-19, the battle against food insecurity will not be over. We are at our best when we tackle problems together and proactively, when we remember that solving an issue upstream has an impact far beyond the present.
Anne Nora, BS, is a Waterloo native and Columbus High School graduate class of 2012, and currently a medical student living in Iowa City. Contributions to this were made by Michael Haugsdal, MD of North Liberty, and Craig Syrop, MD, MHCDS of Iowa City.
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