Originally published in Healthy Debate on May 24, 2023.
By Tim Li
Living in a household struggling to afford food is toxic for people’s health. As the severity of food insecurity increases, so does the risk of a wide range of adverse health outcomes, including premature death. The toll on physical and mental health manifests in greater need for health-care services.
Food-prescription programs are one way that health-care providers are trying to mitigate the health-eroding hardships they witness. These programs provide limited amounts of healthy foods to patients, typically through collaborations with community organizations.
The idea brings together two increasingly popular trends in health care: social prescribing and “food as medicine.” Social prescribing sees health-care providers connect patients with non-clinical community services and supports. “Food as medicine” is a resurgent interest in the role of food and nutrition in disease management and prevention.
The emergence of food prescriptions in Canada has raised questions about their place in our health-care system. These questions are especially important now. Our health-care systems are in crisis and record food price inflation threatens to worsen the already-high rates of food insecurity.
Another stopgap measure?
While food prescriptions are relatively new in Canada, the governments of both the U.S. and the U.K. are investing in them as part of their efforts to respond to poor health and food insecurity. However, there are many questions about the appropriateness and effectiveness of this policy direction.
Food-insecure households don’t only struggle to afford food; they are also compromising spending on other necessities like housing and prescription medications. Like other food-based interventions, food prescriptions are unable to resolve the broader experiences of material deprivation, let alone the underlying income inadequacy.
Providers of food prescriptions in Canada have acknowledged that they are “at best, stopgap measures,” “not a sustainable response,” “not a solution to food insecurity” and “a response to broken social systems.” Canada already has a long history of stopgap measures in food banks and charitable meal programs. Can we afford to entrench another?
Just as food charity reflects Canadians’ desire to support each other, food-prescription programs reflect the desire of health-care providers to do more to ease the burden of food insecurity. Food prescriptions also are similar to food charity in that proponents often argue that doing “something is better than nothing.” But that argument obscures the scale of food provisioning required to erase the diet-related health compromises of food-insecure patients.
What it takes to address food insecurity
Despite being presented as a “prescription,” we should be careful around assumptions that these programs provide enough food to meet recipients’ needs and lead to measurable, lasting health benefits if nothing changes around the root causes of their food insecurity.
Altering the disease trajectories of severely food-insecure patients hinges on the provision of ample amounts of healthy food over the long-term, not just for the individual patients whose disease status “qualifies” them for this intervention but also for the people with whom they live.
The cost of implementing and sustaining such programs is substantial, especially if food prescriptions are to address the diet-related health risks of everyone in Canada who is food insecure, but anything less amounts to a token gesture.
The underpinnings of food insecurity are clear – low wages and inadequate income supports for low-wage earners and people in need of social assistance. However, descriptions and promotions for food-prescription programs rarely mention the political decisions that perpetuate food insecurity and create the health problems they’re trying to solve.
The patients prioritized for these programs are social assistance recipients and other low-income patients. This means health-care providers are mobilizing precious resources to subsidize provincial social assistance programs that keep most recipients food insecure and steadily erode their health. Insofar as food prescriptions go to people in the workforce, they are in effect subsidizing low-wage employers and masking the failure of federal child and worker benefit programs to provide adequate supports for the working poor.
Ignoring the root of the problem?
Health researchers in the U.K., where social prescribing was first popularized, have pointed to the inability for social prescriptions to address health inequities and warned against claims that they do. Doctors have also raised concerns that food prescriptions ignore the root of the problem and put an extra cost on already strained health-care systems.
There are similar concerns in the U.S. around the “medicalization of poverty.” Focusing on initiatives that health-care providers can do with limited time and resources obscures the policy inaction they are trying to compensate for.
Researchers in the U.S., where “food as medicine” first came to prominence as a movement in health care, have also highlighted its inability to address the structural determinants of food insecurity and have called for health-care systems to champion structural change.
At a time when food banks in Canada are speaking out about governments’ abdication of their responsibility to ensure that people’s basic needs are met, calling for immediate policy reform and eschewing public funding that would further institutionalize them, health-care providers should not be introducing yet another charitable food-assistance initiative.
Entrenching an ad-hoc, food-based response that intervenes at the point when food-insecure people need health-care services may hinder policy progress by giving the impression that this problem is being addressed.
The role for health-care providers
What we badly need, instead, from health-care providers and their representing organizations is for them to advocate for policies shown to reduce the prevalence of food insecurity, like increases to social assistance, higher minimum wage and a basic income guarantee.
As the conversation around food prescriptions in Canada continues, we should remain cautious about how we frame these programs, particularly in the context of public policy. We should be wary of the false dichotomy of “short-term” and “long-term” solutions, as if structural change is only possible in some distant future, and that interventions like food prescriptions are truly resolving people’s immediate hardships.
This article is republished under a Creative Commons Attribution/No derivatives license.
Reconsidering Food Prescription Programs in Relation to Household Food Insecurity
In their commentary “Reconsidering Food Prescription Programs in Relation to Household Food Insecurity” in The Journal of Nutrition, founding PROOF investigators Dr. Valerie Tarasuk and Dr. Lynn McIntyre raised important questions about food prescription programs and their ability to provide lasting health benefits for food-insecure patients and their families and to meaningfully reduce health inequities.
AHS review and recommendations on food insecurity screening
This extensive review of literature on food insecurity screening in healthcare settings by Alberta Health Services (AHS) asks the critical question, is screening for food insecurity an appropriate or effective action in Canadian healthcare settings? Instead of specifically screening for food insecurity in healthcare settings, they recommend screening for poverty to support referrals to assistance accessing income supports to as a more appropriate approach.