Subscribe

Social Determinants

SPONSORED | Heisman winner Joe Burrow highlights a problem too familiar to health leaders

Hal Paz, MD | February 3, 2020

Joe Burrow, the quarterback who led his Louisiana State University team to a national championship, was already a hero to many of us here in Ohio, where he was raised and where he started his football career. Burrow cemented that status in December when he won the Heisman Trophy and used his acceptance speech to call attention to a phenomenon that deserves much wider coverage: food insecurity.

“Coming from southeast Ohio,” Burrow said, “it’s a very impoverished area, and the poverty rate is almost two times the national average. There’s so many people there that don’t have a lot, and I’m up here for all those kids in Athens and Athens County that go home to not a lot of food on the table, hungry after school. You guys can be up here, too.”

Almost immediately after Burrow’s speech, Americans donated more than half a million dollars to the Athens County Food Pantry, which serves a community in which one in four children is food insecure. The donations are a heartwarming gesture, but they should be the first step toward addressing this epidemic, not the last.

Food insecurity—or a lack of regular access to the amount of food a person needs to sustain themself—is a much larger challenge than many of us would imagine possible in an affluent and fortunate nation like ours. According to the Economic Research Service at the U.S. Department of Agriculture, a whopping 11% of American households were food insecure at some point during 2018. The majority of these households, tragically, included at least one child.

How do we address this troubling situation?

We must recognize food insecurity for what it truly is: a full-blown health crisis, and one of several health determinants based on socioeconomic factors.

To address it, we must do what we do with any other pandemic: raise public awareness about the magnitude of the problem and bring together disparate stakeholders—communities, policymakers, educators and others—to take action and turn the tide.

One insight in particular seems promising if we want to curb food insecurity quickly and efficiently: To make a real impact, we need to change the way we think about what people need to get and stay healthy. Excellent medical care accounts for only 10-20% of our overall health outcomes, according to some estimates. According to the American Hospital Association, a significant portion—as large as 40%—rests on what healthcare professionals call the social determinants of health, including the resources available to us in our communities.

Disparities in those community resources are alarming when it comes to food. According to a 2009 study by the U.S. Department of Agriculture, 23.5 million Americans lack access to a supermarket within a mile of their home. The situation is much more dire in rural counties, 20% of which are located more than 10 miles away from the nearest supermarket.

How America measures up

According to a recent joint study by the Brookings Institute and the USC Schaeffer Center for Health Policy & Economics, many of the world’s developed nations have realized that health outcomes are about more than care; it’s why they spend $1.70 on social services for every dollar that goes to health services.

In America, the ratio is still inverted, with 56 cents going to social services for each dollar paid for health care.

We can and must inverse this ratio in the U.S. by investing in a few rudimentary food-related social services. We can provide new mothers with the education they need to better understand the nutritional needs of their babies, assist school districts in offering healthy food choices to struggling students without risking shame or stigma, and make sure our seniors receive healthy, nutritious meals in their homes.

Then, we may begin to address the question Americans have been asking themselves with a growing sense of urgency: why we keep spending more and more money on health care—17.8% of our gross domestic product, more than nearly any other country on Earth—while we keep getting sicker and dying younger.

The role of health systems

To meet the challenge of reducing food insecurity, many health systems across the nation have begun addressing the issue as they would any other public health epidemic. A few months ago, for example, my colleagues and I at The Ohio State University Wexner Medical Center teamed up with the Mid-Ohio Foodbank for a “Mid-Ohio Farmacy” program to identify patients whose ailments—mainly diabetes, obesity and hypertension—stem from food insecurity.

Our physicians give them not only prescriptions for medicine, but also forms that provide access to extra fresh, nutritious food at any of 12 participating food pantries. Similarly, we’re currently converting a former Columbus Public Library location into a community food education center because we know that those experiencing food insecurity also need instruction on how to prepare and cook healthy meals to maintain a balanced and healthy diet.

This alone, again, isn’t enough. Like health organizations all over the country, we continue to work with local organizations to raise awareness that fresh, nutritious food is a basic right, not a luxury, and that fast food, however available, ought not to be the default. We work with local food-related social services, empowering them to do their important work. And we continue to educate everyone from students to policymakers about the opportunities and obligations to make sure we all have access to the food we need to survive and to thrive.

Still, you hardly have to be a doctor to see why our nation’s current approach isn’t working. All you have to do is listen to Joe Burrow, a great quarterback and a compassionate human being, who gave us all an important and urgent call to end food insecurity in 2020.

About the Author

Hal Paz, MD, Author

Dr. Harold L. Paz is executive vice president and chancellor for health affairs at The Ohio State University and chief executive officer of the OSU Wexner Medical Center. At Ohio State, Dr. Paz leads all seven health science colleges and serves as CEO of the $4-billion Wexner Medical Center enterprise, which includes seven hospitals, a nationally ranked college of medicine, over 20 research institutes, multiple ambulatory sites, an accountable care organization, and a health plan. Before joining OSU in June 2019, Dr. Paz was executive vice president and chief medical officer at Aetna where he led clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses. He reported to Aetna’s chairman and CEO and was a member of its executive committee. Prior to joining Aetna in 2014, Dr. Paz served as president and CEO of the Penn State Hershey Health System, senior vice president for health affairs at the Pennsylvania State University, and dean of its College of Medicine for eight years. Before his appointment at Penn State, he spent eleven years as dean of the Robert Wood Johnson Medical School and CEO of the Robert Wood Johnson University Medical Group. Dr. Paz received his bachelor's degree from the University of Rochester, a master of science in life science engineering from Tufts University, and his medical degree from the University of Rochester School of Medicine and Dentistry. He completed his residency at Northwestern University, where he served as chief medical resident. Dr. Paz was a Eudowood Fellow in pulmonary and critical care medicine at Johns Hopkins Medical School. In addition, he was a post-doctoral fellow in environmental health science at Johns Hopkins School of Hygiene and Public Health.