#WickedProblemsinWellness: Food Justice and Health Equity

In a world where abundance coexists with scarcity, where farmers’ markets flourish in affluent neighborhoods while food deserts persist in marginalized communities, the issue of food justice stands as a stark reminder of systemic inequities. Food justice encompasses every individual’s right to access healthy, culturally appropriate, and sustainably produced food. However, reality paints a different picture—socioeconomic status, race, and geographic location often determine access to nutritious food.

Health equity reflects the absence of unfair and avoidable disparities in health outcomes. It is a fundamental principle of social justice, emphasizing the need to address underlying factors contributing to health disparities. One such determinant is access to healthy food.

The Link Between Food Security and Health Outcomes

Research indicates a strong correlation between food insecurity and adverse health outcomes. According to a report by the United States Department of Agriculture (USDA), food-insecure individuals are more likely to experience chronic diseases such as diabetes, hypertension, and obesity. Moreover, marginalized communities, including low-income neighborhoods and communities of color, bear a disproportionate burden of food insecurity and its associated health consequences. Understanding the cultural nuances of diverse communities is paramount in addressing health inequities. Culturally competent nutrition education programs are necessary to promote healthier food choices. Nonprofits can play a crucial role in creating tailored interventions that respect and embrace the cultural diversity of the populations they serve.

The USDA has also uncovered an “Urban-Rural Disparity” regarding food access. While urban areas may grapple with issues like food deserts, where access to affordable and nutritious food is limited, rural communities face challenges in transportation infrastructure and distribution networks. Nonprofits can address these disparities by developing innovative solutions, such as mobile farmers’ markets or community-supported agriculture programs. One such solution is currently taking place in North Carolina, where Rev. Carl Nichols drives a cargo van on a daily 320-mile rural circuit to deliver food boxes to people who cannot always afford their own.

Proposing Solutions

The concept of food justice extends beyond mere access to food. It encompasses broader issues such as food sovereignty, emphasizing community control over food systems and decision-making processes. Initiatives promoting food justice aim to empower communities to address the root causes of food insecurity rather than merely providing short-term solutions.

One promising approach is the development of community gardens and urban agriculture initiatives, which increase access to fresh produce and foster community engagement and empowerment. Research published in the American Journal of Public Health suggests that community gardening can improve dietary habits, mental health, and social cohesion. Additionally, the Journal of Hunger & Environmental Nutrition emphasizes the effectiveness of community-led initiatives in promoting food justice. Nonprofit organizations can foster community partnerships, supporting initiatives beyond community gardens, such as local food cooperatives and nutrition education programs driven by the people they aim to serve.

At NNSI, much of our recent research has centered around innovations connecting healthcare and social service organizations. For example, 1115 waivers allow states to design and implement more tailored, innovative programs to improve healthcare delivery using Medicaid dollars. The delivery of food boxes to community members (like Rev. Nichols in North Carolina, for example) is a way states can create wellness initiatives covered by Medicaid without relying on government-required provisions. Many states have taken advantage of 1115 demonstration waivers to address health-related social needs, providing others with valuable insights regarding implementing Medicaid to enhance health outcomes in novel ways.

Furthermore, initiatives supporting local food systems and small-scale farmers are crucial in promoting food justice. By prioritizing locally sourced and sustainably produced food, communities can reduce their reliance on industrialized food systems, which often prioritize profit over public health and environmental sustainability.

The Path of Policy

Policy advocacy is another critical component of advancing food justice and health equity. Various ongoing advocacy efforts promote policies that support equitable access to nutritious food, such as expanding funding for SNAP (Supplemental Nutrition Assistance Program). Advocates push for increased funding for SNAP to ensure that benefits adequately meet recipients’ needs and help alleviate food insecurity. Additionally, efforts are made to remove barriers to SNAP enrollment, streamline application processes, and enhance outreach to underserved populations to maximize program participation. Currently, a research team led by Benefits Data Trust and the UPMC Center for High-Value Healthcare is working to determine which of their low-income dual eligible (enrolled in Medicare and Medicaid) members are eligible but not enrolled in the federal Supplemental Nutrition Assistance Program (SNAP). It will proactively assist these members with enrollment. Most older Americans who are eligible for federal nutrition assistance programming remained unenrolled, placing them at increased risk of food insecurity and its associated adverse health conditions and healthcare costs. By matching this enrollment data with claims data, the team will use a randomized controlled trial to determine the impact of SNAP enrollment on health status, healthcare utilization, and costs. Results will indicate whether there are strong clinical and economic reasons for the nation’s Medicare and Medicaid health plans to adopt programs that proactively assist their members with nutrition assistance enrollment.

Policy advocacy is also essential when investing in community-led food initiatives. Community-based organizations and grassroots movements are crucial in addressing local food challenges and promoting food sovereignty within their neighborhoods. Advocates support policies that provide financial support, technical assistance, and resources to empower communities to develop sustainable food systems tailored to their unique needs and preferences.

Food justice and health equity are inextricably linked, forming a challenging battleground for nonprofits committed to social impact. Research into this intersection allows organizations to gain insights into the complex dynamics at play and unearth potential avenues for intervention. Food justice provides food access and signals a broader social justice issue connected to health equity, environmental sustainability, and community empowerment. Additional work is needed to advance these principles through research, advocacy, and community engagement. Organizations across the spectrum should be encouraged to leverage this knowledge, collaborate with communities, advocate for policy changes, and champion cultural competency to create a more just and equitable food system for all.