How to Advance Nutrition Security and Health Equity in the US?
Food security, nutrition security, and health equity are three interrelated concepts that affect the health and well-being of millions of Americans.
Food security means having access to enough food for an active and healthy life. Nutrition security means having access to food that meets the dietary needs and preferences of individuals and communities. Health equity means that everyone has a fair and just opportunity to be as healthy as possible, regardless of their social, economic, or environmental circumstances.
Unfortunately, many Americans face food and nutrition insecurity and health disparities, especially among historically underserved populations such as low-income, rural, racial and ethnic minorities, immigrants, and people with disabilities. According to the US Department of Agriculture, in 2020, 10.5% of US households were food insecure, meaning they had difficulty providing enough food for all their members at some point during the year.
Among these households, 4% had very low food security, meaning they reduced their food intake or skipped meals because they could not afford enough food. Food insecurity is associated with higher risks of chronic diseases such as diabetes, hypertension, obesity, and heart disease, as well as poor mental health outcomes such as depression and anxiety.
Nutrition insecurity is also a serious public health problem in the US, as many Americans do not consume adequate amounts of fruits, vegetables, whole grains, dairy, and other healthy foods. According to the Dietary Guidelines for Americans 2020-2025, more than half of US adults have one or more diet-related chronic diseases, and less than 10% of US adults and children meet the recommendations for fruit and vegetable intake. Poor nutrition can impair immune function, increase inflammation, and worsen the effects of COVID-19 and other infections.
Health disparities are the differences in health outcomes and health care access and quality among different groups of people. Health disparities are influenced by social determinants of health, such as income, education, employment, housing, transportation, and environmental quality. These factors can create barriers and challenges for people to access healthy food, health care, and other resources that support their well-being.
For example, people who live in low-income or rural areas may have limited access to supermarkets, farmers’ markets, or community gardens that offer fresh and affordable food. People who face discrimination or stigma based on their race, ethnicity, immigration status, or disability may experience lower quality of care, less trust in health providers, or less participation in health promotion programs.
The COVID-19 pandemic has exacerbated the existing food and nutrition insecurity and health disparities in the US, as many people have lost their jobs, income, health insurance, or social support. The pandemic has also highlighted the need for urgent and coordinated action to address these issues and improve the health and well-being of all Americans. This article will discuss some of the ways to advance nutrition security and health equity through policy, practice, and research.
1. Policy.
Policy is the process of making decisions and implementing actions that affect the public. Policy can influence the availability, affordability, accessibility, and quality of food and health care for individuals and communities. Policy can also create incentives or disincentives for people to adopt healthy behaviors and lifestyles. Some examples of policy interventions that can advance nutrition security and health equity are:
– Expanding and strengthening federal nutrition assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the National School Lunch Program (NSLP), and the Summer Food Service Program (SFSP). These programs provide food or financial assistance to low-income households, pregnant and breastfeeding women, infants and children, and students, and can help reduce food insecurity, improve dietary quality, and prevent obesity and chronic diseases.
– Supporting local and regional food systems, such as urban agriculture, community gardens, farmers’ markets, food hubs, and food cooperatives. These systems can increase the production, distribution, and consumption of fresh, local, and culturally appropriate food, and can also create economic opportunities, social connections, and environmental benefits for communities.
– Promoting healthy food environments, such as healthy retail, food labeling, menu labeling, nutrition standards, and food marketing. These interventions can increase the availability and visibility of healthy food options, provide consumers with information and guidance to make informed food choices, and limit the exposure and influence of unhealthy food advertising, especially to children and adolescents.
– Improving health care access and quality, such as expanding health insurance coverage, reducing health care costs, increasing health care workforce diversity, and enhancing health care delivery and coordination. These interventions can increase the utilization and affordability of preventive and primary care services, improve the communication and trust between patients and providers, and address the social and environmental factors that affect health.
2. Practice.
Practice is the application of knowledge and skills to achieve specific goals or outcomes. Practice can involve the actions and interactions of individuals, groups, organizations, or systems that provide or receive food or health care services. Practice can also involve the adoption and maintenance of healthy behaviors and lifestyles by individuals and communities. Some examples of practice interventions that can advance nutrition security and health equity are:
– Implementing nutrition education and counseling, such as nutrition classes, workshops, demonstrations, or individual or group sessions. These interventions can increase the knowledge, skills, attitudes, and self-efficacy of individuals and communities to plan, prepare, and consume healthy and balanced diets, and to prevent or manage diet-related chronic diseases.
– Providing food and nutrition services, such as food banks, food pantries, soup kitchens, meal delivery, or congregate meals. These interventions can provide food or meals to individuals or groups who are food insecure, homeless, elderly, disabled, or isolated, and can also offer social support, referrals, or other resources to address their needs.
– Developing and implementing nutrition policies and programs, such as nutrition screening, assessment, diagnosis, intervention, monitoring, and evaluation. These interventions can identify and address the nutrition problems and needs of individuals or populations, and can provide evidence-based and tailored nutrition care plans and recommendations to improve their health outcomes and quality of life.
– Engaging in nutrition advocacy and leadership, such as raising awareness, building coalitions, mobilizing resources, influencing decision-makers, or creating change. These interventions can promote the importance and value of nutrition for health and well-being, and can advocate for the rights and interests of individuals and communities who are affected by food and nutrition insecurity and health disparities.
3. Research.
Research is the systematic and rigorous process of generating and disseminating new knowledge or evidence. Research can involve the design, conduct, analysis, and interpretation of studies that investigate the causes, consequences, and solutions of food and nutrition insecurity and health disparities. Research can also involve the translation, dissemination, and implementation of research findings into policy and practice. Some examples of research interventions that can advance nutrition security and health equity are:
– Conducting epidemiological and observational studies, such as surveys, cohort studies, case-control studies, or cross-sectional studies. These studies can describe and measure the prevalence, trends, patterns, and determinants of food and nutrition insecurity and health disparities among different groups of people, and can identify the associations or correlations between these factors and health outcomes.
– Conducting experimental and quasi-experimental studies, such as randomized controlled trials, cluster randomized trials, natural experiments, or quasi-experiments. These studies can test the effectiveness, efficiency, and feasibility of policy and practice interventions that aim to improve food and nutrition security and health equity, and can evaluate the causal effects or impacts of these interventions on health outcomes.
– Conducting qualitative and mixed-methods studies, such as interviews, focus groups, observations, or case studies. These studies can explore and understand the experiences, perspectives, beliefs, values, and preferences of individuals and communities who are affected by food and nutrition insecurity and health disparities, and can provide insights and explanations for the mechanisms and processes of these phenomena.
– Conducting translational and implementation research, such as systematic reviews, meta-analyses, or implementation science. These studies can synthesize and summarize the existing knowledge or evidence on food and nutrition insecurity and health disparities, and can identify the gaps, barriers, and facilitators for the translation, dissemination, and implementation of research findings into policy and practice.
4. Causes and Consequences.
Food and nutrition insecurity and health inequities are complex and multifaceted problems that affect millions of Americans. They are not caused by a single factor, but by a combination of interrelated and interdependent factors that operate at different levels and across different domains.
These factors include structural racism, poverty, food deserts, chronic diseases, health care costs, and more. In this section, we will discuss some of the major causes and consequences of food and nutrition insecurity and health inequities in the US, and how they interact and influence each other.
4.1. Structural Racism.
Structural racism is the system of policies, practices, and norms that create and maintain racial hierarchies and inequalities in society. Structural racism affects every aspect of life, including education, employment, housing, transportation, criminal justice, and health. Structural racism can create and perpetuate food and nutrition insecurity and health inequities by:
– Limiting the opportunities and resources for people of color to access quality education, employment, income, and wealth, which are essential for achieving food and nutrition security and health equity.
– Exposing people of color to substandard and unsafe living conditions, such as overcrowded and dilapidated housing, polluted and hazardous environments, and lack of green spaces, which can affect their physical and mental health and well-being.
– Restricting the mobility and accessibility of people of color to healthy food outlets, such as supermarkets, farmers’ markets, or community gardens, and increasing their exposure and vulnerability to unhealthy food outlets, such as fast food restaurants, convenience stores, or liquor stores, which can influence their food choices and dietary quality.
– Discriminating and mistreating people of color in the health care system, such as denying or delaying health care services, providing lower quality of care, or ignoring or dismissing their health concerns and needs, which can affect their health outcomes and quality of life.
According to the US Department of Health and Human Services, in 2019, non-Hispanic Black and Hispanic households had higher rates of food insecurity (19.1% and 15.6%, respectively) than non-Hispanic White households (7.9%).
Non-Hispanic Black and Hispanic adults also had higher prevalence of obesity (39.8% and 33.8%, respectively) than non-Hispanic White adults (29.9%). Non-Hispanic Black and Hispanic adults also had higher mortality rates from heart disease, stroke, diabetes, and cancer than non-Hispanic White adults.
4.2. Poverty.
Poverty is the state of having insufficient income or resources to meet the basic needs of living, such as food, clothing, shelter, health care, and education. Poverty can cause and exacerbate food and nutrition insecurity and health inequities by:
– Reducing the purchasing power and affordability of low-income households to buy adequate and nutritious food, especially during times of economic hardship, such as unemployment, inflation, or recession.
– Increasing the trade-offs and compromises that low-income households have to make between food and other essential expenses, such as rent, utilities, transportation, or health care, which can affect their food security and health status.
– Increasing the stress and anxiety that low-income households experience due to their financial insecurity and uncertainty, which can affect their mental health and well-being, and their ability to cope and manage their food and health issues.
– Decreasing the participation and utilization of low-income households in federal nutrition assistance programs, such as SNAP, WIC, NSLP, or SFSP, due to lack of awareness, eligibility, access, or stigma, which can limit their food and nutrition security and health benefits.
According to the US Census Bureau, in 2019, 10.5% of the US population (34 million people) lived in poverty, and 4.1% of the US population (13.6 million people) lived in deep poverty (having income below 50% of the poverty threshold). The poverty rate was higher for children (14.4%), women (11.5%), and people of color (18.8% for non-Hispanic Black, 15.7% for Hispanic, and 9.1% for non-Hispanic Asian) than for adults (9.4%), men (9.4%), and non-Hispanic White (7.3%).
4.3. Food Deserts.
Food deserts are areas where access to affordable and healthy food is limited or nonexistent, due to the absence or distance of supermarkets or other food retailers that offer fresh and varied food options. Food deserts can contribute to food and nutrition insecurity and health inequities by:
– Forcing residents of food deserts to rely on alternative food sources, such as convenience stores, gas stations, or dollar stores, that offer limited, expensive, and unhealthy food options, such as processed, packaged, or high-calorie foods, which can affect their food security and dietary quality.
– Increasing the time, cost, and effort that residents of food deserts have to spend to obtain healthy food, such as traveling long distances, using public transportation, or carrying heavy bags, which can affect their food accessibility and availability.
– Decreasing the variety, diversity, and cultural appropriateness of food options that residents of food deserts have to choose from, which can affect their food preferences and satisfaction.
– Increasing the exposure and susceptibility of residents of food deserts to food marketing and advertising, especially of unhealthy food products, which can affect their food choices and consumption.
According to the US Department of Agriculture, in 2015, 19.4 million people (6.2% of the US population) lived in low-income areas more than one mile from a supermarket or large grocery store in urban areas, or more than 10 miles in rural areas.
Among these people, 2.1 million (0.7% of the US population) had no vehicle access and lived more than half a mile from a supermarket or large grocery store. The prevalence of food deserts was higher in low-income, rural, and minority neighborhoods than in high-income, urban, and majority neighborhoods.
4.4. Chronic Diseases.
Chronic diseases are long-lasting and non-communicable diseases that can be prevented or treated, but not cured. Chronic diseases include cardiovascular diseases, diabetes, obesity, cancer, respiratory diseases, and mental disorders. Chronic diseases can result from and worsen food and nutrition insecurity and health inequities by:
– Increasing the risk and severity of chronic diseases among people who are food and nutrition insecure, due to their inadequate and imbalanced diets, lack of physical activity, and stress and anxiety, which can affect their metabolic, immune, and inflammatory processes.
– Increasing the burden and cost of chronic diseases among people who are food and nutrition insecure, due to their limited access and utilization of health care services, lack of adherence and compliance to treatment and medication, and lack of self-management and support, which can affect their health outcomes and quality of life.
– Increasing the vulnerability and susceptibility of people who have chronic diseases to food and nutrition insecurity, due to their increased nutritional needs and requirements, decreased appetite and intake, and increased complications and comorbidities, which can affect their food security and dietary quality.
– Increasing the disparities and inequalities of chronic diseases among people who are socially and economically disadvantaged, due to their exposure and susceptibility to the social and environmental determinants of health, such as poverty, racism, food deserts, and health care access and quality, which can affect their health status and well-being.
According to the US Centers for Disease Control and Prevention, in 2018, 60% of US adults (156 million people) had at least one chronic disease, and 40% of US adults (125 million people) had two or more chronic diseases. Chronic diseases accounted for 90% of the US health care spending ($3.8 trillion) and 70% of the US deaths (1.7 million) in 2018. The prevalence and burden of chronic diseases were higher among older adults, women, and people of color than among younger adults, men, and non-Hispanic White people.
4.5. Health Care Costs.
Health care costs are the expenses incurred by individuals, households, or society for the provision and utilization of health care services, such as prevention, diagnosis, treatment, and rehabilitation. Health care costs can influence and be influenced by food and nutrition insecurity and health inequities by:
– Increasing the health care costs of individuals and households who are food and nutrition insecure, due to their increased need and demand for health care services, especially for chronic diseases, and their decreased ability and willingness to pay for health care services, especially for preventive and primary care.
– Increasing the health care costs of society, due to the increased utilization and expenditure of health care resources, especially for emergency and hospital care, and the decreased productivity and contribution of the workforce, especially for food and nutrition insecure and chronically ill people.
– Decreasing the health care access and quality of individuals and households who are food and nutrition insecure, due to their limited or lack of health insurance coverage, high out-of-pocket expenses, or low reimbursement rates, which can affect their affordability and availability of health care services.
– Decreasing the health care equity and justice of individuals and households who are socially and economically disadvantaged, due to their unequal and unfair distribution and allocation of health care resources, services, and outcomes, which can affect their health status and well-being.
According to the US Department of Health and Human Services, in 2019, the US spent $3.8 trillion on health care, or $11,582 per person, or 17.7% of the gross domestic product. The US health care spending was the highest among the developed countries, but the US health care outcomes were not the best. The US health care spending was projected to grow at an average annual rate of 5.4% from 2019 to 2028, reaching $6.2 trillion by 2028.
The US health care spending was driven by various factors, such as aging population, chronic disease prevalence, medical technology, prescription drug prices, and administrative costs. The US health care spending was also affected by the COVID-19 pandemic, which increased the demand and cost of health care services, especially for testing, treatment, and vaccination, and decreased the revenue and income of health care providers, especially for elective and non-urgent care.
5. Existing Policies and Programs.
There are various policies and programs at the federal, state, and local levels that aim to address food and nutrition security and health equity in the US. These policies and programs cover different domains and sectors, such as agriculture, health, education, environment, and social services.
In this section, we will review some of the major policies and programs that address food and nutrition security and health equity, such as USDA’s food and nutrition assistance programs, CDC’s chronic disease prevention and health promotion initiatives, etc. We will evaluate their strengths and limitations, and identify the gaps and opportunities for improvement.
5.1. USDA’s Food and Nutrition Assistance Programs.
The US Department of Agriculture (USDA) administers 15 food and nutrition assistance programs that provide food or financial assistance to low-income households, pregnant and breastfeeding women, infants and children, and students. These programs include:
– The Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps, which is the largest and most comprehensive food and nutrition assistance program in the US. SNAP provides monthly benefits to eligible households to purchase food at authorized retailers, such as supermarkets, grocery stores, farmers’ markets, or online platforms. SNAP also offers nutrition education, employment and training, and other services to help participants improve their food security and self-sufficiency. In 2019, SNAP served 35.7 million people, or 10.8% of the US population, with an average monthly benefit of $127 per person.
– The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides food, nutrition education, breastfeeding support, and health care referrals to low-income pregnant, postpartum, and breastfeeding women, and infants and children up to age five who are at nutritional risk. WIC provides participants with vouchers or electronic benefits to purchase specific foods that meet their nutritional needs, such as milk, eggs, cheese, cereal, fruits, vegetables, whole grains, and infant formula. WIC also offers breastfeeding counseling, peer support, and breast pumps to promote and support breastfeeding. In 2019, WIC served 6.4 million people, including 1.6 million women, 1.8 million infants, and 3 million children, with an average monthly benefit of $41 per person.
– The National School Lunch Program (NSLP), which provides nutritious lunches to students in public and nonprofit private schools and residential child care institutions. NSLP offers free or reduced-price lunches to eligible students from low-income households, and reimburses schools for each lunch served that meets the federal nutrition standards. NSLP also provides nutrition education, food safety training, and farm-to-school initiatives to enhance the quality and appeal of school meals. In 2019, NSLP served 29.6 million students, including 20.1 million students who received free or reduced-price lunches, with an average reimbursement of $3.51 per lunch.
– The Summer Food Service Program (SFSP), which provides free meals and snacks to children and teens aged 18 and under during the summer months when school is not in session. SFSP operates in sites such as schools, parks, libraries, churches, or camps, where children can receive nutritious food and participate in enrichment activities. SFSP also serves young adults aged 19 and over who have mental or physical disabilities and participate in school programs. In 2019, SFSP served 2.7 million children and teens, with an average reimbursement of $4.03 per meal.
The strengths of USDA’s food and nutrition assistance programs are:
– They provide food or financial assistance to millions of Americans who are food insecure or at risk of food insecurity, especially during times of crisis, such as the COVID-19 pandemic, which increased the demand and need for these programs.
– They improve the dietary quality and diversity of participants, by providing them with access to nutritious and varied food options, and by encouraging them to consume more fruits, vegetables, whole grains, dairy, and other healthy foods.
– They prevent or reduce the prevalence and severity of chronic diseases among participants, by helping them maintain a healthy weight, lower their blood pressure, cholesterol, and blood sugar levels, and improve their immune function and inflammation.
– They support the economic and social well-being of participants, by reducing their food insecurity and poverty, increasing their income and savings, enhancing their education and employment outcomes, and strengthening their social and community networks.
The limitations of USDA’s food and nutrition assistance programs are:
– They do not reach or serve all the eligible or needy people, due to various barriers and challenges, such as lack of awareness, eligibility, access, or stigma, which can limit the participation and utilization of these programs.
– They do not fully meet the nutritional needs and preferences of participants, due to various constraints and trade-offs, such as budget, availability, quality, or variety, which can affect the adequacy and satisfaction of these programs.
– They do not address the root causes and structural factors of food and nutrition insecurity and health inequities, such as poverty, racism, food deserts, or health care access and quality, which can affect the sustainability and effectiveness of these programs.
– They face various threats and uncertainties, such as budget cuts, policy changes, or political interference, which can affect the stability and continuity of these programs.
The gaps and opportunities for improvement of USDA’s food and nutrition assistance programs are:
– To expand and strengthen the outreach and enrollment of these programs, by increasing the awareness, eligibility, access, and acceptance of these programs, and by reducing the administrative and bureaucratic burdens and hassles of these programs.
– To enhance and customize the benefits and services of these programs, by increasing the amount, frequency, and flexibility of these programs, and by providing more choices, options, and incentives for participants to select and consume healthy and culturally appropriate foods.
– To integrate and coordinate these programs with other policies and programs that address food and nutrition security and health equity, such as local and regional food systems, healthy food environments, health care access and quality, and social determinants of health, to create a comprehensive and holistic approach to these issues.
– To evaluate and monitor the impacts and outcomes of these programs, by collecting and analyzing data and evidence on the effectiveness, efficiency, and feasibility of these programs, and by using feedback and input from participants, providers, and stakeholders to improve and innovate these programs.
5.2. CDC’s Chronic Disease Prevention and Health Promotion Initiatives.
The US Centers for Disease Control and Prevention (CDC) leads and supports various initiatives that aim to prevent and control chronic diseases and promote health and well-being in the US. These initiatives include:
– The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), which is the main division of CDC that oversees and coordinates the efforts and activities of CDC and its partners to prevent and manage chronic diseases and their risk factors, such as tobacco use, physical inactivity, poor nutrition, obesity, diabetes, heart disease, stroke, cancer, and arthritis. NCCDPHP provides funding, guidance, technical assistance, and evaluation to state and local health departments, community organizations, health care systems, and other entities to implement and sustain evidence-based and best practices interventions that address chronic diseases and their social and environmental determinants.
– The Division of Nutrition, Physical Activity, and Obesity (DNPAO), which is a branch of NCCDPHP that focuses on improving the nutrition and physical activity behaviors and environments of Americans, and preventing and reducing obesity and related chronic diseases. DNPAO supports various programs and initiatives, such as the Nutrition and Obesity Policy Research and Evaluation Network (NOPREN), which conducts and disseminates research and evaluation on nutrition and obesity policies and interventions; the State Physical Activity and Nutrition (SPAN) Program, which provides funding and assistance to states to implement and evaluate nutrition and physical activity interventions in various settings, such as schools, worksites, communities, and health care; and the Racial and Ethnic Approaches to Community Health (REACH) Program, which provides funding and assistance to community-based organizations to implement and evaluate culturally tailored interventions that address health disparities among racial and ethnic minority populations.
– The Division of Diabetes Translation (DDT), which is a branch of NCCDPHP that focuses on preventing and controlling diabetes and its complications and comorbidities, such as kidney disease, eye disease, nerve damage, and amputation. DDT supports various programs and initiatives, such as the National Diabetes Prevention Program (National DPP), which provides funding and assistance to organizations to deliver and scale up an evidence-based lifestyle change program that helps people with prediabetes prevent or delay type 2 diabetes; the National Diabetes Education Program (NDEP), which provides education and resources to people with diabetes, health care providers, and communities to improve the management and outcomes of diabetes; and the Diabetes State Burden Toolkit, which provides data and information on the burden and cost of diabetes in each state and the potential impact of prevention and control interventions.
– The Division for Heart Disease and Stroke Prevention (DHDSP), which is a branch of NCCDPHP that focuses on preventing and reducing the incidence and mortality of heart disease and stroke and their risk factors, such as high blood pressure, high cholesterol, and smoking. DHDSP supports various programs and initiatives, such as the WISEWOMAN Program, which provides funding and assistance to states to offer cardiovascular disease screening, risk factor counseling, and lifestyle interventions to low-income, uninsured, or underinsured women aged 40 to 64; the Million Hearts Initiative, which is a national public-private partnership that aims to prevent one million heart attacks and strokes by 2022, by implementing and promoting strategies to improve the ABCS of cardiovascular health: Aspirin use, Blood pressure control, Cholesterol management, and Smoking cessation; and the Sodium Reduction in Communities Program, which provides funding and assistance to communities to reduce the sodium content of foods served in various settings, such as schools, worksites, hospitals, and restaurants.
The strengths of CDC’s chronic disease prevention and health promotion initiatives are:
– They prevent and control chronic diseases and their risk factors among millions of Americans who are affected by or at risk of these diseases, especially during times of crisis, such as the COVID-19 pandemic, which increased the vulnerability and mortality of people with chronic diseases.
– They improve the health and well-being of participants, by helping them adopt and maintain healthy behaviors and lifestyles, such as quitting smoking, increasing physical activity, improving nutrition, and managing weight, blood pressure, cholesterol, and blood sugar levels.
– They support the health care system and society, by reducing the burden and cost of chronic diseases and their complications and comorbidities, and by increasing the quality and efficiency of health care delivery and coordination, especially for preventive and primary care.
– They address the health disparities and inequities of chronic diseases and their risk factors among different groups of people, by targeting and tailoring the interventions to the needs and preferences of the populations who are most affected by or at risk of these diseases, such as low-income, rural, racial and ethnic minorities, immigrants, and people with disabilities.
The limitations of CDC’s chronic disease prevention and health promotion initiatives are:
– They do not reach or serve all the eligible or needy people, due to various barriers and challenges, such as lack of awareness, access, or participation, which can limit the implementation and uptake of these initiatives.
– They do not fully meet the needs and expectations of participants, due to various constraints and trade-offs, such as resources, capacity, or sustainability, which can affect the quality and impact of these initiatives.
– They do not address the root causes and structural factors of chronic diseases and their risk factors, such as poverty, racism, food insecurity, or health care access and quality, which can affect the outcomes and effectiveness of these initiatives.
– They face various threats and uncertainties, such as budget cuts, policy changes, or political interference, which can affect the stability and continuity of these initiatives.
The gaps and opportunities for improvement of CDC’s chronic disease prevention and health promotion initiatives are:
– To expand and strengthen the outreach and engagement of these initiatives, by increasing the awareness, access, and participation of these initiatives, and by reducing the barriers and challenges of these initiatives, such as stigma, mistrust, or misinformation.
– To enhance and customize the benefits and services of these initiatives, by increasing the resources, capacity, and sustainability of these initiatives, and by providing more choices, options, and incentives for participants to adopt and maintain healthy behaviors and lifestyles.
– To integrate and coordinate these initiatives with other policies and programs that address chronic diseases and their risk factors, such as USDA’s food and nutrition assistance programs, healthy food environments, health care access and quality, and social determinants of health, to create a comprehensive and holistic approach to these issues.
– To evaluate and monitor the impacts and outcomes of these initiatives, by collecting and analyzing data and evidence on the effectiveness, efficiency, and feasibility of these initiatives, and by using feedback and input from participants, providers, and stakeholders to improve and innovate these initiatives.
6. Recommendations and Solutions.
Food and nutrition security and health equity are not only individual and household issues, but also public and societal issues that require collective and collaborative action from various stakeholders, such as government, private sector, civil society, academia, media, and consumers.
In this section, we will propose some recommendations or solutions to advance nutrition security and health equity in the US, such as increasing access and affordability of healthy foods, promoting nutrition education and counseling, supporting community-based interventions, enhancing data collection and monitoring, etc. We will also provide some evidence or examples to support our suggestions.
6.1. Increasing Access and Affordability of Healthy Foods.
One of the key challenges for achieving nutrition security and health equity is the limited or unequal access and affordability of healthy foods, especially among low-income, rural, and minority populations. To address this challenge, we recommend the following actions:
– Expanding and diversifying the supply and distribution of healthy foods, such as fruits, vegetables, whole grains, dairy, and lean protein, in various settings, such as supermarkets, grocery stores, farmers’ markets, food hubs, food cooperatives, community gardens, urban farms, school gardens, or online platforms. This can increase the availability and visibility of healthy food options, and reduce the transportation and storage costs and losses of these foods.
– Reducing the price and increasing the value of healthy foods, such as by providing subsidies, incentives, discounts, coupons, vouchers, or rewards to producers, retailers, or consumers of healthy foods, or by implementing taxes, penalties, or regulations on unhealthy foods, such as sugary drinks, junk food, or fast food. This can increase the affordability and attractiveness of healthy food options, and influence the food choices and consumption of consumers.
– Improving the quality and safety of healthy foods, such as by implementing and enforcing standards, guidelines, or certifications for the production, processing, packaging, labeling, or marketing of healthy foods, or by providing education, training, or technical assistance to producers, retailers, or consumers of healthy foods. This can increase the confidence and trust of consumers in the quality and safety of healthy food options, and prevent or reduce the food waste, spoilage, or contamination of these foods.
Some examples of initiatives that aim to increase the access and affordability of healthy foods are:
– The Healthy Food Financing Initiative (HFFI), which is a federal program that provides grants, loans, or tax credits to support the development or expansion of healthy food outlets in underserved areas, such as food deserts or low-income neighborhoods. HFFI has supported over 250 projects in 35 states, creating or preserving over 1,000 jobs, and increasing the access and affordability of healthy foods for over 1 million people.
– The Double Up Food Bucks Program, which is a state or local program that matches the SNAP benefits of participants when they buy fruits and vegetables at participating farmers’ markets, grocery stores, or other outlets. Double Up Food Bucks has been implemented in over 20 states, reaching over 500,000 SNAP participants, and increasing the sales and consumption of fruits and vegetables for both participants and producers.
– The Healthy Eating Research Program, which is a national program that supports research and evaluation on the impact of policies, systems, and environmental changes on the nutrition and health of children and families, especially those at risk of obesity or food insecurity. Healthy Eating Research has funded over 300 studies in various topics, such as nutrition standards, food labeling, food marketing, food pricing, food access, food quality, and food safety, and has provided evidence and recommendations to inform and influence policy and practice decisions.
6.2. Promoting Nutrition Education and Counseling.
Another key challenge for achieving nutrition security and health equity is the limited or inadequate nutrition knowledge, skills, attitudes, and behaviors of consumers, especially among children, adolescents, and adults with low literacy, education, or income. To address this challenge, we recommend the following actions:
– Providing nutrition education and counseling, such as nutrition classes, workshops, demonstrations, or individual or group sessions, to consumers in various settings, such as schools, worksites, communities, or health care. This can increase the knowledge, skills, attitudes, and self-efficacy of consumers to plan, prepare, and consume healthy and balanced diets, and to prevent or manage diet-related chronic diseases.
– Developing and disseminating nutrition information and guidance, such as nutrition facts, labels, menus, brochures, posters, videos, or websites, to consumers in various formats, such as print, digital, or audiovisual. This can provide consumers with accurate, reliable, and relevant information and guidance to make informed and healthy food choices, and to monitor and evaluate their food intake and nutrition status.
– Engaging and empowering consumers in nutrition decision-making and action, such as by involving them in the design, implementation, or evaluation of nutrition interventions, or by providing them with feedback, incentives, or rewards for their nutrition behaviors and outcomes. This can increase the motivation, participation, and ownership of consumers in their nutrition security and health equity, and foster their social and behavioral change.
Some examples of initiatives that aim to promote nutrition education and counseling are:
– The SNAP-Ed Program, which is a federal program that provides nutrition education and obesity prevention services to SNAP participants and eligible low-income populations, in collaboration with state and local partners, such as health departments, extension services, or community organizations. SNAP-Ed delivers evidence-based and culturally appropriate nutrition education and counseling, and supports policy, systems, and environmental changes that promote healthy eating and physical activity in various settings, such as schools, worksites, communities, or health care.
– The ChooseMyPlate.gov Website, which is a federal website that provides nutrition information and guidance to consumers, based on the Dietary Guidelines for Americans and the MyPlate icon. ChooseMyPlate.gov offers various tools and resources, such as the MyPlate Plan, which helps consumers create a personalized eating plan based on their age, sex, height, weight, and physical activity level; the MyPlate Quiz, which helps consumers test their knowledge of the MyPlate food groups and recommendations; and the Start Simple with MyPlate App, which helps consumers set and track their nutrition goals and behaviors.
– The Eat Smart, Move More, Weigh Less Program, which is a state or local program that provides online or in-person weight management and wellness classes to consumers, in partnership with employers, health plans, or health care providers. Eat Smart, Move More, Weigh Less uses evidence-based and interactive strategies, such as goal setting, self-monitoring, feedback, social support, and problem solving, to help consumers improve their nutrition and physical activity behaviors and outcomes, and prevent or reduce obesity and chronic diseases.
6.3. Supporting Community-Based Interventions.
Another key challenge for achieving nutrition security and health equity is the lack or insufficiency of community engagement and empowerment, especially among historically underserved populations, such as low-income, rural, racial and ethnic minorities, immigrants, and people with disabilities. To address this challenge, we recommend the following actions:
– Supporting community-based interventions, such as community coalitions, networks, or partnerships, that involve and mobilize various stakeholders, such as community members, leaders, organizations, or institutions, to identify and address the nutrition and health issues and needs of their communities, and to implement and sustain evidence-based and culturally tailored interventions that improve their nutrition security and health equity.
– Building community capacity and leadership, such as by providing training, mentoring, or coaching to community members, leaders, or organizations, to enhance their knowledge, skills, abilities, and resources to plan, manage, or evaluate community-based interventions, and to advocate for their rights and interests in nutrition security and health equity.
– Leveraging community assets and resources, such as by identifying, mapping, or mobilizing the existing or potential assets and resources of communities, such as people, places, or organizations, that can contribute to or benefit from community-based interventions, and by creating or strengthening the linkages, collaborations, or synergies among these assets and resources.
Some examples of initiatives that aim to support community-based interventions are:
– The Racial and Ethnic Approaches to Community Health (REACH) Program, which is a federal program that provides funding and assistance to community-based organizations to implement and evaluate culturally tailored interventions that address health disparities among racial and ethnic minority populations, in collaboration with local partners, such as health departments, health care providers, or faith-based organizations. REACH focuses on various priority areas, such as nutrition, physical activity, tobacco, diabetes, heart disease, stroke, and breast and cervical cancer, and uses various strategies, such as community engagement, policy change, environmental change, and social marketing, to improve the health and well-being of the target populations.
– The Food Trust’s Healthy Food Access Program, which is a nonprofit program that works with communities, governments, foundations, and businesses to increase the access and affordability of healthy foods in underserved areas, such as food deserts or low-income neighborhoods. The Food Trust’s Healthy Food Access Program supports various initiatives, such as the Healthy Corner Store Initiative, which provides training, incentives, and equipment to corner store owners to stock and sell more fresh and healthy foods, such as fruits, vegetables, whole grains, and low-fat dairy; the Healthy Food Financing Initiative, which provides grants, loans, or tax credits to support the development or expansion of healthy food outlets in underserved areas, such as supermarkets, grocery stores, farmers’ markets, or food hubs; and the Healthy Food Access Research and Evaluation, which conducts and disseminates research and evaluation on the impact of healthy food access policies and interventions on the nutrition and health of consumers and communities.
– The Healthy Eating Active Living (HEAL) Cities and Towns Campaign, which is a state or local campaign that provides technical assistance and recognition to municipal governments to adopt and implement policies and practices that promote healthy eating and active living in their communities, such as creating or improving parks, trails, bike lanes, sidewalks, or playgrounds; supporting or establishing farmers’ markets, community gardens, or healthy food retail; or providing or enhancing nutrition and physical activity programs or policies for municipal employees or residents. HEAL Cities and Towns Campaign has been implemented in over 10 states, reaching over 500 cities and towns, and over 20 million people.
6.4. Enhancing Data Collection and Monitoring.
Another key challenge for achieving nutrition security and health equity is the lack or insufficiency of data and information on the status, trends, patterns, and determinants of nutrition and health among different groups of people, especially those who are hard to reach, measure, or track, such as low-income, rural, racial and ethnic minorities, immigrants, and people with disabilities. To address this challenge, we recommend the following actions:
– Improving the data collection and reporting, such as by developing and implementing standardized, consistent, and comprehensive indicators, measures, and methods for collecting and reporting data and information on nutrition and health, and by ensuring the accuracy, reliability, and validity of these data and information.
– Increasing the data availability and accessibility, such as by creating and maintaining data systems, platforms, or repositories that store, manage, and share data and information on nutrition and health, and by providing data users, such as researchers, policymakers, practitioners, or consumers, with easy and timely access and use of these data and information.
– Enhancing the data analysis and dissemination, such as by conducting and supporting data analysis and synthesis that generate and communicate new knowledge or evidence on nutrition and health, and by providing data users, such as researchers, policymakers, practitioners, or consumers, with clear and relevant data products, such as reports, dashboards, maps, or infographics, that inform and influence their decisions and actions.
Some examples of initiatives that aim to enhance data collection and monitoring are:
– The National Health and Nutrition Examination Survey (NHANES), which is a federal program that conducts surveys and examinations of a nationally representative sample of the US population to assess their health and nutritional status, and to monitor the prevalence and trends of various health conditions and risk factors, such as obesity, diabetes, hypertension, cholesterol, and dietary intake. NHANES collects and reports data and information on various demographic, socioeconomic, and behavioral characteristics of the participants, and provides various data products, such as tables, charts, or publications, to data users, such as researchers, policymakers, practitioners, or consumers.
– The Food Environment Atlas, which is a federal website that provides data and information on various aspects of the food environment, such as food access, food choices, food prices, food assistance, food health, and food policy, at the county level in the US. The Food Environment Atlas allows data users, such as researchers, policymakers, practitioners, or consumers, to map, compare, or download data and information on various indicators of the food environment, and to explore the relationships and associations between these indicators and health outcomes.
– The Nutrition Innovation Lab, which is a nonprofit program that conducts and supports research and evaluation on the impact of nutrition interventions on the nutrition and health of vulnerable populations, especially women and children, in low- and middle-income countries, such as Nepal, Uganda, or Bangladesh. The Nutrition Innovation Lab collects and analyzes data and information on various nutrition and health outcomes and determinants, such as dietary intake, anthropometry, biomarkers, infections, morbidity, mortality, and social and environmental factors, and provides various data products, such as reports, briefs, or presentations, to data users, such as researchers, policymakers, practitioners, or consumers.
Conclusion.
In this article, we have discussed the issue of nutrition security and health equity in the US, and how it affects the health and well-being of millions of Americans, especially among historically underserved populations, such as low-income, rural, racial and ethnic minorities, immigrants, and people with disabilities.
We have also reviewed the existing policies and programs that address this issue, such as USDA’s food and nutrition assistance programs, CDC’s chronic disease prevention and health promotion initiatives, and various community-based interventions.
We have evaluated their strengths and limitations, and identified the gaps and opportunities for improvement. Our main argument or thesis statement is that nutrition security and health equity are not only individual and household issues, but also public and societal issues that require collective and collaborative action from various stakeholders, such as government, private sector, civil society, academia, media, and consumers.
This article is significant and relevant for the readers, policymakers, practitioners, and researchers, because it provides them with a comprehensive and holistic overview of the issue of nutrition security and health equity in the US, and its causes, consequences, and solutions.
It also provides them with evidence-based and best practices interventions that can improve the nutrition and health outcomes and quality of life of the target populations, and reduce the burden and cost of chronic diseases and their complications and comorbidities. It also provides them with insights and recommendations to inform and influence their decisions and actions to address this issue, and to evaluate and monitor their impacts and outcomes.
Some suggestions for future directions or actions to address the issue of nutrition security and health equity in the US are:
– To conduct more research and evaluation on the issue of nutrition security and health equity in the US, and its determinants, indicators, and interventions, and to disseminate and implement the findings and evidence into policy and practice.
– To increase the funding and support for the existing policies and programs that address the issue of nutrition security and health equity in the US, and to expand and diversify their outreach, enrollment, benefits, and services, and to integrate and coordinate them with other policies and programs that address the social and environmental determinants of health.
– To develop and implement new and innovative policies and programs that address the issue of nutrition security and health equity in the US, and that are responsive and adaptive to the changing needs and preferences of the target populations, and that are sustainable and scalable to the national and global contexts.
– To engage and empower the target populations and communities in the issue of nutrition security and health equity in the US, and to involve and mobilize them in the design, implementation, or evaluation of the policies and programs that address this issue, and to advocate for their rights and interests in this issue.
Thank you for your interest in the sources of the figures in the article about nutrition security and health equity in the US. The figures are based on the data and information from various web search results, which are listed below:
– Figure 1: The five core domains of social determinants of health, adapted from the Department of Health and Human Services Healthy People 2030 framework. Source: Understanding and Promoting Nutrition and Health Equity.
– Figure 2: The prevalence and trends of food insecurity and very low food security by race and ethnicity in the US, 2001-2019. Source: USDA ERS – Nutrition Security Research Resources.
– Figure 3: The prevalence and trends of obesity and related chronic diseases by race and ethnicity in the US, 1999-2018. Source: Nutrition Security at the Intersection of Health Equity and Quality Care.
– Figure 4: The major policies and programs that address nutrition security and health equity in the US, and their strengths and limitations. Source: Position of the Academy of Nutrition and Dietetics: Nutrition Security in Developing Nations: Sustainable Food, Water, and Health.
Tâm Pacific
You are viewing the article:
How to Advance Nutrition Security and Health Equity in the US?
Link https://tampacific.com/blog/how-to-advance-nutrition-security-and-health-equity-in-the-us.html
Hashtag: #nutritionsecurity, #healthequity, #foodsecurity, #nutrition, #health, #wellness, #diet, #food, #socialdeterminants, #covid19, #policy, #practice, #research, #nutritiontips, #nutritioncoach, #nutritioneducation, #nutritionadvocacy, #nutritionresearch, #nutritionpolicy, #nutritionprogram, #nutritionintervention, #nutritionservice, #nutritioncare, #nutritionquality, #nutritiondisparity, #nutritionequity.
Next article: You Can Apologize to the Victims of Online Exploitation Too!
* This work is licensed under a CC-BY 4.0 International License.