When you get sick, your path to wellness depends on more than your health care. For someone diagnosed with diabetes, for example, access to nutritious food can be just as important as insulin. Health care providers and policymakers are increasingly recognizing the health impacts of social drivers such as access to healthy food, transportation, and safe housing.
But even as new federal incentives require health systems to collect information that would help them identify if that new diabetes patient lives in a food desert, it’s not always clear what to do with that information. In a draft recommendation published on Tuesday, the United States Preventive Services Task Force, made up of national experts who advise on evidence-based preventative medicine interventions, found no strong evidence that screening for food insecurity in primary care settings improves health outcomes.
“Food insecurity is a complex social risk,” said Tumaini Coker, a pediatrician and clinical researcher who served on the task force. People who don’t have access to nutritious food could also face lack of transportation, unstable housing, and financial instability. That makes it difficult for researchers to pick apart the impact of food interventions on their own.
So the task force issued primary care food insecurity screening an “I” statement, for insufficient evidence to make a recommendation. For now, the USPSTF recommends clinicians continue having discussions with patients about food insecurity and connecting them with resources available in their communities. The statement is open for public comment until July 22.
Food insecurity is only one social driver that suffers from these data gaps. In a recent paper published in JAMA Network Open, researchers at RTI International, the Kaiser Permanente Center for Health Research, and University of California, San Francisco evaluated clinical trials studying the impact of social needs interventions. The researchers sifted through data from 93 publications spanning the years 1995 to 2023, which included over 135,000 participants. Within the studies, researchers had tracked the impact of 78 social need interventions, in domains like childcare, social isolation, and financial strain. They concluded that the effectiveness of those interventions are difficult to determine — a result of study design limitations and the complexity of social issues.
It’s hard to parse social determinants of health when they’re so intertwined, said study author Meera Viswanathan. The director of the Evidence-based Practice Center at RTI International and the University of North Carolina at Chapel Hill, she has spent her career studying the methodology behind public health interventions. “Unfortunately, the evidence shows that these interventions are complex, multifaceted, and very intense,” Viswanathan wrote in an email to STAT.
Despite the challenges in evaluating the impact of social interventions, Viswanathan hopes that since “you’re trying to address root causes, there’s lots of hope that they will improve health outcomes.” But policymakers can’t afford to “just sit around waiting for the best study” before they act, she said.
In North Carolina, the Healthy Opportunities Pilot program, launched in March 2022, is experimenting with a social health care approach by tackling patients’ housing, transportation, and food access needs. “Most non-medical needs are primary drivers of health status,” said Laurie Stradley, executive director at Impact Health, which supports one of the program’s three pilot regions in rural North Carolina.
Impact Health teams up with care managers at primary care offices to connect Medicaid patients with local nonprofit agencies that regularly deliver food boxes with fresh fruit and vegetables along with non-perishable items, made to meet the nutritional and cultural needs of families.
Since the end of 2023, the Healthy Opportunities Pilot has delivered nearly 200,000 services — 85% of which support food access — to its 13,000 enrollees. And talking about food insecurity can be a valuable starting point for clinicians to talk about other social factors that could improve health outcomes.
It might be hard for researchers to assess the effectiveness of food screening, but to Stradley, the individual impact is obvious. “Families are always doing math to pay bills,” said Stradley, recalling one patient who was struggling to make ends meet. “Knowing they’d have a food box delivered every Friday meant they felt safer paying rent on Wednesday.”